Hello, dear readers, and welcome to a bonus letters column. We have some interesting questions to address and will get right down to business.

-- A column about a study that found resistance training yields benefits for adults in their 80s and 90s -- and older! -- got quite a bit of interest, including this letter from a reader: “I do wish you had told these folks that lifting weights doesn't have to mean really heavy weights. I imagine a lot of people have an image of weightlifting involving pressing 300 pounds,” he said. “If you write on this subject again, you can do older adults a great service by letting them know that benefits can be had from weights as light as 2 to 5 pounds.” Thank you for making an excellent point. When you begin weightlifting, you want to exercise at your existing level of fitness. Older adults can begin with weights as light as a pound. Through repetition, and with proper form, they can gain strength. If desired, they can gradually move up to heavier weights.

-- We heard from a reader asking about the biopsy she recently underwent. “After a breast biopsy, they installed a titanium marker,” she wrote. “Do I need to worry about that if I get an MRI in the future?” This type of tissue marker, sometimes also known as a clip, is used to identify a specific site from which cells were taken during a biopsy. Its presence allows doctors to locate the precise area in future scans and if treatment is needed. These types of markers are about the size of a sesame seed and cannot be felt. They can safely remain in place during an MRI and will not set off a metal detector.

-- A recent column discussed how the stigma associated with hearing aids can prevent some people from using them. An otolaryngologist in Chicago has shared his approach to the challenge. “In these cases, I often recommend the family try a ClearCast PAL, a personal assistive listening device,” he wrote. “This is an FDA-registered medical device that works really well to help seniors hear conversations and the television clearly without having to rely on hearing aids. In my experience, there is little reluctance to trying this product as it looks like a set of headphones. It is also very easy to put on and take off, so the user can use it when they want.” Thank you for this suggestion. The device you mention falls into the category of assisted listening systems, or ALS. Some people with hearing loss find these easier to use, and also more affordable, than hearing aids. They are not a replacement for hearing aids, but can be a first step to the management of hearing loss.

Thank you, as always, for taking the time to write to us. We love hearing from you. It is time for a reminder that we cannot examine any medical records or data, offer a diagnosis, comment on treatment plans or offer a second opinion.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My husband is having an elective surgery soon. It requires full anesthesia, so he has had a lot of pre-op tests. One of the blood tests showed that his red blood cells are too big. The nurse said it happens when you drink too much. What causes that? Is it dangerous?

Dear Reader: When someone’s red blood cells become abnormally large, it is a condition known as macrocytosis. These enlarged blood cells are nutrient-poor and break down faster than normal cells. The name of the condition derives from Greek, with “macro” meaning large in scale, “cyto” referring to cells and “osis” indicating an abnormal condition.

Unless it is quite severe, macrocytosis usually does not cause any noticeable symptoms. As a result, it is often discovered in the course of routine blood tests, such as the pre-operative workups your husband was asked to undergo. Those workups typically include a test known as a complete blood count, or CBC. The size of someone’s red blood cells is one of the findings included in a CBC.

Macrocytosis isn’t a disease or disorder. Rather, it is a sign that an underlying health condition may be present. It is often linked to a deficiency of vitamin B12, which is absorbed from the blood and stored in the liver. B12 deficiency is common in people who abuse alcohol. Chronic alcohol abuse leads to widespread inflammation of the liver, and over time it will cause liver damage. That damage reduces the body’s ability to absorb, store and release B12, which in turn can result in macrocytosis.

Malabsorption of B12 can have other causes, as well. These include conditions such as Crohn’s disease or celiac disease, hemolytic anemia, bacterial overgrowth, bariatric surgery, certain cancers and intestinal parasites. The use of certain medications can also impair absorption of B12 and lead to a deficiency. These include proton pump inhibitors and H2 blockers, which are used to manage acid reflux; some chemotherapy drugs; and colchicine, which is used to treat gout. It is also possible to become deficient in vitamin B12 when following a vegan diet, which excludes food products made from and by animals. Because B12 is not produced by plants, vegans must be vigilant about using supplements and eating foods fortified with the vitamin to maintain adequate levels. Generally poor nutrition in any type of diet can lead to low folate levels, also a factor in macrocytosis.

If alcohol use is suspected as a cause of this condition, the person may be asked to undergo a liver function test. It can either pinpoint or rule out the liver as the source of the individual’s B12 deficiency. Other types of blood tests can identify whether the condition is linked to problems in blood cell development. A bone marrow biopsy can also reveal issues with red blood cell production.

If macrocytosis is linked to B12 deficiency, steps are taken to improve the individual’s diet and address any issues of malabsorption. And when alcohol abuse plays a role, a conversation about either moderation or abstinence is likely to take place.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: A man I have been dating had a stroke a few weeks ago, and now he has aphasia. When I visit him at the rehab, he’s ready for me to leave after a short time. Is this normal? He seems to be happy I’m there, but he dismisses me quickly. I’m trying not to feel hurt.

Dear Reader: A stroke occurs when something prevents blood from reaching the brain. The most common cause is a blockage in the blood vessels that serve the brain. Known as an ischemic stroke, it is often due to the presence of a blood clot, but it also can occur due to a narrowing of the blood vessel itself. In the other major form of stroke, known as a hemorrhagic stroke, a blood vessel develops a tear or completely ruptures.

Any type of stroke deprives the brain of oxygen and nutrients. In a short period of time, brain cells begin to die. This can cause a wide range of symptoms, including aphasia. This is a disorder in which it becomes difficult to understand and engage in spoken and written language. Someone with aphasia may speak in garbled sentences, be unable to find the proper word, speak in halting or choppy sentences and be unable to follow a conversation. These same difficulties can apply to writing and reading.

The physical effects of a stroke are typically the most obvious. However, our brains are also home to various regions that oversee emotion, behavior and cognition. It means this type of brain injury can cause a wide range of emotional and behavioral changes, as well. These include confusion, inattention, irritability, forgetfulness and carelessness. People who have experienced any type of catastrophic health event can be overwhelmed by the sudden change to their circumstances. That often leads to feelings of depression, grief, fear, anger and frustration.

It is important to remember that someone who has had a stroke tires quickly. That means not just physically, but emotionally and mentally, as well. It is also easy for them to experience sensory overload. Situations and settings that previously had been effortless, including a visit from a loved one, can quickly become a burden. After a stroke, the brain is physically healing and rewiring. This is particularly true with recovery from aphasia. As a result, it is entirely possible for this man to be genuinely glad to see you, and also to need your visits to be brief. If possible, ask the staff for guidance on the length of a visit and what interactions will be the most beneficial.

If you find these visits to be difficult or emotionally upsetting, you might consider seeking out a stroke recovery support group for family and caregivers. You will meet other people who are facing the same challenges as you. It can help you navigate your own feelings during this stressful time and understand what comes next. A wealth of information about stroke, as well as a searchable database of support groups, is available at the American Stroke Association website, stroke.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)