to be annoyed by the doctor about my iron levels!

[Gennz]

Ths is a very boring AIBU. I just want to have a rant.

I hav a 5 month old DS. Lately he has been sleeping a lot better but still not sleeping through - he goes to bed at 7, I dreamfeed him at 10 and he wakes between 3 - 5 for a feed and gets up at 6.30 - 7am. So only waking once. I'm still BFing.

However I have been feeling more exhausted than I did when he was newborn and waking round the clock! I feel dizzy and faint, can barely walk to the end of the road, my arms feel weak, I generally feel like I've been run over by a truck.

I had very low ferritin levels - 10 (e.g. iron deficient) in pregnancy and took iron supplements. The normal reference range is 12 - 150. I feel now like I did then - i.e. it's not just the normal shatteredness that comes with sleep deprivation or broken sleep. I'm sure that's the culprit now, so I started taking the iron supplements I had left over from pregnancy & upping my red meat intake. I went back to the doctor for blood tests and my ferritin came back at 26. (Thyroid function etc all came back fine so that's not it).

I called the doc & said I knew the ferritin was within the normal range but it was still quite low & I was taking my leftover iron already but that they were going to run out soon & given my symptoms I'd like an iron prescription to get it up further (from what I can tell from doing a bit of reading online - yes yes I know, don't trust Dr Google ... but still...) while 10 - 150 is "normal" optimal ferritin levels for females are 70 -90.

She said no, it was well within normal, they wouldn't prescribe and if I wanted iron supplements I would have to buy them over the counter myself. And that I was probably just "tired from the baby" (at which point I really wanted to hit her - I mean no shit that hadn't occurred to me! The baby might be affecting my sleep, oh really?! )

AIBU to think this is a bit blinkered? I don't really mind about buying the iron supplements myself, but if someone presents with symptoms is it not bit bloody lazy & narrow minded to say "no that's not it, no I won't help you" and stick to a massively broad reference range for a possible issue? I already feel much better afer a week of taking my leftover iron supplements and upping my red meat intake.

Buy some good multi vits and minerals. They can make an amazing difference to your well being.

I second floradix, I found it much easier to tolerate. If you can also sit out in the sun for 25 mins, most people are very low in vit d at this time of year (assuming you are in the northern hemisphere) and can lead to feelings of exhaustion and General achey bones, low mood etc.
hope your mojo comes back to you soon.

The key is your haemoglobin - if it is normal then this is unlikely to be what is making you tired - have you got those results?

Dark chocolate is good for iron boosting as well (Plus Vit C as said previously)

Thanks for all the tips everyone. I am in NZ so Vitamin D shouldn't be a problem, it's still 22 degrees and sunny here! I'll double check the haemoglobin, I know that ferritin is the reserve iron, but I do feel almost as bad as I did at 28 weeks pregnant when I was first tested and had ferritin at level 10. Or rather I should say I did, until I started taking the iron supplements! I went for a walk today with the buggy which I just wouldn't have been capable of 10 days ago.

I just don't think I could blame the exhaustion on having a young baby when I felt better when he was 3 months and waking round the clock than I did last week.

My understanding was that it was more difficult to increase ferritin levels than haemoglobin levels through normal iron supplementation? I'd go back to the doctor and ask again. A friend of mine had an iron infusion to sort out her ferritin levels.

OP interesting that you've tested positive for antibodies. I get symptoms at the lower end of the 'normal range' for TSH. Took a while to convince the doctors! Same as you've discovered with iron, not everyone has the same 'normal' or optimal range.

Have you been checked for beta thalassemia minor ?

For years my brother suffered from "low iron" (I went with him once to give blood and they refused it, as it was too low). Luckily he didn't feel anaemic, and didn't take any supplements.

He then got started in genetic research, and discovered that he was in a high-chance category of this disorder (it's when a single allelle is affected). Got tested and Lo! - he has it. It's a disorder of processing ferritin, and no amount of iron supplements will fix it - in fact they can be dangerous as the iron builds up in the body.

