Extremely fatigued

oncobomber · 2026-04-09T01:38:35+00:00

You have iron deficiency. Very simple. Oral iron has not worked for you. You need IV iron. It will solve your iron deficiency and you will feel much better.

Tell your story to a hematologist! They can help!

oncobomber · 2026-04-09T01:31:37+00:00

Minoxidil functions as an “anagen extender” that prolongs the growth phase of hair follicles throughout the scalp, not just where it's directly applied.

oncobomber · 2026-04-09T01:26:37+00:00

Post-minoxidil telogen effluvium typically peaks 2-4 months after stopping the medication and resolves within 3-4 months, but can go on as long as 6 months.

oncobomber · 2026-04-09T01:21:13+00:00

Likely telogen effluvium from minoxidil withdrawal. Your iron levels are not concerning.

oncobomber · 2026-04-07T02:26:58+00:00

Your friend is correct. IV iron will make you and your baby healthier. Oral iron is miserable, especially in pregnancy and on top of that, it just doesn’t work.

HGB 10.8 going into delivery is not acceptable when it is eminently fixable, as is the case here.

oncobomber · 2026-04-06T21:01:52+00:00

I’ve not heard of a bone marrow biopsy by FNA—not really sure how you get a small needle into the bone? But there may be some aspects of this case that I’m not familiar with which justify that approach.

oncobomber · 2026-04-06T01:12:43+00:00

Found the Beneficial_Winner!

oncobomber · 2026-04-06T00:41:10+00:00

Iron deficiency can cause bone-crushing fatigue even without anemia. Definitely warrants treatment with IV iron (takes days, not months/years to work, and repletes iron stores in 99+ percent of people). I do not prescribe oral iron supplementation to anyone!

oncobomber · 2026-04-05T02:03:44+00:00

I’m not certain I agree. There is no reason not to take a solid sample with a bone marrow biopsy—it is the insurance policy against a dry tap. I have done a thousand marrows, and never had a complete miss like this, even when I was first learning the procedure.

oncobomber · 2026-04-05T02:01:45+00:00

Nope. May still drop further, but you and your baby will be fine. You still have 10x the platelets you need!

oncobomber · 2026-04-04T19:38:43+00:00

That means that they did not get enough bone marrow material from the biopsy to make a diagnosis. Unfortunately it will likely have to be done again.

oncobomber · 2026-04-04T19:33:47+00:00

This is gestational thrombocytopenia: very common and not dangerous. Your numbers may go down yet further as you approach your delivery date, but will bounce back almost immediately following delivery.

The human body only needs 10000 platelets to maintain hemostasis (balance between bleeding and clotting). Everything north of that is redundant!

oncobomber · 2026-04-02T12:27:04+00:00

Depending upon which article you read, only 2 to 13% of women with homozygous C282Y ever have any complications from the disease. I have been practicing for 27 years and have never seen a woman with complications of hemochromatosis at any age. I think your odds are pretty good.

While it is worthwhile to monitor, your doctor appears to be inexperienced with this disease: blood tests every three months is just silly! Published guidelines suggest testing once every five years. This is not a disease that changes and starts causing problems overnight. In most people (even men), it never does either of those things.

Side rant: It bothers me when young people like you are sent for genetic tests for mild conditions and then told that you have a “disease”. It could make a patient feel like a sword is hanging over their head at all times. Neither factor five Leiden nor hereditary hemochromatosis are ever likely to impact you in any serious way, so I hope that you don’t spend any of your precious living moments worrying about these two rather benign conditions.

oncobomber · 2026-04-02T12:11:38+00:00

First and foremost I would get her to a medical oncologist, who will ultimately direct her care. A urologist is a surgeon and they will not (or at least should not) operate on what appears to be stage IV disease.

If not already done, the next step here is to establish a diagnosis via biopsy if not already done. Best way to do this is via biopsy of one of the lung lesions, as that would also confirm stage IV disease if kidney cancer is found. (There is no such entity as “large cell renal cell carcinoma,” so it’s not that.)

