Worry about Anemia or let it slide?
August 17, 2012 10:50 AM   Subscribe

Having a hard time getting a doctor's appointment, feeling run down and probably anemia has gotten VERY bad. Ok to wait, or step up the urgency?

The past 2 weeks I’ve been feeling slightly off. Tired, headachey, a little lightheaded. At work people have been dropping like flies (1 heart attack, 1 stroke, 1 blood clot in lung, one unspecified heart problem) and I thought that was a good signal to maybe stop ignoring this issue and get to the doctor.

Maybe it’s just a mild cold, or stress, but I think maybe it’s anemia. I’ve always been very anemic, and I don’t think I’ve ever managed to get my iron ranges up where they ought to be. But I haven’t done as much about it as I should have because iron pills never made me feel any better, just constipated. (I’ve had a hematocrit of 4 when they said I should have 13-150 and not felt any bad side effects, but the nurse was really upset with me) So my worry is that if my anemia is possibly bad enough to make me feel iffy, that it's actually pretty bad.

But the Nurse Practitioner I like has moved to a new practice. So I called them up, and they said they wouldn’t see me without transferring my records. Yesterday I ran over and signed off a release so they could fax them. But the new place still won’t make an appointment till they actually have them. I called back again today and they said ‘no nothing yet, call back Monday afternoon.’

So now that’s Monday before I can even book an appointment to see a doctor and try and get bloodwork done. Probably not until late next week.

My question is, should I just roll with it? If I’ve been ignoring minor side effects for days, what’s a few more? On the other hand, if it is anemia and I actually have side effects then that means it’s got to be pretty bad for it to actually register on me. But this doesn’t seem like something I could take to urgent care, does it? IDK, what would you do?
posted by Caravantea to Health & Fitness (18 answers total) 1 user marked this as a favorite
Do you have to deal with that specific doctor's office? Personally, I'd tell them to fuck off and find a place that doesn't go to lengths to alienate the clientele.
posted by griphus at 10:54 AM on August 17, 2012 [3 favorites]

I think you should keep up with the records-shifting and make an appointment the minute they get in (seems like a silly appointment policy, but nothing you can do about that).

I also think you should re-visit taking the iron you need. Really, lots of people take medications that have side effects--I'm one of them!--and the way we deal with them is to make sure we offset them.

For instance, if you have to take an anti-depressant that can also interfere with your sexuality, you take Welbutrin, or testosterone, or sildenafil too, so that you can go ON with your life. If you take something that makes your skin or eyes or hair dry out, you have to compensate by moisturizing, using intensive hair conditioner and drinking extra fluids, etc. Good health trumps minor inconvenience.

You don't want to give up on living because you're anemic! So don't give up on iron because of the side effects. Work to find a way to get around them. Take something that will offset the constipation, or change your diet to have more fiber--there are all kinds of workarounds for constipation! That's a minor issue, and really not one worth messing up your health over by refusing to take the iron you KNOW you need.
posted by misha at 10:59 AM on August 17, 2012 [1 favorite]

Anemia is one of those things that you can resolve with diet more than with anything else, so regardless of the doctor, I'd see if you can work some iron-rich foods into your diet in the next couple of days and see if that makes you feel better.

This is going to sound grody to most people, but my mother would make us black pudding whenever we gave blood, to get our levels back up. It was how I dealt with feeling run-down when I was at university. However, if black pudding doesn't appeal, here's a list of other iron-rich foods that might help.
posted by LN at 10:59 AM on August 17, 2012 [1 favorite]

Working in the medical field - specifically hematology - I'd say go to your previous office and ask to pick up your records if you are concerned. They have a medical records transfer process and yours is probably in a stack FULL of other patients. If you feel really terrible, in the meantime you can stop by your local pharmacy and pick up some vitamin B12 and iron pills.
posted by AbsolutelyHonest at 11:10 AM on August 17, 2012 [3 favorites]

IANAD, so this IMA but..you can't be alive and have a hematocrit of four, so I'm assuming you're talking about your hemoglobin concentration. If I had a history of having a hemoglobin of below 8.0 g/dl (which is considered severe anemia) and I was having the symptoms you are having, I would probably want to see a healthcare provider sooner rather than later.

