Dear Dr. Donohue: Five years ago I had my first colonoscopy. The doctor told me I had diverticulosis. He said if I keep my fiber intake over 35 grams a day, I can eat whatever I want. I have a friend who had colon cancer 20 years ago. Her doctor told her that she has diverticulosis and a hole in her colon. Another man told her that he has several holes in his colon from diverticulosis. What causes these holes? And why do so many people have diverticulosis? — L.R.
\Answer: Let me give you a clear picture of diverticulosis. A diverticulum is a tiny pouch that springs up on the outside colon wall. Dry, hard stool makes the colon work very hard and makes it generate great force to push undigested food through it. That same force drives the colon lining through the colon wall, where it forms a tiny, pea-size bulge like an inner tube bulging through a tire. That’s a diverticulum. The diverticulum still communicates with the center of the colon through a tiny opening. I believe that the opening of the diverticulum must be the hole that your friends speak of. If the opening of a diverticulum becomes plugged, then the bacteria inside of it multiply and cause the diverticulum to expand. The expansion can become so great that the diverticulum bursts. That is diverticulitis, a painful and potentially dangerous condition. So many people in industrialized countries have diverticulosis because their diets consist of refined grains — grains with their outer bran coat removed. Bran is an excellent source of fiber. Without fiber, undigested food dries out and begets the forces that end up producing diverticula. That’s why diverticulosis is so prevalent in Canada and the United States. Our diets are devoid of fiber. Do what your doctor told you, and you won’t come down with diverticulitis and won’t form more diverticula. The diverticulosis booklet describes this condition, how it’s treated and how it’s prevented. Readers can obtain a copy by writing: Dr. Donohue — No. 502W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I’ve been told that if you ingest more salt than your body requires, the body can slough off the excess if you increase your water intake. Is that true? — G.S.
\Answer: That’s false. In fact, the extra salt holds onto fluid. The kidneys are excellent chemists, but they can do only so much. If a person overwhelms them with too much salt, they can’t get rid of it all. Much of it stays in the body and holds onto fluid.
\Dear Dr. Donohue: What happens to artery buildup when one stops eating trans fats? — M.C.
\ Answer: It takes a lot of work to reverse artery buildup, but it can be done if a person carefully watches the amount of saturated fat, trans fat and cholesterol eaten. You have to do other things too. You have to keep blood pressure in the normal range. You have to exercise regularly. You can’t smoke."; drDArticle[2] = "Dear Dr. Donohue: I would like to know more about hepatitis C. I know sex, childbirth and sharing hypodermic needles with drug users can pass it on. Can a person contract it from using the same toilet as an infected person or from using such a person’s cups or dishes? — D.S.
\Answer: Hepatitis C is anything but a seldom-seen illness. Around 4 million Americans have it. The initial illness — acute hepatitis — brings symptoms like fatigue, nausea and vomiting. Rarely does it cause yellowing of the skin and whites of the eyes. Most get over the acute sickness in a short time. In fact, the largest number of infected people never have a single day of illness and never know that they are infected. The virus, however, stays in the body for life in many and can continue to wreak havoc in the liver. Twenty years down the road, about one-fifth of those infected will have developed liver cirrhosis, and some will have come down with liver cancer. The chief route of viral transmission in North America is sharing of contaminated needles for illicit drug injection. Having multiple sex partners is another important route of infection. However, transmission from an infected marital partner to a spouse is possible but not common. Medical personnel can catch the illness through an accidental needle stick from an infected person. Infected mothers can transmit it to their babies. Blood transfusions, once a great contributor to spread, rarely pass the illness now that all blood is checked for the virus. And there is a category of people whose source of infection is not known. The illness is not picked up from toilet seats. Using cups, plates or eating utensils of an infected person doesn’t spread it. Neither does kissing or hugging an infected person. It is not wise, however, to share things that might have blood on them — for instance, razors or toothbrushes. Hepatitis C is treatable but not always curable. The medicines are interferon and ribavirin. The pamphlet on all the hepatitis viruses explains the illnesses they cause and their treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 503W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Will you assure my mother that it is OK to take the anxiety medicine her doctors recommend? She thinks it is a weakness to use such medicine. When she takes it, she is happy. When she doesn’t, she is miserable. — M.M.
\ Answer: Anxiety prepares us to fight or flee when danger arises. Constant anxiety is not normal. It takes its toll on the heart, on blood pressure, on the digestive tract and on just about all organs. It does not come from a moral weakness. It comes from a mix-up in the production of brain-messenger chemicals. Medicine can correct such an imbalance, and your mom should not hesitate to use it."; drDArticle[3] = "Dear Dr. Donohue: I am seeking advice for my dad. He is 75. He has gone to doctor after doctor, to no avail. He sits in his recliner 24/7. He has been diagnosed with spinal stenosis and arthritis. He is so bent over, it’s pathetic. He says his back feels weak. He walks with a shuffle. Any suggestions? — C.D.
\Answer: Stenosis is a narrowing and, spoken of here, it refers to the spinal canal. The backbone — the spine — is a series of blocklike structures called vertebrae, which are stacked one on another. The spinal cord is a delicate structure, about the width of a little finger, that runs from the top of the neck to the lower back. It passes through a tunnel in the spine — the spinal canal. Narrowing of the canal — spinal stenosis — puts pressure on the spinal cord or the nerves that emerge from it. When the process develops in the lower back, as it often does, it generates pain in the back. The pain often runs down into the buttock and leg. Sometimes there is numbness, tingling or muscle weakness. Arthritis of the spine is often responsible for spinal stenosis. It leads to bone spurs that compress spinal nerves. Thickening of spinal ligaments can also squeeze the cord, spinal nerves or both. Your dad needs a physiatrist (fizz-EYE-uh-tryst). This doctor is not a psychiatrist. Physiatrists are specialists in rehabilitation medicine. They devise exercise programs for people like your dad. They prescribe medicines for pain and evaluate back patients to see if they are candidates for steroid injections to mobilize the spine. They can also assess people’s potential for spinal surgery to enlarge the spinal canal or to remove bone spurs or anything else that might be compressing the cord or nerves. They can tell you if your dad is a candidate for newer treatments such as spacers. Spacers are devices that push spinal structures apart to give the cord and spinal nerves some breathing space. Your dad must become more active, if that’s possible. Disuse is going to weaken all his muscles. The back booklet gives a rundown on the many causes and treatments for back pain. Readers can order a copy by writing: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Is it better to drink diet pop or regular pop? — B.
\ Answer: It’s OK to drink either if you do so in moderation — one or two cans a day. Regular pop has a hefty supply of calories, about 150 for 12 ounces. You don’t get any other nutrients with those calories — no minerals, no vitamins, no fiber. Sugar in regular pop promotes tooth decay. Diet pop has no sugar, so that’s something in its favor. Caffeine in either form of pop puts women at risk for coming down with high blood pressure if they drink four or more cans a day."; drDArticle[4] = "Dear Dr. Donohue: Please explain the difference between Protonix and the other medications available for GERD. I have been on Protonix for nine months, and no one is able to give me a clear definition. — E.S.
\Answer: Heartburn, acid reflux, hiatal hernia and gastroesophageal reflux disease are different names for the same condition — the upward spurting of stomach acid and digestive juices into the esophagus, the long muscular tube that stretches from the throat to the stomach and through which food travels to arrive in the stomach. The medicines that are the most powerful in suppressing acid production, and therefore in quieting heartburn symptoms, are proton pump inhibitors. “Proton” is another word for “acid.” There are five of them: Prevacid, Prilosec, Nexium, Aciphex and your Protonix. They work in a similar fashion. Each has its own slightly different profile and its own slightly different set of side effects. Which is best? The best one for you is the one that stops your heartburn, causes you the fewest side effects and costs the least. There are many other GERD medicines — simple antacids like Maalox, for example. Tagamet, Zantac, Axid and Pepcid cut acid production in different ways from the proton pump inhibitors. If they work for a person, then he or she should stick with one of them. Raising the head of the bed with 6-inch blocks under the bedposts or lying on the left side while asleep keeps stomach acid in the stomach and can put an end to some people’s heartburn without resorting to medicine. Staying away from caffeine, citrus fruits and juices, tomatoes and tomato products, chocolate, peppermint, onions and fatty or fried foods is another approach to minimizing heartburn symptoms. The booklet on GERD (heartburn and hiatal hernia) explores this topic in full. Readers can order a copy by writing: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: A psychiatrist recently diagnosed my 20-year-old granddaughter with dysthymia. Can you explain what it is? — B.L.
\Answer: Dysthymia is sadness that lingers for no good reason. It’s not quite the depths of dejection that qualifies as a major depression, but it is a state of a down mood that affects a person’s life and work. Dysthymic people have little energy, have poor appetites, are unable to sleep or sleep excessively and are consumed with pessimism. With direction from a mental health professional and perhaps with medicines to right any imbalance of brain chemistry, most dysthymics can obtain relief.
\Dear Dr. Donohue: I am 67 and have high blood pressure, high cholesterol and arthritic knees. Walking was my favorite exercise, but knee pain now prevents that. What exercise would be best for my knees? — R.C.
\ Answer: Swimming would be the ideal exercise. Even if you don’t know how, 67 is not too old to learn. You also could do water aerobics — exercising in the water. Water provides buoyancy that protects your knees."; drDArticle[5] = "Dear Dr. Donohue: I have never seen you address ductal carcinoma, in situ, of the breast. My daughter, 46, has it and just had a second incision to get clean borders. I am optimistic about my daughter’s recovery. She is scheduled for radiation. The cancer was missed on mammograms but was picked up on an MRI. There is no cancer history in our family. I wonder, since this cancer was in place and had not spread, if she needed to have surgery and go through all this. Any light you can shed will be appreciated. — M.N.
\Answer: Body cells sit on a thin floor called the basement membrane. An “in situ” (in place) cancer is one where the cancer cells have not penetrated the basement membrane. It’s a very superficial cancer, one that has not invaded adjacent tissues or cells. An in situ cancer has the greatest chance for complete cure. Such a cancer is an early cancer. You have every right to be optimistic. Ductal breast cancer (carcinoma) is one that arises in the breast’s milk ducts. Your daughter needed all the treatment she got. Ductal cancer can infiltrate neighboring tissue and can spread to distant sites. Your daughter’s cancer was caught before this happened. Without the treatment she got and is getting, her ductal breast cancer could have been lethal. The booklet on breast cancer gives a comprehensive coverage of this topic. Readers can obtain a copy by writing: Dr. Donohue – No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I would like to know why you lose flesh with age, but not bone, nor skin nor fat. One doctor told me that’s why people get colder when they get older. I am rapidly losing flesh. — L.J.
