Living With Anemia

[femi fan]

It turns out that my wife (in her late 30s) has anemia, after official confirmation today.

Now while she has her doctor's advice (not a whole lot!), and i've done lots of research on how to deal with having anemia in one's body, i'm keen to see if any posters here have anecdotal experiences of living with this blood problem, and what they do to counteract its effects. What do you eat, drink, take that gets your blood count back to normal, and that hopefully returns normal energy levels, and so on?

I've been highly recommended getting Floradix liquid iron supplement, but as yet have not managed to find any here in chiang mai.

I'm also wondering if a more sort of naturopathic approach to it might be of use.

In short, who has anemia, and how have you been dealing with it?!

[Sheryl]

There are several different types of anemia.

It is important to know which type your wife has. From the fact that iron supplement was recommended, as well as that the patient is female, it is probably an iron deficiency anemia. This is common in women of reproductive age as, due to menstruation and, in many cases, the demands of child-bearing, their iron requirement is higher than that of men and many women's diet fall short of providing enough.

In Thailand, hookworm is also a common cause of anemia. Often both dietary factors and hookworm play a role. The treatment

(assuming that it is an iron deficiency and not another type of anemia) is iron supplementation, dietary modification, and eradication of hookworm if present. With regard to the latter many doctors just treat empirically while some will wait for lab confirmation. Since the rate of false negative results is high even with 3 consecutive stool samples, there is something to be said for just empirically treating, especially since it is just a single dose treatment (albendazol, brand name Fugacar).

She should also get a stool examinatuon for occult blood, as loss of small amounts of blood through the intestinal tract (as in gastric ulcer or cancer of the colon) can also cause anemia. However with a Thai woman in her 30's odds are an iron deficiency anemia is just the result of insufficient iron intake plus perhaps hookworm.In older women the index of suspicion for occult blood less is greater. but still, get the stool test to be on the safe side, if it was not done already.

The iron supplementation is essential and usually needed for several months. Appropriate changes to diet can help ensure that the anemia, once resolved, does not recur but correcting it in the first place requires a replenishment of iron stores that is hard to do from diet alone.

I am not sure why that particular brand and liquid form of iron was recommended for her. A tablet form should be fine and these are readily available in all pharmacies. Should be taken about 20 minutes before meals to maximize abosrption and minimize stomach upset. In order for her body to be able to utilize the added iron it is important that she also take in enough Vitamin C, e.g. fresh fruits and vegetables or a vit C supplement.

She should have repeat blood tests in about 2 months to see if her iron stores have been adequately replenished and her blood count back to normal.

As for the dietary modifications -- which are important to ensure that the anemia does not recur -- you can easily google lists of iron rich food. If realistically she is just not going to eat enough of those foods then taking a good multitamin and mineral supplement daily may be wise. (This differs from the iron supplementation needed know, which was probably prescribed as 2 times daily...that's needed to replenish depleted iron stores. On an ongoing basis a single daily supplement that includes iron should do it).

Last thing to consider is her form of contraception and how heavy her menstrual periods are. Some forms of contraception (i.e. the IUD) increase the menstrual blood loss while others (e.g. the injection or implants) usually decrease it. if her periods are heavy and if there are no other contraindications a switch of methods may be helpful.

If you are planning to have a baby, should postpone conception until the anemia has fully resolved.

Edited August 26, 2010 by Sheryl

[femi fan]

Wow, thank you for your time there sheryl, very kind. I didn't know there was more than one type of anemia. I'll reread your post in a minute, but briefly:

it was my sister in australia who recommended the floradix. She told me to avoid tablet form since it caused constipation problems. Since my wife has those sometimes anyway, i was reluctant to get a non-liquid form of supplement.

also, the doctor that saw her fixed an appointment to see a specialist doctor tomorrow (friday), and i shall go too. The doctor was quite supportive i think, and told my wife not to be worrying. But i do/did get the impression that her anemia is here to stay. You talked as if after treating it, we can get rid of it? Would that be certain types? I think she's had this for years now, because in the time i've known her she from time to time gets dizzy and/or her hands shake, but without causing her undue problems. She had her daughter 14 years ago, but can't remember how long she's had dizzy spells.

