Iron levels pre-op

CaitlynR

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Jun 7, 2017
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North Carolina
First, you guys and gals are so awesome.

I know my anxiety is in overdrive, I need help determining whether this is an issue or not. I was concerned with my low iron stores 3 months ago, but the PA wasn't. When I went to my pre-op I again expressed concern. However she is not concerned. I did switch up my supplement and added Vit C so we agreed we would re check.

It was almost exactly the same!! Percent iron saturation 7%, iron 37, total binding capacity 513. She didn't take ferritin this time but it was 13 in late May. My hemaglobin though is fine at 13.

I really want a iron infusion as if my stores are still this low what is going to happen after sugery? Any suggestions? Or should I just chill and not worry about this?
 
First, you guys and gals are so awesome.

I know my anxiety is in overdrive, I need help determining whether this is an issue or not. I was concerned with my low iron stores 3 months ago, but the PA wasn't. When I went to my pre-op I again expressed concern. However she is not concerned. I did switch up my supplement and added Vit C so we agreed we would re check.

It was almost exactly the same!! Percent iron saturation 7%, iron 37, total binding capacity 513. She didn't take ferritin this time but it was 13 in late May. My hemaglobin though is fine at 13.

I really want a iron infusion as if my stores are still this low what is going to happen after sugery? Any suggestions? Or should I just chill and not worry about this?
I wouldn't chill. Hemoglobin is just part of the story. Ferritin is the savings account and anything below 50 should be addressed pre-surgery.

I know great PA's but this time, get your doctor involved. The switch part of your surgery will remove the part of your intestines where iron is absorbed out of service. That will leave JUST the common channel for post surgery absorption.
 
Keep persisting, even if you have to see a hematologist. Transferrin saturation < 20% indicates iron deficiency, regardless of ferritin level, and you are right to think I ron supplementation may be necessary. I am going in for another series of infusions in October
 
Thanks. I've been working on this yesterday and today and it is very frustrating. No hematologist or any place capable of giving infusions allows self referrals. Now two different nurses at my surgeon's office (one who said she talked to the surgeon) basically are blowing me off. Acting like asking for iv iron is the equivalent of asking to amputate your toe because you stubbed it. Gahhhhh
 
Thanks. I've been working on this yesterday and today and it is very frustrating. No hematologist or any place capable of giving infusions allows self referrals. Now two different nurses at my surgeon's office (one who said she talked to the surgeon) basically are blowing me off. Acting like asking for iv iron is the equivalent of asking to amputate your toe because you stubbed it. Gahhhhh
Then ask for an appt with the surgeon and ask him yourself. You don't want to go into surgery ferritin deficient.
 
I was able to get through to my surgeon by emailing his academic email. I feel I very slightly crossed a line there as that address is probably not for patients. He did reply quickly and say he will put in a hematology referral. I have no idea if I can get in one on time but am hopeful.
 
Keep persisting. You are learning a critical lesson in being a DS patient. You have to fight for yourself.

If your serum ferritin is 13, you should point out that serum ferritin is falsely elevated in obesity. Transferrin saturation % less than 20 is diagnostic of iron deficiency.

Infusions are expensive, so there is an incentive to restrict treatment.

Can you change from the PA to another primary care provider to get the referral to the hematologist?
 
I was able to get through to my surgeon by emailing his academic email. I feel I very slightly crossed a line there as that address is probably not for patients. He did reply quickly and say he will put in a hematology referral. I have no idea if I can get in one on time but am hopeful.
If it's a publicly available email, you did not cross a line. You required his input on the surgery he was going to be performing. And while PA's and nurses are great, he is the one who will be tasked with your health and your making it thru surgery, not them. Sometimes gatekeepers can be a roadblock not a help.
 
Another avenue I am perusing is that I have a friend who is a nurse practitioner who has physician friends. At least one is at a practice that does infusions, and may be willing to fit me in to see him and get the treatment. My surgeon did say he would put in a referral for a hematologist. However I'm concerned there won't be enough time to get in and then get in for an infusion.

I'm slightly concerned I'm being such a PITA that the bariatric surgery team will just fire me. Between this stuff, debating him on CC length, and a message I sent sharing concern and disagreement with the opioids free pain management plan and asking for a PCA, I'm not sure if they think now I'm unstable or too demanding or something. Oh well too late already I guess.
 
I feel your pain of being an epic PITA as well. I had never had my ferritin tested prior to getting pre-op labs but when I did it was a 3. Getting an infusion was an epic pain. My PCP referred me out to hematologist who would not give me one because I did not seem to be experiencing negative effects from anemia. Proceed to months of begging my PCP who couldn't do it because the hematologist did not clear it and that is necessary to satisfy bureaucratic monster and clearance for insurance etc, etc. My surgeon told my doctor that he wouldn't operate without an infusion, so my PCP prescribed one and then I still have to pay out of pocket for it. It was an ordeal and it still makes me feel like a beggar. Like the others said though, it may have to be something we get used to.

In the meantime I have to harass my insurance company, its amazing all the guilt I don't feel about that.
 
I really, really don't get the seeming rarity and reluctance about infusions. From what I see in articles and professional recommendations, iron infusions are both safe and very effective. As for cost, I get that, but given I am getting a $55k surgery, a $600 treatment is a drop in the bucket.
 
If anyone is in New York City and has anemia, there is a clinical trial of Monofer vs. Venofer that would provide infusions at no cost. There is no placebo arm, so you would be guaranteed to get either the available effective treatment or a product that has proven effective in Europe seeking approval in the US. PM me if you want the contact information for the research coordinator. There are several pre- and post- infusion visits as part of the study, so you will pay a price in time, but not in dollars.
 
So, I had a call today about the hematology referral. Soonest appointment is the end of December. As I really can't think of anything else I can do, I guess I'll proceed and hope for the best.
 
So, I had a call today about the hematology referral. Soonest appointment is the end of December. As I really can't think of anything else I can do, I guess I'll proceed and hope for the best.
When is your surgery? If before the end of December, your surgeon needs to get involved cause you do NOT want to go into surgery deficient.
 
It's next week. I don't think I have a choice unless I significantly delay the surgery. The surgeon did get involved, and his involvement was to make the referral to hematology. I could contact him again, but given that my request was for him to arrange iv iron before or shortly after sugery and he did not, and given the stubborn apathy of the nurses at the office, I don't see that going anywhere. I don't see any other choices here for me. I had already called around to several urgent care centers, none have iv iron as a treatment. My primary care doesn't want to get involved. I called a different hematologist who I might be able to get in 3 weeks instead of 3 months, but given no openings in October for sugery, it means a delay of two months or more. This is a huge deal at my workplace so I am very loathe to delay surgery unless absolutely necessary.
 

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