DEAR DR. DONOHUE: I am a woman and a well-controlled diabetic. I also have high blood pressure, which is under control. For the past year and a half, I have been anemic. My hemoglobin has been as low as 8.4, and I received two blood transfusions. I have seen five doctors and still have no answer about the anemia. I have had scopes put into my stomach, duodenum and colon and have had bone marrow biopsies, and all results are normal.

My doctor now says I have chronic kidney disease. My last creatinine was 1.9. When I asked about the reading, she said not to worry about it. I would like your advice. Should I see a specialist? – Anon.

ANSWER: An adult woman’s hemoglobin should be 12 to 16 gm/dL (7.9 to 9.9 mmol/L). Hemoglobin is the stuff inside red blood cells that attracts oxygen to the blood cell. A hemoglobin measurement gives an accurate assessment of the number of red blood cells a person has. A drop in hemoglobin, therefore, indicates anemia.

Chronic kidney disease is a slowdown of the kidneys’ blood filtration. A creatinine blood test gives an indication of how well the kidneys are working. The normal value should be equal to or less than 1.4 mg/dL (133 micromol/L).

The kidneys make a hormone, called erythropoietin, that stimulates the bone marrow to make red blood cells. Failing kidneys don’t make enough of that hormone, and that’s why kidney failure leads to anemia. When anemia is part of kidney failure, the degree of kidney malfunction is significant.

Your doctor might not be worried about this, but I am. If your anemia is caused by kidney failure, then you need treatment for both the anemia and the kidney problem.

Yes, see a specialist. You should see a nephrologist (a kidney specialist) or a hematologist (a specialist in diseases of the blood). Don’t waste any more time before seeing one of these doctors.

DEAR DR. DONOHUE: I have heard that if an expectant mother drinks or smokes, she can cause birth defects. Is this true? – M.M.

ANSWER: There’s no dispute that a pregnant woman who drinks alcohol puts her baby at a high risk of being born with serious birth defects. Facial features can be affected. The head might be small. The eyes can also be smaller than normal and spaced widely apart. The jaw often recedes.

A baby with fetal alcohol syndrome, as the condition is known, suffers from slow growth and never catches up to children of the same age.

Most devastating is brain development, which often lags behind other children’s and makes learning most difficult for an affected child.

The greater the amount of alcohol drunk, the greater the chances for birth defects. The safe amount of alcohol that can be drunk during pregnancy has not been established. For that reason, pregnant women ought not to drink any alcohol. The risk is too great.

The question about smoking during pregnancy being a cause of birth defects is less settled. Smoking does increase the rate of miscarriages. It can cause placental abnormalities, which threaten the child’s life. It raises the possibility of premature birth and all the attendant troubles associated with prematurity. It increases the risk that the child could succumb to sudden infant death syndrome. Pregnant women should follow the same advice they are given for alcohol. They should not smoke.

DEAR DR. DONOHUE: What can you tell me about opium? Is it the same as heroin? My son uses it every day. I am concerned. – R.H.

ANSWER: Opium is obtained from the seeds of the poppy plant Papaver somniferum. Opium contains a number of compounds, one of which is morphine – the painkilling medicine. Heroin is morphine that has been treated with the chemical acetic anhydride. It is more potent and more addicting than morphine.

Opium itself is addicting. Its unprescribed use is illegal. Your son should be as concerned about it as you are. If he cannot stop using it, he should seek professional help to get over the habit or addiction.

DEAR DR. DONOHUE: My granddaughter was diagnosed with polycystic ovary syndrome. Would you explain this? Is there any help for it? – M.S.

ANSWER: Polycystic ovary syndrome is near the top of all causes for women having irregular menstrual cycles. It’s also a major cause of infertility.

Its signs are many. Women might experience hair growth on the chin, cheeks, neck and chest. They can break out with acne. Their hair might thin. About half of affected women are overweight. The syndrome causes many women to become insensitive to the action of insulin, and their blood sugar rises.

All of these are dramatic signs and make the diagnosis easy. The trouble is, not all of the above signs are always present. In some women, the diagnosis is difficult because overt signs are few. The three most frequent indications of the syndrome are: enlarged, cystic ovaries; menstrual periods that become infrequent and might even stop; and a high blood level of the male hormone testosterone. The high testosterone level is responsible for most of the signs.

The diagnosis is made by finding a high blood testosterone level and a change in the level of two other hormones that influence estrogen production. They are called LH and FSH. An ultrasound of the ovaries shows them to be large and studded with cysts. And frequently, blood-sugar levels are higher than normal.

Yes, there is help. If women with the syndrome are overweight, simply losing weight can often fix the hormone derangement. Birth-control pills diminish male-hormone production, and the signs of PCOS eventually disappear. Spironolactone, a water pill, can neutralize the effect of testosterone, and it is sometimes used as treatment. Some doctors put their patients on the diabetes medicine metformin to correct the many endocrine abnormalities of this syndrome. This is only a sample of the treatments available for polycystic ovary syndrome.

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. Readers may also order health newsletters from www.rbmamall.com.


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