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From nurse to patient: Anemia management restores energy, hope

Brooke Aarhus, PA-C, consults with Mary White

Mary White was a critical care nurse at University of Iowa Hospitals & Clinics for nearly 30 years, but she has spent much of the 21st century as a patient searching for treatment to help her digestive issues.

Her health problems began about five years after she had surgery for a duodenal ulcer (a sore that forms in the first part of the small intestine, next to the stomach).

“I had bouts of four or five days of not feeling right, and lots of vomiting – just enormous piles of undigested food,” White says.

At the time, she also was struggling with depression and anxiety. “I didn’t do anything about the digestive issues. I just started taking ibuprofen,” she says.

She developed gastric bleeding, which she attributes to the ibuprofen, and sought medical help.

“I had about 50 endoscopies over the years,” she says. “No one knew what was wrong, and no one could offer any help.”

Eventually, White was referred to Yehudith (Judith) Assouline-Dayan, MD, a gastroenterologist at UI Hospitals & Clinics. Assouline-Dayan suspected gastroparesis – a condition in which the stomach muscles lose their ability to move food along the digestive tract. White underwent a gastric emptying study; she ate eggs with a small amount of radioactive material, and a scanner that detects movement of the radioactive material was used to find out where the food went.

“Mine went nowhere,” White says.

Her condition was so severe that she underwent surgery to remove 70 percent of her stomach, a procedure called a Roux-en-Y gastric bypass. The procedure involves creating a small pouch out of the stomach and attaching it directly to the small intestine, bypassing most of the stomach and the duodenum (where White had an ulcer).

After the procedure, White started having pain again and began taking ibuprofen again, with the same result as before: She began vomiting blood again. Her hemoglobin – the protein in red blood cells that carries oxygen from the lungs to the rest of the body – dropped to 3. Normal hemoglobin for an adult woman is 12 or higher.

“Once I hit that low, I could never get back on my feet,” White says. She was hospitalized several times, but other times she simply stayed home, unable to keep food down and too weak to do anything else.

Assouline-Dayan referred White to the UI Anemia Management Clinic, where Brooke Aarhus, PA-C, worked with White to create an effective treatment plan for her anemia and related issues.

“Malabsorption of iron and other nutrients is a common side effect of the Roux-en-Y procedure, because it bypasses the part of the small intestine where most nutrients are absorbed into the body,” says Aarhus.

White couldn’t tolerate oral iron pills, so she has intravenous iron infusions every three to six months. After one infusion, her hemoglobin level rose to 7, and after the second infusion, it rose to 12.

“I go for several weeks with all this energy that I didn’t know I had,” White says. “The iron has made everything else in my body produce. It’s just made an amazing difference.”

“We’re still trying to establish her trend, but we think we’ve found her balance,” Aarhus said. “This is going to be a lifelong partnership to keep her system working as well as possible.”

In addition to the iron infusions, White is taking vitamins and using hot showers, heating pads, and peppermint tea to help with pain relief.

“I’ve made everything as holistic as I can,” she says. “I eat six small meals a day, and I’ve gained weight, which I’m thrilled about.”

She’s also thrilled with Aarhus and the treatment she has received at the Anemia Management Clinic.

“I’m treated with dignity and kindness and respect. This is exactly what I would want for a family member, and it’s how I did nursing – the best care, to the best of my ability, and with kindness,” White says. “Brooke is taking care of me the way I would take care of someone.”

About the Anemia Management Clinic

The UI Anemia Management Clinic offers comprehensive diagnoses and therapy for anemia management for elective surgery, pregnancy, and chronic medical conditions. Located at the Iowa River Landing in Coralville, the clinic is open 8 a.m. to 5 p.m. Monday through Friday.

Tuesday, February 25, 2020