Is Patient’s Anemia Really Worsening?

DEAR DR. GOTT:
I am a 67-year-old female with metastasized breast cancer. In 1997 I was diagnosed with breast cancer, had a core needle biopsy, lumpectomy, radiation and chemotherapy for six months. I was then cancer free for 10 years.
During most of those 10 years I was a third grade teacher. I followed a diet endorsed by Compulsive Eaters Anonymous and speed walked (two miles) daily with my husband. I continue to speed walk.
Three years ago, my cancer returned. The first year was spent being misdiagnosed by my primary care physician who insisted I had bursitis. Then I developed digestive problems and went to a kinesthetic chiropractor who suggested I become a vegetarian and give up taking acetaminophen and ibuprofen. After six months I switched doctors.

This time, my new doctor listened to me and immediately sent me for an MRI which showed that my cancer was back in most of my bones. Because my pain was localized to my hip, I had radiation for 15 days. The radiologist told me I would be wheelchair bound in six months but I am still walking and pain-free.

After that I was given chemotherapy every 28 days which kept my cancer tests in a normal range for two years. Now it is abnormal again and a CT and PET scan both showed the cancer was spreading but there is no organ involvement. I am back on chemotherapy every 28 days.

I also have white coat hypertension because of the constant needle prodding during my doctor visits (my veins are not good). In office, my pressures are between 130/85 and 155/74. Outside the office they are about 117/76. My doctor suggested putting a port in, but I am reluctant because I have watched three close cancer survivor friends die from port complications.

Now, I provided that history in the hopes it will help you answer my question. My oncologist has been telling me for months that I am anemic and its getting worse. I started eating red meat, fish and turkey again and have gained some weight. Wanting to know more, I went online and looked up anemia and iron deficiency but strangely, I don’t seem to fit the profile for someone who is anemic. I am not fatigued or irritable, don’t have a gray pallor, weakness, brittle or grooved nails and I don’t crave anything strange like clay. I feel fit and healthy and just accepted an eight week long-term substitute position.

I have enclosed a copy of my lab results from the August 08 to January 09. I don’t know what is going on.

DEAR READER:
You have complex history but I hope I can simplify at least one matter for you. According to your lab reports, you were indeed anemic during all of your blood work. However, that anemia was so slight, it was inconsequential. For example, your hospital uses normal lab values of 4.2 to 5.4. Five of your six results were about 3.9 and the sixth was 4.1. To me that shows improvement, not worsening. With your results so close to normal, I wouldn’t worry but I urge you to return to your oncologist and ask why he thinks your anemia is worsening.