All posts by Andy Smith, MD


cutlery-dining-dinner-109395.jpg            “Goldilocks was hungry.  She tasted the porridge from the first bowl. ‘This porridge is too hot!’ she exclaimed. So, she tasted the porridge from the second bowl. ‘This porridge is too cold,’ she said.  So, she tasted the last bowl of porridge. ‘Ahhh, this porridge is just right,’ she said happily and she ate it all up.”

The story of Goldilocks and the three bears fits the story of our relationship with the vital mineral, iron.  We don’t want to have too little, but we actually don’t want to have too much either; we want to have just the right amount.

Iron is an essential element for blood production. About 70 percent of our body’s iron is found in red blood cells as part of hemoglobin, which carries oxygen to the body, and in muscle cells, as myoglobin, which accepts, stores, transports and releases oxygen.  About 6 percent of body iron is part of certain proteins which are essential for respiration, energy metabolism, and nerve function. Iron also is needed for proper immune function.

Where do we get iron in our diet?  A wide variety of foods contain iron.  Red meat is a rich source of iron, and iron in animal products is absorbed better than iron from plant products.  Nevertheless, foods such as spinach, fortified breakfast cereals and even dark chocolate have substantial amounts of iron.  However, individuals vary a great deal in how well they absorb the food in their diet.

If iron consumption and absorption is chronically low, iron stores become depleted.  In the typical American diet, iron depletion from poor dietary intake alone is uncommon.  Most often, having low iron results from losing iron by blood loss.  In women who are still menstruating, blood loss from their monthly cycle is the most common cause of iron deficiency.  In non-menstruating women and in men, iron deficiency usually points to unrecognized persistent microscopic blood loss from the gastrointestinal (GI) tract.  Thus, a colonoscopy and upper endoscopy are usually carried out to search for a GI source of blood loss such as a colon polyp or cancer, or a bleeding ulcer.  There are numerous other causes of low iron, but the point is that, in addition to taking iron supplements, the reason for the iron deficiency must be thoroughly sought after.

What’s wrong with not having enough iron in our bodies? When iron is depleted over time, it begins to cause reduced red blood cell production and eventually results in a low red blood count, called iron deficiency anemia.  Other symptoms such as fatigue, shortness of breath with exertion, restless legs, paleness, headache, racing heart, and a desire to chew on ice (oddly enough) can accompany the low iron state.

So, should everyone take an iron supplement just to play it safe? No, indeed; in a healthy non-menstruating adult an iron supplement can cause iron overload, which has its own toxicity.  Likewise, children getting ahold of excessive amounts of iron-containing vitamins is a common cause of poisoning.

Besides taking too much iron in the form of supplements, there are also built-in genetic abnormalities which cause some adults to hold on to too much iron, even with a normal diet.  The best known of these hereditary conditions is called hemochromatosis.  It affects over 1 million Americans.  Iron overload from these causes can damage the liver, pancreas, joints and heart, and can even be fatal if left untreated.  Hemochromatosis is one of the few condiclose-up-idiomorphe-crystals-iron-56030tions that can benefit from an updated version of the old practice of blood-letting.

So, if you have symptoms that make you wonder if you have too little, or even too much, iron, get it checked out.  Iron is vital, but like Goldilocks, we want the amount to be just right.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835



As I leaned in, thirty-year-old Jim related his recent striking experience: “I’m sitting at my desk at work, when all of a sudden my heart starts pounding out of my chest for no good reason.  I’m thinking I’m having a heart attack.   My chest starts hurting and I get short of breath and lightheaded.  Then my fingers and around my mouth start tingling.  By this time, I’m so scared my co-workers dialed 911.  The frustrating thing is, at the hospital all the tests are normal.  They say my heart and lungs seem fine… that I must have had a panic attack.  Ever since then I keep getting anxious off and on at work.  I’m afraid it’s all going to happen again, or I’m just going to lose my mind next time.”

Jim’s description pulls together some of the symptoms and feelings one might experience while having a panic attack.  Panic disorder is one of the dozen or so recognized anxiety disorders.  With over 40 million Americans suffering from them, anxiety disorders are considered the most common mental health maladies.

Panic disorder is a type of anxiety disorder in which a person has repeated attacks of intense fear that something bad is about to happen. The cause is unknown but it is a bit more common if it runs in your family.  Panic disorder is also twice as common in women as in men. Usually symptoms begin before age 25, but sometimes not until one’s mid-30s.  At times, even children can have panic disorder.

            Panic attacks tend to strike rather suddenly and symptoms usually reach a peak in about 10 minutes and then may last up to an hour or so.  To fit the criteria, a panic attack will include at least 4 of the following symptoms:

  • Palpitations
  • Sweating
  • trembling or shaking
  • shortness of breath
  • feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • dizziness or lightheadedness
  • feelings of detachment or unreality
  • fear of losing control or going crazy
  • fear of dying
  • numbness or tingling
  • chills or hot flashes

Not a pleasant list of symptoms to experience.  Also at least one of the attacks is followed by one month or more of either persistent concern about having additional attacks or worry about the consequences of another attack (like going crazy or really having a heart attack), or a significant change of behavior related to the attacks.

