Crunching ice cube syndrome

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1234
  1. Francois L P Fouin, retired GP, Aberdeen
  1. flpf{at}

    The sound of crunching ice was obviously beginning to irritate the other members of my regular golfing foursome. Two were fellow doctors, but it was the retired garage proprietor who was getting most unsettled.

    It had crept up on me imperceptibly, but now there was no mistaking that something odd was going on. Whatever soft drink I consumed had to be fully topped up with ice, while my regular lunchtime sherry was brimming over with small cubes. It was only when the craving began to afflict me at bedtime that I realised I had a problem.

    My health otherwise seemed good, although I was tiring more in the garden—but, at almost 80 years old, what else could one expect? Only on the last day of the shooting season did I think I was really failing. Shooting at the end of January calls for a little more exercise than simply standing still while pheasants are driven to one, as happens earlier in the season. At the end of that day I had no chest pain, no marked breathlessness, just an overpowering feeling of extreme fatigue.

    My garage proprietor friend slipped a small cutting from the Daily Express across the table to me as I sat crunching at the golf club. It stated: “although the exact reason is unclear, it is claimed crunching ice cubes may be a sign of iron deficiency anaemia.”

    “Old wives’ tale,” snorted my fellow golfing medics, but one bent over and squinted at my conjunctiva. Silence for a moment and then a gentle suggestion that my own doctor should have a look.

    Next day I handed my general practitioner the cutting. I could sense the wheels turning as he surmised that I was really getting past it to take such things seriously. “Better do a blood test then. Phone up in a week, and you’ll get the result.”

    Two days later the telephone rings, and a contrite voice tells me that my haemoglobin is 8.1 and the cells are microcytic and hypochromic.

    I await gastroscopy and colonoscopy. Meanwhile a few weeks of ferrous sulphate has perked me up no end, and crunching ice now holds no attraction for me at all—but why? At the golf club we have welcomed a new consultant: he may have run a garage, but in our eyes he has fully qualified as a medic of distinction.

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