Getting Slapped Back to Reality

“The low Hemoglobin is probably just caused by low iron. I’d recommend taking an iron supplement every other day. I did notice you have a colonoscopy coming up next year. It would be a good idea to talk to a gastroenterologist to see if that should be moved sooner”. I stared at the text in the patient portal. A severe overreaction began immediately at the suggestion to touch base with gastroenterology. Alarm bells sounded in my brain as I frantically Googled symptoms of colon cancer.

Some months ago, last June to be exact, I visited my general practitioner for my annual checkup. Aside from a recently burgeoning waist line, these had always been pretty routine over the years. A verbal review of any problems or issues, a look through the routine blood work, a quick examination, and a “See you next year”. This time though, there were a couple results flagged in red as abnormal by the lab. The biggest one was low hemoglobin. Hemoglobin is a protein found inside red blood cells and is responsible for carrying oxygen throughout the body. Several related findings also showed low indicating slight anemia. I remembered making a blood donation shortly before the lab work and chalked it up to that, but Dr. Strohl suggested we do some followup bloodwork in a few months just to be sure.

Fast forward to February. While cleaning up the mound of paper and trivia on my desk, I unearthed the lab order from Dr. Strohl for the followup. Criminy! I forgot all about it. Thinking all would come back normal, I got the routine test done on a Monday morning. Tuesday, my e-mail pinged from Quest Diagnostics telling me my results were ready. Confident all would be green, I logged in and was immediately crestfallen. The same tests from June showed even worse values this time. I should be clear. The numbers were not off dramatically. For each abnormal finding they were just off the “good” scale by a few points. Still, I messaged Dr. Strohl to ask if she saw the results and if I should be concerned. That is when the message appeared in my portal suggesting to see a specialist.

Dr. Google displayed the likely list of colon cancer symptoms:

• Blood in stool – Nope
• Abdominal pain – Nope
• Black stool -Nope
• Unexplained weight loss – Ha! Just the opposite.

Talking to friends with a medical background helped. I was coming off the wall and realizing the most likely scenario was low iron. This still seemed odd considering the amount of iron rich food I consume but I am also a very regular blood donor and my medical friends assured me it can take longer for us older people to recycle after a donation. I had given blood 3 times between my June and February tests.

Rather than leave things to chance, I scheduled a visit with a practitioner at US Digestive Health. May as well leave things to the experts. I was able to get an appointment relatively quickly and was assured my numbers were nothing to worry about, especially as a regular blood donor. She seconded the opinion about an iron supplement (which I had already started), and ordered an iron test. She pointed out that the ranges for my results wouldn’t even have triggered an “abnormal” a few years ago. She did agree that moving the colonoscopy up a year made sense for absolute peace of mind. I wasn’t excited about the upcoming prep day but have to admit knowing for sure nothing was wrong internally would be good.

Aside from getting the iron test, and taking the iron supplement there was nothing to do but wait once I scheduled the colonoscopy. I decided then that this blog post would either be news that I had a big fight ahead or total relief. Either way, the first abnormal test results in my life got me thinking about my lifestyle of late. I spent 13 years as a die hard runner and triathlete. Not only was I working out several times a day but was really persnickety about what I ate. (Persnickety? Yes. I’m that old.) The last 3 years I could not have fallen harder off that wagon. I’ve eaten like an out-of-control teenager, and let alcohol become a regular part of my daily life polishing off 2-3 bottles of wine a week. My stomach had grown from non-existent to having a dewlap hanging over my belt again. I kept making excuses to do nothing. I’ve blogged about doing something. I’ve bent my friends ears about doing something. But all I did was get in worse shape and add on more pounds.

The abnormal blood work was a slap in the face. “Wake up idiot! You’re throwing your health away!” Yes, I know I could exercise and eat the healthiest diet known to science and still wind up with cancer or some other horrendous disease. Some things you can’t control. I can control what I shove in my pie hole, alcohol consumption, and a sedentary lifestyle. I thought about the alcohol, and junk food I’d consumed over the past few years and the havoc that must be wreaking on my body. Time to stop. As in NOW!

I immediately returned to the practices that got me from 240+ lbs back in the early 2000s down to my race weight of 170ish. I started using tracking tools for both diet and exercise, and made sure there were healthy alternatives in the house when the afternoon munchies kicked in. I also kicked both my cardio and weight workouts up a notch or two. Within a couple weeks, weight was noticeably melting off my frame and I already felt better.

With the colonoscopy scheduled I moved ahead with the iron test. Not surprisingly some of the results, though not all, were out of range. Total iron was literally right at the borderline of “good”. My suspicion is it would have been red if I hadn’t been taking the iron supplement for a few days prior to the test. I had already stopped taking iron in preparation for the upcoming colonoscopy so it will be interesting to see if the numbers improve with longer term use of a supplement.

I’ll admit that despite reassurances from the medical people, I was still anxious for the colonoscopy results. Yesterday I went through the rather miserable preparation for the procedure. (Note: If I never have orange Powerade again it will be too soon. IYKYK.) This morning I enjoyed a really great nap while the procedure was performed.

