Some of you might remember my posts about the overuse injuries in his hands that have prevented my son from playing any instruments all semester (his first at Berklee!).
He got evaluated and is being treated by performing arts specialists in Boston. He has spent his entire holiday break doing whatever he can to heal–resting (hard when he’s at school), icing, playing guitar in two-minute increments, etc. Today he just finally lost it–he goes back to Boston Monday, and there has been almost no real improvement. He spoke of “losing his dream” of staying at Berklee and majoring in Composition/film-scoring. It broke my heart.
Over break, I asked him to humor me and see our GP just to get some basic bloodwork to see if anything turned up that might make the healing process harder. One thing he doesn’t generally do, in spite of my nagging, is pay a lot of attention to his diet. I just had a feeling…
Sure enough, turns out he has an iron and a vitamin D deficiency, and has been prescribed supplements.
I’m wondering how much, or if, the deficiencies might impede his healing–especially iron. I’ve seen some indications that this may be the case while googling around, but I wonder if anyone here might have some insight.
We’ve been considering @compmom’s suggestion of PRP therapy, and it sounds as if there may be some connection (platelets, etc.?).
I just hate so much to see him in so much (physical and emotional) pain, when he’s finally where he so much wanted to be! He’s doing very well in his other classes, and is even helping some of his friends who have trouble with theory, etc., but he can’t even use a keyboard to work on compositions.
@AsMother very sorry to hear of this update but also happy to hear of the GP and bloodwork route you took. Hoping that this will provide some improvement to this very difficult situation. Sending you and your son positive thoughts
Thank you so much, @HereWeGoAgain2018 !
This thread caught my eye since I’ve had low iron anemia on and off for decades.
Did he get his Ferritin level tested? What is the cause of the low iron? It’s not that common for young men to have low iron and you need to find out whether it is caused by poor absorption, poor diet, or some form of hidden bood loss.
And low iron can definitely cause a lot of symptoms, including muscle and joint pain, and slow healing.
One thing I recommend is for him to take his iron supplement once ever other day. If you google " oral iron and hepcidin" look for fairly recent studies that show that wating 48 hours between doses increases absorption and decreases GI symptoms.
@scholarme , thank you–this is very helpful! My son said that the doctor told him that the deficiency is not severe, but if it was enough that they felt he should get the supplement, then I’m taking it seriously. I have a feeling it’s a dietary thing, but I will try to find out about other possible causes, as well as the Ferritin.
Did your anemia affect your ability to play and/or other adl’s?
Spinach salads and steak. And doesn’t everyone in the Northern Hemisphere get Vitamin D deficient this time of year?
Yeah–no problem with steak, but YOU try to get him to eat a spinach salad!! (He has something against food that “looks like leaves” 
)
But seriously, I’ve been talking to him nonstop about the necessity of thinking of himself as an athlete who needs to do everything possible to stay in great physical condition–or to treat his body as well as he treats his most prized guitars. Advice just gets through better when it comes from his peers/fellow musicians. I mean, how much can his mother possibly know?!
Honestly it doesn’t sound as if the iron deficiency is a factor In his healing. It doesn’t sound serious. Cooking with an iron pan helps by the way. Has he been checked for autoimmune problems at all?
PRP is kind of like stem cell therapy. The plasma that is reinjected is so rich with platelets that it regenerates and tightens the tissue. There is also prolotherapy with dextrose, but we recommend PRP. Spaulding in Wellesley, Dr. Borg-Stein.
Does Berklee require composition students to play? I know composers who haven’t touched an instrument in years Finale can play back. Can he type?
@compmom , Berklee requires that all students take four semesters of private instrumental instruction. There’s that, plus the ensembles and impromptu jams he can’t participate in–not to mention his enjoyment in just playing. He can type, and does use composing software, but he says even that hurts. A lot. And aside from the musical losses, he now has to wear things like velcro sneakers, and has trouble with doing very simple tasks like opening bottles, etc. We had just really hoped that the rest period over break would help.
It does seem, as @scholarme mentioned, that it’s unusual for a young man to be anemic–he is very much NOT a vegetarian, and although he doesn’t like spinach, etc., he puts away his share of red meat.