Don't know if this information changes your ideas? I have to say i wonder where it all came from, and assumed she must have had it since her child was born. Where does this hookworm come from?

[femi fan]

They didn't do a stool examination. I'll talk about that with this other doctor tomorrow.

The pills she was given this week after her blood test were

folic acid tab

flunarizine 5mg cap sibelium

merision

if that means anything to you! I shall look them up myself in a minute, but it they're not iron supplements, then i wonder why not?

[ktamp]

Sheryl has given alot of good info. You need to find what is causing the anemia. The most common causes in women are female problems and in the GI tract. I would recommend a full workup with a gynecologist and a full GI workup.

I was severely anemic and I had colon cancer. I have found the doctors here in thailand to have been quite casual about my anemia and missed the cancer for an entire year. I don't mention this to scare you but to point out that there is usally a reason for anemia and it can be corrected. The oncologists here in thailand tell me colon cancer is quite rare in the thai population.

Once the cause of the anemia is determined and treated, it really can be resolved in a few months to a year. My blood levels returned to normal a few weeks after my surgery with iron supplements. I still take them to build up my iron stores. The oral ones aren't too bad with a stool softener. I have found the brand ferril 6 here in thailand to be quite gentle on the stomach and didn't cause me any constipation at all. I had a hard time with the ones prescribed in the US.

[Sheryl]

I did not realize it was not her doctor who prescribed the iron.

Since he did not, and also given that she is being referred to a specialist, there has been something said that suggested she has a chronic condition that is life long, together with the prescribing of flunarizine all suggest that she has (or is suspected to have) thalessemia.

Thalessemia is a genetic blood disorder comparatively common among Thais, and anemia is one of its prssenting symoptoms, but it is not an iron deficiency anemia.

Thalessemia is a complex disease and there are several subtypes.

You need to confirm exactly what her diagnosis is. Do not self treat with iron or anything else if it is thalessemia; all meds should be cleared with her doctor first.

Edited August 26, 2010 by Sheryl

[femi fan]

Sheryl, i have talked again with my wife. I had already been aggrieved when she told me that the results of her tests were not to be given to her. That's another story.

But your second post is illuminating, and you certainly have a lot of knowledge! She had mentioned to me that she had something, some word which i'd never heard of. To cut the story short, when i read 'thalessemia' in your post, it leapt out at me because that was the word she'd said to me.

I get so fed up with the pill culture here, where thais go to a hospital with a problem and get told a few things and sent on their way with pills, always three kinds. I normally go with her when she's got a health problem, but this time i thought it was just going to be a simple test. We had been recommended to go to Dr Satawat at his clinic in the road one block south of nimminheimin road. He told us to get a blood test and then to return to him. Of course, we don't have the results, because the 'big boss' had to be asked at rajawet hospital.

I am very happy i posted this up here, because you have now enlightened me as to the problem she's been diagnosed with. The reason i've just found out for seeing the specialist tomorrow is because of the sort of irritation she has felt in the last couple of weeks just below where the rib cage finishes. Anyhow, i shall see what happens tomorrow, but suffice to say thank you lots for your diagnosis! Sorry for wasting your time a bit with my earlier belief it was simply anemia. It definitely is thalessemia. I should have tried putting this word into google phonetically when she told me.

Whoops, just to add that i had forgotten i'm not in the chiang mai forum, so ignore that road reference!

Edited August 26, 2010 by femi fan

[femi fan]

Sheryl has given alot of good info. You need to find what is causing the anemia. The most common causes in women are female problems and in the GI tract. I would recommend a full workup with a gynecologist and a full GI workup.

I was severely anemic and I had colon cancer. I have found the doctors here in thailand to have been quite casual about my anemia and missed the cancer for an entire year. I don't mention this to scare you but to point out that there is usally a reason for anemia and it can be corrected. The oncologists here in thailand tell me colon cancer is quite rare in the thai population.

Thanks for your help too ktamp. As you may see, i was barking up the wrong tree through interlanguage miscommunication, and it is actually this thalessemia thing. But, and maybe my brain's slow this evening, what is the GI in GI tract?

As for reasons, they always seem to be thin on the ground in thailand. I'll get to the bottom of this somehow!