Hereditary spherocytosis

DEAR DR. ROACH: I am 75 years old and have had spherocytosis since birth. I am extremely tired all the time, and it seems to be getting worse.

I currently take amlodipine for blood pressure, rosuvastatin, folic acid (400 micrograms) and a multivitamin. What can I do, and what medications can I take to give me more energy so I am not lying down all day?

ANSWER: Hereditary spherocytosis is a condition of abnormal red blood cells, seen in only 1 in 5,000 people. As the name suggests, the red blood cells are shaped like balls (“sphero-”), rather than the doughnut shape that helps them get through very small blood vessels. In hereditary spherocytosis, the blood cells are more likely to break, causing a chronic anemia.

Folic acid is an important nutrient in anyone making many red blood cells, but you already are taking a reasonable dose.

You should have your hemoglobin level checked, and if your count is too low, a transfusion should be considered. However, there are many, many causes of tiredness and fatigue, so if your blood count is near-normal, it’s time to look for other causes.

DEAR DR. ROACH: I have mandibular tori. What in the world got this started? Was it medication or something catching, like from the dentist? I am 92 and don’t want it to get worse.

ANSWER: The mandible is the lower jaw, and a torus is a bony growth. They usually are present on both sides, so they are called tori. A torus also can be present on the hard palate. They may grow slowly over time.

It’s not clear where they come from, but they are more common in men and in people who grind their teeth, so they are thought to arise from stress in the bone.

They are of no concern and do not need to be treated unless they are bothering you. Occasionally they get so big that they interfere with eating or speech. If that’s the case, they can be treated surgically. Tori are quite common, but I have never referred a patient with a torus for surgery.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.