DEAR DR. DONOHUE: I have iron-deficiency anemia. Will I be anemic for the rest of my life? I am a 57-year-old female, five years past menopause. Some months ago, I became out of breath while playing tennis. My family doctor had my blood checked, with the enclosed results. Which of these tests convinced my doctor I was bleeding someplace? I am now on iron. I have had my stools checked for blood, and there was none. I have had gastroscopy, colonoscopy and a barium enema. All are normal. I feel fine. — E.B.
A: If you’re like most irondeficient people, you won’t be anemic for the rest of your life. On your panel of blood tests, your ferritin is low. Ferritin is protein that acts as a storage bin for iron, so you have to replenish your iron supply, which you’re doing with your iron pills. Your hemoglobin and hematocrit are a trifle low. They indicate a deficiency of red blood cells. The definition of anemia is a low red blood cell count.
An iron shortage comes about because the diet isn’t providing enough of it or the digestive tract can’t absorb it. The third and most important cause is bleeding, most often from the digestive tract and most often not recognized by the patient. Your scope exams and barium enema have pretty much ruled out the digestive tract as a source of bleeding. If you were still menstruating, loss of menstrual blood could be an explanation. Between 2 percent and 5 percent of menstruating women are iron deficient and anemic.
Now that you’re on iron, the deficiency should be corrected in short order and your blood picture should return to normal. If it doesn’t, then the doctor has to look for the poor-iron-absorption causes of anemia. Celiac disease and a stomach-acid deficit are two such causes.
My guess is that your iron pill will cure your anemia and that the anemia came about because your diet was lacking in iron.
DEAR DR. DONOHUE: Eight years ago my husband was said to have Alzheimer’s disease. A few years later, the diagnosis was changed to Parkinson’s disease. Now the diagnosis is progressive supranuclear palsy. What is that? His speech is hard to understand, and his walking is bad. How does it end up? — B.C.
A: Quite a few illnesses can look like Parkinson’s disease or Alzheimer’s disease, especially in their early stages. These illnesses share with each other an attack on brain centers that produce similar signs. However, each also affects brain centers not stricken by the others, and that gives each of these illnesses distinctive features.
An unsteady walk with frequent falls is a sign common to both progressive supranuclear palsy and Parkinson’s disease, because the brain area that governs walking is affected in both illnesses. Some distinctive signs of PSP are a soft, monotone, barely understandable speech; forgetfulness; irritability; and decreased blinking, which leads to dry eyes. Swallowing can become a formidable task. One of PSP’s most distinguishing features is the inability to turn the eyes downward and, later in the illness, to turn them upward. Loss of eye movement makes reading impossible and adds to the patients’ instability.
Many patients eventually have to use a wheelchair.
The Society for Progressive Supranuclear Palsy is ready to help patients and their families with reams of information and with support. You can reach the society at (800) 457-4777 or on the Web at www.psp.org.
DEAR DR. DONOHUE: Can a sunken sternum be corrected? If so, how? I don’t like to go shirtless because of it. — S.A.
A: A sunken sternum (breastbone) can be fixed. It’s a relatively common congenital condition. It happens in one out of every 300 births, and it happens mostly to males. Surgeons can reconstruct the breastbone and can bolster its supports.
Sometimes the surgery has to be done when the sunken bone presses on the heart and lungs, and affects their functioning.
c. North America Syndicate