These unpredictable, frightening, and embarrassing episodes sometimes cause folks to more and more pull back from their normal activities.  Some sufferers end up barely able to leave the house.

So what can you do about them?  While there is no quick cure for panic attacks, there is much that can help.  See your doctor about them and they can first make sure your symptoms aren’t from something else like heart disease, thyroid disease or one of a few other mimickers. If your symptoms really do point to panic disorder, there are several treatment choices, including appropriate counseling and possibly, meds – options include both those that treat you at the moment of the attack and those that, when taken regularly, can help prevent the attacks altogether, or at least reduce them.

All this often takes some patience as one approach doesn’t fit everybody.  But it’s worth the effort to keep this frightening but non-deadly specter from haunting your thoughts and shrinking the boundaries of your life.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


Gallbladder Blues

RUQ pain“This pain is pretty intense.  It goes right from the right upper abdomen through to my back.  It started about twenty minutes after a big meal out last night.  I’ve had it happen a couple other times but it usually goes away after a couple hours; this one’s dragging on.”  This is one of the many ways a gallbladder attack is described.

In the U.S. about 20 million people have gallstones, and each year about 700,000 patients have their gallbladders removed to relieve troublesome symptoms.  The gallbladder follows the appendix as the other sack-like organ next most frequently removed due to disease or malfunction.

So what does the gallbladder do when it’s working correctly?  The gallbladder is a 3 to 4-inch-long pouch-like organ tucked up into a pocket of the liver in the right upper abdomen.  It stores and secretes bile and other digestive enzymes.  When we eat a meal, especially a large fatty one, this little sack contracts, squirting its digestive enzymes through a little duct or tube into the intestine where the enzymes help digest the meal.

So far, so good.  But things can go wrong.  The gallbladder can develop gallstones of varying sizes.  Then when the gallbladder contracts one of these stones can become wedged in the duct leading to the intestine.  Depending on where the obstruction occurs, this can sometimes also block off the pancreas causing still more problems.  Either way, it produces a tremendous crampy pain, usually in the right upper abdomen or upper mid abdomen and sometimes radiating through to the back.

The pain typically starts shortly after a meal and may last for a couple of hours or more, until the stone passes into the intestine or falls back into the gallbladder after it finally stops contracting.  Occasionally the pain persists and a trip to the emergency department, sometimes followed by emergency gallbladder removal (cholecystectomy) is the only solution.  An ultrasound of the gallbladder and lab work are usually able to diagnose the problem.

Gallstones are not the only pathology that can arise in the gallbladder.  A situation can occur in which it excretes less and less effectively even though it has no stones.  In this condition, the gallbladder may look OK on ultrasound and a special scan is needed to identify the problem. Or, even more dangerous, the gallbladder can become infected with bacteria, often due to one of these other malfunctions already mentioned.   This requires urgent treatment with antibiotics and eventual surgery.  And like most organs in the body, cancer can occasionally occur in the gallbladder, though this is quite rare.

Anyone can have problems with their gallbladder, but certain groups are more at risk.  The most common group is Caucasian females around their forties who are overweight.  Also, during weight loss there is a temporary increase in gallbladder attacks as the person processes their own fat.

For these reasons and more, the gallbladder may sometimes have to be removed.  Often this affords a huge amount of relief for the person.  However, besides infrequent complications of residual stones, infection or problems with wound healing, about 10-15% of people have ongoing symptoms after the gallbladder is removed.  This has been given the long name post cholecystectomy syndrome (PCS).  This is not surprising since God puts things in place for a reason; when we have to remove them, sometimes there are issues to deal with.  The loss of the gallbladder can cause symptoms such as heartburn, indigestion, loose stools or cramping.  These can be managed but are certainly a nuisance.

So if you’re getting symptoms that make you wonder about this little 3 inch sack, see your doc and get it checked out.  It’s helpful when it’s healthy; but if it’s betraying you, it just might have to go.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835




Christmas Rejoicing!

To our Trinity patients and friends,

In the 1st chapter of the Gospel of Luke, Mary responds to being told she will give birth to the Savior of the world with this expression,

“My soul magnifies the Lord,
and my spirit rejoices in God my Savior,
for he has looked on the humble estate of his servant…
for he who is mighty has done great things for me,
and holy is his name.”

            During this season, we want to mirror Mary’s thankful celebration of all that God was done, because for each of us as well, he who is mighty has done great things.  He has given us physical life and offers us spiritual life complete with forgiveness that is free, full and forever.  He gives peace in the midst of life’s bludgeoning storms, an endless array of sunrises and unexpected expressions of real love that poke through our cynicism.  And the list goes on and on.  He has placed these presents at the foot of the tree on which he was crucified, reminding us of the price that was paid for them.

            Thankfulness for these endless gifts is ultimately why we do what we do here at Trinity.  We never serve perfectly or with a perfect heart, but we do want to serve the One who is perfect, and to do it with grateful hearts.  This time of year makes that a little easier as we remember Him and all that He has given us.

Wishing you a Christmas full of rejoicing and magnifying our Savior who has done great things for us,

The doctors and staff at Trinity Medical Associates