\ Answer: People lose muscle with age. The process is called sarcopenia (SAHR-coe-PEA-knee-uh). I never thought of it until you brought it up, but it could be a reason why older people chill quickly. Muscles generate heat, and they serve as insulation. Shivering is a response to a cold environment. Shivering muscles give off heat. Lots of unpleasant things happen with aging. Metabolism slows, and that’s another reason why older people complain of the cold. Our bodies don’t repair themselves as well as they did when we were young. Bones do lose strength and size with age. Growing old is not for the faint of heart. Sarcopenia and bone loss can be kept to a minimum and possibly reversed if people exercise. The kind of exercise they must do is “resistance” exercise – lifting weights. It sounds nutty, but it’s for real. Weights don’t have to be of the same magnitude that people use to prepare for a bodybuilding contest. You can start with one–pound weights and gradually increase the poundage when you become comfortable with that amount of weight."; drDArticle[6] = "Dear Dr. Donohue: When my son was in high school, he was diagnosed with epilepsy. His first and second seizures occurred at school. No one there had any training on how to handle a seizure. I am writing to ask you to explain to people what a seizure is and how to help a person having one. There is so much misinformation about this. My son, incidentally, has graduated from college and has not had a seizure in the past five years. — L.L.
\Answer: Most people are frightened when witnessing a seizure and are at a complete loss about what they should do. There are many seizure varieties, but I’ll confine my remarks to a grand mal seizure, the kind with the most dramatic manifestations. All seizures are sudden, excessive electrical discharges from brain cells. A grand mal seizure affects most of the brain, and that’s why its signs are so striking. Quite often, it occurs without warning. The person stiffens and might make a loud moaning noise. He or she then falls to the ground and makes a series of jerking movements of the arms and legs as muscles contract and relax rapidly. The jerking usually lasts about half a minute to a minute. Bystanders who have never witnessed a seizure are unnerved by it. Invariably, one will try to pry open the seizing person’s mouth so the person doesn’t swallow the tongue. That’s the wrong thing to do. During a seizure, people never swallow their tongues. Onlookers should not try to restrain the arms or legs. They should place the seizing person on his or her side to keep the airway open, and they can loosen the collar or tie. The seizure will run its course in a short time. Once the muscle contractions have stopped, the person is unconscious for a while and gradually awakens, confused. The best course is to offer the person transportation to a place where treatment can be given if needed, or to call 911 for help.
\Dear Dr. Donohue: I caught my fingers in a closing door. Two fingernails have turned black. I don’t want my nails pulled off. How can I get them back to normal? — S.F.
\Answer: If the black is pooled blood, a doctor can bore a tiny hole into the nail and let it out. If the blood has congealed, it has to stay there and you have to wait until it’s absorbed by the body, which will happen in time. That might take a couple of months. If the nails themselves have become discolored, then it takes six months for a new nail to grow from the base to the nail tip.
\Dear Dr. Donohue: What happens to artery buildup when one stops eating trans fats? — M.C.
\ Answer: It takes a lot of work to reverse artery buildup, but it can be done if a person carefully watches the amount of saturated fat, trans fat and cholesterol eaten. You have to do other things too. You have to keep blood pressure in the normal range. You have to exercise regularly. You can’t smoke."; drDArticle[7] = "Dear Dr. Donohue: I am a 52–year–old lady with bad varicose veins in both my legs. How did I get them? My legs get tired easily, and they hurt if I have to stand for any time. A friend told me about an injection in the veins that gets rid of them. Can you tell me what that is? My husband has them too, and he’s also interested in getting rid of them. I didn’t know men got them. — L.T.
\Answer: Varicose veins are dilated, gnarly leg veins that aren’t limited to women. Men get them too, but women with varicose veins outnumber men by a factor of 2–to–1. You got them like most people get them. There’s a strong family influence in coming down with varicosities. Pregnancy, jobs where people must be on their feet for long times and obesity are other factors that generate such veins. I just learned that taller people have them more frequently than shorter folks. The basic problem is faulty vein valves. Veins are equipped with valves that close shut as blood passes by to keep it from falling back down. If leg-vein valves aren’t working, blood does fall back down, and it stagnates in the legs and dilates the veins, causing them to balloon. You can do some things on your own to improve the situation. Take a couple of breaks during the day when you can lie down with your legs raised above heart level. Compression stockings keep blood flowing upward in leg veins. The best are ones that are specially fitted for your legs and that have more compression at ankle level than at thigh level. Removal techniques are many. You ask about sclerotherapy. In that procedure, a solution that irritates the veins’ inner lining is injected into them. The lining sticks to itself, and the vein collapses. It’s not used for all veins. It doesn’t work well for very large ones. Catheter ablation is another newer technique where a thin, flexible tube — a catheter — is threaded into the veins. The catheter has a probe that emits radio waves that heat the lining and cause the vein to shrivel. The menu for varicose–vein treatment is large; this is only a small sample of what can be done. The booklet on varicose veins explains this condition in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 108W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Please explain the meaning of “homonymous hemianopsia.” I am a senior and a diabetic. Does it have anything to do with either? — J.B.
\ Answer: Hemianopsia is a loss of half the visual field. For example, a person can see from the center to the right but not from the center to the left. Homonymous (hoe–MON–uh–mus) indicates that both eyes have the same defect. Head trauma, brain tumors, strokes and a few other conditions cause such a vision loss. Diabetes and aging are not common causes.."; drDArticle[8] = "Dear Dr. Donohue: Will you write about dizziness? What causes it? What can be done for it? — M.H.
\Answer: Dizziness — vertigo — is a sensation that you or the world around you is whirling like a merry-go-round. It’s not light headedness, which is the sensation of being on the verge of fainting. The ear is more than the organ of hearing; it’s also the balance organ, sending information to the brain, telling it where we are in space and making us feel firm-footed. With impairment of the body’s balance organ, dizziness results. Dizziness also can come from a misfiring of the nerve that transmits balance sensations to the brain or to the part of the brain that reads the balance input. However, most of the time, it’s an ear problem. Vestibular neuritis is a viral infection of the hearing nerve that causes dizziness. It comes on suddenly and produces such vertigo that a person has to stay in bed for a day or two. Severe dizziness leaves in a week or more, but residual effects can last for months. Phenergan, Antivert and the scopolamine patch can reduce this sort of dizziness. Meniere’s disease consists of recurring episodes of dizziness, hearing loss and ear ringing. Between episodes, things return to normal. With the passage of time, however, intervals between spells become briefer and symptoms last longer. Treatment for this condition is more complicated. Benign positional vertigo is a common cause of dizziness. When a person turns over in bed, turns the head or looks up to search for something on a top shelf, vertigo strikes. Sometimes people can treat this kind of dizziness with a series of the following maneuvers. The affected person sits on a bed and turns the head to the right. That position is held for half a minute and returned to the original position. Then the body is lowered to the bed so the head projects over a pillow at neck level. The head is turned to the right again and held there for 30 seconds. Then it’s turned to the left for 30 seconds. At that point, the person rolls onto the left side for another 30 seconds. This drill is repeated two more times, and the series of exercises is done three times a day. If the movements make dizziness worse, stop. Self-treatment might not get you anywhere. If that’s the case, an ear, nose and throat doctor should be asked to step in. The vertigo pamphlet describes dizziness in detail. Readers can order a copy by writing: Dr. Donohue — No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have pain in one knee. What kind of doctor should I see? — M.M.
\ Answer: A family doctor. He or she can examine the knee and usually come up with a diagnosis and treatment. If the doctor cannot, then he or she will refer you to the appropriate specialist — a rheumatologist or an orthopedic surgeon."; drDArticle[9] = "Dear Dr. Donohue: My wife’s mobility has been quite limited by her breathing difficulty from COPD — chronic obstructive pulmonary disease. Are there some measures you might suggest that could enable her to start very gradually on an exercise program to build some muscle strength, especially leg-muscle strength? — E.M.
\Answer: Emphysema and chronic bronchitis are the two chronic obstructive pulmonary diseases. Most people with COPD have a touch of both illnesses. Emphysema is a destruction of the lung’s air sacs. Shortness of breath on slight activity is its hallmark symptom. Oxygen cannot get into the blood through damaged air sacs, so people are constantly short of breath. Chronic bronchitis is irritation of the airways, the bronchi. Cough with thick sputum is its major symptom. Exercise isn’t easy for people with COPD, since they become breathless so quickly. Exercise is necessary for the very reason you state. COPD patients tend to sit most of the time. Their muscles become deconditioned, and that’s another impediment to these people being active. Interval exercise usually can be tolerated. On a stationary bike, interval exercise means pedaling somewhat quickly for only 20 seconds and then slowing down for the next 40 seconds. Repeating these cycles as many times as possible builds muscle strength and helps COPD patients achieve mobility. The same kind of training can be done while walking or swimming. Breathing through pursed lips helps a person with COPD. These people should inhale through the nose to a count of four then exhale through pursed lips to a count of six. Pursed lips are lips held like one would do when whistling. While exercising, COPD patients should lean slightly forward at the waist to give the lungs more room to expand. The booklet on COPD provides detailed information on this common malady. Readers can order a copy by writing: Dr. Donohue — No. 601W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: A psychiatrist recently diagnosed my 20-year-old granddaughter with dysthymia. Can you explain what it is? — B.L.
\Answer: Dysthymia is sadness that lingers for no good reason. It’s not quite the depths of dejection that qualifies as a major depression, but it is a state of a down mood that affects a person’s life and work. Dysthymic people have little energy, have poor appetites, are unable to sleep or sleep excessively and are consumed with pessimism. With direction from a mental health professional and perhaps with medicines to right any imbalance of brain chemistry, most dysthymics can obtain relief.
\Dear Dr. Donohue: I need to know what is considered normal when it comes to menstrual cycles. Please tell me. — R.K.
\ Answer: Most women have cycles that last from 21 to 35 days. For 90 percent of menstruating women, bleeding lasts seven days. A little more than 1 ounce of blood (30 to 35 ml) is lost with each cycle. That amount of bleeding requires three to five pads a day."; drDArticle[10] = "Dear Dr. Donohue: My mother-in-law had chest pain in the center of her chest. The emergency-room personnel told her it was indigestion. By the time it was diagnosed as a heart attack, 24 hours later, it was too late to save her. Please add this to your description of heart-attack pain. — N.N.
