DEAR DR. DONOHUE: I read your article about irritable bowel syndrome with interest. For seven and a half years I was treated for it. About half an hour after eating, I was in such pain that no painkiller could touch it. In late 2008, I was rushed to the emergency room and diagnosed with colitis. I ate nothing but liquids. The doctor said he wanted to do an invasive test, so I had an angiogram (X-ray picture of arteries) of my abdomen. They discovered that my mesenteric artery was almost totally blocked. I had stents inserted, and now I can eat anything. I am sure others are suffering just the way I was. — V.H.

ANSWER: You had a rare condition that most doctors, myself included, would miss. It’s chronic mesenteric artery ischemia, pain stemming from reduced blood flow. The mesenteric artery is one of the principal arteries of the digestive tract. A blocked mesenteric artery cannot deliver enough blood to meet the demands of food passing through the intestine. The pain arises shortly after eating. It’s quite similar to the chest pain of angina due to blocked heart arteries.

The same processes that clog heart arteries clog other arteries, including the abdominal arteries. Cholesterol, fat and other material, clinging to the artery wall, block blood flow.

Mesenteric artery ischemia is often misdiagnosed as some other condition. Because of its rarity, it isn’t thought of. A tip to it is weight loss. Affected people stop eating because of the pain it causes. Another tip is its relationship to eating a meal.

Once the diagnosis is made, generally through scans that are designed to take clear pictures of abdominal arteries, the problem is eliminated by opening the artery through angioplasty, a balloon-tipped tube inserted through a surface artery and advanced to the site of blockage where the balloon is inflated. Stent placements keep the artery opened. Sometimes the occluded artery has to be surgically opened and cleaned.

DEAR DR. DONOHUE: I was recently diagnosed with a blood clot behind my knee. While in the hospital I was placed on Coumadin, the blood thinner. On my first visit to the doctor after hospitalization, I asked his nurse what happened to the clot. She told me that the medicine would dissolve it. I asked the doctor the same question. He stated the clot wouldn’t dissolve. I would like to know what’s going to happen to it. — S.L.

ANSWER: Coumadin doesn’t dissolve a blood clot, but it keeps the clot from growing larger. Large clots break into pieces. The pieces are swept in the blood to distant places like the lungs, where they can be lethal.

The clot in your leg will shrink. Sometimes a tunnel bores through the clot so that blood can resume flowing through the vessel. You’re going to be OK. You can sleep in peace.

DEAR DR. DONOHUE: A friend was told that in order for her to have a knee operation, her blood levels would have to come up. She had low iron. They injected iron in an IV drip five times. It did nothing for her blood count. The doctor said her body was not making iron. This doesn’t seem logical. It’s three months later, and she living with painful knees. It’s hard to believe nothing can help her. Can you straighten this out? — T.B.

ANSWER: The body needs iron to make red blood cells. Her intravenous iron should have corrected an iron deficiency if that’s what caused her low red blood cell count. A low red blood cell count is the same thing as anemia. There are many other causes of anemia. She could well have one of those. Those anemias do not respond to iron treatment. Your friend needs to consult a hematologist, a specialist in blood diseases.

DEAR DR. DONOHUE: My mother is 101. Her main concern is low sodium. Her only treatment is to reduce her water intake. Is there something else she might do? — R.M.

ANSWER: If her low blood sodium came from excessive fluid intake, then fluid restriction is the right way to treat it. To lower blood sodium, a person has to drink pretty prodigious amounts of fluid. If fluid restriction doesn’t correct the situation somewhat promptly, the many other causes of low sodium must be investigated.

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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