Welcome to The Iron Maiden! My name is Leona, and I live in the Greater Toronto Area. With my background as a registered nurse consultant in patient blood management at a Toronto community hospital, in combination with my own personal health struggles, I am an advocate for the early diagnosis and treatment for iron deficiency – hence, the creation of my new blog!
My goal is and always has been to empower my patients to be health care consumers rather than be consumed by health care. As health care evolves, patients must be well informed and willing to contribute to the process that determines the direction their care takes.
Read below for more information on my experiences in the health care industry and my own personal health experiences, including iron deficiency. To read my entire health journey, check out My Story: From the Bottom of My Heart.
Please don’t hesitate to comment or ask questions on any post.
After graduating from the University of Ottawa, School of Nursing, I worked in Emergency Services for 20 years before a health crisis related to inflammatory bowel disease left me unable to work at the pace I once did. This caused me to switch directions and I entered the field of pharmacology research. After 4 years in this venue, I longed to return to patient care – fortunately, I was able to parlay my research experience into a position in a patient blood management program.
The mandate of a patient blood management program is to optimize patients prior to major surgeries to reduce dependence on blood and blood products. Statistics show that many patients with lower than optimal hemoglobin (less than 130 grams) had iron deficiency – given the luxury of time, many of these patients benefit from iron supplementation. Since beginning this role, my personal health history evolved into yet another area of special interest; after bariatric (weight loss) surgery, I developed iron deficiency related to malabsorption, secondary to bariatric surgery. I quickly learnt that strategies I had applied to my pre-operative patients could easily be applied to patients like myself.
My practice has always been guided by two credos: Nursing is where the science of medicine meets the art of caring and Knowledge is power.
57 thoughts on “About Me”
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Hi Hugh – Thank you very much, I’m glad that the articles are helpful to you! Is there anything in particular you are searching for?
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Hi Vincent – Thanks for the positive feed back and for making it a favorite, I hope you continue to find information you can use here!
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Sima – Thanks for all the positive feedback. I guess it proves to me that I found a niche that very much needs to be filled with useful and easily understood information about iron deficiency. Unfortunately I don’t know of other resources, message boards, online groups that address solely the topic of iron deficiency. I am keeping my eye out for them, if you know of any please let me know. In the interim I am happy to continue to field your questions, and take suggestions regarding topics you’d like to see addressed here at “The Iron Maiden”.
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Some have commented about the length of the articles – Many who have heard me speak know I can speak for hours on this subject! However it’s a fine line between giving complete information and holding the readers attention. These articles are just that… one complete thought. If an article leaves you with a question, please post that question in the comment, and I will reply. No doubt other readers have similar questions, and sometimes your questions turn into the subject of a future article!
Keep this going please, great job!
Thanks for the valuable iron-related information. I have a question for you.
My 91 year old mother was recently prescribed 300 mg ferrous sulphate 2X day to treat low hemoglobin (90). She refused to take the supplement knowing it had constipated her in the past and my pharmacist says that is a very high dose of iron. Her nurse practitioner suggested she take FeraMax instead. FeraMax 150 was the only product available in our local pharmacies, but it provides 30mg/day more than the already high doctor-prescribed daily dose. The pharmacist suggested she take one cap every 2 days. Instead, I transferred the contents of each capsule into 2 gelatine capsules (75 mg per cap) and I intend to give her one 75 mg capsule per day until I’m sure she can handle it without getting constipated. If her weekly tests show she is still deficient, the pharmacist suggests we up the dose to one 150mg cap/day. Does that make sense? Thanks.
You’re right, 300 mg of an iron salt twice daily seems like a high dose but the iron available for absorption is only 50mg/300 mg dose, the constipation issues she is experiencing is related to her body trying to get rid of the 250 mg that were not converted for absorption – here is a link to my article talking about different supplements and be sure to look at the comments on this page where I explain some of these issues.
A comparable dose of FeraMAX 150 is once daily with the bonus that most patients experience less GI side effects, some will experience a looser than normal stool pattern. The absorption may be increased by opening the capsule and dissolving the contents in a warm beverage.
I am concerned if the Doctor is treating anemia based solely on the CBC or if he has a Ferritin Level and an Iron Panel to back up the premise that your mother’s anemia is based on a deficiency of iron. If the Ferritin Level is less than 20, no amount of oral iron will replete the stores in her bone marrow and liver – you can look at my article about the different stages of iron deficiency and appropriate testing to learn more about this.
I would encourage you to continue speaking with your mother’s Doctor about this issue and determining the best course of action. Please let me know if you have any more questions and I will be happy to help in any way that I can.