Today we’re going to pick up a printout of his labs from the doctor here, and have my son sign a release so that I can ask questions about the possibility of autoimmune issues, etc. It’s hard to coordinate healthcare between two different cities, especially when we’re not sure exactly where to look for answers. Do we talk to a rheumatologist? A good GP in Boston? The performing arts clinic where he’s been getting OT? I wish we just had one omniscient doctor!
I hesitate to comment on anything medical…and suggest you talk with the doctor that found the anemia (as you will do). However I two experiences with this 1) as a runner and 2) as an individual who experienced sever anemia. Anemia is fairly common in runners for a variety of reasons so it is monitored closely for elite athletes. Anemia in athletes causes fatigue, a lowered immune system and overuse injuries (mainly stress fractures). The bones are particularly susceptible to injury if a runner is anemic (the bones can’t absorb the needed iron to stay strong). Once an injury happens oxygenization is needed in the area for healing. Anemia slows that process as well. The anemia has to be treated for the healing process to be fully effective and to keep the athlete healthy. However there are different levels of anemia. He may be slightly anemic…and that may not be enough to be the primary problem. I had sever anemia due to uterine fibroids (probs not his problem…lol). The main symptom was fatigue and a notable decrease in my ability to run without feeling out of breath. No matter how hard I would breath there was not enough iron to carry the oxygen around my body…leaving me tired. So I would imagine that the lack of oxygen is not good to healing…but again how sever is it. I was told I had to eat red meat cooked on an iron skillet once a day for 5 days and come back for testing (plus took iron supplements) or get a transfusion (since the levels were very low…still I seemed to tolerate the low levels ok…everyone’s body is different…I went due to my running not bc I was tired). A week later the levels had shot up close to normal. It was fixed quickly. I felt a lot better. In the end I did have to have surgery as taking the iron sups and eating red meat daily wasn’t a long term solution to my problem. But if the body can absorb iron fine (mine could) it can be a quick and easy fix to get the levels up. Diet should be discussed. There are sources of iron more easily absorbed by the body (mainly animals protein…also includes clams and sardines)…protein from plants is not as easily absorbed. If the levels do not go up (meaning there’s an absorption issue) then that gets into an area where I have no experience. Here’s hoping he can absorb iron fine.
@bridgenail , I totally understand any reluctance to offer any kind of medical advice here! I wasn’t really trying to solicit that; I just wanted to see if any musicians here had had experience with pain issues related to iron deficiency.
We did pick up a copy of his labs today, and I left a bunch of questions for his doctor to try to get back to me on.
But I do keep coming across articles (mostly about athletes) that mention things similar to the following (thanks again to @scholarme for bringing up the ferritin question!):
" While iron depletion rarely results in the general lethargy associated with true iron-deficiency anemia, distance runners with low ferritin will likely experience abnormal exhaustion, increased blood lactate, SLOW RECOVERY, declining performances, heavy legs, muscular tightness, loss of motivation, and substantially increased risk of injury… Overuse injuries (the type of injuries distance runners get) double with ferritin levels under 20 and triple with levels under 12."
My son’s ferritin level is 11, so…
If it turns out that the iron supplement/improved diet can help with that, I consider it very good news! I was just hoping to find some specific thing that we can actually work with, rather than just flailing around in the dark and hoping for the best! If this is that thing, then annoying my son by making him see the doctor and get bloodwork here will have been well worth it.
Oh, and yeah–I think we’ve ruled out uterine fibroids, unless I’ve been misinformed for 20 years!
I do appreciate your relating how the anemia issues affected you. I’m learning that musicians really do need to think of themselves as “elite athletes” to some extent.
Ferritin of 11 is quite low. He should probably see a hematologist. Is it possible he has something like celiac?
Subway offers spinach wraps for their sandwiches. Might help regarding his aversion to eating green leaves.
@scholarme --BOOM (that was the sound of thunder)!
I’ve been begging him to get checked for Celiac or gluten sensitivity for years.
About 8 or 9 years ago, I started to physically fall apart–all kinds of issues, including very rapid weight loss (fun until I started to look scary) no matter what I ate (and my favorite foods were bread and pasta–LOTS of it), and terrible joint and muscle pain. I was tested for RA, given tramadol and one round of steroids, and left to deal with it.
