Iron Fortified

The relentless fatigue that plagued me after I ran my half marathon and carried on one weekend later following the Cabot Trail Relay was starting to worry me - was I progressing faster than I (and my hematologists) thought? Was the stress of exam writing, residency, running, trying to get out of my return of service contract and sleepless nights filled with haunting nightmares catching up to me? Sure. But, there was more to it. I just wasn't myself. I couldn't stay awake for an entire day without a nap and it got to the point where I was struggling to make it to lunchtime for yet another coffee, in order to see an afternoon of patients in clinic. I was never a big coffee drinker, now I absolutely relied on a dose of caffeine multiple times a day. It was upsetting.

I remember one of my worst days, it was mid week and I still had two weeks of residency to go. My lymph nodes were bothering me, I wasn't sleeping and one of my patients didn't show up for their appointment. Normally I would be super bummed. I love the opportunity to learn and see patients. That day, I put my head down on my desk, lightly sobbed out of frustration and closed my eyes. I could have slept the day away sitting in that uncomfortable office chair. I made it through the morning, but just couldnt get through the rest of my day. I felt defeated. I felt I had let my patients down, my colleagues and myself down. I don't give up, or give in. That used to be my attitude, though I've changed my tune in recent months. This feeling was different. I couldn't possibly do one more day operating on an empty tank. I left at lunch time that day, I slept until late evening when I woke up to eat something light and back to bed I went. Even after all of those hours of sleep when I returned the next day, I knew there was something off within my body.

Luckily, I had an appointment coming up with my new hematologist, as my care has been transferred and I asked for an urgent visit. When I met with her, I expressed my concerns. I was profoundly fatigued and my nodes were reacting, kind of like the disgruntled playground kid who wanted her way but wasn't getting it. I needed to rest or slow down my running, I had no idea what to do. I was so stressed, though Ive been more stressed than I can put into words these past few months so it wasn't just that.

She looked at me and plainly stated "I bet its your iron". Kind of like when you are blinded by sunshine and say "Boy, its sunny outside!" It was obvious. Why didn't I think of low iron?! Im a doctor too...but wait, now I am a patient. How many times do I have individuals in front of me, in a similar state and I can peg iron deficiency/low iron as the cause for their fatigue. Many times. She sent me on my way for blood work and I was called the next day with an astoundingly low iron level. Not due to bone marrow failure as my other cellular lines are ok, but I don't eat red meat (rarely), I run(too much) and I am a woman with a monthly cycle. The fatigue was largely related to low iron. Thank goodness.

They got me in within three days for my first infusion. I sat in a chair wondering how many patients I had referred to go in for this treatment and had no great understanding as to what would happen during or after. The nurses asked me if I had taken my tylenol and antihistamine on arrival. "Shoot, was I supposed to?" The nurse replied that it would reduce allergic reactions, as there was no time to give me a test dose - we were going for it, the whole dose today (I was leaving for a trip ten days following my infusions)

Well...lets say I should have taken the meds. The first infusion went well, but immediately following, I puffed up like a marshmallow for the remainder of the day, with stiff joints and limited range of motion. It was uncomfortable, not painful. Something to definitely tell my patients in the future. Side effects. Noted. Four days later I had another infusion and was given the appropriate medications to reduce my risk for side effects, luckily they worked brilliantly.

My fatigue has improved immensely. For the first time in weeks, I ran longer than 5km last weekend without having to stop and catch my breath. I can make it through most days without a nap, though when I do feel the urge to lay down, I do so. Without knowing what to expect personally, how could I have accurately told my patients an iron infusion takes atleast 3 hours, you should take anti-histamines beforehand and after one infusion you are unlikely to feel positive effects.

I continue to take each piece of news, each investigation or treatment as an integral part of this journey of mine. Good or bad, I'm not about to sit and wait for the wheels to fall off. For now, I'm feeling fortified with iron and stuffing my face with steaks and dark chocolate to keep my iron stores up. Bring on the chocolate!