GENERAL INTERNAL MEDICINE + IV IRON INFUSIONS

I have a Family Doctor - why do I need to see a General Internal Medicine (GIM) Specialist?

Simply put, family medicine encompasses a broader patient population than internal medicine. Family medicine doctors manage the overall physical and mental health of all ages, including children. In Ontario, General Internal Medicine (GIM) specialists have at least four years of residency training in adult medicine, with intensive training on internal organ systems and complex physiological processes in adults.

What kind of things are seen by an Internist?

General Internal Medicine (GIM) specialists are expert physicians dedicated to the treatment of complex diseases affecting multiple systems within the body. In collaboration with our cardiology and other specialist teams, the internal medicine department offers comprehensive care for conditions such as diabetes, hypertension, cholesterol and lipid disorders, as well as managing blood, kidney, electrolyte, neurological, respiratory, liver, thyroid, pancreatic, and infectious diseases. For certain health issues, our GIM doctors can provide assessments through virtual (video) consultations. However, for some conditions that necessitate a physical examination, in-person visits may be required. The decision between virtual and in-person consultations is determined by our physician and administrative team during the referral triage process.

I want to see an Internist. Can I make an appointment?

In Ontario, seeing a GIM Physician requires a referral from a doctor or nurse practitioner. Please take our referral information to your family doctor or nurse practitioner and let them know we are happy to see you in a fast and efficient manner. Once our team receives the referral, we can arrange assessments quickly, virtually or in person, typically within 7 days.

What are the indications for intravenous (IV) iron therapy?

IV iron therapy is indicated when a patient has confirmed iron deficiency (with or without anemia) and either cannot tolerate oral iron, has failed oral therapy, requires rapid repletion, or has ongoing losses that exceed oral replacement capacity. Assessment typically includes hemoglobin, ferritin, transferrin saturation (TSAT), and evaluation for an underlying cause.

Common indications include:

1. Iron Deficiency Anemia (IDA)

• Symptomatic anemia (fatigue, dyspnea, reduced exercise tolerance)

• Malabsorption (e.g., celiac disease, bariatric surgery, IBD)

• Chronic blood loss (e.g., heavy menstrual bleeding (Periods), GI loss)

2. Iron Deficiency Without Anemia (IDWA)

• Low ferritin with normal hemoglobin

• Symptoms such as fatigue, reduced cognitive performance, congestive heart failure and reduced exercise capacity

3. Pre-operative Optimization

• Iron deficiency identified prior to elective surgery (particularly orthopedic, cardiac, colorectal, or gynecologic surgery)

4. Post-operative or Postpartum Iron Deficiency

• Accelerated repletion when rapid recovery is desired

• Intolerance to oral iron in the recovery phase

5. Restless Legs Syndrome (RLS)

• IV iron may be considered in moderate–severe RLS when oral iron is ineffective or not tolerated

6. Hair Loss (Telogen Effluvium / Diffuse Hair Thinning)

• IV iron may be considered if oral therapy fails and deficiency is confirmed

7. Anxiety and Neurocognitive Symptoms Associated with Iron Deficiency

• Emerging evidence links low iron and low ferritin with worsened anxiety and mood symptoms

• IV iron may be appropriate when deficiency is documented and oral therapy is insufficient

When IV Iron is Preferred Over Oral Iron

IV iron is generally recommended when:

• Oral iron causes significant gastrointestinal intolerance

• There is inadequate rise in hemoglobin or ferritin after 6–8 weeks of appropriate oral dosing

• Rapid repletion is clinically necessary

• There is chronic inflammatory disease impairing absorption

Safety and Administration

At Unify Health, IV iron infusions (e.g., Monoferric®, Ferinject® or Venofer®) are administered in a medically supervised environment with appropriate monitoring and emergency preparedness. The specific product and dosing are determined by the GIM physician based on weight, hemoglobin, and iron indices.

Patients may also elect to have the medication dispensed and administered at another infusion centre if preferred.

If you believe you may require IV iron, please arrange assessment with your family physician or request referral to our General Internal Medicine specialist for evaluation. Proper laboratory confirmation and clinical assessment are required prior to proceeding with infusion therapy. Our internists also will follow up with the patients

I want an intravenous iron infusion - what should I do?

If your family doctor, nurse practitioner or specialist discovers that you have anemia or iron deficiency that needs further work-up, they can refer you to our GIM specialist for further assessment. Once our GIM physician has met virtually with you, they may refer you for IV iron infusion therapy, which can be done within the Unify Clinic in Leaside in a safe and supervised manner or the medicine can be taken to another infusion center at the patients’ discretion. OHIP does not cover IV iron infusion therapy, which costs $175 per infusion. This is often covered by private insurance plans.

For information on your infusion please see our information and consent form here for Monoferric and here for Venofer.

Can you get me a CT Scan or MRI?

In Ontario, most advanced imaging systems like CT and MRI are available within hospitals. Our team works closely with multiple surrounding hospitals and will refer you to a local hospital for imaging if needed. How fast you can get an imaging test is based on the urgent issue and the hospital-based radiologist's decision. We can help discuss your issue with our hospital partners to advocate for you if and when needed.