Tag Archives: Ferritin

DR. C’S MEDICINE CABINET: THE BENEFITS OF “IRON”

Iron is the most common element, by weight, on earth, so it should come as no surprise that it has evolved to be an essential component in the mechanism that is life.

The ENERGY of the eukaryotic cell is dependent on the Iron in mitochondria, which are elaborate electron-transfer mechanisms. To quote Nobel Laureate Albert Szent Gyorgyi, “Life is nothing but an electron looking for a place of rest”.

Iron is essential, so it is possible to have too little of it. There is no physiologic pathway to get rid of it and so you can have too much iron in your body, which comprises a disease called Hemochromatosis. Excessive Iron can be TOXIC to the body, and produce damaging free radicals.

Deficiency of iron will produce ANEMIA. Regulation of incoming Iron is the body’s way of keeping excessive Iron out. It is absorbed only in the upper part of the small intestine, and a special protein called Hepcidin can block it from release into the circulation. It is carried through the blood by Transferrin and also Ferritin, which stores the iron that is not in the hemoglobin of RED BLOOD CELLS, the main storehouse of iron.

Blood loss is a common problem which leads to increased Iron requirement, This is reflected in the increase in RDA of Iron in Women during their menstruating years. Colonic Cancer, among other conditions, can also bleed and lead to the anemia of Iron deficiency. This is the reason for Doctors ordering a test for “occult”, or hidden, blood in the stools. My reason for taking Iron is a continuing loss of blood from the small intestine.

I have had multiple colonoscopies and Gastroenteroscopies to rule out cancer and other blood-losing conditions in the lower and upper intestinal tract. The small intestine is the “silent” area to gastroenterologists, and I cannot have the Capsule/camera examination because of my small bowel surgery.

I must take extra iron, and hope that this will be sufficient to keep me from developing anemia again. Green vegetables and red meat are more satisfactory sources, but insufficient for me. I worry a little about the recent finding that Heart Failure has been associated with Ferritin levels below 100 ng./ml.

I struggle to keep mine at 50 ng. by taking 2 tablets of feosol daily and dealIng with the subsequent constipation. An ANNUAL PHYSICAL and laboratory examination is important for the maintenance of health. Enough Iron and blood are important factors for vigorous Well-being. —

–Dr. C.

INFOGRAPHIC:

IN THE LAB: TESTS FOR AND DIAGNOSING “aNEMIA”

I should have known something was wrong.

I was getting short of breath with a third of a 45-minute exercise I had done for years, but I rationalized it away. I reasoned that I hadn’t been sleeping well, I am getting old. And my heart isn’t working as well because of the Atrial Fibrillation.

Physicians have a big armamentarium of excuses they can generate, and besides it is their Karma to GIVE Medical care rather than to RECEIVE it.

The AHA moment came when I bumped my leg, and peeled back some skin. My skin is old and fragile, and I’m always tearing it in small areas.

This time, I got to see the blood run all the way down my leg like a drop of grape juice, not the thick blood I’m used to. If anything, my blood should be thicker, more viscous, since my average Hemoglobin is 16 gm., on the high side of normal.

I got my blood drawn, and ordered a CBC and a ferritin. The CBC shows the Hemoglobin level, and a number of other measurements bearing on anemia, and the ferritin gives a measure of IRON STORES.

I can’t remember the first time my ferritin was ordered, or why, but it has for years been borderline, just barely in the normal range, dipping down as low as 18, and rising as high as 35.

Since a common cause of low iron stores with a good diet is colon cancer, I had about 3 colonoscopies to rule out cancer over a period of 6 years; lucky me.

At least they were all negative, and without polyps.

This time the ferritin was 12, well into the abnormal range, and the Hemoglobin was 8.6 gm. little more than half my usual.

I had been fibrillating for 5 months, and been on 5 mg. Eliquis ( an anticoagulant/blood thinner) for the same period. Having a recent normal colonoscopy, the most likely diagnosis was AVMs (arteriovenous malformations) of the small bowel, with bleeding accelerated by the Eliquis,

Since small bowel surgery contraindicated a diagnostic videocapsule, this diagnosis would have to remain an assumption.

I reduced the Eliquis by 25%, calculated my blood loss rate and started 2 capsules of feosol alternating with 3 capsules daily. Over a period of 4 months, my Hemoglobin came back up to 15 gm., and my ferritin came up to 50. I am due another test as soon as I get enough nerve to brave the Covid and go to the lab.

This story is a good illustration of treating one illness, and thereby creating another in this world awash with medication. How much better it is to stay as healthy as possible.

However, I am becoming increasingly aware of the fact that Health is not often the top priority in most peoples lives.

As an illustration, I refer to todays’ Sunday New York Times, which reviewed 2 books on walking, one written to praise its’ health benefits. To quote the reviewer, “

The issue with ‘ in praise of walking’ is Mr. O’Mara’s assumption that how good an activity may be for us is the most essential measure of its worth”. Praising health raises an issue?

Personally, my main exercise is walking, and I do it expressly for health. That doesn’t mean that I don”t enjoy walking and have other motivations. I would not be walking as FAST, however, it it were not so healthy.

–Dr.C.

PHYSICIAN’S CORNER: NEJM “COVID-19 PRIMER – VIRTUAL PATIENT SIMULATION” (2020)

CLICK ON PATIENT BELOW TO LAUNCH “VIRTUAL PATIENT SIMULATION”

COMMENTARY

This interactive simulated case of Covid 19 (SARS CoV-2) is remarkable: a unique opportunity to stand in the shoes of a ER Doctor without any risk, except to our egos.

This is meant for doctors, but the intellectually curious  Guests of this site might enjoy the experience, especially Doctor Lisa Sanders fans.
The vocabulary is full Medical, and will give a foretaste of the words I will slowly be exploring. I believe that patients should not be intimidated by their lab reports.

I’ll start the vocabulary journey with FERRITIN which is a marker for IRON STORES in the body. You can have too much iron, which is dangerous (iron overload), in which case the ferritin is high.

There was a time when I had too little iron ( was anemic, with a hemoglobin of 8.6, and felt terrible) and my ferritin was low. I now check my ferritin every 6 months to make sure I am taking enough iron to offset my blood loss, which is another story I will tell when I start go through my medicine cabinet and discuss the Meds one at a time.

The reason for testing ferritin in our interactive Covid 19 case was because ferritin is markedly elevated in cases of inflammation/ infection. It is an “acute phase reactant”, and may reflect the “cytokines storm” that may be a contributor to the lethality of Covid 19.

There is another way to benefit from this simulation: the train-wreck of a patient serves as a cautionary tale of what you wish NOT to become. Our present medical profession is so DISEASE oriented. How much better if our society and our medical profession were HEALTH oriented instead.

—Dr. C.