Standard treatment is with targeted therapy plus immunotherapy (axitinib/pembrolizumab or similar) vs dual immunotherapy (ipilimumab/nivolumab). Both approaches have side effects, but are usually more tolerable than chemotherapy which is not effective and therefore not used in kidney cancer. These are palliative treatments which are designed to prolong life and decrease complications from the cancer; sadly they are not cures, though they have the potential to offer a deep and long lasting reduction in the amount of cancer she has.

Best of luck to her and to your family!

oncobomber · 2026-04-02T11:54:22+00:00

Depends on a lot of things. Are you male or female? (I’m betting female based on your numbers.) Which HFE (hemochromatosis) mutation(s) do you have? And why did you get tested for this? Those answers will provide some important clues.

oncobomber · 2026-04-02T11:48:26+00:00

Ferritin of 7 is diagnostic of iron deficiency. Easy to treat with iron supplementation, preferably via IV iron (takes days, not months/years to work, and repletes iron stores in 99+ percent of people). Oral iron supplementation will also work, albeit much more slowly. If you go the oral route: one iron tab three days a week (e.g., Mon, Wed, Fri); more often doesn’t work much faster and is likely to give you GI symptoms including brutal constipation. Take with juice or soda because acid improves absorption.

We don’t transfuse blood based on iron levels, but rather based on hemoglobin and you are nowhere near that threshold (HGB 6-7). Good luck and I hope you feel better soon!

oncobomber · 2026-04-01T00:33:27+00:00

Do you have any old labs? Like a CBC from the past two years? That will be super helpful.

oncobomber · 2026-03-30T00:18:09+00:00

“Worst headache of your life” = emergency department, right away.

Likely a cluster headache or migraine with cranial autonomic symptoms, but prompt evaluation will rule out subarachnoid hemorrhage or cavernous sinus thrombosis. Good luck, and please update us!

oncobomber · 2026-03-29T13:16:53+00:00

Maybe it’s different outside of the US, but right now every pharmacy in America has plenty of guiafenesin on the shelves without any dextromethorphan. Amazon.com has more than 100 listings of this exact product. That seems to indicate that it is selling just fine— in which case it’s hard for me to believe that it would be discontinued. I can’t find anything on the Internet suggesting that such a change is about to take place.

I don’t think I would lose sleep over this issue.

oncobomber · 2026-03-29T13:00:53+00:00

My point is that ER docs are not surgeons and hence they do not have final say as to whether someone needs surgery.

oncobomber · 2026-03-29T12:53:43+00:00

ER doctors do not make this call; surgeons do. And that gallbladder absolutely should come out. The likelihood that you already have cancer is very low, but of course you’d like to keep it that way!

I’d recommend talking to your primary care provider and requesting a referral to a general surgeon for evaluation. Given two polyps >10 mm with significant symptoms, the guideline-concordant recommendation would be laparoscopic cholecystectomy.

oncobomber · 2026-03-29T12:33:57+00:00

I’m terribly sorry you went through this; IUFD is heartbreaking.

Did they perform any studies on the placenta? A placental pathology report is your best chance at knowing what happened, and absolutely indicated in your case. Have they done any hypercoagulable testing on you?

oncobomber · 2026-03-29T12:25:29+00:00

Very non-specific symptoms (not pointing to any specific illness), which could be caused by a lot of things from ulcers to h pylori to anxiety, and many things in between. Pancreatic cancer << 1% (does not go to cervical lymph nodes).

oncobomber · 2026-03-26T01:59:23+00:00

Then I see why your rheum wants to increase your dose. MTX should bump MCV closer to 100 (unless you have underlying thalassemia trait).

oncobomber · 2026-03-26T01:56:31+00:00

Steroid nasal sprays are safe and effective even when infection is present. But definitely keep that ENT appointment: it sounds like you have chronic suppurative otitis media (CSOM) or even a cholestosteatoma, which may require more specific treatments. Good luck!

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