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Sports Anemia

skatey-mark's picture

Some might find this interesting...  Our story begins inthe spring of 2004...

I had gone in for a normal run-of-the-mill annual physical.  I felt fine, it had just been a couple years since I had a checkup...  No big deal.  Well, I got a phone call from my doctor's office a few days later saying my white blood cell count was a little low, and I should go see a specialist about it.  Now, at the time I felt absolutely fine, so I figured the blood test was just a fluke and the person on the phone didn't seem terribly concerned, so I just let it go...

Fast forward to spring of 2005...  Another physical, this time with a different doctor.  (My previous doctor moved away...)  Again, I get a call a few days later -- this time from the doctor herself.  She says the WBC is low again and she is going to make an appointment for me to see a hematologist.  She is obviously much more concerned about this than I was, and more concerned than I perceived my previous doctor to be.  After all - she personally made the call instead of having one of her lackeys do it.

So, I go see a hematologist and she takes more blood from me and subjects it to more and more exotic tests, looking for things that might be wrong.  After all the blood work came back as normal, we then had to start looking for physical causes.  Meanwhile, the hematologist tells me that some people just have a naturally low WBC, so that might be the case here...  BUT my red cell count is also low, and she's very concerned about that.  So I get to learn about ferretin levels as well, which is and indicator of how much iron "reserves" your body has stored.  Mine were pretty much off the bottom of the chart.  Normal for men is something like 20-120 and mine were like 6...

In retrospect, 2004 was a "bad year" for my skating performance.  I attributed it to poor training.  (I didn't skate as much that year as I did in 2003.)  I also had put on a little weight...  But the low iron levels could have certainly been a factor as well.  So I should have listened to the first suggestion to get it checked out!  (Of course, the first one didn't say anything about RBC or iron - just WBC...)

Also, my insurance changed in 2005, and all these tests I had to get done were at least twice as expensive as they would have been if I had gotten them done the year before...  Yet another reason I shouldn't have procrastinated!  Oh well...

Anyway, I've now had every inch of my digestive system inspected and scrutinized (looking for internal bleeding).  The worst testby far, though, was the bone marrow biopsy.  If anyone ever tells you it's no big deal - THEY ARE LYING.  There just aren't words to describe the sensation (even after many shots of a local anaesthetic) of the procedure.  The only thing that comes to mind is that it felt something like what sucking my soul out of my body might feel like...

So...  all physical tests come back normal.  This is getting a little old now, but I understand the doctor's need to be thorough and cover all possibilities.  So it eventually occurs to me that I should do a little research on my own.  I eventually stumble onto a condition called "Sports Anemia".  Now, this is more common in women, but only because they're more prone to anemia in the first place.  The gist of it is that doing long endurance things decreases the body's ability to absorb iron.  Athletes in general eat less iron than the general population, so they take a "double hit".  Studies have shown that iron absorption can be cut in half for endurance athletes.

Now, the diet part wasn't an issue -- I love eating meat, especially red meat...  So I'm sure I'm eating as much iron as the next guy.  But if the physical activity was really affecting the absorption - now that might explain something.  That, combined with the fact that my last normal blood work was before I started training for endurance events was a possible link.  It wasn't conclusive though, since I had been a bit lax in getting an annual physical and it had been several years since I had one, so it could have happened after the training, or before...  No way to know for sure.

So at my next appointment, I mention my theory and I gave the doctor a printout of an article about it.  She seemed a little intrigued by the idea and then asked, "well, how much do you skate, anyway"?  I kinda grinned and said, "well, I just did a 60-mile skate last weekend."  She pretty much gave me the same look anyone gives you when you tell them something like that.  You know the look...

She wasn't quite ready to buy into the theory yet - still thinking there must be something physically wrong.  However, she had run out of tests.  So we decide to start an iron supplement to see if that helps.  This was good timing, since A2A was about 3 months away at this point, and I wanted to get some sort of treatment under way and possibly get the anemia under control before then.

So, I had periodic checkups to monitor the iron levels and they did indeed start to increase with the iron supplement.  Late in the fall, we cut the dosage n half and it kept climbing.  As a side note, my skating performance in fall of 2005 was awesome...  I trained my ass off last year, of course, so I can't say for sure that the iron levels helped or not, but they certainly didn't hurt...

