Doc: Iron anemia brings suspicion of colon cancer

Keith Roach
To Your Health

Dear Dr. Roach: I recently went for an annual checkup, and was told that I am anemic. Other than advising me to take iron pills, I was told to see my gastroenterologist. Upon seeing him and advising him that I’m feeling fine (no problem with GERD or any other conditions), he wanted to schedule me for a colonoscopy and an endoscopy. I’ve had these procedures before, most recently in 2010. Do you think I need to have them done now? I’m 70 and have not experienced any pain or esophageal problems at all. Does this relate to my being anemic? (I had no idea of this, as I don’t have any symptoms that I can describe.)

C.A.

Dear C.A.: It sounds like you have iron deficiency anemia, though it’s important to be sure of that. Iron deficiency can come from excessive loss (by far the more common) or inadequate intake.

All cases of iron deficiency anemia should trigger a suspicion of colon cancer, unless there is another known source of blood loss, and even then it should be considered. You definitely should have a colonoscopy. Six years is enough time for a polyp to develop that’s large enough to bleed and become precancerous or even cancerous.

If the colonoscopy does not show a source of bleeding, it is appropriate to look for other sources, such as from the upper GI tract via an upper endoscopy, although some gastroenterologists routinely do the upper and lower at the same time.

Increasing dietary iron or taking a supplement may be appropriate, but ask your gastroenterologist when to stop before the colonoscopy.

Dear Dr. Roach: My son is 42 years old and has been plagued with severe migraine headaches for at least four or five years — so severe that they leave him incapacitated. Recently, he was driving and had to pull over, get out of the car, vomit and lie on the ground, helpless. Thankfully, an aware policeman called an ambulance and rushed him to the hospital, where he had X-rays, MRIs and loads of tests. They found nothing. They did find dried blood on the brain and said it was old and couldn’t explain its presence; we didn’t recall any previous injuries in his life. He has been getting these headaches several times a week. He has been to several local doctors, a chiropractor and a masseuse, to no avail. He has been on a number of prescriptions, tried gluten-free diets and even had a procedure that they said would numb the sinus area where headaches occur. Nothing has helped. He says he is not stressed out, but questions the amount of sleep he gets. If he has a headache and goes to bed, he is fine the next morning. The headaches are affecting his life and his job. We don’t know what to do or where to go next. What type of doctor specializes in migraines and migraines only? It seems to me people don’t always take a headache seriously.

E.C.

Dear E.C.: Migraine headaches can show up with a wide range of symptoms — some of which are not even located in the head — and levels of severity, all the way up to totally incapacitating. Several of his features do sound like migraine, such as the vomiting, but the “dried blood” found in the brain by MRI (it sounds like a subdural hematoma, a blood collection usually caused by trauma) worries me.

Most general doctors and internists are comfortable treating migraine, but neurologists often have the most expertise. Given your son’s severe symptoms, I would recommend he see the most experienced headache specialist available, who is likely to be a neurologist.

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