\Answer: People experience a huge variety of different pain sensations on having a heart attack. The pain is described as burning, crushing, pressing or squeezing. It can be felt under the middle of the breastbone or in the left side of the chest. It may spread to the right side of the chest, the left or right shoulder and arms, the upper back, the neck, the jaw or the upper abdomen. One usually consistent feature of the pain is that it lasts for half an hour or more. There is so much variability to heart-attack pain that other clues have to be taken into account in order not to miss an attack. One-quarter of heart-attack patients have no pain. Fatigue can be the sole symptom — a fatigue that is not sleepiness but such a total loss of energy that it’s hard to hold the head up. Nausea and vomiting can accompany a heart attack or can be the only signs of it. Sudden shortness of breath is another common sign. Tests confirm a heart attack. The EKG usually shows clear evidence that a heart attack is occurring or has occurred. Blood tests are also helpful. Creatine kinase is an enzyme found in heart muscle, and a rise in its blood level is a tip-off of a heart attack. The same goes for the blood test for troponin, a protein found in heart muscle. Your mother-in-law’s story is not something that happens often, but it is something that does happen. A patient might have none of the signs or symptoms of a heart attack. All tests might be normal. The patient is dismissed, only to die at home — a tragic chain of events about which everyone is desolate. Heart attacks and related problems are North American’s No. 1 killer. The booklet on this subject explains what’s happening and what to look for. Readers can obtain a copy by writing: Dr. Donohue — No. 102W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\ Dear Readers: Some time ago, a reader asked if I knew of any organization that accepts used orthopedic devices like crutches, canes, braces and splints. I didn’t, but I asked readers if they had suggestions. They did. I’ve gathered some of them for publication now and hope to mention the rest at a later date. I want to thank those who were kind enough to write. The following organizations distribute such devices to people in need: The Lending Cupboard Society of Alberta, 5406 C 43rd Street, Red Deer, Alberta, Canada, T4P 1C9; Elks Lodges and Senior Centers (many locations); local posts of the Veterans of Foreign Wars; in the St. Louis area, check www.equipyourneighbor.org; many local hospices."; drDArticle[11] = "Dear Dr. Donohue: This question is one I cannot ask my family physician. I take about 15 laxatives a day — all at once — and have been doing so for about two years. I feel I am really doing myself harm, but I can’t seem to wean myself from them. Your thoughts are appreciated. — A.B.
\Answer: You’re going to need your family doctor’s input in getting you over the laxative habit. The doctor isn’t going to recoil in disgust or swoon on hearing this. He or she has heard the same story many times. The dangers of laxatives have been overstated in the past, but taking 15 a day is a bit much for anyone’s colon. There are four general classes of laxatives. I don’t know which you’re taking, so I’ll spend a moment on each. Osmotic laxatives pull water into undigested food. MiraLax, Cephulac, Enulose and milk of magnesia belong in this class. They have few side effects. If your stools are loose and voluminous, you can lose minerals like potassium. That applies to all laxatives. Bulking laxatives attract water into the food residue too. Metamucil, Citrucel and psyllium are such laxatives. So is fiber. And fiber can safely replace the 15 laxative pills you take. As you decrease the number of your laxative pills, increase the amount of fiber you eat. Do this slowly; too much fiber gives you gas and bloating. Drink more fluid than you usually do. Fruits, vegetables and whole grains are fiber sources. We’re supposed to get around 25 grams a day. An apple with skin has 4.7 grams; a carrot, 4 grams; 1 ounce of All-Bran cereal, 14 grams; 6 prunes, 8 grams; a cup of baked beans, 9 grams. If all 15 of your pills are bulking agents, you’re not in deep trouble at all. Stool softeners act like soap to promote the mixing of food and fluids. They keep stools moist and soft. Colace is an example. Stool softeners don’t get people into dire straits. Stimulant laxatives irritate the colon wall and cause it to contract more forcefully. If taken in large amounts, they have the potential to disturb colon action, but the colon can return to normal when a person eventually gets off them. Senokot and Cascara are stimulant laxatives. Do tell your doctor, who can work with you to get you over your laxative habit. The booklet on constipation and laxatives treats this topic in depth. To order a copy, write: Dr. Donohue — No. 504W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am 67 and have high blood pressure, high cholesterol and arthritic knees. Walking was my favorite exercise, but knee pain now prevents that. What exercise would be best for my knees? — R.C.
\ Answer: Swimming would be the ideal exercise. Even if you don’t know how, 67 is not too old to learn. You also could do water aerobics — exercising in the water. Water provides buoyancy that protects your knees."; drDArticle[12] = "Dear Dr. Donohue: I had stomach pain for two weeks and finally had an ultrasound of my abdomen. Nothing bad was found, except for a fibroid in my uterus. The doctor said this had nothing to do with my pain. He must be right, because the pain went away. Do I need to pursue the fibroid thing any further? The doctor never said I should. — L.C.
\Answer: Fibroids are benign (not cancerous) growths of the uterine muscle. The uterus is a muscular sac with a specialized lining for the support of a developing fetus. Fibroids are very prevalent. Forty percent to 50 percent of women over the age of 35 have one or more of them. Their cause is baffling. Genes have some role, because they run in families. Hormones influence their growth. As evidence of that, they enlarge during pregnancy and usually regress after menopause, when estrogen production wanes. Most often, fibroids are incidental findings that need no attention. I’m putting your fibroid in that category. Troublesome fibroids can lead to heavy menstrual periods. Sometimes they’re the source of pelvic pain. Large fibroids pressing on the bladder give rise to frequent urination. Large fibroids also can complicate pregnancy, depending on their size and location. Extremely rarely are they implicated in infertility. You should let your gynecologist know that a fibroid was discovered, but you don’t need to take any more action than that. The fibroid booklet discusses this common condition in detail. Readers who would like a copy can obtain one by writing: Dr. Donohue — No.1106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have a tremendous itch problem. If I rub the skin on my arms just a little, it will itch for quite a while. After I take a shower, I itch for an hour or more. When I get hot and perspire, I itch. I would appreciate your help. — H.B.
\Answer: Water (especially hot water), heat, sweat, a light touch to the skin and emotional stress can bring about a release of body chemicals like histamine that make the skin itch. This doesn’t happen to everyone, but it happens to enough that it’s a relatively common problem. Antihistamines might bring you relief, but be careful: Some are sedating. Some illnesses cause itching. Diabetes, liver disease, thyroid problems, kidney failure, cancers like lymphomas and the blood disorder polycythemia are itch makers. Your doctor can investigate any of these that might apply to you. The biggest cause of itching is dry skin. Take only lukewarm showers or cool baths. Immediately after washing, apply a moisturizer. Don’t wear woolen clothes.
\Dear Dr. Donohue: I have been taking the expensive drug Lipitor for nine years. When can I expect to see a generic Lipitor on the market? — G.L.
\ Answer: The patent on Lipitor (atorvastatin) expires in 2010. Lipitor is one of the statin drugs, the widely prescribed medicines for the lowering of cholesterol."; drDArticle[13] = "Dear Dr. Donohue: I am an 86-year-old woman. I have had shingles twice in my life. My family physician thinks I should get the shingles vaccine. I went to a health clinic to get the injection. I was told by the RN on duty that her instructions were not to give the shot to anyone who had previously had the shingles. How would you advise me? Should I have the vaccine? I don’t want the shingles again — ever. — V.J.
\Answer: Shingles questions are among the most-asked questions I receive. Shingles comes from the chickenpox virus, which stays with people for life. It lives in nerve cells. Even if people say they have never been infected with chickenpox, more than 90 percent of adults have. The childhood infection could have been so mild that it wasn’t recognized as chickenpox. Later in life, the virus leaves its nerve-cell home, travels down the nerve to the skin, where it gives rise to the typical shingles rash — small blisters on red patches of skin — and the typical pain of shingles. The pain that arises when the rash is present is bad, but the pain that stays after the rash is gone is worse. That’s called postherpetic neuralgia, and it comes from damage to the nerve that the virus caused as it traveled down the nerve to the skin. Lyrica is the newest medicine for postherpetic neuralgia. Because of postherpetic neuralgia, the shingles vaccine was developed. It cuts down the chances of developing shingles and postherpetic neuralgia by 66 percent. If it doesn’t provide complete protection, it makes a shingles encounter less fierce. The Advisory Committee on Immunization Practices, a board of vaccine experts, advises older people to get the vaccine even if they have had shingles. However, a second case of shingles is rare. (V.J. is an exception to the rule.) A third case is very, very rare. It’s up to you, V.J. If you want the vaccine, you are entitled to get it. First check on its cost and if your insurance will cover it. The shingles story is told in the booklet on that subject. Readers can obtain a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am a person between 65 and 80. I’ve noticed that my fingernails have taken on a condition that I’ve never heard talked about. From the cuticle to the tip of each nail, there are raised surface ridges. The nails no longer have a smooth surface. I am puzzled as to what could have caused this to happen. What did? — M.G.
\ Answer: I don’t know the cause, and I don’t know anyone who does. I do know that those ridges are very common and very normal. They most often appear at older ages, like gray hair. They’re not a result of vitamin deficiency or an infection, nor are they a sign of anything dire."; drDArticle[14] = "Dear Dr. Donohue: Every summer I go camping and fishing with three friends. We’ve been doing it for 10 years. I enjoy it, but mosquito bites make it hellish. I’m a mosquito magnet. My friends rarely are bitten, but I am covered with bites. What can I do about it? Someone suggested taking the vitamin thiamine. Does it work? And what works best to stop the itching that drives me crazy? — R.K.
\Answer: Someone always suggests thiamine to prevent mosquito bites. I haven’t seen any proof that it works. It’s the female mosquito that bites. She needs blood for the development of her eggs. It’s a survival thing, so don’t be too hard on her. Some people do attract mosquitoes. Researchers have many theories why this is so. It might be that the mosquito magnets have more cholesterol, uric acid or lactic acid on their skin. Or they might produce more carbon dioxide, which attracts mosquitoes. Repellents are the answer for you. Those with DEET are very good. DEET can eat through fishing lines, so beware. It can also damage plastics, rayon, spandex, leather and some paints and varnishes. Another good repellent is picardin, found in Cutter Advanced. Permethrin kills mosquitoes on contact. It’s put on clothes. It doesn’t harm skin if it gets on it, but skin breaks it down and it loses its effectiveness. You can doubly protect yourself by using a skin repellent and also using permethrin on your clothes. The antihistamine Zyrtec quells mosquito-bite itching quite well. It’s a prescription drug.
