By Erik Dolson
The burning in my legs began a couple of months ago. Again. It was before I embarked on a five-week adventure on my boat to the wilds of northern British Columbia, so I remember. I recall the crushing fatigue as well, the feeling that I could use a nap a half-hour after I woke in the morning.
The symptoms progressed slowly during the journey north, and were debilitating enough that the day after my return to Oregon, I requested my blood be tested. I thought it might be long-COVID, since symptoms were similar, but wanted a blood test to rule out other causes.
My MD called the day the results came back. It was a Friday, and she strongly suggested I go to the emergency room for a transfusion. My hematocrit was at 26.1%, and it should have been between 41% and 50%, according to test standards of the lab used. My hemoglobin was 7.9, and should have been between 13.5 and 18.
Somehow, I was short about a third of my blood.
I had no external symptoms of blood loss, such as obvious blood in my stool or urine, and no vomiting. So where did my blood go?
That was the focus of ER doctors, who wanted exploratory procedures to find a leak. But I have a condition that makes such procedures dangerous, and I put on the brakes.
But the severity of the problem last week caused me to do some more research. While acknowledging they may be right, I think I’ve identified another cause of my low blood levels.
I didn’t lose blood. I haven't been making blood.
To begin with, my diet sucked. I’d been somewhat successful in building my blood back after a severe anemia that followed blood thinners used during surgery for a coronary stent last September. I was almost normal last May. But weight gain and personal events caused a bit of back-sliding, to say nothing of life on my boat where I’d been spending more time and tend to eat less balanced meals.
Because of the condition mentioned earlier (Barrett’s Esophagus), I’ve been taking a drug called Nexium every morning for decades. And about five years or so ago, a previous MD added Pepcid to my routine in the evenings. This worked, and my acid indigestion abated.
Except when I get a little heavy. I normally run about 180 to 185 pounds, but occasionally billow up to 190 to 195. When that happens my indigestion gets worse, probably because when lying down, liquids in my stomach are pushed by belly fat up past the malfunctioning valve that separates stomach from esophagus that I inherited from my father.
When this happens, I turn to another old stand-by, baking soda. A small spoonful in a glass of water (carbonated water is even better) settles that acid right down after a belch or two (think grade-school volcano).
Nexium (a PPI inhibitor) and the Pepcid (an H2 blocker) are known to hamper the uptake of B12 and folate, two vitamins necessary for blood creation. Finally, sodium bicarbonate and calcium carbonate cause “the plasma iron increase to be 50% and 67% less than the control values,” according to an article in JAMA.
Another process affected by acid reduction meds is the release of “intrinsic factor,” also necessary to metabolize iron and make oxygen-carrying blood.
Consequently, I think the ultimate source of my occasionally debilitating anemia was the attempt to find relief from persistent heartburn.
I’m not alone in this. PPI meds like Nexium are a $3 billion business in the U.S. I get it: persistent heartburn disrupts life in many ways. First Prilosec, then Nexium and Pepcid, were major factors in improving my quality of life for decades. But there has been a price to pay.
Too many doctors are unaware of these links. Too many health professionals want to look only at causes of blood loss, rather than failure to make blood, as a cause of anemia. In my case, too few asked about my use of medications that might be at fault.
So to others who may be experiencing a similar situation, I suggest you do your own research, look at your own patterns, and add what may be critical information to your profile.
Good sign. (smile)
Yikes! So glad you figured that out!
Is it a bad sign that I read "Where did my blood go?" and unbidden, my mind launched into a full-on Diana Ross and the Supremes version? "Baby, baby, where did my blood go?"