It can raise an eyebrow in doctors - it's more associated with African and middle eastern people. Being a genetic disorder, I got myself tested (negative) as one of the complications is vasculitis which I needed ruling out a few years ago before being diagnosed with glaucoma.

How long has your baby been sleeping better.

It's just my experience but when my dds started sleeping better after a looooong period of severely interrupted sleep I actually felt a lot worse for a while.

Once I started to get more sleep it was like I craved more sleep and felt more tired for some time. It did settle down though.

It is frustrating when they won't take tests further - my ferritin levels are about 259 and despite me begging them to test me for iron storage disorders they won't. If I still worked in the lab if be able to do it myself !!!

Op, your iron levels aren't that low (low yes but not critical) I second the other posters above in saying to ask for a thyroid test . A proper one, with TSH and free t4 etc. get a good thorough checkup at a private doc if needs be.

Hmm I thin I will seeanother doctr and egt the thyrid stuff checke dout a bit more.

I jus got a voicemail message from the doctor's surgery to say she "strongly advises" that I supplement with iron as I have levels in the normal range and there is a "danger of toxicity" if I was to take iron supplements. My level is 26. Iron toxicity is indicated by levels of 1000 or more. I think it's very unlikely I'd stray into toxic levels any time soon. I'm sorry but I think she's a muppet.

I understand that there are normal reference ranges for the whole female population but there are also optimal levels for individuals which she doesn't appear remotely interested in looking into. And she's also not remotely interested in finding it what the problem is, if it's not low iron.

Now I am ranting again!

Excuse my typo-riddled first sentence!

Your doctor does indeed sound like a muppet. Or perhaps, to be charitable, had the wrong chart in front of her when she called. It's important to get out front of this, as I've recently found out with a pernicious anemia diagnosis. Years-long chronic gastritis has destroyed the parietal cells which secrete intrinsic factor. This factor binds with B12 to make it, and iron, useful in your body. If you are low on iron you're almost certainly low on B12 as well. My latest HgB is 10.4, HCT is 31.9 and my iron is just squeaking into the 'acceptable' range at 55. B12 is at 233, under the accepted range of 239-931. Oh, and my Ferritin, at a reference range of 6-115, was a whole 11.

I know you're in NZ OP so the ranges might be different, but I'm in the US and our guidelines for a nonpregnant woman of childbearing age are, for iron itself, a reference range of 50-212 micrograms/deciliter. Hemoglobin should be between 12-16 grams/deciliter and the acceptable range for hematocrit is 37-47%.
Also, see if you can get a B12 level checked and if it's even low clinically normal start supplementation. My hematologist has me on 2,000 units of B12, plus fish oils, plus dark leafy greens, fish, etc.

I hope you get to feeling better soonest! It's so terrible to feel all dragged down by anemia when you're trying to heal from a significant event. But congrats on your bouncing babby boy! :D

Thanks so much for your post Historia, I will take a look at my tests and see how they come up!

haven't read the whole thread, just wanted to point out your iron levels are fine, and iron tablets take many weeks to work, so if you are feeling better after a week on iron tablets, then it isn't the iron tablets that have changed anything.

Gennz- I would strongly urge to to pursue the thyroid further. Lots of people with hypothyroidism are initially told that their blood tests show their thyroid is "in the normal range" when in fact it's far from optimal and the range most health services refer to is too broad. The fact you have antibodies may indicate an autoimmune condition and at the very least you should ask for this to be retested regularly.

What you are experiencing isn't normal tiredness - it's extrem fatigue and I can completely identify with the rage when someone suggests it's just baby related tiredness. When all your energy is so sapped that you can lift your arms or walk the length of yourself this is something far more debilitating than exhaustion. It's a sign your body isn't working as it should.

I think you are entirely reasonable I had a similar situation and my midwife suggested I buy spatone which you add to orange juice, she said that the cheapest prescribed ones tended to cause more problems like constipation whereas the spatone seemed gentler.

