Please read "A Case of Iron Deficiency Anemia: Commentary" below

Anna Monias, MD, Erickson Retirement Communities, Oak Crest Village, Parkville, MD, USA.

Mr. WH is a 72-year-old-man who presented in April 2004 with a hematocrit of 21%. His previous hematocrit was 34% in February 2004. He complained of bright red blood per rectum and rectal pain secondary to external hemorrhoids. Mr. H was admitted with a presumed gastrointestinal bleed.
Mr. H’s past medical history is significant for bovine aortic valve prosthesis in 1997 secondary to aortic stenosis, Addison’s disease, hypocalcemia, seizure disorder, B12 deficiency, colon cancer with partial colon resection, and small bowel obstruction due to adhesions. Mr. H had chronic diarrhea secondary to bowel surgeries. His last colonoscopy was in 1997 and it revealed hemorrhoids. An esophagogastroduodenoscopy done at the time showed duodenitis.
The patient’s medications on hospital admission were as follows: calcium carbonate 500mg three times a day, vitamin B12 1000mcg I.M. monthly, divalproex sodium 750mg twice a day, hydrocortisone 25mg every 12 hours, vitamin D 100,000 IU every three months, phenobarbital 30mg every 12 hours, lasix 20mg by mouth daily, and potassium chloride 20m.e.q. daily. He has no known drug allergies.

Derick M Todd MB, ChB, Clinical Fellow, Arrhythmia Service,
University of Western Ontario, London, ON.
Andrew D Krahn MD, Associate Professor, Cardiology, Department of Medicine,
University of Western Ontario, London, ON.

Introduction
A prompt and accurate diagnosis of syncope in the elderly is important in reducing morbidity¹ and mortality, and for maintaining independence.^2,3 The risk of a serious cardiac arrhythmia as the underlying cause for syncope is increased in the elderly, especially in those with an abnormal resting electrocardiogram and/or impairment of left ventricular function.⁴ The key to the diagnosis most often lies in the history from the patient and an eyewitness account. Detecting underlying heart disease by history, clinical examination and a resting 12-lead ECG are crucial in directing further investigation and treatment.⁵ Patients considered likely to have a cardiovascular cause for syncope have a significantly increased mortality rate compared to patients with a non-cardiovascular cause or who remain undiagnosed.⁶ The following case report is intended to illustrate some of these issues.

Chui Kin Yuen, MD, FRCSC, FACOG, FSOGC, MBA, Chairman, Manitoba Clinic, Winnipeg, MB.

Current History
Mrs. Brittle Bone presents to your office because of low back pain of insidious onset in the past three weeks. Mrs. Brittle is a healthy 68 year old female and is an active gardener. Following the death of her husband one year ago, she continued to live in her house and has done many of the household chores, including gardening. Her pain began three weeks ago and, since then, she has found it difficult to do her household work. She is not able to rest peacefully at night because of the discomfort.

Family History
She has no family history of osteoporosis. However, her mother was diagnosed with breast cancer at 55 years old.

Lifestyle Habits & Medications
Mrs. Brittle Bone is a healthy non-smoker with adequate nutrition and regular exercise. She drinks occasionally. She takes calcium and vitamin D supplements every day. She is not on any medications and has never been on Hormone Replacement Therapy.

Physical Examination
Physical examination of the spine demonstrates that she has mild kyphosis. Her range of motion is limited and the pain is exacerbated with extension and rotation. Percussion of the spine reveals point tenderness at L2.