DEAR DR. DONOHUE: Since my knee-replacement operation in 2009, I have questions that doctors shy away from answering. Is there a possibility of temporary or lasting brain damage from an anesthetic? For a week after my operation, I had difficulty reading and pressure in the front of my head. Do painkillers damage the brain, like Tylenol No. 3 and Extra-Strength Tylenol? How about sleeping pills? I use a quarter of a pill every 10 days. Do anesthetics affect memory? — S.B.

ANSWER: You ask good questions that deserve answers. Mental confusion after general anesthesia, the kind that puts a person in deep sleep, happens to as many as 60 percent of those older than 65. Most of these people recover in two days, but a few do not. Even younger people, those between 18 and 60, show a decline in mental processing after a general anesthetic. In three months, their cognition is back to normal. However, a percentage of older people are still impaired after three months. So, the answer to your question is: Yes, there can be brain damage after an anesthetic. Memory can be affected. Damage, in a few, can be permanent.

Because of this, some places advocate greater use of local anesthesia whenever possible — spinals and epidurals or nerve blocks.

Many hospitals are experimenting with low doses of anesthesia, not putting surgical patients into deep sleep, but putting them in a state that frees them from pain but allows them to answer questions. This is something that will probably become more widespread in the coming years.

Your dose of sleeping-pill medicines ought not to affect your brain at all.

Tylenol No. 3 contains 300 mg of acetaminophen (not a big dose) and 30 mg of codeine. Codeine is an opiod but a weak one. Inordinate amounts could affect the brain. The same can be said for Extra Strength Tylenol, which has 500 mg of acetaminophen. Huge amounts could cloud the brain. Doses printed on the instructions should not. Narcotic painkillers, if used indiscriminately, can have deleterious effects on the brain.

DEAR DR. DONOHUE: The latest food fad emphasizes fiber. How much is adequate? Will you elaborate? — B.E.

ANSWER: Fiber isn’t a recent fad. Your mother spoke of it as roughage, and probably told you to take it to stay regular. Fiber keeps people regular by speeding the passage of food through the digestive tract and by keeping the food residue moist and soft. It prevents diverticulosis. It has been touted as a preventive for colon, breast and prostate cancer. Those claims are not on solid ground. Oat bran, a popular fiber, lowers cholesterol. Whole-grain foods, fruits and vegetables are good sources. Whole grains are grains that have not been refined. They keep their outer coat, bran, which is excellent fiber.

The daily fiber intake ought to be 25 to 30 grams a day. One cup of navy beans has 19 grams; split peas, 16; lima beans, 13; raspberries, 8; spinach, 7; brussels sprouts, 6. Many cereals have a high fiber content. Kellogg’s All-Bran contains 10 grams in half a cup; one cup of Kellogg’s Raisin Bran has 7 grams. The fiber content of most food is included on the nutrition labels.

DEAR DR. DONOHUE: Two years ago, I was diagnosed with having too much iron. Doctors started drawing off a pint of blood a month. In June of this year, my blood count showed I had too little blood, and they stopped drawing it off me and gave me a transfusion. They said I was leaking blood, and I had all sorts of tests and scans to find the source. None was found. Now I am going to see a blood doctor for a second opinion. Where could it be going? Did the blood drawing cause this? — J.C.

ANSWER: You probably have hemochromatosis, a condition in which too much iron is absorbed. An oversupply can damage the pancreas, liver and heart. Treatment is removing blood, the primary repository of iron. It did not cause your present problem. Now, with your blood count so low, you don’t need such treatment. Your doctors have investigated the digestive tract, the place usually responsible for a leak of blood. The new doctor, the hematologist (blood doctor) will look for things like diminished blood production in your bone marrow.

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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