I have no outward symptoms of any illness. I tell my doctors that I am a vegan, but each year they search for some other cause. In non-Western countries where animal protein is not a large part of the diet, do doctors have different standards for blood-test results? Would I then be normal in those countries?

DEAR READER: Frankly, I am unsure if you were tested in another country whether your lab work would reveal anemia or not. Numerous studies have shown that poor meal planning is the cause of nutritional deficiency, not the absence of animal foods.

Do you feel tired, run-down and lacking in energy? From the sound of your letter, I would guess not. You are likely healthier than a great number of us. If you feel your diet may be lacking in any way, consider a good daily multivitamin. Beyond that, stay on course and you’ll likely outlive us all.

To provide related information, I am sending you a copy of my Health Report “Vitamins & Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0157. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

This time, my new doctor listened to me and immediately sent me for an MRI which showed that my cancer was back in most of my bones. Because my pain was localized to my hip, I had radiation for 15 days. The radiologist told me I would be wheelchair bound in six months but I am still walking and pain-free.

After that I was given chemotherapy every 28 days which kept my cancer tests in a normal range for two years. Now it is abnormal again and a CT and PET scan both showed the cancer was spreading but there is no organ involvement. I am back on chemotherapy every 28 days.

I also have white coat hypertension because of the constant needle prodding during my doctor visits (my veins are not good). In office, my pressures are between 130/85 and 155/74. Outside the office they are about 117/76. My doctor suggested putting a port in, but I am reluctant because I have watched three close cancer survivor friends die from port complications.

Now, I provided that history in the hopes it will help you answer my question. My oncologist has been telling me for months that I am anemic and its getting worse. I started eating red meat, fish and turkey again and have gained some weight. Wanting to know more, I went online and looked up anemia and iron deficiency but strangely, I don’t seem to fit the profile for someone who is anemic. I am not fatigued or irritable, don’t have a gray pallor, weakness, brittle or grooved nails and I don’t crave anything strange like clay. I feel fit and healthy and just accepted an eight week long-term substitute position.

I have enclosed a copy of my lab results from the August 08 to January 09. I don’t know what is going on.

DEAR READER:
You have complex history but I hope I can simplify at least one matter for you. According to your lab reports, you were indeed anemic during all of your blood work. However, that anemia was so slight, it was inconsequential. For example, your hospital uses normal lab values of 4.2 to 5.4. Five of your six results were about 3.9 and the sixth was 4.1. To me that shows improvement, not worsening. With your results so close to normal, I wouldn’t worry but I urge you to return to your oncologist and ask why he thinks your anemia is worsening.

I recently had a couple of pre-cancerous lumps on my head removed and treated. They healed well.

Lately any cuts I get, whether they are big or small, seem to get infected. I am not diabetic and my weight is normal. Is there a cause for low A cells? Is there something I can do make them rise?

DEAR READER:
First, I feel I must explain what type A cells means, as you appear to be slightly confused. Type A simply refers to your blood type. There are four blood types, A, B, AB and O. The reason for knowing a blood type is only so that should you need a blood transfusion, doctors would know what type to give you. Type A cannot receive blood from a person who is type B or type AB as this would cause the body to fight the abnormal blood leading to severe illness or death. Type O is a universal donor which can be given to any blood type as it lacks the markers that the other three have.

Now to your blood cell number of 3.1 to 3.6. I assume this is referring to your red blood cells which carry oxygen to the various parts of the body. When red blood cell counts are low it is known as anemia. There are several causes for this. However, based on your letter, I believe your anemia is simply due to a lack of iron in your diet. Iron is found in several foods but is abundant in red meat which you say you rarely consume. I urge you to speak to your physician about this and ask if he or she agrees that an iron supplement is appropriate. This should eliminate the anemia. If it does not, I recommend further testing. If your physician refuses, ask to be referred to a hematologist (blood specialist) who can perform further testing and recommend treatment.

Also, I would like to add a small comment on your fish consumption. While fish is highly beneficial, your should limit your intake. Studies have found that mercury levels in the ocean is rising and several types of fish are accumulating it in their bodies. Swordfish, shark and similar large fish, if eaten in large quantities, may, in theory, lead to mercury poisoning. Continue to eat fish but consume farm-raised or small ocean fish. Salmon, cod, haddock and similar fish contain all the benefits but have limited exposure to ocean mercury levels.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I am only 47 years old and have been healthy my whole life. I need a diagnosis or at least a hint of what could be wrong with me.

DEAR READER:
I urge you make an appointment with a rheumatologist (immune system specialist).

Inflammation of the throat, sinuses, area behind the eyes, and anemia suggest to me you have an autoimmune disorder. These symptoms are common in Wegener’s Granulomatosis, a rare disorder that involves vasculitis (inflammation of the blood vessels). Wegener’s could also explain your Meniere’s type symptoms because ear infections are common and can cause hearing loss, tinnitus, pain, and more. Blood pressure is also affected by vessel inflammation.

I suggest you mention the possibilities of Wegener’s and vasculitis to the specialist, as well as requesting an anti-neutrophil cytoplasmic antibody test (positive in 80-95% of sufferers). Wegener’s may be fatal if left untreated so I urge you to seek medical help.

If I am off base, I apologize. However, based on your symptoms and tests, a rheumatologist is your best bet. You should also be tested further for rheumatoid arthritis, lupus and similar disorders to explain your abnormal rheumatoid factor and Ig antibodies.

I was hospitalized for each attack and during that time, various tests were done and found to be normal. The only thing that was different was my blood count. The first attack it was 8.1, second was 6.1 and the third was 5.1.

So far, I have had two colonoscopies plus two endoscopies. I was told during my last hospital stay that I have sores on my esophagus that may be contributing to the bleeding and that it should stop soon, but it hasn’t yet. I received 4 pints of blood which brought my blood count up to 9.7. I was still bleeding when they released me and continue to now that I’m home. I have not had any pain during these “attacks”.

At this point, I am not very confident in my doctor. Can you give me your opinion as to what could possibly be wrong? I would also like to know what kind of specialist doctor I should see.

DEAR READER: You are at risk of suffering fatal intestinal bleeding unless the source can be discovered and treated. In my opinion, you need to see a gastroenterologist for further testing. In particular, you need a study of your small intestine, in addition to the normal upper and lower bowel testing you have already had.

You have had severe anemia as a consequence of your blood loss. Therefore, I advise you not to wait. Ask your doctor to refer you to the specialist. If he has done that already, ask for a referral to a second specialist for another opinion. Don’t delay.

To give you related information, I am sending you a copy of my Health Report “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Bless his heart! He’s working 40 hours a week, and comes home to a nag who can’t understand why he’s tired. If taking naps is ruining a 50-year marriage, let her go! He may just perk up when her negativity walks out the door.

DEAR READER: I disagree with you. Sleepiness can be a symptom of depression, anemia, and a host of medical conditions that should be addressed. Perhaps the husband needs a sleep study to determine if his sleep pattern is disrupted several times a night. In my opinion, he should also have an exam by his primary care physician. If everything is normal, he may need counseling, but I don’t believe that breaking up a marriage is going to solve his wife’s anger and bring everything back to normal.

To give you related information, I am sending you a copy of my Health Report “Sleep Wake Disorders”. Other readers who would like a copy should send a self-addressed, 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.