\Dear Dr. Donohue: My ankles are covered with spider veins. I hate them. How did I get them, and how can I get rid of them? They will ruin my summer. I don’t like people staring at my ankles. They disgust others as much as they disgust me. — E.D.
\Answer: Spider veins are visibly dilated small veins. They pop up on the lower legs and ankles because gravity keeps blood pooled in the lower legs. The pooled blood stretches these veins, just as it does in varicose veins. Genes also have a role, as they do in just about everything. Sunlight contributes to their formation. Pregnancy and standing in one place are other factors that cause them. Injecting those veins with a solution that irritates their lining and causes the lining to collapse and stick together gets rid of them. Some doctors use lasers for the same purpose. I can tell you for a fact that I haven’t heard a single soul complain about your ankles.
\Dear Dr. Donohue: After 18 holes of golf, the tendons on the back of my heels hurt. What should I do? — C.K.
\ Answer: The likely cause is inflammation of the Achilles tendon, the tendon of the calf muscle. It attaches to the heel. Don’t play golf for two weeks. Take Aleve if there’s no reason for you not to use it. Put warm compresses on it for 15 minutes three times a day. Try heel inserts, obtainable in every drugstore. When you start playing again, ice the tendon for 10 to 15 minutes after you’re through playing."; drDArticle[15] = "Dear Dr. Donohue: Please explain angina. I have it. I am under the impression that it is one step before a heart attack. Am I right? My father had angina and lived only three months after he was told what he had. He had a massive heart attack. I am concerned about this. What lies ahead for me? — R.T.
\Answer: Angina is chest pain described as a squeezing or pressure sensation that comes on when a person is active, in a particularly stressful situation or is out and about in very cold weather. The pain leaves when the activity stops, the stress is relieved or the person becomes warm. The pain is felt in the chest, but it can spread to the shoulder, the arm or the neck. Angina is a sign that the heart isn’t getting enough blood to support the stress, emotional or physical, that it must endure. It is the cry of a breaking heart. The cause of decreased blood flow usually is a buildup of cholesterol, fat and other material in the heart arteries. Angina is quite treatable. It’s not a prelude to an inevitable heart attack if measures are taken to increase blood flow to the heart muscle. People with angina have to adopt programs that increase blood flow through clogged arteries. They have to lower their cholesterol, keep their blood pressure at desirable levels and take part in physical activities prescribed by their doctors. They take medicines that ease the heart’s burden and that open up clogged arteries. They might need angioplasty, the procedure where a doctor threads a balloon-tipped soft tube to the point of artery obstruction and then inflates the balloon to squash it. I don’t know when your dad died, but I’m sure it was at a time when the opportunities that now exist for angina patients were not available. The booklet on coronary artery disease, the basis of angina, explains the ins and outs of this common problem and what can be done for it. Readers can obtain a copy by writing: Dr. Donohue — No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have a touch of arthritis in my hands. It makes unscrewing jars very hard for me. Can you suggest an exercise that will build up my hand strength? — A.K.
\ Answer: You need a firm rubber ball, not one that’s rock-hard but one that you can push in. Hold the ball with one hand and squeeze it hard. Hold the squeeze for four seconds. Relax and take a short rest. Then repeat nine more squeezes, with a rest between each squeeze. Switch hands and repeat the exercise. As you get stronger, do two or three sets of 10 squeezes with each hand. If a rubber ball becomes too easy for you, use a tennis ball. Tennis balls are hard to compress. If these exercises hurt your hands, don’t do them."; drDArticle[16] = "Dear Dr. Donohue: My daughter was told she has fibromyalgia. She is 43. I’ve never heard of this. Exactly what is it and what is the treatment? — W.S.
\Answer: Fibromyalgia is difficult to have, difficult to treat and difficult to understand. It consists of a large number of symptoms, the chief of which is pain all over the body. Furthermore, fibromyalgia patients are chronically tired, cannot get a decent night’s sleep and wake up as unrefreshed as they were when they went to bed. Some authorities estimate that as many as 10 percent of all adults suffer from it. In making this diagnosis, doctors have to first search for illness with similar symptoms. Lupus, rheumatoid arthritis, hidden infections and a nonfunctioning thyroid gland are such illnesses. Only when these illnesses and others are ruled out can the diagnosis of fibromyalgia be made. A distinctive feature of the condition is tender points, specific body areas where moderate finger pressure elicits pain far in excess of the pressure applied. There are 18 mapped tender points on the body. Attempts to find a cause have not been rewarding so far, and that’s a barrier to prescribing an ideal treatment. Many medicines have been tried, and some are at least partially successful. Amitriptyline, an antidepressant, can restore refreshing sleep and can correct any derangement of brain chemistry that might be the basis of this condition. Muscle relaxants have helped some. Capsaicin cream, with many brand names and obtainable without prescription, sometimes relieves pain. Lyrica is a relatively new medicine that has been approved for treatment. Exercise, within a person’s limitation, prevents muscle weakening from disuse. The National Fibromyalgia Association is a source of timely information and advice. Its Web site is www.fmaware.org. The fibromyalgia booklet provides more complete information on this bewildering condition. To order a copy, write: Dr. Donohue — No. 305W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am writing to ask you about hepatitis C. My 46-year-old son just confirmed that he has it. He used to be an alcoholic, but he hasn’t had a drink in eight years. What are the odds against him with this? I am at my wits’ end. I lost a son three years ago. I pray that this son will be OK. — Anon.
\ Answer: About 85 percent of people with hepatitis C stay infected with the virus for life. Twenty percent of those chronically infected develop liver cirrhosis in 20 or so years, and a smaller percentage come down with liver cancer. Looked at in another way, 80 percent do well even though they are infected. Treatment with interferon and ribavirin is available if judged necessary. Liver transplantation is possible for people who develop cirrhosis. Your son must stay off alcohol at all costs. Alcohol speeds liver destruction in one who is infected with the hepatitis C virus."; drDArticle[17] = "Dear Dr. Donohue: At my urging because of a strong family history of colon cancer, my 30-year-old son had a colonoscopy. He had four tubular adenomas — a surprise to us and the doctor. The doctor suggests a repeat colonoscopy. Please explain the different types of polyps. Don’t all polyps become cancerous if not removed? — E.T.
\Answer: A polyp is a growth that springs from the outermost lining of hollow organs. Polyps arise in the nose and sinuses, but I am going to speak only of colon polyps. There are two major types of colon polyps. One is a hyperplastic polyp, and it is almost never a cancer threat. The other is an adenoma. More than 90 percent of adenomas do not become cancerous, but the remaining 10 percent can turn into cancer. By looking at a polyp, the doctor cannot tell if it is a dangerous one; it must be examined microscopically. Up to 40 percent of people older than 60 have at least one colon polyp. Adenoma polyps larger than 1 cm (two-fifths of an inch) raise the suspicion of cancer and the more numerous are the polyps, the greater the cancer threat. Adenoma polyps are further subdivided according to their appearance. Ones that look like drinking straws with a round cap on one end are tubular adenomas, the most common kind, and the least likely to become cancer. Villous adenomas resemble a tiny cauliflower and are most likely to turn into cancer. Tubovillous adenomas are a cross between these two and have an intermediate cancer threat. If no adenoma polyps are found, then the next colonoscopy can wait for 10 years. One or two low-risk polyps should call for a repeat colonoscopy in five to 10 years. If three to 10 polyps are found, then colonoscopy should take place again in three years. More than 10 polyps require an examination sooner. Large polyps, polyps with microscopic evidence of precancer changes and people with a family history of colon cancer have to be judged individually for the next scope examination. Readers can obtain the booklet covering colon cancer, its detection and treatment by writing: Dr. Donohue — No. 505W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have a touch of arthritis in my hands. It makes unscrewing jars very hard for me. Can you suggest an exercise that will build up my hand strength? — A.K.
\ Answer: You need a firm rubber ball, not one that’s rock-hard but one that you can push in. Hold the ball with one hand and squeeze it hard. Hold the squeeze for four seconds. Relax and take a short rest. Then repeat nine more squeezes, with a rest between each squeeze. Switch hands and repeat the exercise. As you get stronger, do two or three sets of 10 squeezes with each hand. If a rubber ball becomes too easy for you, use a tennis ball. Tennis balls are hard to compress. If these exercises hurt your hands, don’t do them."; drDArticle[18] = "Dear Dr. Donohue: Nine months ago, our son, 42, had a deep-vein thrombosis. The clot was in the calf and thigh vein. He was given an anticoagulant and the clot was surgically removed, but surgery was only partly successful. Some of the clot remains in his leg veins. He continues to take Coumadin and is told it may take a year for the clot to dissolve. His calf is often swollen and painful. Can you suggest any additional treatment? — M.T.
\Answer: For readers unfamiliar with this problem, some definitions are necessary. Thrombophlebitis (THROM-boh-flea-BITE-is) is a clot in a vein. “Thrombo” means “clot,” and “phlebitis” is vein inflammation. The leg is the common site for it to happen. A person on bed rest after surgery (especially knee and hip surgery), who is sitting for prolonged times during a car or plane trip, taking birth-control pills or suffering trauma is at risk of getting thrombophlebitis. Clots in the deep veins of the leg, the ones you cannot see, are the dangerous kind. Bits of those clots can break away from the main clot and be carried in the circulation to the lung, where they can plug a lung blood vessel. That’s called a pulmonary embolism, and it can be deadly. Clots in leg veins cause the overlying skin to turn red and become tender. The leg swells and is painful. Ultrasound examination of the veins establishes the diagnosis. Anticoagulants are the treatment. They don’t dissolve the clot, but they keep it from growing larger and they prevent the chance of a pulmonary embolus. In time, a canal burrows through the clot, and blood flow is re-established or blood finds alternate routes to leave the leg. It takes months for this to occur. Nothing speeds the process. Time is the medicine of choice. A large number of people develop what’s called the post-thrombotic syndrome after thrombophlebitis. The leg remains swollen and painful. Compression stockings and frequent leg elevation minimize this complication. The peripheral vascular disease booklet discusses this illness, its treatment and outlook. Readers can order a copy by writing: Dr. Donohue — No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am on a diet in which the food portions for each meal are small. We are instructed to drink eight glasses of water a day. My question is: When is a good time to drink the water? I understand that liquid drunk with a meal interferes with digestive juices. The meals are small, with snacks about two hours after a meal. So every two to two and a half hours, I am eating and digesting food. When can I get this water in? I also heard that ice water is good to drink because it sparks your metabolism. Is this so? — P.F.