Back in January, my doctor was reasonably satisfied with where the levels were and decided to stop the supplements to see what would happen.  If this had been during the skating season, I probably would have objected.  But since it was in the off season, I also felt it was a good time to check.  My checkup in March showed the ferretin even higher (by then it was around 50).  So everything was going great...

I just had another checkup today, and the news wasn't as good...  Red cell count was down from the last checkup, and I'll know the ferretin count tomorrow.  (That test takes longer to run, apparently.)  So it's back on the iron again.

So now my doctor is again trying to think of a cause for all this, and wondering if the low WBC and RBC are related.  We talked about diet, and if I took any supplements (hence my other blog post)...  Nothing there out of the ordinary that would affect it...

So I'll go back in 6 weeks and see if the iron supplement is working -- I suspect it will, since it did before.

The moral of the story:

  • Annual physicals are a good thing, and athletes should mention their level of activity to their doctors
  • I think an annual ferretin test for athletes is a good idea -- it's not one of the standard tests
  • If your doctor tells you to see a specialis, don't procrastinate
- SM -


eebee's picture

Very interesting piece,

Very interesting piece, Mark! I am very impressed with your doctors for not just slapping you with iron supplements and saying 'it's nothing'. And way to go for doing your own research AND telling the docs about it. I need to switch doctors asap.


There have been times when skating that I feel so utterly lousy, even if I'm not tired or hungry, and other times when I feel out of this world. I'm low on iron too and take supplements every day. When you're low on iron it's like skating around, dragging a 50lb anvil behind you!  

Activity level and overall health . . .

This is a fabulous discussion because many times we see the physical results of our activity level, but we have a tendency to neglect what's really going on inside.  I know for myself there have been times when I've assumed that everything must be fine with my health because of my appearance.  I realize that may not sound right, but I have had people say to me that I must be healthy, afterall, "you're so skinny."  They say it as though I do nothing to work at.  Exercise and pushing away from the table at the right time are vitality important.

   While there are overwhelming positive results for our bodies due to our activity level, it doesn't mean that we are meeting the specific needs of our own bodies or that something can't go wrong.  Generally, we will enjoy a measure of health and well-being beyond that of our "couch potato" counterparts.

   On a positive note, I had gall bladder surgery just over a year ago.  Every doctor and nurse that looked at my chart, bloodwork, vitals, and overall health history, asked me what I did.  They didn't ask me "if" I did.  That's an entirely different question in my mind and a complement. 

   The surgery went remarkably well, and my recovery was amazingly quick.  The day after my surgery I went for a 3 mile walk.  Two days later, I went for a 6 mile walk.  The 3rd day, my walk was full speed ahead!  Keep in mind that I'm approaching 50 yrs. of age, too.

   I said this was a positive thing because it confirmed everything else that I've learned about my body and activity level.  "Activity", in this case, skating, has benefited me in so many ways, but it does not mean that I am invincible, as the gall bladder removal proved.  Get your physical and take care of your body.  Communicate to others the idiosycrasies of an active life style, so that we can all benefit.  Great thread . . .

skatey-mark's picture

More info...

Slow day at work, so I decided to do some googling... :)




From the page:

For the casual athlete who trains less than four hours per week, iron deficiency is no more of a concern than for a sedentary person. But athletes who train for six or more hours per week often have iron-deficiency anemia and should be checked yearly for the condition.



skatey-mark's picture

ferritin update, lab results, iron tablets

 Okay, I got my lab results from Monday...  My ferritin is up to 68 (from 50 in April.) I wish I could remember what test was "down"...  For some reason I'm thinking it was "38" down from "49" in April.  I found the following table of normal ranges for blood tests:




I'm thinking it might be RBC (red bloodcell count) and maybe I'm remembering the 'power of ten' wrong, or she told it to me in a different power of ten.  Anyway, I guess I'm still supposed to take the iron tablets for now, at least until my next checkup in 6 weeks.  Even though the ferritin is up, it's still pretty close to the bottom of the range (18-250 on the above link, although the nurse said 22-322 when she called today.)


So - looks like mixed results this week.  One test improved, one got worse... 

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