Another Mystery Solved

If you’ve been reading my updates with any regularity during the past year, then you probably know that my that breathing hasn’t exactly been the best. So what else is new, right? Still, I managed to get out and walk pretty much every day. Lung issues aside, the one thing I haven’t written about was how incredibly difficult it was to do those walks. From late summer till just recently, the physical effort required to do almost any physical activity was off the charts and I couldn’t figure out why.

Not that long ago, back in 2020 during the early days of the pandemic, and despite lots of severe exacerbations, I was walking an average of 3-5 miles every day and upwards of 30 miles a week if training for a race with no problem. But come this past Fall, it was all I could do to finish a 1 mile without collapsing from exhaustion. I found myself constantly having to stop to rest my legs and catch my breath. The breathlessness part was no big deal, I always get short of breath when I exert myself…Im used to it. But the muscle weakness and just a sense of overwhelming fatigue was something I hadn’t experienced before.

My first thought was, Dude, you’re just getting old. You’re 67 years old now and your disease is finally catching up with you. My second thought was my age can’t be the problem. Heck, I can walk faster and farther than most people half my age who have good lungs. Maybe I’m just overdoing it? The course I walk is mostly uphill, so perhaps my leg muscles just can’t handle the strain anymore. I had fully recovered from my hospitalizations before restarting my exercise regimen, so that couldn’t be the cause. Maybe it was a combination of different things? Whatever the reason, I wasn’t happy about this sudden downward trend.

Then about a month before my last hospitalization in November, while checking online to see what my eosinophils count was(I had just started on Fasenra), I noticed on the same lab report (a CBC) that various red blood cell related tests, including my Hemoglobin, MCH< MCHC and MVC were out of range. They were either too low or too high. Upon further inspection it became apparent that I had Iron Deficiency Anemia. What’s more, Id been anemic to some degree for at least 2 years. During the last 3 months my numbers started to get worse. On one of tests (Ferritin) my Iron level was almost nonexistent. Could this be the cause of my muscle fatigue and my worsening breathlessness during my walks? And if it was, how the heck did I become Anemic in the first place? I eat fairly healthy.

Well, after talking to my primary doc and doing some internet research on the subject, I learned that anemia in men is usually a result of blood loss from the GI track, ie ulcers, intestinal tumors. Though Ive had major problems with abdominal bloating these past couple of years, the GI tests Ive had done (colonoscopy and transit test) all came back normal with no signs of bleeding. The definitive test would be an upper GI where they look into your esophagus and stomach, but because of my lung issues I’m considered too high risk to have it done.

In an attempt to treat the Anemia, I began by taking over the counter iron supplements, but there were too many side effects, so I switched to the liquid form. The liquid was easier to tolerate then the pills, but after taking it for 6 weeks my blood counts weren’t getting any better. Finally in November while hospitalized for my asthma and asleep on the ventilator, they gave me a series of iron infusions. It took a while them to kick in and coax my body into storing more iron, but now 2 months later my blood tests are completely normal again. More importantly, I have more energy, less fatigue and virtually no muscle pain anymore.

It’s amazing how getting a little bit more oxygen to the tissues, can make you feel 100% better. Fact is, you need lots of oxygen going to your leg and breathing muscles when you do a strenuous walk or workout. Lack of iron in your hemoglobin, which is what carries the oxygen in your blood to the tissues, prevents that from happening. This can result in increased shortness of breath, especially on exertion, muscle fatigue, dizziness and just plain feeling run down. Also, important to know, especially if you have severe lung disease, is that you can have a completely normal O2 sat, yet still have depleted amounts of oxygen available for the body to use.

Luckily, my anemia was only moderate. Some people have such severe anemia that they need blood transfusions. For those who cannot receive blood products for religious reason, they will sometimes get hyperbaric treatments, where they put you in special chamber and super-oxygenate your blood. I know this because as an RT I once worked as a hyperbaric technician.

There’s no guarantee that the iron infusions I received will have a long-lasting effect, and we still haven’t figured out the cause of my anemia, so for now were just gonna check my blood every couple of months in case my numbers get out of whack again and go from there.

Here are some of my CBC lab results over the past few months and my Ferritin levels over the past few years.

You can see that the dip in my numbers correlates with my complaints of fatigue and increased breathlessness, then bounces back up after receiving the iron infusions in November.

Its sometimes difficult to tell what’s causing what when you when you have a chronic lung disease. There are lots of conditions that share the same symptoms, and anemia is one of them.

So I guess the takeaway is to let others out there know, especially those with chronic asthma or COPD, that symptoms of worsening breathlessness and/or unusual fatigue might not always be related to your lung condition…. you could anemic as well. It’s probably a good idea to have your lab values checked for anemia now and then. And don’t rely on your healthcare provider to monitor these things for you. My doctors weren’t even aware that I was anemic until I pointed it out to them.

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