\ Answer: You can drink the water anytime you want. Water or other liquids do not interfere with digestion. Cold water doesn’t spark metabolism, nor does it burn calories because the body has to warm it. You can drink it anytime you want — before, after or during a meal or snack."; drDArticle[19] = "Dear Dr. Donohue: I have read about heart problems in your column many times. You seem to avoid any commentary pertaining to strokes. Why ignore this medical issue? I am particularly interested in brainstem strokes. Are aftermaths of such a stroke constant headaches and difficulty riding in a car? — D.G.
\Answer: I’d better not ignore stroke. It is the second leading cause of death in the United States and Canada. Strokes come in two varieties. The more common kind — representing 80 percent of all strokes — comes from a block in blood flow to part of the brain. That’s called an ischemic stroke. The block is a clot in an artery feeding the brain. It’s similar to what happens in a heart attack, when one of the heart arteries becomes plugged and blood cannot get to the heart muscle. The less common kind of stroke is due to bleeding from a brain blood vessel. The brainstem is a narrow part of the brain that consists of three different sections — the midbrain, pons and medulla. Through those structures, located at the back and underside of the brain, run bundles of cables connecting brain centers to the spinal cord. The brainstem has its own important centers, two of which regulate blood pressure and breathing. A brainstem stroke is often fatal. Surviving such a stroke makes you very lucky. Constant headaches and difficulty riding in a car are not things commonly ascribed to a previous brainstem stroke. Prevention of strokes, regardless of where they strike the brain, is similar to the prevention of heart attacks — lower cholesterol, maintain normal blood pressure, exercise, don’t smoke, control blood sugar if diabetic and lose weight if need be. People who have had a clot-induced stroke should talk to their doctors about going on anticoagulant prevention by taking aspirin or a similar medicine. The stroke booklet provides details on this important topic and its treatment. Readers can obtain a copy writing: Dr. Donohue — No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My son-in-law got tired of picking the seeds out of watermelon, so he swallows them whole. He encourages his small children to do the same. Is this practice harmful? — M.D.
\Answer: It’s not harmful if the children are not so young that they could choke on the seeds. I have to confess: I swallow watermelon seeds. I like to. Your son-in-law shouldn’t force the children to swallow the seeds if they don’t like to do so. He can buy seedless watermelons.
\Dear Dr. Donohue: I have osteoarthritis and osteoporosis. I am 92. What kind of over-the-counter pill can I take to relieve the pain in my hips? My pharmacist and doctor are too busy to answer my question. — G.P.
\ Answer: Try Tylenol (acetaminophen). It’s a good medicine for relief of osteoarthritis pain. It’s gentle on the stomach too. If you plan to take it every day, let your busy doctor know what you’re doing."; drDArticle[20] = "Dear Dr. Donohue: Two years ago I had surgery for breast cancer, and lymph nodes were also removed during the surgery. I recently developed lymphedema and am quite upset about it. I don’t think I ever read where you (or anyone else) discussed it. I didn’t know what it was until I saw something about it on TV. It seems to be under control, but I must wear an arm sleeve, which I hate. Please comment on it. — J.R.
\Answer: We have two circulatory systems. Everyone knows the blood circulatory system. Few know the lymph circulatory system. Lymph is the watery part of blood that oozes out of blood vessels and bathes all body cells and tissues. It provides nutrition and protection. Lymph vessels — similar to arteries and veins but more delicate — are open-ended affairs that suction lymph fluid and eventually return it to the circulation. On its journey back to the main circulation, lymph fluid passes through lymph nodes, which remove from it foreign material and germs. Anything that disrupts the return of fluid back to the circulation causes swelling — lymphedema. In your case, the disruption was breast surgery with removal of lymph nodes. About 15 percent of women who undergo such breast surgery develop lymphedema of the arm on the side of the removed breast. Early treatment of lymphedema prevents permanent changes from happening. Arm elevation encourages drainage out of the arm. Elastic garments squeeze lymph fluid back into the main circulation. Compression pumps are another way to mobilize the fluid. A special kind of massage, performed by a trained therapist, can effectively promote drainage of lymph fluid. It’s called manual lymphatic drainage, and practicing therapists are found in about every section of the country. The National Lymphedema Network can put you in touch with such a therapist and can provide you with information on this condition. You can reach the network at 1-800-541-3259 and on the Web at www.lymphnet.org. The booklet on edema and lymphedema provides details on both these common conditions. Readers can obtain a copy by writing: Dr. Donohue — No. 106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My doctor has me taking two blood pressure medicines every day. There was a time when my pressure was quite high. Now it’s normal. I take my pressure every day. I am retired, and I think that brought my pressure down. Can I safely stop one of my blood pressure medicines? — D.K.
\ Answer: It would be safe for you if your doctor thinks it is a good idea. He or she probably will, if you discuss it. When you see your doctor, bring with you a record of your blood pressures. That information will carry much weight in making the right decision. Blood pressure medicine is usually, but not always, taken for life. If people make big life changes — reduce their salt intake, exercise, lose weight, minimize life’s stresses — then it is possible to decrease the dose of blood pressure medicine and sometimes to eliminate it."; drDArticle[21] = "Dear Dr. Donohue: Will you please tell me about head lice? My granddaughter has them and passed them to her mother. They are devastated, since they bathe every day and shampoo, too. How do you get them? How do you get rid of them? — K.H.
\Answer: Nothing destroys the peace of a home more than discovering a child has head lice. They’re not evidence of poor hygiene or lax housekeeping. They usually don’t cause serious illnesses. They’re a nuisance. Outbreaks of lice happen every year when children go back to school. Lice are transmitted from one head to another through direct contact or by sharing hats, combs, brushes or earphones. They cause itching and, most often, nothing more. Lice eggs are glued to the shafts of hairs and look like oval pinheads. They’re called nits. Permethrin can almost always eliminate lice. One brand name is Nix. Follow directions on its application. If over-the-counter permethrin doesn’t work, a stronger version, the 5 percent product, is available by prescription. Its brand name is Elimite. Other products also work. Combing the hair with a fine-toothed comb dislodges the nits. Those combs are part of the kit that comes with the medicine. Mothers don’t have to shift into overdrive to de-louse the home. A louse lives only a few days off the head. It’s only necessary to vacuum the carpets and furniture. Wash in hot water all clothing and bedding that has come in contact with the head, and dry them on high heat in the dryer. Soak combs and brushes for an hour in rubbing alcohol or Lysol, or wash them in hot water whose temperature is 130 F (55 C). Lice do not live on pets. Pets don’t need any treatment.
\Dear Dr. Donohue: Suddenly I was stricken with unbelievable dizziness. It has waylaid me. I can hardly walk 10 steps without having to hang on to something or someone. The ear, nose and throat doctor says I have labyrinthitis. How long will it last? — T.D.
\ Answer: The labyrinth is part of the inner ear, and the inner ear contains our balance organ. Inflammation of the labyrinth — labyrinthitis — not only makes people dizzy and unsteady, but it leaves them sick to their stomach and often having to contend with bouts of vomiting. It’s seasickness in the extreme. Quite often, the inflammation comes from a viral infection. The first few days are the worst. Then the dizziness begins to subside. It can take several weeks before you get your balance back, and full recovery returns in one to three months. If you can get by without medicines, fine. Too much dependence of medicine slows the brain’s return to equilibrium. People who are severely nauseated and are vomiting need medicines to control those consequences of labyrinthitis. Dizziness is a common complaint of older people. The booklet on that topic explains its many causes and treatments. Readers can order a copy by writing: Dr. Donohue — No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[22] = "Dear Dr. Donohue: I’m in my late 40s and was told I have COPD. Will I die? Is it like cancer? I have smoked for 30 years. I can’t seem to stop. I cough real bad at night. Will you tell me more about COPD? — N.N.
\Answer: You and I will die. We all do. But you are relatively young, and you don’t have to die from COPD, even though it’s fourth on the list of causes of death. You must, however, stop smoking. That is the most important facet of treatment, and it’s your way to a longer life. If you need help, talk with your doctor. The nicotine patch, gum, nasal spray or nasal inhaler can lessen your cigarette cravings. Chronic obstructive pulmonary disease consists of two illnesses: emphysema and chronic bronchitis. Most people with COPD have both illnesses, and most are or were cigarette smokers. Emphysema is the destruction of air sacs, those delicate structures through which oxygen passes from the lungs into the blood. Emphysema’s primary symptom is breathlessness when exerting, and the exertion doesn’t have to be all that. Chronic bronchitis is airway (bronchi) inflammation that narrows the air passages and increases the production of thick mucus. Its primary symptom is coughing that brings up thick sputum. Neither illness can be undone. The progression of both can be halted by stopping the irritation of lungs from cigarette smoke. Medicine can soothe airways, decrease mucus production and boost oxygen passage into the blood. Many of those medicines come as inhalers. If need be, oxygen makes life livable when breathlessness makes simple tasks impossible. You’re not at that stage, but you’ll reach it if you don’t get a handle on your habit. The booklet on chronic obstructive pulmonary disease discusses the causes of and treatments for emphysema and chronic bronchitis. Readers can obtain a copy by writing: Dr. Donohue — No. 601W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am raising my two granddaughters, ages 14 and 16. At my age, it’s a bit taxing, but they love me and I love them. The only thing we disagree about is milk. They won’t drink any. They say they find it “gross.” I wonder if they’re getting enough calcium. What would you say to them? — W.F.
\ Answer: I’d say, “Girls, drink your milk like your grandmother tells you.” If they are not eating or drinking any dairy products, they are not likely meeting their calcium requirements. An adequate daily calcium intake for girls their age is 1,300 mg. Dairy products are the best sources of calcium. Will they eat cheese or yogurt? That would help matters. What do they mean by “gross”? Does milk give them gas and diarrhea? If it does, they might have lactose intolerance. Lactose is milk sugar. To digest it, people must have in their intestine an enzyme called lactase. If they don’t have enough of it, dairy products make them miserable. That can be remedied by taking the lactase enzyme with dairy products or using products already treated with the enzyme."; drDArticle[23] = "Dear Dr. Donohue: Isn’t it odd to come down with asthma at age 66? They tell me I have it. I had a cough that started this past winter, and it wouldn’t go away. It comes in spurts and is always worse at night. My family doctor sent me to a lung doctor, who did all sorts of tests on me; his verdict was asthma. No one believes me when I say I have asthma. They don’t say so, but I know they’re thinking I’m too old. — P.G.