One day my mother was telling me about her friend’s husband, who had Celiac (I’d never heard of it). She gave me an article about it. On really just a whim, I tried going gluten-free. The difference it made was amazing!
So I’ve been gluten-free since then, but I will never know if I actually have Celiac because testing would require weeks of eating wheat, etc.–can’t take that chance of feeling so horrible again.
When my son started at Berklee, I asked him to ask the doctor there for the test, but she saw no reason for it. I’d hoped it would (a) give me a sense of whether I actually have Celiac, and (b) account for some relatively minor issues (and some not–minor depression) he’d had.
Hence the boom…now maybe I can convince him. Thank you!
@Publisher , your comment made me smile. Every time I complain that my son doesn’t eat enough vegetables, he counters by telling me about the lettuce in his Subway subs! Oy…
Some people with Vitamin D deficiencies find mood lamps to be helpful-improving mood as well-research is mixed. in terms of seasonal affective issues. But may be worth a try. Pretty low cost and not invasive.
http://www.jlgh.org/Past-Issues/Volume-1—Issue-3/Vitamin-D-And-Mood-Disorders.aspx
If Celiac disease were to be the cause of your S’s anemia, it will likely not resolve with supplementation as poor iron absorption would be the cause in that case. With your history it seems very reasonable that he get tested for that.
Have you considered having him take a medical leave so that he could have these issues addressed, heal and be ready to really dive in maybe next fall? Just a suggestion. Hope he’s on the mend soon
@cellomom2 , I’m afraid that taking medical leave from Berklee at this point would pretty much destroy him (long story; long journey). Obviously if things got really bad we would need to consider it, but I couldn’t even bring that up to him right now.
He had OT all last semester; I’m kind of annoyed that no one at the performing arts clinic thought to run any tests before he started, just to rule out possible issues/deficiencies. That’s why I sent him to our doctor here to get some bloodwork done, on the off chance that we might get a clue. I wasn’t expecting much, but the results have given us a lot to think about, and I’m going to find an appropriate doctor to follow up in Boston. Just need to figure out what kind of doctor that might be…
He has (now that I told him about comments here and sent him some articles about low ferritin and Celiac, in addition to reminding him about my own experience) agreed to try going gluten-free for a few weeks in addition to taking the supplements. Yes, I understand that that will prevent him from getting a proper Celiac test for a while, but I’m gambling that if his pain issues resolve as mine did fairly quickly after going GF, we will have saved him time and more pain.
I have no idea if it will make a difference–I’m praying that I’ll get a call in the next few weeks in which he tells me the pain is subsiding (I will have him see a doctor up there in the meantime, though). Fairy-tale ending, perhaps, but we’ve managed some of those in the past!
If there’s no fairy-tale ending with that route, we will move on to the next step, whatever that might be. I’m aware now that some serious GI or other issues could be culprits in the iron deficiency, so I don’t plan to just let things slide!
What remains to be seen is if Berklee will continue to be supportive through another semester–so far they’ve been very understanding. But my son’s patience is running very low, and his frustration level, in spite of his best efforts, is really high at this point.
Thank you for your kind thoughts!
Iron deficiency will have no impact on healing overuse injuries (assuming that is the correct diagnosis). Iron deficiency is very common in women…it is very uncommon in men. It is dietary for men only in very unusual/extreme dietary practices and is more likely due to an underlying inflammatory or hematologic condition. In men, iron deficiency anemia requires further evaluation, typically by a hematologist.
Vit D deficiency is very common. In the US, we are indoors too many hours of the day and wear too much sunscreen when we are outside (that’s right dermatologists, I just typed that). Most everyone benefits from D3 supplements and should spend even a little more time out in the sun and increase skin exposure. Those who are very physically active should consider supplementation beyond the USPSTF dosage, which is actually quite low compared to that recommended by experts, and why you can easily find 1-5,000U chewable or capsules.
Circling back to the issue of overuse injury, it is possible in the course of diagnosing the iron deficiency, that you find an underlying inflammatory condition that may be contributing.
Lastly, stay as far away from PRP therapy as possible. It is being recommended for just about every musculoskeletal ailment under the sun, with no convincing data or its effectiveness.