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Pernicious anemia
Mar 28, 2002

Dear Dr. Bob,

I first need to send you a BIG thank you from the bottom of my heart! I have been struggling with the ups and downs of testing and fearing the worst for 10 months. I have been following the postings of The Body for months, but until recently I had never read your site. I was actually laughing instead of crying while I was reading your responses!

I will spare you all the details, but this American female was "wooed" by an Italian stallion while on vacation and had a lapse in judgement while under the influence of alcohol. I am not sure of all the details, but I believe there was a definite/significant risk and from my subsequent contacts with this "stallion", he likes his "mares". Multiple, multiple tests have come back negative and I have not had any other exposures, so New York Jack is probably cursing another worried well (SORRY). Through some counseling I am starting to accept the test results, though I have not been able to flip that woohoo switch and move on!

But, to get more to my question, which is about anemia. I was diagnosed with anemia back in 1993 with the doctor prescribing iron pills, which I discontinued due to the pain they caused in my gastro tract. I had no other treatment. I have recently undergone some lab work-up showing normal blood counts and "no anemia". I feel chronically tired and cold with my nailbeds at times purplish (usually around my period). I have had more of a whitish tongue, more predominint on the posterior 2/3. I was convinced this was oral thrush...one doctor said it looked "yeasty" but not "thrushy" (her words!!) while my dentist says it looks normal. I am brushing by tongue like I am on a serious mission, but it returns and will "hold" the color of whatever I may have ate/drank...gross!!! I read a posting from you about pernicious anemia and the lack of the "intrinsic factor" causing some tongue changes. Could you elaborate on this and provide some symptoms of this type of anemia...would the "typical" blood work-up necessarily find this type of anemia?

Your response would be greatly appreciated, along with some of the Dr. Bob humor and sarcasm! I thank you again, even if you can not get to this question as you have already helped me tremendously!!!! I pray that my small donations to the AIDS fight will help as much as you and other professionals have helped me over these last 10 months. God bless!!!

Response from Dr. Frascino

Hi,

I would hope all my Italian Stallion buddies would be wise enough to protect their "mares" (and other stallions for that matter) by wearing the appropriate protection. I'm glad to hear you are starting to accept your negative test results. That way, you can go from being "wooed" to being "woo-hooed."

Anemia is a very common condition, HIV-positive or not. Iron deficiency is one of he more common causes. Fatigue and intolerance of cold can be a sign of anemia, but also a sign of other conditions as well, such as a thyroid problem. Nail beds are usually pale (whitish) when one is anemic. Purplish nails usually means you visited the wrong manicure parlor.

"Yeasty?" "Thrushy?" Sounds like baby talk! Is your doctor a pediatrician? She sounds a bit "loony" to me. I'd believe the dentist.

Brushing the tongue in moderation is good oral hygiene, but being "on a serious mission" with that brush could be part of the problem. You could be brushing away the top layer of your tongue and that could contribute to you noticing that lovely color your tongue gets whenever you drink wild berry Kool Aid. So take it easy with that brush!

Is it pernicious anemia? No. First of all, you'd be anemic (hemoglobin less than 12 g/dL). Second, the tongue changes of pernicious anemia are not similar to what you describe.

OK, that's it. So take that toothbrush out of your mouth, give your tongue a rest, believe in those negative tests, keep smiling, keep laughing, and don't give up on all Italian stallions. Just make sure that stud is dressed for the occasion!

Stay well.

Dr. Bob


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