DEAR DR. DONOHUE: I take iron for anemia. The iron tears up my stomach, and I don’t know if I’ll be able to continue with it. Does it come in shots? – K.B.

ANSWER:
I want to expand a bit on anemias, but I will get to your question.

All anemias have one thing in common: a shortage of red blood cells. Not all anemias come from a deficiency of iron. Many other factors can be involved, such as the lack of vitamin B-12 in pernicious anemia.

When there is an iron deficiency, the doctor must find out why. In menstruating women, it can be the loss of excessive amounts of blood during periods. Red blood cells are the body’s chief repository of iron. Silent bleeding from the digestive tract – for example, from an ulcer – is another cause of iron loss. Replacing iron is important, but eliminating the cause of iron lack is even more important.

When iron supplies are depleted, the production of red blood cells falls off. People become weak, can be dizzy and almost always lose their energy. Cracks can appear in the corners of the lips, and sometimes the whites of the eyes develop a blue tinge. Fingernails often thin and have a scooped-out indentation in the middle that makes them look like spoons. Developing a craving for ice or starch is another sign of iron deficiency anemia. People often complain of unpleasant sensations in their legs when they go to bed. That is restless leg syndrome, and restoring the iron supply can put an end to it.

You are not the only one who has a problem tolerating iron tablets. They are absorbed best when taken on an empty stomach, but if they cause too much stomach distress, taking them with meals is permitted. Sometimes a doctor lowers the iron dose to lessen stomach irritation. There are iron preparations that can be given through an intravenous drip, but that route is reserved for people who absolutely cannot tolerate oral iron. The intravenous route can sometimes lead to serious reactions.

DEAR DR. DONOHUE: I wonder if I have been given a death sentence. I have myasthenia gravis. I know so little about this illness that I am terrified. Please fill in some details for me. – J.K.

ANSWER:
With myasthenia gravis, muscles become weak. The reason why is a disconnect between muscles and the nerves that activate them. An errant immune system produces weapons of mass destruction in the form of antibodies. Antibodies are missiles that destroy incoming germs. In the case of myasthenia, antibodies form a blockade against muscle receptors, the sites where nerve messages are transferred to muscles. Without full activation of muscle receptors, the muscle response is greatly weakened.

Eye muscles are often initially involved, and the result is double vision. Involvement of hip and shoulder muscles makes it difficult to rise from a chair or to comb the hair. Swallowing and speech muscles can also be involved.

A popular treatment is the drug Mestinon. It increases the number of nerve messengers that activate muscles and, in so doing, returns strength to muscles. There are many other drugs that work in different ways, so you have a large menu to choose from. Sometimes, the thymus gland, a gland located in the upper chest, is removed, and that can improve muscle strength.

This is a complicated topic, but the Myasthenia Gravis Foundation of America can unravel it for you. It can provide you with a supply of information and can rid you of the feeling that you are the only person on the face of the Earth who suffers from this disease. Call the foundation at 1-800-541-5454, or go to www.myasthenia.org. You’ll be glad you did.

DEAR DR. DONOHUE: I am a 34-year-old woman. I have to shave my legs every third day, or they look like those of King Kong. I have been told that it’s my leg shaving that promotes the growth of leg hair. Have I been doing something that I should not have been doing? – C.S.

ANSWER:
Shaving does not promote hair growth anywhere – legs, face or anywhere.

DEAR DR. DONOHUE: I have suffered from profuse sweating of my hands for as long as I can remember. My feet sweat, too, but I can live with that. My hands are the problem. Through the years, doctors have prescribed powders, including Drysol, but none has worked. I understand there is a surgical procedure that can alleviate this problem. Can you tell me something about it? – R.T.

ANSWER:
The surgery is a sympathectomy. Sympathetic nerves innervate sweat glands, telling them to turn on the sweat faucet. One way of attacking those nerves is by cutting them. Some doctors can accomplish that task by making a small incision under the arms and introducing a viewing scope into the chest where the sympathetic nerves are found. Cutting instruments are also inserted through a small incision. You don’t live far from a large medical school, and a call to its neurosurgical department ought to get you the name of a doctor who does this procedure. It is called endoscopic transthoracic sympathectomy.

Injecting Botox into the palms is another technique. Botox is the diluted toxin of the most common kind of food poisoning. It can block the nerve impulses stimulating sweat glands. The procedure is painful, but numbing agents make it bearable. Dermatologists can perform this procedure. A repeat procedure is often necessary some months later.

For readers’ sake: Drysol, which the writer mentioned, is a 20 percent solution of aluminum chloride that dries out the sweat glands for some people.

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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