I've just taken another look at my test results, which also have the comparative results from September when I was 28 weeks pregnant with DS, weak, exhausted & white as a sheet with a ferritin level of 10.

Funnily enough my haemoglobin levels then were within the normal reference range (just) - they higher now but still at the lower end of the range. So it was only the ferritin levels that prompted the iron supplementation then, and I started to feel better within a week (as I have this time).

What annoys me I guess - and the AIBU probably isn't very well phrased - is that I went to the doctor asking for help for something and was basically dismissed. She ran the tests, I came back "normal" and that was the end of it. If I hadn't requested the results I would never have even heard back because they don't contact you for normal results.

I know the difference between baby-induced sleep deprivation and being so shattered and weak I can't lift my arms! I just find the whole "well of course you're tired you have a baby" excuse really annoying and lazy.

Is the point of being a doctor to try to help people feel better or what? I'm totally not a hypochondriac at all, but I was anaemic in pregnancy, I had a CS and a post partum haemorraghe (nothing dramatic but it's probably relevant), my nails are brittle, I'm pale and weak... y'know would it have killed her to say "well your levels are normal but you're obviously not feeling quite right, how about you supplement with iron for a month & see how you feel and we can re test then to make sure you stay safely in the normal range". Or something... Suggesting that I'd end up with toxic levels of iron is just ridiculous.

Corabell I wondered about thyroid but the levels look fine, TSH is ony 1 so seems tobe ticking along fine.

I realise that contrary to my post above I am acting like a total hypochondriac!!

"Ferrous sulphate tablets are available over the counter and would be significantly cheaper buying them like this than paying for a prescription."

Thanks for this magrat, good to know. OP I had a pph a few weeks ago so all fresh in my mind! Mine is 9, I have been prescribed tablets (pregnant and post natal women get free prescriptions NHS so worth it) however 7 or less is a transfusion. On this basis I've got to say yours sound really well within range

I agree with floradix but don't expect diet to help you much; the levels in food are tiny and you never know if you're absorbing much of it.

Go on the thyroid society website and have a nosy around on the forum. TSH can be normal but when they test T3/T4 that's where you see problems. Good luck

If you're buying your own iron tablets, don't bother with ferrous sulphate - it's the least easily absorbed of the iron supplements and the one most likely to cause constipation.
Get some ferrous citrate, or ferrous fumarate instead - they might be more expensive but you'll absorb more of them so they'll work better (and give you less in the way of bowel disruption).

Gennz - I wouldn't dismiss the concerns over your vit D levels - I've been in Australia for nearly 6 years now, and my entire family has low vit D levels, including DH who is Australian. We supplement Vit D.
I don't know if NZ has the same sort of "slip slop slap" advice re. sun exposure, but if they do then your vit D levels could well be down. I know that low vit D is endemic in Australia, and that GPs are quite happy and even keen to test for vit D levels, just in case.

Thanks all, I will def get the Vitamin D sussed out and the thyroid - they checked T4 but not T3 (or the other way round, I can't remember).

I have done some digging and ferritin of under 15 is diagnostic of iron deficiency anaemia, but levels of under 30 are "highly suggestive" of IDA, so I don't know why she was so insistent that I shouldn't supplement.

Hi op I suggest getting your b12 levels checked, Oftan tablets won't help, it needs to be injected. Hth

My b12 was 400 and the "normal" range was 200-2000. I read that it should be at least 500 to feel well. I take a sublingual b12 supplement and a vit d spray and I do feel a lot better - seems to have made my levothyroxine work more effectively.

I found doctors more understanding when I spoke about what my "tiredness" meant in real terms eg unable to go up stairs without testing, unable to walk for more than 5 mins without feeling extremely fatigued and really pushed the fact that I had no quality of life. This might prevent them eye rolling at the word tired.

At the very least your doctor should be checking for other conditions just in case you are ill!