DEAR DR. DONOHUE: Do people ever recover from pernicious anemia? I was told I had to take the B-12 injection for life. – W.R.

ANSWER: People recover from pernicious anemia, but they have to continue having lifelong treatment.

This anemia – a decrease in the red blood cell count – comes from a lack of vitamin B-12. That vitamin is essential to the production of red blood cells in the bone marrow.

Vitamin B-12 is unlike all other vitamins. It has special requirements. It needs something called intrinsic factor for absorption. Intrinsic factor, IF, is made in the stomach and acts like an usher in a theater, leading people to their seats. IF takes B-12 by the hand and helps it across the intestinal lining and into the circulation, which takes it to the bone marrow. Without IF, B-12 is not absorbed. It passes through the digestive tract.

B-12 deficiency does more than upset the production of red blood cells. It can adversely affect the digestive tract. One sign of that is a beefy, red, painful tongue. Appetite is often lost, and people can develop diarrhea.

It can also wreak havoc on the nervous system and cause muscle weakness, peculiar sensations and great trouble in walking.

To bypass the need for intrinsic factor, the doctor injects B-12 into muscles, and then it gets into the blood. At the beginning of treatment, B-12 injections are given weekly for eight weeks. Once the body’s B-12 tanks are filled, the injections are then administered monthly.

DEAR DR. DONOHUE: I am 56 and have COPD. I use supplemental oxygen for sleeping and sometimes during the day. This past year I noticed something I don’t understand. While being treated for an infection, not a respiratory infection, I was given antibiotics. For the two-week period I took those medicines, I felt like I was in seventh heaven. I could breathe deeply. I can’t help but wonder why the components in an antibiotic can’t be isolated and given as treatment for people who have COPD. I have a debate with my partner, who says my lungs are probably in a constant state of some infection, albeit small. Is this the case? – S.D.

ANSWER: The two chronic obstructive pulmonary diseases, COPD, are emphysema and chronic bronchitis. Most COPD patients have elements of both illnesses.

Emphysema is a destruction of the millions of air sacs through which oxygen passes into the blood. The burst air sacs give people a barrel chest, and they cannot draw in enough air to supply their bodies with oxygen.

Chronic bronchitis is inflammation of the airways, the bronchi. They fill with thick, yellow mucus in which bacteria find a haven for multiplying. Cough is its hallmark. Your partner is right. There is an element of constant infection in people with chronic bronchitis. Antibiotics could have decreased the bacterial population and made it easier for you to breathe.

In most circumstances, however, you can’t put people on antibiotics for life. You can give them antibiotics when there is a worsening of their symptoms – an increase in cough and sputum production – but the antibiotics are prescribed only during those periods of symptoms worsening.

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

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