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鈥檓 feeling fine (no problem with gastroesophogeal reflux disease or any other conditions), he wanted to schedule me for a colonoscopy and an endoscopy. I鈥檝e had these procedures before, most recently in 2010. Do you think I need to have them done now? I鈥檓 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鈥檛 have any symptoms that I can describe.)
C.A.
It sounds like you have iron- deficiency anemia, though it鈥檚 important to be sure of that. Iron deficiency can come from excessive loss (by far the more common) or inadequate intake. 聽
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鈥檚 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 both 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 鈥� 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鈥檛 explain its presence; we didn鈥檛 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鈥檛 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鈥檛 always take a headache seriously.
E.C.
Migraine headaches can show up with a wide range of symptoms 鈥� some of which are not even located in the head 鈥� 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 鈥渄ried blood鈥� 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鈥檚 severe symptoms, I would recommend he see the most experienced headache specialist available, who is likely to be a neurologist.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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