As you mentioned at your very informative and comprehensive session at the meet and greet for WLS in Paris, my family doctor and the NP at hospital didn’t flag me as at risk despite my ferriten levels being at 6. I will be getting proferrin at the pharmacy this weekend as they too had to order it in, but I am interested in getting the iron infusions. Can you e-mail your contact info and how/ when and where I would be able to get started with this regime asap.
Hi Sara, I am glad you were able to get some useful advice from my discussion in Paris. I have forwarded a reply to your request privately.
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Hi Leona, My husband had heard about you on a radio station today…..ask me to check it out….I am so pleased I did…..I was under a lot of stress while my dad was in hospital not eating properly too tired to eat….I fell one day in hospital….my level was 5….my other lever was 46….taken to emerg….and had a blood transfusion…levels dropped again I came off iron pills when feeling better….I would love to know when you have a speaking engagement in Toronto ….I live in the Oakville area….hope to hear from you….Thank you….Thank you…..Thank you…..Christina
Many of my scheduled talks in the GTA are currently in association with Bariatric (Surgical Weight Loss) Support Groups. I believe there is one being Scheduled for Burlington early next year although the dates have not been firmed up yet. Again, there are many treatment options available such as intravenous iron, that you should discuss with your physician and/or pharmacist.
Hello! Can you tell me if iron liquids are more absorbable than pill? Thank you
Theoretically, liquid, chewable, and powdered formats are more bioavailable and thus more readily absorbed. The biggest issue with liquid formats of iron salts is that they can stain your teeth. You can safely open the capsule of polysaccharide irons (FeraMAX 150 in Canada, which is also available in a palatable powder format designed for children but usable in adults for convenience) and dissolve the contents in warm liquids or soft food. Heme irons can be safely crushed, although they are not fully dissolvable. I would not recommend crushing iron salts.
I had RNY surgery about 10 years ago. I am now living in Northern Manitoba, where the doctors have NO experience with bariatric surgery patients. I have been diagnosed as anemic, and the doctor keeps telling me to take more and more Proferrin. I currently take 4 a day, and she now wants me to take 6. I finally got her to do iron testing on me, and my hemoglobin is 116 and my ferritin is now 9. She tells me they do not do infusions here, but offered the possibility of iron injections. I am looking for help, and information. Will my numbers go up if I take more vitamins? Will iron injections work? Are there problems with injections? Should I push to be sent south to get infusions? I appreciate any help you can give me.
Thank you in advance
You are a prime example of iron deficiency in the absence of anemia. I am hopeful that some of the articles here were helpful in advocating for yourself with your physician. Certainly you do need parental iron therapy (something other than just iron supplementation). Anecdotally, I have learnt that once a patient’s ferritin level is less than 20, it is difficult (if not impossible) to replete iron store with oral iron alone. With your RNY, your oral iron choices are limited to the Heme iron (Proferrin) or the PIC (FeraMAX), as the section of the small intestine that absorbs iron salts has been bypassed.
When we look to parental iron therapy, IV iron is the route of choice. Patients have faster absorption and repletion of their iron store with IV iron. Coming soon, I will be talking about IV iron on the blog. Intramuscular injections do replete iron stores but at a slower rate as they must first be absorbed into your blood stream, then deposited for storage. Intramuscular injections are very painful and can lead to calcification, skin discolouration and tissue scarring. If this is your only option, then yes go with this route, if there is an avenue to get yourself IV iron then I would suggest that this is what you should push for.
Once your iron stores are repleted, please consider optimizing the absorption of your current Proferrin tablets to increase bioavailability. Also, you mentioned that you are currently taking 4-6 tablets per day of Proferrin – you could consider FeraMAX to help reduce the number of pills you need to take daily (this is related to the amount of elemental iron available in each capsule – learn more in my article about the available iron supplements).
Hi! Do you know why the iron is high in FerMax? Do you think they will ever come up with an iron patch? You know you stick it on your arm and it avoids the stomach? That would be good if that could happen. Thank you Carolyn
Hi Carolyn, Thanks for another very good question.
I like to say that FeraMAX is one of the types of iron (polysaccharide-iron complex) your body likes to absorb, as it is a non-salt (non-ionic) formulation. You are correct – FeraMAX currently offers the supplement with the highest amount of elemental iron on the market. Please have a look at my article on the available iron supplements and formulations; I hope that it will help you explore the options with your pharmacist or physician.
Your thought on an “iron patch” is interesting… while it would be intriguing to have many nutritional supplements available through transdermal patches, I suppose we have to wait for science to catch up with our demands!
Just wanted to say hello.