\Answer: You can get asthma at any age. About 12 percent of adults suffer from it, and 15 percent of children have it. The number of adult asthmatic men equals the number of adult asthmatic women. In childhood, more boys than girls have it. What happens in an asthma attack is a sudden narrowing of airways. Asthmatic airways are super-sensitive and asthmatics react to things that the rest of us don’t. In addition, the airways’ mucus glands pour out thick, sticky mucus, and the lining of the airways becomes swollen and inflamed. All of these mechanisms make it hard for air to pass into and out of the lungs. Coughing is a characteristic asthma symptom. Wheezing during an attack is another telltale sign, but a cough might be the only thing indicating asthma. Your doctor must have looked for a trigger for your attacks. If one is found, eliminating it assures successful treatment. If a trigger can’t be found or can’t be eliminated, then medicines have to keep attacks in check. Some asthma drugs dilate the constricted airways, while others soothe the airway lining to minimize mucus production and swelling. Many asthma medicines can be given by inhaler. That route of administration lessens the chances for side effects. Readers who would like more information on asthma can order the booklet on that topic by writing to Dr. Donohue — No. 602W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My daughter’s boyfriend has focal segmental glomerulosclerosis. What is done for it? They were planning to marry. Is that still possible? — K.D.
\Answer: The young man has kidneys in which some of the filters are scarred. It’s an autoimmune illness. Prednisone, one of the cortisone drugs, is the medicine usually given for it. Seventy percent of people achieve a remission from it. Your daughter and her boyfriend can continue to discuss their marriage plans.
\Dear Dr. Donohue: I’ve been told that if you ingest more salt than your body requires, the body can slough off the excess if you increase your water intake. Is that true? — G.S.
\ Answer: That’s false. In fact, the extra salt holds onto fluid. The kidneys are excellent chemists, but they can do only so much. If a person overwhelms them with too much salt, they can’t get rid of it all. Much of it stays in the body and holds onto fluid."; drDArticle[24] = "Dear Dr. Donohue: You have said that calcium is important for everyone, certainly for growing children and teens. I know people who will not give their children milk because of the hormones used in cows. They don’t give them calcium supplements either. What is your feeling about this, and do you think these hormones bring about early puberty? — E.H.
\Answer: Dairy products are the best sources of calcium. If people shun dairy products, then they must find alternate calcium supplies. In youth, bones are rapidly growing and storing calcium. Young bones that are shortchanged of calcium are destined for problems like osteoporosis later in life. An 8-ounce glass of milk has 300 mg of calcium. One slice of cheese contains from 200 mg to 270 mg. Foods with this much calcium are hard to come by. Children’s daily requirement is 1,200 mg to 1,500 mg. Alternate sources include: 3 ounces of sardines with bones, 325 mg; 1 cup of spinach, 138 to 240; half a cup of navy/lima beans, 50; 1 ounce of almonds, 70. Parents are not going to get children to live on sardines and spinach. As for the hormone controversy, I respect people’s concerns. I, for one, do not share those concerns. Parents who are adamant about banning dairy products for their children have to provide calcium for them in some other way, and often that way is calcium supplements. Not doing so is a great disservice to these children.
\Dear Dr. Donohue: I thought salt was salt. One soup manufacturer lists sea salt as an ingredient in its low-salt soup. Does this imply sea salt is better than ordinary salt? — Anon.
\ Answer: You’re right. Salt is salt — sodium chloride, NaCl. No one can change that. However, where salt comes from and how it’s processed make it taste somewhat different. Sea salt, as the name implies, comes from bodies of saltwater. The water is allowed to evaporate, and what’s left is salt. Sea salt is coated with other minerals found in saltwater — magnesium, calcium, potassium, manganese, zinc and iodine. Those minerals are present in small amounts, but they give sea salt a bit of a different flavor than salt taken from a salt mine. People might use less sea salt than regular table salt because of the additional zing that those minerals impart to it. It still boils down to the amount of sodium that is in a product. The daily limit for sodium is 1,500 mg to 2,300 mg. Most of our salt intake comes from processed foods, so label-reading is essential for anyone on a low-sodium diet. The facts on sodium and potassium are discussed in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue — No. 202W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[25] = "Dear Dr. Donohue: My son has excessive perspiration, particularly in the head and torso. He literally drips water with the least exertion. Some time ago, while watching a science program, I saw two sisters who experienced the same symptoms my son has. The treating physician operated on the girls, and it stopped the phenomenon. Do you know the name of the procedure? — W.C.
\Answer: Excessive sweating is called hyperhydrosis (HI-purr-hi-DROWE-siss). When it occurs in a few places, like under the arms, on the palms or on the soles, it is localized hyperhydrosis. When, as in your son’s case, it happens in a larger body area, it is generalized hyperhydrosis, and it’s more difficult to treat. Illness like an overactive thyroid gland, some neurological conditions and infections such as tuberculosis and an unusual tumor — a pheochromocytoma — can be responsible for generalized hyperhydrosis, but usually it’s an idiosyncrasy in which the sweat glands are overly sensitive to acetylcholine. Acetylcholine is the chemical secreted by the nerve cells that control sweat glands. It activates the glands. A 20 percent solution of aluminum chloride (a prescription item) applied to the skin where sweating is excessive can lessen it. It can be put on the face and back as well as the palms, soles and under the arms. The directions on its use have to be followed explicitly. Medicines that block the action of acetylcholine can also work. A reader wrote to me that his life was changed by Robinul Forte (glycopyrrolate). Glycopyrrolate can be made into a 5 percent solution to be put on the skin, but a pharmacist has to make arrangements to prepare it. Clonidine and Ditropan are two other medicines that block the effects of acetylcholine. The program you watched might have been on endoscopic thoracic sympathectomy. Through a viewing tube and with instruments inserted through a small incision, a doctor severs chest nerves that control sweating. Your son can ask his family doctor for a referral to a specialist who does this kind of surgery — if medicines don’t work.
\Dear Dr. Donohue: Seven years ago, I suffered a cardiac arrest (a stopping of all heart action). Since then I have had exams with my cardiologist and have had periodic stress tests. Last week I ran up the stairs and my chest began to feel funny. I saw my heart doctor, and the choices were a stress test or angiogram. I chose angiogram, and it revealed two blockages in my heart arteries. My message is: so much for stress tests. — J.B.
\ Answer: We live in an imperfect world, and a world of imperfect medical tests. Stress tests are not infallible. They can give both falsely positive and falsely negative results. Women tend to have more falsely positive tests than men. You made a good decision. You are a special case. You lived through a harrowing heart catastrophe. You cannot take any chances. For others, stress tests are better than resting EKGs but not as good as having dye injected into heart arteries while X-ray pictures are taken — angiograms."; drDArticle[26] = "Dear Dr. Donohue: My grandchildren have warts on their hands. What causes them? What can be done for them? We are applying a wart remover, and it works after some time. Someone told me they are caused by a vitamin deficiency. What is your opinion? — E.P.
\Answer: This isn’t my opinion; it’s a fact: Viruses cause warts, specifically the large family of HPV viruses — human papillomaviruses. Wart removers do work for many people, and they’re available in drugstores without a prescription. Most of them contain salicylic acid. Don’t cringe when you see the word “acid.” These products don’t burn, and they do take time to work. Follow the directions carefully. Another popular remedy is duct tape, the kind of tape you find in hardware stores. Cover the wart or warts with the tape for six days. Then remove the tape and soak the warts in water, after which you rub them gently with an emery board or pumice stone, both of which also are found in drugstores. Repeat the cycle until the warts go away. That can take two months.There is another acceptable treatment for warts: Ignore them. They usually disappear on their own, but it can take some time for that happy event to occur. The family doctor or a dermatologist can remove warts by freezing them or drying them with an electric current. I am not talking about genital warts. That’s another topic. They, too, are caused by papillomaviruses, but their treatment is different. The genital wart story is told in full in the booklet on that topic and on herpes genital infections. Readers can obtain a copy by writing: Dr. Donohue — No. 1202W, Box 536475, Orlando, FL 328536475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My liver enzymes are elevated. My AST is 54, and my ALT is 53. How bad is this? Could it be cancer? — S.H.
\Answer: All body cells have enzymes. They’re proteins that keep cell chemistry perking along at the right speed. If an organ has enzymes that are found only in that organ, then a rise of the blood level of those enzymes indicates damage to the organ. AST — aspartate aminotransferase — and ALT — alanine aminotransferase — are found mainly in the liver. Your elevation is not great. When the rise is three times the normal value, then eyebrows rise. All you have to do is follow your doctor’s directions for repeat tests. The rise might be only a transient thing. This is not a sign of cancer.
\Dear Dr. Donohue: This past summer, after a colonoscopy, my wife went into atrial fibrillation. This past month, a friend had colon surgery for cancer. Shortly after, he too had atrial fibrillation. Is there some relationship here? — A.I.
\ Answer: Perhaps the stress of both procedures brought on the atrial fibrillation. Stress — both physical and mental — can do it. This is the only relationship I can see."; drDArticle[27] = "Dear Dr. Donohue: I know you have written about diverticulosis before, but would you mind going over it again? I was hospitalized with it and had to have intravenous fluids. My brother-in-law says that wasn’t necessary. He has it, and it has never caused him any trouble. He says he’s careful about not eating nuts, seeds, popcorn and berries, and that’s all you have to do for it. I know I was in pain, and I know it wasn’t imagined. Can you clear up these issues for me? — W.F.
