DEAR DR. DONOHUE: Will you write about anemia? I am anemic. I started having terrible pains in my arms and legs. I read that anemia starts drawing from your muscles. I’ve been on iron and am feeling better. — P.R.

ANSWER: The definition of anemia is too few red blood cells, the cells that cart oxygen from the lungs to all parts of the body. It’s not one illness; a large variety of anemias exists.

Failure of the bone marrow to produce red blood cells, many chronic illnesses (rheumatoid arthritis), an immune attack on the red blood cells, chronic kidney disease, a lack of vitamin B-12 and some inherited diseases, like sickle cell anemia, all can cause anemia. So can iron deficiency, and apparently that’s the kind you have. Quite often, iron deficiency develops from blood loss, and the loss may not be visible. A constant dripping of the blood into the digestive tract, for example, eventually leads to a depletion of red blood cells and their iron. Red blood cells are the chief storage place for iron.

Some anemias have distinctive features, but all share some common symptoms. Shortness of breath on activity is one of those common features. The diminished number of red blood cells cannot deliver enough oxygen to the body. Listlessness, a fast heartbeat and pallor of the fingernail bed are seen in anemias.

Iron replacement is the treatment for iron-deficiency anemia. An attempt should be made to unearth sites of unrecognized blood loss.

I don’t know what you mean when you say “anemia starts drawing from your muscles.”

DEAR DR. DONOHUE: I recently read of the experimental placement of fecal matter from a healthy person into the colon of a person suffering from colitis after that person’s healthy bacteria had been killed off by antibiotics and replaced by bad bacteria.

Aside from the “ick” factor, what do you think of this treatment? — D.B.

ANSWER: The colitis you refer to is antibiotic-associated colitis, caused by the Clostridium difficile bacterium. As you say, sometimes antibiotics have collateral damage. They might kill the good bacteria in our colons. That gives the clostridium bacteria a chance to become the colon’s supreme rulers. These bacteria produce toxins (poisons) that lead to diarrhea.

Stopping the antibiotics often restores equilibrium to the colon, but not always. When it doesn’t, then antibiotics such as metronidazole and vancomycin are brought into play. A new antibiotic fidaxomicin can be turned to if success eludes the other two drugs.

In a small number of people, the diarrhea responds to no drugs. That’s when transplantation of normal colon bacteria from a healthy donor is tried. The bacterial are introduced into the patient’s colon by enema or by a tube that enters the digestive tract through the nose. It works, many times. I think it’s a wonderful treatment when all other treatments fail. Incidentally, a variation of this technique is to raise colon bacteria in the lab and put them in a sterile solution for transplantation into a patient’s colon. That eliminates the “ick” factor.

DEAR DR. DONOHUE: I believe I am drinking too much, and I can’t control it. I drink one or two glasses of wine a day, but often it’s more than that. Since there are different remedies to stop smoking, why is there nothing to stop drinking? I am not a joiner, so AA isn’t an option for me. — B.W.

ANSWER: You’re aware that you have a problem, and you want to do something about it. That’s a good sign. Most alcoholics deny they have a problem.

How about asking your family doctor for help or for a referral to a competent alcoholism counselor for private sessions?

Medicines to reinforce a person’s resolve to stop drinking do exist. Antabuse is one such medicine. There are others. None of these drugs cures alcohol abuse, but they can be a powerful aid in helping a person stop drinking.

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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