DEAR DR. DONOHUE: I've been anemic for a long time, and my anemia grows worse. My family doctor sent me to a medical school's hospital. The tests showed I have ample iron and vitamin B-12, but also showed I need a kidney specialist. The specialist says my kidneys are not putting out enough hormone to correct my anemia, and he wants to give me Procrit if my blood pressure can be controlled. I also have a slow pulse - 43-49. What can you tell me about Procrit? Is it a forever thing? Is it dangerous? - V.W.
A: The definition of "anemia" is straightforward: too few red blood cells. The causes of anemia are not so straightforward. Everyone knows that iron deficiency is a cause. Few know that kidney disease is also a cause. The kidneys make a hormone called erythropoietin (uh-RITH-row-POI-uh-tin). It stimulates the bone marrow to produce red blood cells. Without it, a person drifts into a red blood cell deficiency - anemia.
Procrit is man-made erythropoietin. Just like the natural hormone, it prods the bone marrow into making red blood cells. It spares people with kidney-caused anemia from needing blood transfusions.
Procrit can't be given until blood pressure is controlled, because it can raise blood pressure. It has some potentially dangerous side effects. It doesn't cause cancer, but it might make cancers currently present grow more quickly. It sometimes leads to blood clots, which, in turn, can bring on a heart attack or stroke. At this point, I am sure you're thinking that you'd just as soon take arsenic. However, by restoring your red cell count only to low normal values, doctors can prevent these serious complications, and you get rid of anemia symptoms - breathlessness on slight exertion and fatigue.
Your slow pulse isn't related to your kidney problem. It's a separate issue that could require treatment unrelated to kidney or red blood cell treatment. Did your doctor comment on it? It also can make people tired.
c. North America Syndicate
DEAR DR. DONOHUE: Three years ago, my stepfather was diagnosed with colon cancer. It reappeared two years later. The doctors were successful at stopping it from spreading. However, when doing CT scans, they found a nodule/speck on his lung. He returns yearly for a check of this speck. Ten days ago, a friend was diagnosed with colon cancer. They also found a nodule/speck on her lung. Do these nodules have something to do with colon cancer? Do people with colon cancer always have them? Do they indicate the cancer has spread to the lungs? - S.J.
A: Lung nodules present a challenge when it comes to interpreting their significance. They can be harmless evidence of an old infection. Or they can be cancer. Size is an important element in determining their meaning. Nodules larger than 8 millimeters (.3 inches) are more worrisome. People without colon cancer get them, as do people with many other cancers. Colon cancer can spread to the lungs, and a lung nodule found in a person with colon cancer raises the question of lung involvement. Most colon cancers spread first to the liver and then to the lungs. Neither your stepfather nor your friend apparently has evidence of liver spread - a point in their favor. Your stepfather's subsequent exams have not shown any change in the size of the nodule, a point greatly in his favor.
Colon cancer is discussed in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue - No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: We received an e-mail that tells us not to drink cold water with meals because it solidifies the oily stuff you eat. Is this correct? - F.L.
A: That's not correct. Swallows of cold water don't congeal fats or oils in the stomach. They don't lower the stomach's temperature very much. I drink ice water with all meals and have done so all my life. I plan to continue to do so.