\Answer: Your brother-in-law is right about diverticulosis. It seldom causes severe pain. Diverticulosis is the formation of diverticula — small protrusions on the outer colon wall. It’s a condition widespread in countries where refining flour is the rage. Refining gets rid of fiber, and a low-fiber diet is believed to be a major factor in the development of diverticulosis. Fiber keeps undigested food soft, moist and easily propelled through and out of the digestive tract. Without it, stool becomes hard and dry. The colon must exert great force to pass it through. That force generates diverticula formation. You had more than diverticulosis. You had diverticulitis — inflammation of the diverticula. Each diverticulum connects with the colon through a narrow neck. If that neck becomes obstructed, bacteria in the diverticulum multiply and cause it to swell and become most painful. Swollen diverticula break and form abscesses, which add to the pain. Most often, diverticulitis must be treated in the hospital. At one time, people with diverticulosis were uniformly instructed to avoid nuts, seeds, popcorn, berries and similar foods in the belief that they would obstruct the neck of a diverticulum and bring on a bout of diverticulitis. That position isn’t universally adopted anymore. However, if your personal doctor tells you to avoid those and similar foods, do so. He or she knows far more about your particular condition than does someone at a word processor hundreds or thousands of miles away from you. The booklet on diverticulosis and diverticulitis deals with all aspects of this too-common disorder. Readers can obtain a copy by writing: Dr. Donohue — No. 502W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have a chronic infection of the urinary tract. I just get over one infection and in two or three weeks have another. Now I am infected with a super bug that oral medicines can’t touch. Am I worried? You bet. The issue is antibiotic resistance. People should be aware that antibiotic overuse has created this monster. A discussion of this would be appreciated. — J.H.
\ Answer: Bacterial resistance to antibiotics due to their injudicious and excessive prescription is a staggering problem. Limiting these wonder drugs to situations only where they are truly required could stem the emergence of such resistance. People should not ask for antibiotics for a cold. They have no place in cold treatment. Colds are due to viruses, not bacteria. Antibiotics don’t kill viruses."; drDArticle[28] = "Dear Dr. Donohue: I live in the far north, where deep snow stays until late spring. This past winter my 16-month-old son came down with a rash. We were snowed in and I couldn’t get to the doctor, but I talked with him on the phone. The doctor said it was probably roseola, a herpes infection. The baby was never very sick, but I wonder if this roseola can cause future trouble. Can it? What’s the herpes connection? — A.S.
\Answer: Let’s get the herpes issue out of the way right at the start. The virus causing roseola is the herpes-6 virus, not the virus of genital infections — herpes-2 — or the virus of cold sores — herpes-1. It’s a common childhood infection. By the third year of life, 2 years of age, 80 percent of infants have been infected with it. A sudden rise of temperature — 103 F (39 C) or higher — heralds the onset of the illness. Even in the face of this high temperature, most babies don’t look or act sick. The fever lasts three to five days and then goes as quickly as it came. Within 12 to 24 hours of the fever’s disappearance, the baby breaks out in a rash that is light red (rose-colored, the basis of the “roseola” name) and appears on the trunk. It spreads to the face, the upper arms and the upper legs. In one to three days, the rash leaves. Almost all children recover quickly. There are no future consequences from the usual roseola infection. No treatment is given, because no treatment is needed. However, children who have a defect in their immune system benefit from antiviral therapy.
\Dear Dr. Donohue: I have had type 2 diabetes for more than 10 years. I can control it by watching what I eat. When I was first diagnosed, I was overweight, and I lost 50 pounds. I have several friends who also have type 2 diabetes, and they are on medicine for it. They say that by taking medicine, they don’t have to watch what they eat. Is this true?
\ Answer: The best way to control any illness is to treat it without medicine whenever possible. All medicines have side effects. Diet is an important aspect of diabetes control. Since weight loss and a diabetic diet have kept your blood sugar in check, stick with them. Only if diet and weight loss cannot bring blood sugar to acceptable levels should a person have to resort to medicine. In point of fact, that happens often enough. Your friends don’t have free rein to eat whatever they want. They need to speak with a dietitian about a diabetic diet. Diabetes is becoming an epidemic disease. The booklet on this illness discusses its many facets and its treatment. Readers can order a copy by writing: Dr. Donohue — No. 402W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[29] = "Dear Dr. Donohue: I am 49, female and in good health. I do not take any medications. Several months ago, I developed an arrhythmia. My pulse would skip anywhere from once every four or five beats to once every 20 beats. I had no other symptoms. A series of tests — including an EKG, an echocardiogram and a stress test — was all normal. My doctor informed me that this was not a concern, since we ruled out heart disease. My pulse continues to skip beats. Is there anything else I need to do? — A.P.
\Answer: Skipped beats are the most common heartbeat abnormality. Everyone has them from time to time. They aren’t “skipped” beats; they’re premature beats, ones that come before the normal scheduled beat. People don’t feel the premature beat. But after it, there is a delay until the next normal heartbeat occurs. During that delay, the heart fills with more blood than usual. When the normal beat arrives, the heart pumps out that extra blood, and the person feels it as a thud in the chest. So long as premature beats are not associated with any abnormal heart condition, they can be dismissed as not indicating current or future trouble. You have had a thorough heart exam. All your tests were normal. Your doctor feels that any more tests would be unnecessary. That’s a valid decision. Worrying about premature beats can be a greater health threat than the beats themselves. Only if they increase in number or produce symptoms like feeling faint would further testing be of value to you now. The booklet on heartbeat irregularities discusses the more common and serious kinds of arrhythmias. Readers can order a copy by writing: Dr. Donohue — No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have black tongue. I was given tablets to put on my tongue, and the black went away but has come back. The tablets didn’t work the second time. I then took a pill that I had to swallow, but it made me sick to my stomach. An ear, nose and throat doctor told me to do nothing and that it would go away. I am worried and unhappy about the situation. Please give me your suggestions about what can be done. — L.M.
\ Answer: Black tongue comes about from elongation of tongue papillae — the tiny projections from the tongue’s surface, some of which have taste buds. Pigment production from mouth bacteria or yeasts adds the black color to the projections. It often happens after taking a course of antibiotics. Most people have no symptoms from it other than the alarming look. Taste isn’t affected. The ENT doctor’s advice is excellent. Time almost always cures the condition. You can lightly brush your tongue with a 1 percent or 2 percent concentration of hydrogen peroxide. That hurries the tongue’s return to a normal appearance."; drDArticle[30] = "Dear Dr. Donohue: Please discuss sleepwalking in children. — Anon.
\Answer: It’s surprising to learn that 15 percent of children sleepwalk at some time. It happens mostly between the ages of 5 and 12, with the peak years being those between 4 and 8. During a sleepwalk, the child’s eyes are open, and he or she is unresponsive, with a blank look on his or her face. On average, a typical sleepwalker experiences an occurrence two or three times a month. Frequently, a relative on either the mother or father’s side will have been a sleepwalker. Sleepwalking occurs one to three hours after falling asleep, during the phase of deep sleep, when brain-wave activity is at its lowest. Almost never is sleepwalking a sign of physical or psychological abnormalities. Medicines are not routinely used to correct it. Provisions for the child’s safety are needed. A ground-floor bedroom is best for a sleepwalker, if that is possible. Latches should be put on the outside of windows and the bedroom door. Don’t wake the child during an episode. Gently guide him or her back to bed. Most children outgrow this by adolescence.
\Dear Dr. Donohue: I have a multinodular goiter. My thyroid lab work is normal. Can you explain what this is? I am due for an ultrasound soon. — S.S.
\Answer: A goiter is an enlarged thyroid gland, the U-shaped gland at the bottom of the neck. Nodules are common in that gland, and their number increases with age. So, you have a larger-than-normal gland with nodules in it. Your doctor has to confront two issues. One is assessing the production of thyroid hormone by the gland. In your case, laboratory work indicates that hormone production is normal. So you’re free and clear on one count. The second task is determining the nature of the nodules. Whether any of the nodules harbor cancer cells is the question that needs to be answered. A large nodule or one that grows rapidly is suspicious for cancer. The cancer question can be answered by having a biopsy of any questionable nodule. The biopsy is often done with a very slender needle, and no cutting takes place. An ultrasound of the gland provides information on which, if any, nodule needs a biopsy. It’s reassuring to learn that 12 percent of adults have a multinodular goiter but very few of these people have thyroid cancer. The thyroid booklet deals with overactive and underactive thyroid glands but not thyroid cancer. Readers can order a copy by writing: Dr. Donohue — No. 401W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: When one loses weight, is the fat loss removed through elimination processes, or what? Does it just drop off? — P.H.
\ Answer: Fat is burned to produce energy and heat, just like gas heats a house. Some of the fat-burning process generates carbon dioxide, which is exhaled. Other waste products are eliminated by the kidneys. It’s all done very discreetly."; drDArticle[31] = "Dear Dr. Donohue: Six years ago, I had a heart attack that resulted in triple bypass surgery, and I had to have my mitral valve replaced. Last year, my cardiologist informed me that my new mitral valve and my original aortic valve were leaking a little. He told me not to worry about it. I do worry. If you have a leak in your pipe in your home, you have it fixed immediately. I would think that applies to the body too. What do you think? — M.G.
\Answer: You can’t compare heart valves to leaky pipes. They’re quite different, and they behave quite differently. Many people at older ages have slightly leaky heart valves that don’t interfere with heart action in the least. If the leaks were compromising your heart’s pumping, the doctor would have jumped right in with a suggestion for immediate repair. Furthermore, unlike a pipe, valve leaks can but don’t always get worse. Your doctor will check your heart regularly, and if the leaks are increasing, he will tell you then. For now, don’t dwell on them. The booklet on heart-valve problems discusses these common medical conditions in depth. Readers can obtain a copy by writing: Dr. Donohue — No. 105W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I would like to know why you lose flesh with age, but not bone, nor skin, nor fat. One doctor told me that’s why people get colder when they get older. I am rapidly losing flesh. — L.J.
\Answer: People lose muscle with age. The process is called sarcopenia (SAHR-coe-PEA-knee-uh). I never thought of it until you brought it up, but it could be a reason why older people chill quickly. Muscles generate heat, and they serve as insulation. Shivering is a response to a cold environment. Shivering muscles give off heat. Lots of unpleasant things happen with aging. Metabolism slows, and that’s another reason why older people complain of the cold. Our bodies don’t repair themselves as well as they did when we were young. Bones do lose strength and size with age. Growing old is not for the faint of heart. Sarcopenia and bone loss can be kept to a minimum and possibly reversed if people exercise. The kind of exercise they must do is “resistance” exercise —lifting weights. It sounds nutty, but it’s for real. Weights don’t have to be of the same magnitude used in a bodybuilding contest. You can start with one-pound weights and gradually increase the poundage when you become comfortable with that amount of weight.
