DEAR DR. DONOHUE: My husband and I have been married for five years, and we are in our early 30s. We have been trying to have a family for two years without any luck. For the past four months my breasts have been leaking milk. I finally went to my doctor, who says he thinks I have a brain tumor. I am scared to death. What kind of tumor causes this? – D.M.

The tumor, I am sure, is a pituitary gland tumor. That gland is attached to the bottom of the brain, and it makes both hormones that have their own properties and hormones that control other glands, such as the thyroid and adrenal glands.

One of the pituitary gland’s hormones is prolactin. Prolactin has two jobs. It encourages milk production for women who have just delivered a baby. It also helps regulate the production of the female hormone estrogen.

Too much prolactin when a woman is not nursing causes milk production and breast leakage of milk. It can also throw menstrual periods off-kilter. It can lead to infertility. Maybe your inability to become pregnant lies in excessive prolactin.

Don’t let the word “tumor” scare you. This tumor is not a cancer tumor. Many are only 0.4 inch (1 cm) in size. Some are bigger, but none becomes huge, and none spreads to other parts of the body.

Your doctor will measure your blood level of prolactin and probably order a brain scan.

Treatment of these tumors depends on the tumor size, the symptoms it produces, the woman’s wish to become pregnant and the woman’s response to oral medicines. Bromocriptine is often the drug that is first chosen as treatment. If no medicine works, then a neurosurgeon operating with a microscope can remove the tumor.

Men can also develop a prolactin-producing pituitary tumor. Male symptoms include infertility, erectile dysfunction and a diminished sex drive.

DEAR DR. DONOHUE: I would like to hear what you say about the vitamin CoQ10. People tell me it is a source of energy, something I lack. Is it a safe product? – J.F.

Coenzyme Q10 (CoQ10) is not a vitamin. By definition, a vitamin is a substance needed only in trace amounts for normal body functioning. Most vitamins, with the exceptions of K and D, are not made by the body.

CoQ10 contributes to the protection of body cells from the toxic byproducts generated during the body’s daily metabolism. It is one of those substances referred to as antioxidants, substances that keep body cells from rusting. It also figures into energy production, but it does not provide energy by itself.

It is found in many organs and tissues and, unlike a vitamin, in somewhat large quantities.

At one time, CoQ10 looked like it might be a promising treatment for congestive heart failure, the common heart disorder where a weak heart is unable to pump enough blood to support body functions. It is also proclaimed as a remedy for Parkinson’s disease, artery hardening, high blood pressure, asthma and AIDS.

It’s a bit much to swallow all the claims made for it. Whether it will be universally adapted as an adjunctive treatment for heart failure remains to be seen. It appears to be safe.

DEAR DR. DONOHUE: My granddaughter, 26, is a diabetic. She is on a strict diet and must take insulin. She has just gone home after two weeks of visiting me. We ate many meals in a restaurant, and I was surprised that she used sugar in her coffee. I thought sugar and diabetes don’t mix. I want to mind my own business, but I don’t want her to become sick. What should I do? – O.G.

For most of my medical life, sugar was forbidden to those with diabetes. Now a more liberal policy is in effect. Sugar is treated like other carbohydrates. Diabetics have to include it in their daily tally of carbohydrate calories. Sugar should not be used in large amounts because it is a carbohydrate that raises blood sugar quickly.

DEAR DR. DONOHUE: As far back as I can remember, my mother took iron for her anemia. Now I find that I am anemic. The doctor says I do not need to treat it and that I most certainly do not need iron. I think I have the same anemia. Why no treatment for me? – T.B.

ANSWER: Anemia is a deficiency of red blood cells. There are many kinds, and iron is not the answer for all anemias. Granted, iron-deficiency anemia is a common anemia. It often comes about from blood leaking in ways hidden from the patient’s eyes. A slow trickle of blood into the digestive tract from an ulcer or from a tumor is an example. Blood has the body’s greatest iron reserves, so when blood is lost, iron is lost. Treatment of such an anemia consists in treating the cause of the iron deficiency and in supplying iron to fill the body’s reserves.

From this point on, what I say is speculation. I am diagnosing your mother’s anemia as thalassemia, a common anemia in people whose ethnic origins lie in countries bordering the Mediterranean Sea.

The most common variety of thalassemia is thalassemia minor. People with thalassemia minor have slightly fewer red blood cells (anemia), and those cells look like the small red blood cells of iron-deficiency anemia. Therefore, these people are mistakenly given iron to treat their anemia. Too much iron can deposit in liver, heart, pancreas and other organs and, in time, can damage them. The degree of anemia is rarely severe and does not require any treatment.

I believe your mother had thalassemia minor and that she passed the gene to you.

You can get the answer by asking your doctor if you have thalassemia minor. If you do, cross it off the list of things that worry you.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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