I would be remiss if I didn’t point out the efficient and excellent care from the Endoscopy Center at U.S. Digestive Health in Wyomissing, PA. The nursing staff before and after the procedure were friendly and helpful. The anesthesiologist was totally professional. Dr. Riverso who performed the procedure was personable, friendly, and knowledgeable. The whole thing from arrival to departure took about an hour and 15 minutes. My only point of improvement would be for them to splurge on the quality of toilet paper in the restroom. Given what people are there for you’d think they’d have the softest, most plush tissue available. Once again IYKYK.

If you’ve never had a colonoscopy, from a patient perspective, once the prep is done the whole thing is over in a few minutes and involves a really awesome nap. In the pre-op room, a friendly and efficient nurse named Jean got me ready to go and prepped the IV. The anesthesiologist wheeled me into the procedure room. He then put a breathing tube under my nose and said “Take deep breaths”. I took one or two breaths and barely heard him say “Have a great nap.”

I swear I was deep enough asleep that I had a dream. Suddenly in my dream Dr. Riverso was telling me he was done and everything looked great. No issues. “Come back in 10 years.”

The anesthesia is not the same as is used for surgery. When you wake up from this you are awake. It is just like waking up from an afternoon nap. My wife was in the recovery room with me and a pleasant young nurse removed the IV and escorted us to the car. As we walked, there were two prevailing thoughts in my mind. The first was absolute relief that there were no issues internally and the second was “I can’t wait to get home and make a stack of french toast”!

So where does that take me health-wise? Well, I have a few thoughts.

First, I plan to stick with the healthier lifestyle. There has been no alcohol in the house for about 3 weeks now. I may buy one bottle now and then when we go camping but I have no plans to return to the 2-3 glass a day ritual. Also, I don’t need to have senior years filled with preventable health issues caused by obesity, too much sugar, and other junk. No, I’m not swearing off sugar but from now on it will be a treat and not a meal or a snack. There is going to be a lot more fruits and vegetables and a lot less M&Ms and chocolate.

That leaves the hemoglobin and iron issues. Throughout the course of the last couple weeks I’ve had some thoughts about this. As mentioned, in talking to the medical people in my life, none of the numbers are dramatically off. But the first CBC was performed in June. The last in February and, at that point, it had been 2 full months since my last blood donation. I wish I had that test done when I was supposed to in November or December. I wonder if the numbers weren’t even lower then? The Red Cross doesn’t allow blood donation if hemoglobin is 11 or below so there is that piece of information. Still, the CBCs are a point in time.

When I research symptoms of low hemoglobin and low iron a few things stand out:

• Fatigue
• Shortness of breath
• Dizziness or lightheadedness when standing up

There are others but those are common and at the top of the list. For the last several years, mostly in winter, I have dealt regularly with all 3 symptoms. Again I don’t know the level of anemia that would cause those things and perhaps I’m reading too much into what Google and AI tell me. But I’ve used some asthma medicines for years that never seems to have much effect on the shortness of breath. This SOB is not life threatening in the least. Just an annoying inability to get the feeling of a full breath.

The fatigue is real. There are days I get to the gym and can barely lift my feet let alone lift weights or run on the treadmill. It is noteworthy that a few days after I started taking the iron supplement, I could feel improvement. Maybe that was just in my head? I don’t know but I don’t think I am tremendously off base.

I had always attributed the lightheadedness to vertigo and it could be that. Mom was afflicted with terrible vertigo in her later years. Still, like the rest of the symptoms above, I almost only have this happen in the winter months. This is significant because October to March account for my most frequent blood donations. In the spring and summer I’m often away from home on the days blood banks are held at my preferred, local location so donations are less frequent.

Let’s be very clear about one thing. I am not blaming all of this on donating blood and I do not want to discourage anyone from donating life. My suspicion is an underlying issue with iron absorption. Once again, Mom was blessed with all sorts of gastrointestinal issues as she aged. I have no idea if iron absorption was a problem for her or not. I suspect she was never tested for Iron but I have no way of knowing at this point. Was blood donation a contributing factor? Of that I have no doubt but only because I focused more on getting that next gallon pin than realizing as we age, it takes longer to build back the supply. Blood donation is extremely rewarding and I encourage every healthy, able bodied person to donate. With 340 million people in the US we should never have a blood shortage. I plan on donating again too once I get my numbers good. Maybe not as often but at least a couple times a year.

Otherwise, I’ll test hemoglobin and iron again in a few months and see if I’ve righted the ship. I’ll wait to hear back from my GP and the gastroenterologist. I want to be sure they are happy with the colonoscopy results. I will heed any other advice they give.

I have a few health and fitness goals I plan to hold myself accountable to:

• Return to and maintain a reasonable, healthy weight
• Continue lifting 3-4 days a week
• Return to longer, faster running (hopefully including summer races).
• Shirtless running in the summer again !