Brief Answer:
need more details and Prophylactic Management

Detailed Answer:
Dear

Thanks for contacting Ayurveda with your health concern.

1. Low hemoglobin due to digestive disorder is due to reduced iron/vitamin B12 absorption, and your blood report says the values is/are due to low iron level, but make sure about Vit. B12 value also as IBS also causes decrease of the same.

2. Since she is suffering from the said problem thus is the cause of hemoglobin falling time and again since due to mal absorption, the body is unable to absorb iron from the digestive tract.

3. Was any Investigation like Endoscopy done to rule out any Ulceration inside the intestine [which could be hidden cause of blood loss and resulting low hemoglobin]?

4. Any associated symptoms due to low hemoglobin like: swelling in feet, undue exhaustion, ringing in the ears, pain in chest, repeated sour eructations, head spinning, breathlessness?

5. Since being female is her menstrual cycle normal/proper?

6. Please revert back with above questionnaire for Ayurveda Management.

7. Dietary Regime in case of low hemoglobin:
. Take: old brown rice, moong/masoor dal,haldi,turnip, rice gruel,methi,carrot, banana,garlic,honey,ghee,butter milk,haritki,dried ginger,amla, mild laxative.

Avoid: urad dal,beans,citric acid,sesame seeds, hinga,betel nut,mustard oil,alcohol,fish,excess water drinking,smoking,day time sleeping, excess thinking-exercise-anger, antacids which render iron insoluble and alter iron absorption,egg yolk, wheat,maize and fibre rich diet.

PS.
. Oral iron capsules are preferred to liquid preparations which are costlier and stain the tongue black. [also make sure while taking iron stool will be black colored]


8. For IBS

DIETARY REGIME

Avoid: wheat/maize,peas,garlic,betel nut,vinegar,milk,citrus, garam masala, late night awakenings,suppression of natural urges, corrylium,smoking,excess physical/ mental exertion, walking in sun.

Take: old brown rice,moong/masoor/arhar dal,banana,jamun,buttermilk, honey, soup [without spices],cumin seeds,coriander/mint,fasting and therapeutic enema.

. Take 5gm amla and soak overnight, when they become soft then crush them and add black salt [q.s.] and make tablet of 500 mg and take twice daily as lozenges.

. Takra arishta: take fresh butter milk everyday, do not add water and add fried cumin seeds and saindhav namak to taste [or you can buy the same from market]

Please revert back for Ayurveda Management of IBS on the line of Grahani.

Dr. Munish Sood
Consultant & Physician
Naimittika Clinic

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Brief Answer:
Investigations/Management/Prognosis

Detailed Answer:
Dear

Thanks for reverting back

1. any history of anxiety/depression: since stress precipitates the symptoms.
2. Since she is a diagnosed case, kindly go with following investigations for better guideline/prognosis of the disease, like: ESR, CRP, coeliac screening,
. going by her age: CA-125 to rule out ovarian cancer.
PS. Since the tests will be helpful in drafting further line of treatment thus I'll strongly recommend you to go for them, since ANEMIA is considered as a 'red flag' sign and warrants referral for higher management.
3. Since blood flow is heavy and with fibroid I would recommend a Gynecological examination to rule out endometriosis and pelvic infection.
PS. At the same time avoid unnecessary referral and investigations which will only prolong anxiety and thus aggravate symptoms of IBS but baseline investigations are must.
4. In Ayurveda one Panchkarma method : Piccha Basti i.e. Medicated Enema is very useful in such disorder but only if Endoscopy confirms there is/are no ulcerative lesions inside so that again is one reason to go for the same.
5.
i. take chitrakadi vati 2 tablets [1/2 hour before meals] before breakfast/lunch/ dinner
ii. panchamrit parpati 250 mg
fried cumin seeds [jeera] 500 mg
fried asafoetida [hinga] 250 mg.. with honey thrice a day
iii. kutjarishta 20ml
jeerakarishta 20ml... after meals with equal amount of water
iv . Tablet Mentat: 2 at bed time with water [since IBS is a Psychosomatic disorder thus tranquility of mind is important

6. People with IBS have been shown to have an increased risk of cholecystectomy which appears to be related to abdominal pain, thus ultrasonography of Hepato biliary system is advised every 2 months.

Please revert back with your concerns

Dr. Munish
Naimittika

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Brief Answer:
Meticulous Examination is necessary.

Detailed Answer:
Dear

Thanks for reverting back.

1. as blood picture indicated 'dimorphic anemia' which means there is both iron as well as vitamin B12 deficiency, and although it is suggested that there are signs of 'nutritional anemia' but more importantly as she is suffering from IBS, the deficiency could be more due to mal absorption.
PS.
i. also if treatment is solely give for one deficiency only, even then dimorphic picture is seen, so in best interest start management simultaneously of both deficiency.
ii. since occult blood in stool is negative thus conditions like ulcer/gastiritis/colo-rectal malignancy,carcinoma of stomach can be excluded [good sign] but in order to avoid false positive result: 3 days high fibre and meat free diet is advocated and then again the tets is done.
iii. also make sure that your attending physician has ruled out possibilities like: sideroblastic anemia, hemolytic anemia [check with bilirubin level], erythropoietin induced erythropoiesis which can contribute to dimorphic picture.

2. Low ferritin levels indicates that iron deficiency is present which may be caused by long-term blood loss: as indicated in your history/investigations:
. heavy blood flow is there,
. not taking enough iron in the diet [nutritional]
.nor bleeding inside the intestinal tract ( since occult blood is negative, can be excluded till further examination).

3. Take vitamin B12 [ as injectable and in diet]: dried beans, whole grain breads, spinach,beetroot, split peas,cabbage,banana,orange,nuts,almonds,beetroot,egg yolk XXXXXXX products,peaches,skimmed milk and after deworming start with oral folic acid. [Fruit and vegetables should be eaten raw whenever possible as cooking destroys Folic Acid].

Dr. Munish
Naimittika

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Brief Answer:
Best Wishes

Detailed Answer:
Dear

Thank you for reverting back with your replies to my consultation. Do let me know about the Management/Treatment adopted and keep updated about prognosis by directly clicking: bit.ly/drmunishsood

Dr. Munish
Naimittika

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