Why not go to an urgent care clinic just to play it safe?
posted by 3T at 11:13 AM on August 17, 2012 [2 favorites]

The test is relatively painless and easy to have done, so you might call around and ask if an urgent care clinic or bloodwork lab could handle it inexpensively. I have really low iron pretty much always, but it's definitely not that low. You should still try to make a proper appointment, since just knowing you have low iron won't solve the issue, and it may be something else entirely. Have you tried different formulations or types of iron pills to see if you react to them better? I like the ones with Vitamin C, personally. Is there another medical issue that could be causing it (or that would explain your symptoms?) In the meantime, perhaps consider skipping the foods that work against iron absorption, and feel better!
posted by jetlagaddict at 11:30 AM on August 17, 2012

I seriously recommend you change doctors. The new doctors could have better recommendations for you. They may also test you to see why your anemia gets so severe.

Doctors told me nothing was wrong with me when I had severe vitamin D deficiency. Now I'm paying for it because I didn't switch doctors soon enough.
posted by Ms. Moonlight at 11:31 AM on August 17, 2012 [1 favorite]

I've had chronic anemia for years. It's not fixed by eating some spinach and a steak (although it could make you feel better temporarily).

All non-heme iron supplements constipate me or give me an upset stomach. If you can afford it and have the time to mail order, Proferrin is the best iron supplement I've ever used. When I can't get Proferrin, I use Bifera. It's nearly as good, but slightly constipating (but nothing like ferrous sulfate/gluconate/etc). Oh, a quick google tells me that Bifera is now known as Feosol Complete. And because they're both heme iron, you don't need to do that whole omg take with vitamin c and avoid calcium and tannins nonsense.

Have you tried calling the old place and asking them to transfer the records already? What about picking them up and hand delivering them to the new place and making an appointment while you stand there?

Meantime, definitely do have a steak and an iron supplement. And then have some Miralax.
posted by elsietheeel at 11:34 AM on August 17, 2012 [7 favorites]

When I was anemic following misdiagnosed burst ovarian cysts, the doc suggested I drink Floradix. It's not unpleasant, and might be easier for you to bear than iron tablets.

I was also a vegetarian, so he told me to drink Guinness, too. (Which has tiny fish debris in it, if that's an issue for you ...)
posted by vickyverky at 11:56 AM on August 17, 2012

Make sure you get plenty of fresh air (including air conditioning, and fans), and lots of rest in the meantime. Grab a steak hoagie with spinach. I presume you've tried Slow-Fe? Fiber-Con is very convenient for constipation. (If you're not worried about money, go to the ER.) If you let it fall too low, you will need a BLOOD TRANSFUSION.
posted by serena15221 at 12:08 PM on August 17, 2012 [1 favorite]

Are you certain that your anemia was iron deficiency anemia? There are plenty of other reasons for anemia that iron will not help with.

It takes about 5 minutes for a fax to go through. If you're calling a day later and the documents haven't arrived, this obviously means they haven't been faxed. Keep bugging your prior doctor's office until they have faxed the records - they should be received on the other end right away.

Feeling fatigued and lightheaded are very nonspecific symptoms and they may not be related to anemia. What about dehydration? I do not think you need to step up the urgency here unless you start experiencing more severe symptoms, like passing out or seeing blood in your bowel movements or something. In the meantime stay well hydrated, do not skip any meals and eat hearty/balanced meals, and take a multivitamin. And don't get up from a lying down/seated position too quickly.
posted by treehorn+bunny at 12:16 PM on August 17, 2012

I'll say that your prior history makes me concerned. A hematocrit of 4 is not possible (for you to be typing) - but almost any other value, hemoglobin, serum iron, plasma ferritin, etc, a value of 4 would be damned low. Symptomatic anemia is what really concerns me. Symptomatic anemia and a hemoglobin of 4 would mean a blood transfusion in the hospital. But I don't know what the value of 4 you're referring to is.

The fact that you have a prior history is significant. Have you ever needed to have a blood transfusion? Did you ever need to get IV iron?

When you called the NP's office, did you tell the person (MA? nurse?) on the phone what was going on? eg, that you have a prior history of severe anemia, and are feeling lightheaded and headachey and fatigued. that sort of thing usually will get you squeezed in for a visit.

