Dear Dr. Roach: I have had pernicious anemia for about eight years and must have an injection of vitamin B-12 every three weeks to stay alive. I am also a diabetic for more than 10 years, with my A1C remaining in the 6.1-6.5 range over that time. My daily glucose level reading is very sensitive, almost overly so, to levels of stress in my life. Do you feel there could be any relationship between the pernicious anemia condition and my A1C? Because of the rarity of my condition (pernicious anemia), there seems to be very little, if any, research of its impact on various medical issues.
Pernicious anemia is not such a rare condition. It is an autoimmune disease where the body attacks cells that make acid in the stomach. Those cells also make a protein called intrinsic factor, which is necessary for efficient vitamin B-12 absorption. Without B-12, the body cannot make blood cells effectively, causing the anemia, but severe cases can cause damage to the nerves. Pernicious anemia is diagnosed now by finding the antibodies to intrinsic factor, and is treated by giving B-12 by injection, usually once a month, although a single injection in theory lasts much longer. B-12 can be absorbed orally if given in high-enough doses. A surprising number of my patients prefer shots, even though oral treatment is just as effective.
The hemoglobin A1C looks at the amount of sugar on the hemoglobin molecule. Hemoglobin is the major oxygen-carrying protein of the blood. Conditions that affect the life of the red blood cell will affect the A1C. However, this is much more a factor in people with other types of anemias, such as sickle cell disease. In that case, checking many blood sugars and looking at the average may be a more effective way of monitoring diabetes. Treated pernicious anemia should not affect the A1C.
Dear Dr. Roach: Six days ago, my father had bypass surgery. Coughing with phlegm started on the day after the surgery and it hasn’t stopped yet. Right now, it is even worse than it was in the beginning. Is this normal? Usually my father smokes a lot and even after surgery he is smoking about 10 cigarettes a day. Can smoking be the cause of the coughing? In several articles I read that coughing after surgery is normal but that it lasts for only a few days. My father is still coughing six days after surgery. This is why I’m worried.
Smoking can indeed be the cause of coughing, but coughing after surgery is sometimes a result of serious complications, such as partial lung collapse or pneumonia. A call or visit with the surgeon’s office would be a good idea. They would have a great deal of experience at telling worrisome causes of coughing from the routine post-surgery cough.
Quitting smoking is the single most important thing your father can do to improve his overall health, especially given a history of heart blockages.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu