Dear Dr. Roach: I am 92 and consider myself very fortunate, health-wise. In the middle of the 1980s, I was diagnosed with sideroblastic anemia. My doctor in Florida did many tests to make the diagnosis and to figure out why my hemoglobin level went up and down.
I moved to Mississippi, and the doctor here referred me to the cancer centre. In a two-week period, my hemoglobin went from 10.2 to eight. I felt no different, and have not been treated for anemia. Do you have any comment?
R.W.G.
Sideroblastic anemia, despite its precise-sounding name, can be any of a number of conditions that have an abnormal red blood cell with a nucleus and iron-rich granules (鈥渟idero鈥� is Greek for 鈥渋ron,鈥� and 鈥渂last鈥� means 鈥渁n immature cell鈥�). There are reversible causes, such as some medications or alcohol; copper deficiency; congenital causes, often due to mitochondrial diseases; and the most likely cause in you, refractory anemia with ring sideroblasts.
Many people who have refractory anemia with ring sideroblasts do not need treatment. Sometimes, blood transfusions are necessary. There is also a medication called azacitidine that helps some people with your condition.
Hemoglobin levels vary from day to day, but a two-point drop in two weeks is concerning. Your doctor will recheck the level, and if it is a real drop, he or she may want to do further testing.
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Dear Dr. Roach: My bloodwork showed my bilirubin number going up to 1.8, then 2.1. A CT scan showed no abnormalities with the liver. I have no symptoms, but my doctor said that if the number stays up, he will refer me to a specialist.
I am concerned that because I have taken a lot of Tylenol over the years, I may have caused liver damage. Also, I have taken an enzyme for lactose intolerance and wonder if that may have caused the problem.
A.W.
Bilirubin is a breakdown product of heme, a protein in blood and, to a smaller degree, muscle. Heme is metabolized by the liver to bilirubin. A high level of bilirubin in the blood can come from excess breakdown of blood or muscle, or from an inability of the liver to metabolize it. There is a familial condition present in four per cent to 16 per cent of the population, Gilbert syndrome, in which bilirubin level is high, but this is a benign condition.
Acetaminophen (Tylenol) can cause liver damage when taken in very large doses, and it also can cause kidney disease with chronic use; however, it鈥檚 unlikely to have anything to do with your elevated bilirubin level if there are no other liver problems found by blood testing and imaging.
Lactase, an enzyme used by many people with an inability to break down the sugar in milk, is very safe. You may have been misled because some of the blood tests we obtain to look at liver function are enzymes, such as the ALT and AST levels.
Most people I see with no symptoms and an elevated bilirubin level have no liver disease, but a referral to a specialist may be reassuring.
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Dear Dr. Roach: I am 73 years old, with osteoporosis and scoliosis. Can scoliosis be corrected?
W.E.W.
Osteoporosis is loss of strength of the bones, and scoliosis is a curvature of the spine. They may or may not be related. The osteoporosis should be treated, but the scoliosis usually does not need to be treated.
Muscle-strengthening exercises are important, and braces and injections may be used. Surgery is reserved for very severe cases, particularly in adults.