IF you think you have iron deficiency anemia or were diagnosed with that .... I know iron pills can suck to take (constipation!). Increase fluids and fibers in your diet. Take the iron pills with OJ, or get the ones with vitamin C, helps with absorbing it. You might not have been taking a therapeutic dose of iron, too - if you're seriously iron deficient, you can take those 325mg iron (ferrous sulfate) tablets 3 times a day. Try not to take it with food, but if it upsets your stomach, any iron supplementation is better than stopping it. Anyway, if you do in fact have iron deficiency anemia and are taking enough iron, you should start feeling better pretty fast (like within a week or two).

also - anemia is a symptom of another process, not a disease. You really need to do some work with this new provider to see if you can find an underlying cause for the anemia. B12 deficiency/pernicious anemia? other malabsorption? folate deficiency? iron deficiency anemia? hypothyroid? copper deficiency? lead exposure? just plain ol not absorbing iron right? etc etc etc. that's all to say that the potential causes for anemia are !@#@ endless, but if you're symptomatically anemic, you need to work with your provider to do the legwork to figure out what's going on.

Finally -- If you start getting real dizzy when you're getting up from lying down, or getting up from sitting (getting dizzy, seeing spots, etc), please consider getting your ass to urgent care.

This weekend, if you feel start feeling short of breath, or significant dizziness/lightheadedness/seeing spots when you're up or worse at rest, or are having heart palpitations, just get your ass to the ER. And if you go to either to those places, stress the fact that you have a known history of serious anemia, even if you're not 100% sure what the exact lab work was. They should at least take it seriously enough to do some basic labwork on it, which is really cheap.
posted by circle_b at 12:23 PM on August 17, 2012 [3 favorites]

Your numbers sound like the standards for blood ferritin levels, which I had also experienced scare-the-doctor-low levels of. I also had some constipation, and she gave me a psyllium fiber supplement (i.e. Metamucil) for that. I took the iron pills in the morning a few minutes before breakfast and the supplement in the evening, both with orange juice, my ferritin levels went back up, and my constipation wasn't nearly as bad.

It took a long time, though. A really long time. I started seeing her about it around 8 months ago, and only last month did I manage to finally test in the low normal ranges. She even had me taking 3x the normal dose of iron for a month because my levels weren't going up as fast as she would have liked.

To be honest, I'm not sure about waiting either way, but I know that to get back your iron levels back up you'll probably have to work at it a long time. And in case you haven't thought about it, I also asked my doctor for birth control, as I figured that my heavy periods might have been contributing to the deficiency, and it really has made my periods lighter and a lot less of a pain.
posted by that girl at 1:02 PM on August 17, 2012 [1 favorite]

Like circle_b said I'd go to the ER and not the urgent care if you start feeling terrible. You need to go somewhere where they'll be able to run lab tests on the weekends and many urgent cares cannot do that. If you are thinking about a trip to the urgent care, it might be worth giving them a call and asking where you should go.

I just got better from a serious illness that ended up being way worse because of similar doctor scheduling issues. Basically, I couldn't get an appointment for weeks with a doctor, just tried to push through, and wound up being hospitalized via a trip to the ER. If you feel like crap and aren't getting better for multiple weeks, I'd recommend making sure you get to see someone highly competent in the next few days. Also, if you do wind up in the ER, bring some reading material. I don't know where you live, but I wound up waiting close to seven hours before being seen.

Hope you start feeling better soon! Feel free to PM me to commiserate about how ridiculously hard it is to schedule a doctor's appointment these days.
posted by JuliaKM at 1:03 PM on August 17, 2012

Given your history (I assume you meant hemoglobin rather than hematocrit since those are two very common tests but you could mean something else as alluded to above) I would be inclined to check it out sooner rather than later. My concern would be that if you are indeed anemic there could be something other than iron deficiency going on and you could be at risk for other problems. Heading to an urgent care center or ER is not at all unreasonable, if not right now, in the next day or two. Certainly if you feel worse or have any other symptoms you should get checked out.
posted by TedW at 1:28 PM on August 17, 2012

Call the doctors office right now and ask to speak to your NP or another provider there on the phone. Don't let the receptionist put you off, tell her straight up that you HAVE to speak to your doctor about an existing health concern. Now.
posted by fshgrl at 1:38 PM on August 17, 2012

Taking iron pills with vitamin c (500 or 1000 mg) can also prevent them from causing constipation.
posted by needs more cowbell at 1:48 PM on August 17, 2012

I have had success with Slow Fe iron supplements - they caused less constipation and stomach upset than any other iron supplements I've taken. In the meantime, I'd call the new doctor's office back, describe the severity of your symptoms, tell them you'll bring the records with you, and drive to your old doctor's office on the way and get the records yourself. If the new place still won't see you, go elsewhere, possibly to the ER if you feel worse over the weekend.
posted by bedhead at 2:22 PM on August 17, 2012

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