I recently had a 47 yr. old female patient complaining of being tired all the time. She was shaky folding laundry, dizzy when she stood up too quick, and had very little endurance during her hikes. She has a decent health history with no chronic disease and is an avid hiker. After looking at her medical history, which included Irritable Bowel Syndrome, I started asking questions about her bowel movements. She had had a mild hemorrhoid a few years earlier, and had been experiencing on and off constipation after trying a commercial diet that was limited to 800 calories a day. After evaluating her diet and bowel issues, we determined she may have unseen hemorrhoids. This could lead to anemia.
Next we set up a doctors appointment to have a colonoscopy to check for bleeding and a blood test to look at her blood count and iron levels. Our goals were to rule out anything serious, and then trace back what could be causing the sudden chronic fatigue. It is not uncommon that as we age, the smooth muscles of the gastrointestinal track slacken and fecal matter does not travel out as quickly. Other lifestyle issues like her regular alcohol consumption, an average of 3-6 per week, can cause the mucus layers to wear down increasing the risk of bleeding and cracking of the cell walls. This, together with her consuming less than the recommended intake of 35 grams of fiber per day, could cause digested food to stay in the colon longer than it should. Strain and tearing during bowel movements can cause bleeding, which may not be detected in the fecal matter or seen in the toilet.
Additionally, if the bleeding is happening with any frequency, it can leech blood slowly, reducing total hemoglobin. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. If you have anemia, your body does not get enough oxygen-rich blood. This can cause you to feel tired or weak. You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. These were the very symptoms she was experiencing. I referred her for blood tests because there are many types and causes of anemia. Mild anemia is a common and treatable condition that can occur in anyone. Some people are at a higher risk for anemia, including women during their menstrual periods and pregnancy and people who donate blood frequently, do not get enough iron or certain vitamins, or take certain medicines or treatments, such as chemotherapy for cancer.
Anemia may also be a sign of a more serious condition. It may result from bleeding in the stomach. Chronic from an infection, kidney disease, cancer, or autoimmune diseases can also cause the body to make fewer red blood cells.
Her doctor considered her medical history, physical exam and test results when diagnosing and treating her anemia. He use a simple blood test to confirm that she had low amounts of red blood cells or hemoglobin. (For some types of mild to moderate anemia, your doctor may recommend over-the-counter or prescription iron supplements, certain vitamins, intravenous iron therapy, or medicines that make your body produce more red blood cells.) Once the cause of the anemia was been determined, we used a series of health coach sessions to educate her and set up a CBM model for changing her lifestyle and health habits to prevent anemia in the future.
After all her test came back, it turned out she had several bleeding polyps and her iron levels were very low. She started on an iron supplement, stopped the low cal diet in exchange for a fiber rich root diet. I recommended she quit drinking alcohol and consume water instead. Within 60 days she was non symptomatic and back to her hikes!