I had RNY in July, I am 40yrs old have no periods (ablation) and I am in a few groups on fb where i have read that the iron in the celebrate vitamins is the wrong one?? I take the complete with iron 36 of elemental 2x a day. Should I be taking feosol with that my ferritin level is 38ng/ml as of Dec 2014. My PC says my iron is fine. Isn’t that low?? TIA Kim
Most Bariatric Designer Vitamins use iron salts in their formulas, unfortunately new literature suggests that these are not the best option for the Bariatric Population, as the absorption surface for iron salts is on the section of the small intestine that is bypassed. As such, I would suggest that your best option for iron supplementation is a Polysaccharide-iron complex or Heme iron. You may need to discuss this with your pharmacist to ensure you are purchasing the appropriate iron supplement.
I love your website! I am a community pharmacist; I will be writing a brief article on iron supplements that are available, and the differences between them, for my pharmacy’s website. Would you be okay with me placing a link to your website in my article, as a place to go for further information?
Tara Loseth, RPh
I would be both flattered and honoured if you included a link to my site as a resource for your group!
Thank you for asking.
I really like your new website a lot of information
i have anemia and my Md give me Femarax 150 , the pharmacist ask me if im a smoker , is there any interaction or danger
Thank you for your question. I am not aware of a contraindication with smoking and the use of FeraMAX 150, but good on you for being a health care consumer and asking!
In previous articles, I have mentioned that anemia in men is not common and to trust your personal physician in taking steps to discover the cause of your anemia. Things like diet or pre-existing health conditions (such as gastric ulcers, inflammatory bowel disease or celiac disease) are the usual suspects, yet something as regular as blood donation is also a possibility.
Perhaps the pharmacist’s question regarding smoking was related more to the correlation between smoking and gastric ulcers than a contraindication to the use of FeraMAX. This is just my speculation of course. If you have the opportunity, for ease of mind, consider asking your pharmacist why she/he asked about smoking. I would be interested in hearing the reply.
Good luck in your journey to wellness! Please keep me informed regarding your progress and don’t hesitate to contact me if you have future questions or feel I may be of assistance in your recovery.
My 88 year old mother has been taking iron pills for a few months, as prescribed by her doctor. The problem is that the iron leaves such a foul taste in her mouth that she hardly eats anything at all anymore.
I am worried about her, as presently she is recovering from heart surgery but still can’t stand most foods, so she is pretty weak. None of her doctors seems to be able to solve the problem, so I am hoping you have some advice on how she can continue to supplement with iron, but lose the foul taste.
I am sorry to hear of the struggles your mom is having and the worries you have as a result of them. I am not sure what iron preparation your mom is taking or what format, however, if taste is preventing her from taking it and decreasing her appetite for other foods it may be time to look into other iron supplement options.
A polysaccharide iron (like FeraMAX) may be a good alternative as it is well absorbed, tasteless and odorless, and one capsule a day is the same as three capsules of most iron salts. If your mom needs or/prefers a liquid format it is safe to open and dissolve the capsule content in liquid. The paediatric format (liquid or powder) may also be an option for the sake of convenience and so you do not have to break into the capsule (however it could be more costly compared to the oral irons). Heme iron (like Proferrin) is another good oral option, also better absorbed, thus requiring fewer doses. A final alternative lies in the consideration of intravenous iron, this is usually reserved for those who cannot tolerate oral iron and/or have reserves so low that their health may be suffering greatly.
With all recommendations, I whole heartedly suggest that you discuss your very valid concerns with your mom’s primary health care provider. There are solutions and your Mom is so worth looking into them!
Best Wishes to her for a speedy recovery, and to you for driving her care.
Hi Leona, I need help. I want to get iron infusions (have been doing shots) b/c my iron saturation was LOW (20%). Now my saturation is at 23% but I’m done with shots – my butt is purple and sore. I have ulcerative colitis and my gastroenterologist practices out of Ajax Pickering. He said I should get infusions but claims he has no way of ordering them for me. He said to go to my GP. My GP has referred me to 2 hematologists and both have rejected me. I’m a tenacious person and not afraid to give up – tell me what to do next. PLEASE!!!!
I have heard that there is an issue regarding patients in your area, who do not have a concurrent oncology diagnosis, getting in to see a Hematologist. If you are able to travel, you may want to consider a referral to a hematologist in Toronto, specifically a benign hematologist. They tend to me more in the community hospitals than the teaching hospitals. However, be aware that many centres are beginning to charge for IV iron therapies.
Did you learn most of this through nursing or did you have more of an understanding after your weight loss surgery when you began having more of these issues?
Thanks for your question, I am going to hedge my response a bit.
