DEAR DR. ROACH: What’s the best advice when one doctor seems more concerned about something than another? I am a 49-year-old woman who doesn’t smoke, is relatively healthy and who weighs about 150 pounds. I have had celiac disease since 2009 and hypothyroidism. I tend to run on the low end of normal with my ferritin levels. A recent reading was 37 ng/mL, but it’s been 11 to 34 over the years, with a recent iron reading of 87 ug/dL. This concerns my neurologist, whom I see for severe restless leg syndrome. I currently take 140 mg daily of ferrous sulfate. The ferritin level doesn’t seem to be a concern for my internal medicine doctor, though the neurologist wondered why he isn’t trying to figure out why my ferritin levels run on the low end of normal. Do I pursue that further with the internal medicine doctor or ask the neurologist if there is more investigating that he would like to pursue? -- S.K.
ANSWER: This is a seemingly simple question: Why a low ferritin with a normal iron level? Ferritin is a protein that reflects total iron stores, so a modestly low ferritin like yours means borderline overall body iron. You are taking a fairly low amount of iron, and it might not have adequately repleted your stores. Celiac disease, unless a gluten-free diet is meticulously followed, usually leads to poor iron absorption, so that might explain why your body isn’t at full iron levels despite your taking supplementary iron. Iron levels go up quickly after supplementary iron or iron-rich foods, and vary during the day. Your neurologist is quite correct that even mild iron deficiency, proven only by the low blood ferritin, can worsen restless leg syndrome.
However, there are some other possibilities that need to be mentioned. One is that hypothyroidism can cause a low ferritin level in absence of iron deficiency, and you should be sure your thyroid level is right in the middle of normal. Also, I don’t know why you are iron deficient in the first place. While the celiac disease is one possibility, I always want to make sure a hidden source of blood loss has been looked for, and for a 49-year-old woman especially, that means a thorough evaluation of the GI tract, especially the colon. Polyps, colon cancer and inflammatory bowel disease sometimes can have minimal symptoms. All could cause blood loss that you might not notice.
I certainly would readdress this issue with your internist, or ask to see a gastroenterologist.
DEAR DR. ROACH: In regard to the recent letter about medical providers demanding nonessential information, why are doctors referred to as “Dr.” while I, the 70-year-old patient, is referred to as “Mary”? Am I not worthy of the doctor’s and staff’s respect? We are not personal friends; we are customers and providers. -- G.M.
ANSWER: I agree with you completely. I find it unprofessional when I see a doctor, especially a young one, speaking to a patient by his or her first name. It is disrespectful.
I will amend what you said: You are more than a customer; you are a patient. That gives us, as physicians, an obligation to treat you with respect and all our skill.
I have had many patients who, after many visits or an invitation to do so, I felt comfortable referring to by their first name, and I expect the same, based on mutual respect. But that isn’t really the situation you are referring to.
TO READERS: The booklet on back problems gives an outline of the causes of and treatments for the more-common back maladies. Readers can order a copy by writing: Dr. Roach -- No. 303, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.