Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
It makes a world of difference to the patient. In one case, they feel good and have no symptoms of disease. Then you'd want to be very conservative with treatment. In the latter, they have symptoms of a disease, you confirmed the underlying cause via lab work, and now you can treat them more aggressively.
If a patient can live a normal and healthy live with subclinical anemia, there is no use in treating them at all.
I have a real problem relating to your philosophy based on my experience. I understand that there are people out there that think the way you do but they are two standard deviations outside of mainstream conventional medicine. I think they can relate more to the dark ages.
It makes a world of difference to the patient to have a proper diagnostic workup whether they have symptoms or not based on serendipitous findings like in this case. I have over forty years of working in the field and can definately tell you that I am firmly biased in my beliefs based on experience.
Most of the horror stories involve misdiagnosis based on symptoms or pateints simply ignoring symptoms they do have until it is too late. I will continue to tell people that if you are ever given a chronic disease diagnosis or one that is turning chronic then get a second opinion.
A whole host of serious and abnormal laboratory findings exist sans symptoms. Of course as stated, first repeat testing.
But you are going to ignore an asymptomatic creatinine of 4.4?
An asymptomatic Hgb of 7? White count of 0.4K? Platelet count of 18K?
An asymptomatic ferritin of 3000?
Asymptomatic liver enzymes 10X over normal?
Asymptomatic immunoglobulin 10X normal?
Asymptomatic serum calcium over 13?
Asymptomatic FBS of 212?
Not to mention all sorts of other medical testing showing potentially serious problems, yet the patient is presently asymptomatic.
My wife had all the above at one time since 2017, and is currently thriving and doing well since all these abnormals were not ignored, and appropriately addressed and treated.
Also hate to think of where I'd be right now if both I, and my PCP had ignored that 9.2 gram hemoglobin ( a drop over over 2 grams in a 6 month period) showing on my lab results about a year ago.
I have a real problem relating to your philosophy based on my experience. I understand that there are people out there that think the way you do but they are two standard deviations outside of mainstream conventional medicine. I think they can relate more to the dark ages.
It makes a world of difference to the patient to have a proper diagnostic workup whether they have symptoms or not based on serendipitous findings like in this case. I have over forty years of working in the field and can definately tell you that I am firmly biased in my beliefs based on experience.
Most of the horror stories involve misdiagnosis based on symptoms or pateints simply ignoring symptoms they do have until it is too late. I will continue to tell people that if you are ever given a chronic disease diagnosis or one that is turning chronic then get a second opinion.
There is no proof modern medicine has left the 'dark ages.' During the dark ages, medicine as practiced was often a detriment to people's long term health, and it maybe so today. It might be controversial and even an unfathomable position for some - after all, LE has gone up but that was principally due to advances in nutrition and engineering.
Albania has a higher LE than the USA, yet Albanians get far less interventions from modern medicine. Food for thought.
I'm not asking anyone, you included, to change their advice. I'm offering mine. For some reason mine is controversial, yours is not. That's because mine is against the group consensus, and yours is with the group. But all individuals need to understand arguments against prevailing consensus, so they can make informed decisions.
Voltaire ~
Quote:
“The art of medicine consists of amusing the patient while nature cures the disease.”
Certainly evangelists would have fought me just as hard saying stenting people with stable coronary disease was saving lives. Until COURAGE came out. And that was in 2007. We older people all know a few who were stented unnecessarily, and even as a detriment to their health.
It makes a world of difference to the patient. In one case, they feel good and have no symptoms of disease. Then you'd want to be very conservative with treatment. In the latter, they have symptoms of a disease, you confirmed the underlying cause via lab work, and now you can treat them more aggressively.
If a patient can live a normal and healthy live with subclinical anemia, there is no use in treating them at all.
As far as anemia is concerned, it often develops slowly over time. People adapt to the lower level and do not realize they were really not feeling well until the anemia is corrected
As far as anemia is concerned, it often develops slowly over time. People adapt to the lower level and do not realize they were really not feeling well until the anemia is corrected
Yeah, I recall seeing people with hemoglobin as low as 5 grams that had apparently adjusted enough to it that they didn't admit to feeling bad. They looked a little grey-ish, and might have been a bit short of breath, but had acclimated to that as well.
On the other hand, a sudden blood loss of 2 grams will leave a person fighting for his life.
As far as anemia is concerned, it often develops slowly over time. People adapt to the lower level and do not realize they were really not feeling well until the anemia is corrected
This is what he wrote earlier,
"All of your abnormal readings are connected.
Your MCV measures the volume of your RBC, it's small, so can hold less hemoglobin. Or another way, since hemoglobin gives structure to your RBC, there is less hemoglobin per RBC. Since your RBC have slightly less hemoglobin than normal, you'd expect lower hemoglobin/hematocrit reading in general. MCH quantifies the amount of hemoglobin per RBC, and it's low, as we'd expect per your MCV reading.
Now onto MCHC, it's normal. But on the lower end. It's hemoglobin divided by hematocrit and since both are low, it's likely this balance kept it in normal range. It's the average sample of hemoglobin in a fixed volume of blood. Basically while each of your RBC have less hemoglobin, they also have less volume, and since you have a normal amount of them, in a fixed volume, you have about the same amount of hemoglobin. This means your body is rationing hemoglobin likely due to iron deficiency.
