DEAR DR. DONOHUE: My mother has pernicious anemia. For about six months before she was diagnosed, she wasn’t herself. She had no energy, and her doctor diagnosed depression. She took antidepressants but then began to have trouble walking, and I insisted she see a neurologist, who made the diagnosis of PA. She has been getting shots for six weeks and she’s a lot more active, but her walking hasn’t markedly improved. Will it? How is that related to the anemia? Is she going to be on shots for the rest of her life? – C.K.

ANSWER: Whoever named pernicious anemia chose the right name. It is pernicious – deadly. Its symptoms come on slowly. All anemias have one thing in common: a deficit of red blood cells, the cells that transport oxygen throughout the body. With too few red blood cells, fatigue and breathlessness on slight activity are expected. Quite often, people with pernicious anemia have a beefy, red, sore tongue.

Not only does PA affect the blood, it affects the nervous system too. It packs a one-two punch. People develop funny feelings or numbness of the feet and legs, feel out of balance and about to fall, and find taking steps to be a huge challenge.

Both the red blood cell deficit and the neurological signs come from a lack of vitamin B-12, a vitamin that requires intrinsic factor for its absorption. Intrinsic factor is a protein made by stomach cells. Without it B-12 cannot get into the blood. That’s why shots are used to administer the vitamin. The shots get it into the body, bypassing the need for intrinsic factor.

The blood picture normalizes fairly rapidly. The neurological picture takes longer to return to normal function.

In North America, shots are the way most doctors treat their pernicious anemia patients. In Europe, large doses of oral vitamin B-12 is the standard treatment.

Very large doses of the vitamin can get into the body without intrinsic factor, but shots are a reliable way of ensuring vitamin replenishment. They have to be taken for life.

DEAR DR. DONOHUE: My uncle has atrial fibrillation. My aunt, his wife, has atrial flutter. What’s the difference? – V.K.

ANSWER: Both are abnormalities of the heartbeat, and both originate in the atria, the two upper heart chambers. In atrial fibrillation, the atria stop beating. They wiggle like gelatin, and they do so very erratically and at a very fast rate, more than 300 times a minute. Blood pools in fibrillating atria and can form clots, which, in turn, can lead to strokes. People with atrial fibrillation take blood thinners to prevent clot formation.

Atrial flutter is a regular fast heartbeat of around 200 to 250 beats a minute. Flutter is less frequently associated with strokes.

Both rhythms can sometimes be converted to a normal beat with a slight shock to the heart or with medicines. If medicines cannot convert them to a normal beat, they can slow the beat so that sufficient blood is pumped out of the heart every minute.

The booklet on heartbeats describes these two rhythms in detail. To obtain a copy, write to: Dr. Donohue – No. 107, Box 536457, Orlando, FL 32853-6475.

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: None of my 21 grandchildren has had their tonsils out. All of my seven children did. Is this no longer done? I wish doctors would make up their minds about these things. – B.B.

ANSWER: When your children were young, it was almost standard practice to remove tonsils as a way to protect against strep throat. We now know this isn’t necessary, and we now have antibiotics to treat strep throat.

Children who have repeated strep throat infections still have their tonsils removed, but the operation is no longer done for prevention.

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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