Why does iron deficiency cause fatigue, even in the absence of anemia?

Source: have done this 2-3 times in the past when I was poor / used to not have self insurance.

For much of my 30s, 40s, and 50s I was strictly a fee for service patient in Southern California. This, of course, is no solution for someone with significant health problems. I've been blessed with good health, undeservedly so. I had cataract surgery on my left eye in 2011 for $2600 cash, up front, at the area's biggest hospital. No further charges materialized. I had no regular primary care physician at the time. To me, $2600 for a surgery, the result of which was so magically wonderful that I burst into happy laughter in the ophthalmologist's office when he removed the eye bandage, was worth far more than the $2600.

Don't overlook businesses like Everlywell or Private Labs MD that enable one to get tests performed outside your own network. I've used such a service to "nudge" my health care provider (with whom I am generally satisfied) to investigate some subject further. Admittedly, this is not much help for exotic tests.

If, like me, you are lucky enough to live reasonably near our southern border, labs in Mexico don't even require a doctor's order to perform tests. There may be exceptions to this -- I don't want to imply that I know more than I do.

I don't want to "wave away" the very real problems that exist for those who cannot afford any service outside their network, nor do I mean to ignore the very real problem of arrogant medical professionals who ignore a patient who tells them, "Listen, Doc, I've had this same test three times in the last three months." I only mean to suggest that sometimes, when it is possible, it helps to work around a stubborn physician, rather than attempting to bend said physician to your view.

Which is a bit of a confused statement.

> Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness.

No, that's a pretty shit analogy and completely wrong. First, because chemotherapy doesn't cause "male pattern baldness" - the mechanisms aren't the same. So that's just wrong - while someone with a hemoglobin of 4 has anemia, whatever the underlying cause may be - it isn't a look alike - it is.

Second, diagnosing Alopecia (secondary to chemotherapy) is a perfectly reasonable diagnosis. Because it is something that doctors do manage with specific things separately from the chemotherapy and other cancer treatment, eg wigs, scalp cooling.

People can have more than one relevant diagnosis that they are treated for and are interrelated. For instance, if someone has anemia that is due to something like a GI bleed, they have both a GI bleed and anemia. If their hemoglobin is less than 7 you will likely treat that anemia with a blood transfusion independent of what you're doing to manage the GI bleed. GI bleed, iron deficiency, malabsorption, microcytic anemia are all diagnoses - they may be all interrelated.

> A more accurate and helpful diagnosis would probably be something like "Babesiosis"--anemia caused by ticks

But babesiosis is not anemia. It often occurs with it, but the diagnostic criteria for babesiosis is blood smear or PCR. If someone has a smear positive for babesia then they have babesiosis regardless of their Hgb/Hct.

And notably they listed a bunch of tick borne illnesses listed, babesiosis was not among them.

Your mother had a microcytic anemia (a broad class based on lab results), of which there are several types including iron deficiency anemia.

Next, there are multiple causes of iron deficiency anemia of which celiac disease is one of them.

You would never diagnose a patient with “anemia” and stop there. Further work up for the etiology is mandatory and endoscopy is commonly performed.

There is no such thing in modern medicine as “just treating anemia” unless you know the cause and the only treatment is transfusions.

It’s a profession that attracts know-it-alls along with those that actually want to help but are overworked.

In your mom’s specific case, it is inconceivable to me that any trained physician would see her post-surgical history and subsequent development of an abdominal mass and not think immediately of a hernia and possible strangulation as it grew. A first-year medical student can palpate the abdomen and readily tell there is herniation through the abdominal wall. Is it reducible or not? An abdominal CT scan should be reflexive. It’s even more maddening when more than one physician misses the obvious or at least the way it sounds to me given the information you’ve provided.

Physician burnout is a real alarming phenomenon with emergency room doctors having one of the highest rates. This was already an issue pre-COVID-19. I can’t help but worry about how worse it may get.

As physicians were trained on the common and the deadly. We’re not that great at rare non-immediately life threatening conditions due to the nature of the discipline.

We’re trained that when you hear hooves, think horses not zebras. This does unfortunately mean that patients with zebras are often misdiagnosed for a while, but that’s because our approach isn’t intended to catch every zebra (which would be impossible).

The other element is to avoid unnecessary harm. Often the tests for zebras are nonspecific and overlap with other conditions (I.e. to be considered after exclusion of other aetiologies).

A late diagnosis of EDS fits in the zebra categories and probably wouldn’t have been picked up until you saw a rheumatologist or vascular specialist at a centre which deals with these.

But otherwise normal/daily supplements for a few months probably won't be negative and indeed, might even be beneficial for certain subpopulations, like athletes.

My go-to for that is Iodine.

The difference is that now we have both empirical evidence that it works, when it works, what the side effects are, and generally why it works. As opposed to cargo culting, poor cost/benefit analysis, and inaccurate understanding of what's actually happening.

I think you should do a blood test and ensure you're at least over 500 pg/ml.