So all of this points to iron deficiency."
He made a diagnosis of iron deficiency solely based on lab results without mentioning one symptom.
Yeah, I recall seeing people with hemoglobin as low as 5 grams that had apparently adjusted enough to it that they didn't admit to feeling bad. They looked a little grey-ish, and might have been a bit short of breath, but had acclimated to that as well.
On the other hand, a sudden blood loss of 2 grams will leave a person fighting for his life.
Indeed and the first thing I look at when I was working in the blood bank was looking at the hemoglobin result and the rest of the CBC. If it was a normochromic normocytic anemia and had a 3 gram hemoglobin then rest assured I fought for every minute because of the likelihood it was an acute blood loss in there. If the MCV was low and the hemoglobin was the same then I knew that it was a long-standing anemia and the patient had an adjusted oxygen dissociation curve. Transfusion is also slow rather than infusing quickly to avoid fluid overload.
As far as anemia is concerned, it often develops slowly over time. People adapt to the lower level and do not realize they were really not feeling well until the anemia is corrected
My wife's Hgb was 6.4, and it didn't keep her from skiing at 11,000 ft. Because it got there slowly.
Mine was also 6.4 after my heart surgery done by a surgeon who mostly did kids. Kids don't usually need transfusions. I had twist everyone's arms for an order to get the blood, as I felt 2/3 of the way to death!
My wife's Hgb was 6.4, and it didn't keep her from skiing at 11,000 ft. Because it got there slowly.
Mine was also 6.4 after my heart surgery done by a surgeon who mostly did kids. Kids don't usually need transfusions. I had twist everyone's arms for an order to get the blood, as I felt 2/3 of the way to death!
Wow, unless your wife spent most of her time while adjusting to that low hemoglobin ( or its downward slide) at that 11,000 ft altitude, I'd have figured her adjustment to that altitude with such a low hemoglobin would have been pretty rocky.
I thought that below 7 grams hemoglobin was where they started considering transfusions ( packed red cells) for a patient, depends on circumstances of course. I'd have thought they'd be pushing transfusion for you with that 6.4 gram hgb post surgery, and you wouldn't have had to twist any arms to get them.
I had a 7.2 gram hemoglobin after my colon resection surgery, the surgeon and the hospitalist bounced the idea back and forth about my having a transfusion for a couple days. They kept telling me they were considering it, they repeated the CBC twice a day, then ( much to my relief), decided it was stable there, and I could do without the transfusion.
My wife's Hgb was 6.4, and it didn't keep her from skiing at 11,000 ft. Because it got there slowly.
Mine was also 6.4 after my heart surgery done by a surgeon who mostly did kids. Kids don't usually need transfusions. I had twist everyone's arms for an order to get the blood, as I felt 2/3 of the way to death!
You let your wife ski at 11,000 ft with Hgb of 6.4 or you got her tested sometime later and it was 6.4 and you assumed it was 6.4 at the time she was skiing?
The only Hgb found to be incompatible with life is below 5 and above 20.
I'm probably the one few people who had a Hgb above 20. In my younger days I climbed G2, which has a summit of just slightly above 8,000m (8,050m +/- 10) . You spend around 5 days above 7,000m. So when I say Hgb > 20 I'm estimating based on altitude. One of the climbers had a heart attack in his sleep in camp 1 (6,000m) after 2nd day from descent. He was a Slovenian mountaineer, very athletic guy, made a lot of records in his own country, but no one knows how altitude will impact them. According to his tent mate, he just woke up in the middle of the night gasping for breath.
Which reminds me, sleeping at that altitude (anything above 6,000m) and you really feel your heart beating. It's actually hard to fall asleep. Nevermind moving, you feel 2x as heavy. When I got back to Askoli (3,000m or so) I slept over 1 day, couldn't even stay awake, just would wake up to have tea and beans, and then back to my mat.
You might think endurance runners have high hemoglobin levels relative to none athletes, but it's actually the reverse. Some function in the slightly anemic range (macrocytic anemia), and many have very low ferritin levels. See here: https://pubmed.ncbi.nlm.nih.gov/7234508/
I have heard crazy theories as to why. One is "footstrike hemolysis" where the theory goes footstrikes on the ground cause some RBC to rupture, over time with many foot strikes this leads to anemia.
Of course, the simpler explanation to me is iron is vital for many energy pathways as it assists fats and carbs to be converted to ATP, usable cellular energy.
As a former athlete, and someone who still exercises 2-3 hours a day with sustained BP in the 140-150 range for the entire interval and spikes in the 170-180 range, I found myself slightly anemic over time and began supplementing with iron. It works well. I take an iron supplement, 65mg, every day. I eat salads with steak or chicken as I told Crazy Cat lady to do.
As someone who pushes his endurance/strength limits within 90% of max at least a few times a week, one great thing about that is that there is no slow changes that creep up. If I don't hit 90% a few times in a row, I begin to wonder why.
Last edited by FlBeachIguana; 02-12-2023 at 09:46 PM..
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