As you likely read in my biography, I was working in Patient Blood Management, for about a year before I had surgery. This specialized field of nursing focuses on “optimizing” patient’s hemoglobin before major surgery to reduce the frequency of blood transfusion. I am proud that in 7 years I reduced transfusion rates in patients I worked with from close to 40% to zero. Most of my success lay in identifying and treating iron deficiency in its early stages (before the patient was anemic)
After my surgery I realized that one of the most common post operative complication our community face is iron deficiency. Like everyone suffering from iron deficiency in the absence of anemia getting definitive treatment is difficult. So while I never used iron salts in my pre-op practice simply because of their side effects and compliance, additional research revealed that they are ineffective in the gastric bypass population because of the limited absorption surface.
So the base knowledge came from my being a nurse, however; the expertise in the Bariatric Population came from my special interest in this population.
Hello! I an desperate for help with my low ferritin levels. I am not comfortable posting my personal health info on here. Is there anyway you could email me? I am going bald at 30 years old from the low levels.
Hi Emilie – I will email you directly 🙂
I had bariatric bypass surgery in 2008 and am now told that I am anemic and have low iron and calcium. I’ve been taking prescription iron tablets and calcium but the doctor who performed the surgery is saying that I should be getting iron infusions. I live in the Montreal, QC area and wonder whether there is a recommended source in this area. Thank you! mo
Thanks for your inquiry, unfortunately, I am not aware of the health care resources available in Quebec. Your Healthcare provider that suggested iron infusions should have a better idea. Barring that you may want to inquire with you private pharmacy, or call patient services at RAMQ.
I know that isn’t as much help as you were hoping for, however access to IV iron varies from city to city and province to province.
Get well, and once finished your infusions please use a supplement that we know post Bariatric Surgical patients can absorb.
Leona (Fellow Iron Deficient, post-Bariatric Patient)
I’m so inspired by your story and all you’ve been through. A few months ago I developed gastritis with some bleeding. The gastroenterologist said it was minor bleeding and put me on PPI. I took it for almost 5 weeks and came off of it because I was having symptoms of low iron anemia. At the time I had no idea what was wrong me. I had heart palpitations, tingling in legs, hair falling out, fatigue and shortness of breath, cold hands & feet, etc.. I’ve been to the emergency and they said I was fine- ran test all came back normal but didn’t test ferritin. My doctor ran tests and found my ferritin was 15 and put me on ferrous gluconate 2x a day (hgb 133). It helped a bit but over time it aggravated my gastritis. I had a heart ultrasound which came back normal and a holter monitor which showed no abnormalities except for PVCs.. She thinks I should stop the iron and focus on treating the gastritis. I think I need an iv iron infusion because stopping the little iron I’m taking will make me feel worse. The low iron symptoms are much harder to deal with than the gastritis. I’m thinking of taking liquid iron to lessen the stomach irritation. Where can I turn to for help or a second opinion. I’ve seen that many doctors know nothing about severe iron deficiency anemia. I live in Surrey, BC. Thank you for taking the time to read my story.
Thanks for your patience regarding my reply. Seems like you have been through the wringer and the treatment perpetrated your symptoms.
First, the ER likely only tested your “Complete Blood Count” seeing a hgb over 130 g/l confirmed you are not anemic (stage 3 iron deficient) however as you know from reading “The Progression of Iron Deficiency” you can be iron deficient and suffer from debilitating symptoms related to iron deficiency long before you are actually anemic.
If you review the “Symptoms Checker” you will see that all the symptoms you describe are related to iron deficiency.
In a surgically unaltered gut, there really isn’t much difference in the effectiveness of the oral irons on the market. However, the use of a PPI actually inhibits the conversion of the iron salt, ferrous gluconate, from the type of iron it is, into the type of iron our body absorbs. When taken, under optimal conditions, only 8% gets converted. Literature suggests that most of the digestive tract issues common to the use of iron salts and vegetable source irons (nausea, heart burn, black tarry stools, abdominal cramping etc) are actually caused by the unconverted iron passing through your gut undigested.
You are right in the thought that you need to continue with iron replacement therapy. I would, however, recommend switching to a polysaccharide iron complex or a heme polypeptide iron. Both of these formats are not affected by PPI inhibitors and significantly decrease, if not completely eliminate gastrointestinal tract side effects.
Finally with regard to IV iron. Normal ferritin levels are 20-300. Symptoms of iron deficiency begin to appear at levels less than 50. Anecdotally we know that is difficult, if not impossible, to rebuild iron stores with oral iron supplementation alone. IV iron would be highly recommended.
You need to ask your health care professional to refer you to a “Benign” Clinical Haematologist, as they tend to be more aggressive in their treatment of iron deficiency than the Haematologist’s that deal with oncology.
So now you have your marching orders, I hope they start you on the road to recovery. Again my sincerest apologies for the delay in my reply.
Hello, I have some questions about chronic iron deficiency and very low ferritin and iron saturation levels. Will you please email me so I can explain more and ask a few questions without posting to a broader audience? Thank you!
My personal email will be sent to your Hotmail account.