[doctor] today i'm seeing christina cooper . her date of birth is 07/01/1954 . uh , ms. cooper is a new patient who was referred by diane nelson for a long-standing iron deficiency anemia . [doctor] hello , how are you ? [patient] i'm good , thank you . [doctor] so tell me what brings you in today . [patient] recently i tried to donate blood , around december i think , and they told me i was anemic , which is something i've been dealing with for a while , so it's not the first time i've been told i'm anemic . [doctor] or how have you been feeling in general with this ? [patient] not great . i have been feeling fatigued often during the day , and even feverish with chills at times . when i try to be active i like i ca n't catch my breath and i feel like i'm wheezing . i've had some headaches too , which is not like me . [doctor] okay . are there any other symptoms ? [patient] i've been noting some chilling sensations . i also get cold so easily . it's annoying . i feel like i have to really bundle up . i do n't know if this is related but my anxiety and depression feel like it has been getting worse lately . i feel like a mess . [doctor] sounds like you're not feeling great , obviously . and i'm glad you came to see us . um , we're certainly going to try to figure this out and figure out what's going on , uh , but it sounds like you've been dealing with this anemia for a long time ? [patient] yeah , i've been anemic since i was 13 years old . [doctor] right . so why do your doctors think you're anemic ? do you have a history of heavy periods ? [patient] well i did have heavy periods until i had a hysterectomy in 1996 . but no , they have not told me why they think i'm anemic , which is frustrating honestly . [doctor] yeah . i can imagine that is . um , let's see if we can help though . since you had your hysterectomy your periods , of course , are no longer the issue . um , when was your last colonoscopy ? [patient] about five to six years ago . [doctor] and was it relatively a normal exam ? did you have any polyps ? [patient] no . they said they'd see me in 10 years . [doctor] well that's good news . [patient] yeah , i agree . [doctor] um , do you have a pacemaker or defibrillator , or have sleep apnea , or use oxygen at night ? [patient] no . [doctor] all right . do you ever drink alcohol ? [patient] yeah , but only once or twice a year . [doctor] okay . are you taking any supplements such as iron or vitamin b12 ? [patient] i already started taking my iron pills which i have not taken in about a year . [doctor] all right . and what are you taking ? [patient] i'm taking 25 milligram tablets , twice daily . [doctor] okay , and that's the , the ferrous sulfate ? [patient] yeah , that's it . i take one in the morning and one in the evening . [doctor] okay . anything else ? [patient] yeah , i take vitamin b12 , just the over the counter stuff . [doctor] okay , very good . all right , well let's go ahead and take a look and see what's going on . [patient] sounds good . thank you . [doctor] of course . you'll hear me , uh , talk through your exam so that i get all the information documented . [patient] okay . [doctor] all right . so use my general physical exam template . i will start by listening to your heart and lungs . [patient] okay . [doctor] all right . next , i'd like you to lay back so i can examine your abdomen . [patient] okay . [doctor] is there any tenderness where i'm pressing ? [patient] no . [doctor] okay . you can sit up . so your physical exam is normal without any significant findings . all right ms. cooper , often when we initially see anemia and your host of symptoms , we suspect internal bleeding . [patient] is that why they want me to have another upper endoscopy ? [doctor] actually it would be an upper endoscopy and a colonoscopy , but yes , likely that's the reason why . [patient] lovely . [doctor] yeah . unfortunately our cameras do not meet all the way in the middle , so if those tests back , come , if those tests come back fine , then we'll have you swallow a pill camera to take pictures as it moves through your , uh , system . [patient] okay . [doctor] we may not need to , but it's just the first thing we can do to make sure that you're not losing blood . um , the second thing we can do is have you see a hematologist . they will tell us if you need to give any , to give you any intravenous iron , or maybe something to help your body store the iron better . [patient] all right . [doctor] so let's go ahead , get your upper endoscopy and colonoscopy scheduled . [patient] okay . [doctor] um , have you ever had any issue with sedation in the past ? [patient] no , i was just sleepy afterwards . [doctor] okay . well we will give you a bowel prep to clean out your bowels ahead of time . um , if we do these tests and they are normal , like i said , then we will consider that capsule endoscopy . [patient] okay . sounds like a plan . [doctor] all right . so after that you'll be all done and we will send you to the hematologist . additionally , i'm going to need you to start taking your iron pills with orange juice . uh , the vitamin c will help you absorb the iron better . do this for about 8-12 weeks , uh , and then we can reassess your blood work . [patient] okay , that sounds great . [doctor] all right . well i think we have our plan . on your way out , stop by and schedule your upper endoscopy and c- colonoscopy . uh , we will send a referral to dr. flores who is is the hematologist , so schedule that appointment . um , here are your instructions for the pre- uh , the bowel prep . uh , call us if you have any questions or worsening symptoms . we'll be happy to help you . [patient] thank you . [doctor] you're welcome . have a great day , have a great day ms. cooper . [patient] you too . [doctor] all right . this is christina cooper , pleasant 65 year old female who was diagnosed with iron deficiency anemia in 12-2019 , and w- and was unable to donate blood . um , her followup blood work on 01/20/20 was revealed a low hemoglobin , stable hematocrit and normal iron labs , although ferritin was low . um , she was taking ferrous sulfate , three hundred , twenty phil- 25 milligrams by mouth . i've asked her to continue each dose with vitamin c found in orange juice , for the next 12 weeks , then recheck to the cbc , iron , ferritin , b12 , and folate . um , a referral was sent to her hematologist . we will plan for an egd and a colonoscopy to assess for potential sources of anemia or gi bleed . if this is inconclusive , capsule endoscopy will be considered . thanks .
ASSESSMENT

• Iron deficiency anemia
 
 Mrs. Cooper is a 65-year-old female who was diagnosed with iron deficiency anemia in 12/2019 and was unable to donate blood. Her follow-up blood work in 01/2020 revealed a low hemoglobin, stable hematocrit, and normal iron labs, although, ferritin was low. She has been taking ferrous sulfate 325 mg by mouth.

PLAN

I have asked her to continue each ferrous sulfate dose with vitamin C found in orange juice for the next 12 weeks then recheck CBC, iron ferritin, B-12, and folate. A referral was sent for her to see a hematologist. We will plan for EGD and colonoscopy to assess for potential sources of anemia or GI bleed. If this is inconclusive, capsule endoscopy can be considered.