DEAR DR. DONOHUE: I have been diagnosed with too little iron and a low hemoglobin count. I am taking iron daily. I had a colonoscopy and a scope exam of my stomach. They were normal. I don’t smoke or drink any alcohol. If it’s not iron deficiency, what causes the anemia? I think low iron and low hemoglobin go together. Are there any foods or beverages I should avoid? — B.K.

ANSWER: A few definitions help clear the air. Anemia is a low red blood cell count. Red blood cells are the cells that pick up oxygen in the lungs and deliver it to all body organs, tissues and cells. Hemoglobin is the stuff inside red blood cells that acts like a magnet for oxygen. A low hemoglobin count is the equivalent of a low red blood cell count. Both indicate anemia. The causes of anemia are multiple. Too little vitamin B-12 produces pernicious anemia. An insufficient amount of folic acid, another B vitamin, also produces an anemia. Some anemias come about because of an early death of red blood cells, which are supposed to last 120 days. Those anemias are called hemolytic anemias. Inherited conditions like sickle cell disease and thalassemia lead to anemia. The bone marrow makes all blood cells, including red blood cells. Anything that bollixes the bone marrow also produces an anemia. Anemia isn’t a simple illness.

Iron deficiency is one of the most common causes of anemia. The iron deficiency often is due to loss of blood. Blood is the body’s iron bank. Frequently, the digestive tract is the site of silent bleeding. Your scope exams were done to find any bleeding in the tract. None was found. Perhaps the bleeding healed by the time you were examined. Perhaps the bleeding site will never be found. At any rate, you have to replenish your body’s iron with iron pills. Now that you’re on iron, the anemia ought to be corrected in about six weeks. You might have to stay on iron for a full year to replenish your exhausted iron bank account. If your doctor hasn’t specifically told you to avoid certain foods and drinks, you don’t have to do so.

TO READERS: Diverticulosis and diverticulitis are common ills that prompt many letters. The booklet on these ills explains their cause and treatment. To order a copy, write: Dr. Donohue — No. 502, Box 536475, 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: Last summer I suffered a hamstring tear. It was accompanied by a loud pop. The pain was immediate and severe. I treated it with ice and rest, and then saw the family doctor. I continued the ice and rest, and graduated to heat along with muscle relaxants and anti-inflammatory medicines. All went pretty well. Six weeks later I had muscle spasms, and I returned to exercise. The spasms increased. I saw a sports-medicine doctor, who said it would take time to heal and told me to cease all leg exercises. Is this going to be a chronic problem? — M.B.

ANSWER: The hamstrings are the muscles on the back of the thigh. Tears of muscles are graded from one to three, with one being the smallest and three, a complete tear. They’re common athletic injuries, and they heal slowly. I think you have to date the onset of your injury to the time when you returned to exercise, and your thigh started acting up again. It takes many months for such an injury to heal. You wouldn’t be wasting your time or your money by consulting an orthopedic doctor for an expert opinion. Hamstring tendon tears do require surgery.

DEAR DR. DONOHUE: What’s going on with young women who have high, nasal voices? I thought it was an affectation, but it seems more TV broadcasters and women in general seem to have the problem.

I was OK with it until my granddaughter came home from college with a high, nasal voice. Is this a medical problem? Can it be treated? — G.K.

ANSWER: I don’t think it’s a medical problem. To tell you the truth, I haven’t noticed it. I’ll start paying closer attention to female broadcasters to see if I detect the changes you do.

I know your question will generate lots of mail. I’ll condense what’s sent to me and pass it on to you.

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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