\Dear Dr. Donohue: I have been on thyroid medicine for years. It was suggested that I take iodine to get my thyroid gland functioning on its own. Why don’t doctors suggest iodine rather than prescription medicine for the thyroid? — V.W.
\ Answer: Unless the circumstances are quite unusual and unless a person is truly iodine deficient, taking iodine doesn’t cure thyroid problems. You shouldn’t stop your thyroid medicine unless your doctor says to do so."; drDArticle[32] = "Dear Dr. Donohue: I’ll be going on a cruise this fall. Since I am susceptible to motion sickness, is there anything I can take, other than the pill Marezine? I have heard the Transderm Scop patch isn’t recommended for older people.
\Answer: A great many people are affected by motion sickness. The waves of nausea are triggered by a mismatch of signals the brain receives from the eyes and from the balance organs in the inner ear. They send conflicting messages, and the brain can’t cope with those messages. You can minimize the mismatch by doing a few simple things:
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•Reserve a cabin in midship, near the waterline.
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•Look off into the horizon. If you see a distant object, fixate on it.
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•Don’t read.
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•Don’t overeat.
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Dramamine belongs to the same class of motion-sickness medicines as Marezine, but you might be able to tolerate it better. Antivert is another drug of the same class. Try them before you take the trip to see if they upset you or make you groggy. Transderm Scop — the patch worn behind the ear — has permitted many people prone to seasickness to have a happy cruise. The manufacturer says it should be used with caution in the elderly because they are more sensitive to its side effects, like dry mouth, difficulty urinating, blurred vision, disorientation and drowsiness. If your doctor OK’s the idea, this is something else you could try before getting on board. If you feel any of the side effects setting in, take the patch off immediately.
Dear Dr. Donohue: Through the years, I have been troubled with restless leg syndrome. One day it struck me that I had the worst symptoms on days when I drank little water. That night, I had symptoms, so I drank 10 ounces of water. The symptoms disappeared. That was seven months ago, and since then I make sure to have plenty of water before bed. I have not had a recurrence of restless legs. I thought I might have to get up often during the night to go to the bathroom, but this has not happened to me. I hope it works for others. — D.M.
\Answer: So do I, D.M. If it doesn’t, I’ll hear about it. For more conventional approaches to restless leg syndrome and nighttime leg cramps, the booklet on those topics covers most of the standard treatments. Readers can order a copy by writing: Dr. Donohue — No. 306W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My dog has Cushing’s disease. Can humans catch it? We eat off the same dishes. — I.G.
\ Answer: Cushing’s disease is an overproduction of adrenal gland hormones and is caused by a tumor of the adrenal glands or of the pituitary gland. You can’t catch it from anyone, including your dog."; drDArticle[33] = "Dear Dr. Donohue: I have a friend who has nonstop hiccups. He has been under the care of several doctors, but no one can help him. What causes hiccups? Is there a cure? He has them so bad he refuses to go out in public. — C.M.
\Answer: Hiccups are the involuntary contractions of the diaphragm muscle — the horizontal muscle that separates the chest from the abdomen. It’s the principal breathing muscle. What brings on the contractions often isn’t known, but sometimes it is a hidden condition that irritates the diaphragm or the vagus or phrenic nerves. Your friend doesn’t have ordinary hiccups, the kind that last from minutes to hours and usually come from a distended stomach or one filled with gas from carbonated beverages. He has persistent, intractable hiccups, ones that last for months, even years. For his kind of hiccups, obscure causes have to be investigated — things like an abscess beneath the diaphragm and things that irritate the vagus or phrenic nerves. The search is arduous and includes lab tests, X-rays and scans. Cures do exist for prolonged hiccupping. Medicines can sometimes stop them. Chlorpromazine, orally or infused into a vein, is one of them, as is metoclopramide. Seizure medicines — Dilantin, Depakote, Tegretol — also have had some success in suppressing hiccups. A number of invasive techniques can be used when medicines fail. The phrenic nerve — the nerve that serves the diaphragm — can be blocked or crushed. An implantable breathing pacemaker that controls the diaphragm by sending nerve messages through the phrenic nerve is another way to end intractable hiccups. Readers, this isn’t the kind of hiccups that responds to many home remedies like swallowing a teaspoon of sugar. This kind of hiccups is in an entirely different league.
\Dear Dr. Donohue: My aunt has taken Xanax for 18 years. She is 78. She suffers from anxiety and panic disorder. She takes the lowest dose and takes one only every 12 hours. It makes her able to live a relatively normal life. She has tried counseling several times, but it didn’t work for her. Could she be damaging her liver or kidneys? This is the only medicine she takes. — M.S.
\Answer: Your aunt has taken this medicine for 18 years without any side effects. It has allowed her to cope with life. She’s taking a very small dose. It hasn’t damaged her organs, and it won’t. I’d leave her alone. She’s doing well with it. Forcing her to give it up would create major problems for her. She has a chronic illness, and Xanax controls it.
\Dear Dr. Donohue: For 20 years, my doctor has told me that my white blood count is low. I am 82. What can I take to improve the count? — L.F.
\ Answer: You might not need to. In those 20 years, has anything bad happened to you? Have you had one infection after another? If not, you don’t have a worry. White blood cells fight infections. There isn’t a lot you can do about raising the count."; drDArticle[34] = "Dear Dr. Donohue: Recently I began having severe headaches. I finally drove myself to the emergency room at a nearby hospital and, after numerous tests and a biopsy, the diagnosis was temporal arteritis. The doctors prescribed prednisone. Since taking it, I do not have the headaches. However, I am very weak and have no energy. The doctors tell me I must keep taking the prednisone or I could go blind. Will you comment? — K.Q.
\Answer: Temporal arteritis is artery inflammation. Since the temporal artery — the one at the side of the head (the temple) — often is involved, that’s how the name came about. In addition to the headache, the scalp often is tender. Sometimes patients are anemic. Its cause is still nature’s secret. The urgency of temporal arteritis is the fact that the artery that brings blood to the eye’s retina is often inflamed too. Without prompt treatment, the retina can lose its blood supply, and the person is then blind. This happens to half of those who get no treatment or whose treatment is delayed. The diagnosis can be made by taking a small portion of the temporal artery for microscopic examination. One simple lab test, the sedimentation rate, is high in people with this condition, and it confirms the suspicion that temporal arteritis is responsible for the headache and other symptoms. Prednisone is one of the powerful cortisone drugs, the best inflammation-fighting drugs we have. It’s unusual for your symptoms of weakness and lack of energy to come from prednisone. It usually has the opposite effects. Temporal arteritis, however, can make a person listless and pooped out. Give the medicine a chance to work. An illness often seen simultaneously with temporal arteritis is polymyalgia rheumatica, whose prominent features are pain and stiffness of the neck, shoulder, back, hip and thigh muscles. Luckily, prednisone controls it too, so both are treated with the same medicine. The headache booklet describes the more common kinds of headaches, but not temporal arteritis. Readers can order a copy by writing: Dr. Donohue — No. 901W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Two years ago, I was a passenger on a motorcycle and fell to the asphalt. I suffered a hematoma of my buttock. A few months later I was rear-ended when stopped in my auto. I was treated only with pain medicine. The hematoma is somewhat smaller, but it’s as hard as a rock. I have lower-back pain and intolerable pain when I sit. Is there any treatment? — S.B.
\ Answer: A hematoma is a collection of blood deep in the tissues, most of the time in a muscle. Athletes who play contact sports are always getting one. It’s like a bruise. Frequently the body absorbs the pool of blood, but sometimes it turns into bone — ossifies. That process is myositis (muscle) ossificans. Even an ossified hematoma can regress. If it doesn’t and if it causes pain, an orthopedic surgeon can possibly remove it. Speak with one of those doctors."; drDArticle[35] = "Dear Dr. Donohue: Are eggs harmful? I’ve been told not to eat more than two a week. I read, however, that eggs are good for us. — M.D.
\Answer: The daily cholesterol limit has been set at 300 mg. An egg has 212 mg of cholesterol, so a single egg just about polishes off the entire day’s cholesterol allotment. However, the 300 mg limit was set in a time when it was believed that most blood cholesterol comes from foods high in cholesterol. That isn’t true. Most blood cholesterol comes from our liver’s production of it. Saturated fat and trans fat, not cholesterol, prod the liver into making cholesterol. Diet restrictions to lower cholesterol, therefore, should focus on those fats and not so much on cholesterol. Unless your doctor has you on a very stringent cholesterol-lowering diet, the rule on egg limitation can be relaxed. A little while ago, a study compared those who ate one or two eggs a day with those who ate fewer than one a week. The egg-eaters were not more likely to die from heart disease than were the abstainers. The only exception was people with diabetes. Diabetics who ate eggs daily were a little bit more at risk of dying from heart disease than were the ones who seldom ate them. Eggs are a nutritional bargain. One egg has 6 grams of protein and many of the B vitamins. It also has vitamins A and D. Lutein and zeaxanthin are found in eggs. They are important for eye health. All of this, and eggs are cheap. One egg a day is permissible for most people. If a person wants to eat two, that’s OK. Just skip the next day’s egg.
\Dear Dr. Donohue: If I don’t take Metamucil every day, I become quite constipated. I know it’s not good to take a daily laxative; many people tell me so. They have me worried about too-frequent use of it. The box says it’s a bulk laxative. Does that mean it’s a laxative that could get me in trouble? — J.R.
\Answer: Metamucil contains psyllium, a substance like bran. It’s a laxative only in the broadest sense of the word. It doesn’t irritate the colon like some other laxatives do. You can safely use it every day. The laxative report explains constipation and its treatment in detail. To obtain a copy, write: Dr. Donohue — No 504W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Since he lost his job, my husband has been very depressed and nervous. His doctor put him on an antidepressant. He has taken it for 10 days and says he feels no different. Should he ask for another medication? — S.S.
\ Answer: It takes four to six weeks for an antidepressant to take hold. Ten days is not enough time to consider a medicine ineffective."; drDArticle[36] = "Dear Dr. Donohue: Everything I read or hear about macular degeneration is always about dry macular degeneration. I happen to have the wet kind, and would like to know what its treatments are. I’ve heard that vitamins work. Do they? Thank you. — T.R.
\Answer: In the well-off countries of the world, macular degeneration is the leading cause of blindness in people over 50. There are two varieties, wet and dry. The dry kind is the more common of the two, accounting for 85 percent to 90 percent of all macular degeneration cases. Both involve deterioration of the macula, a small circle on the retina, jam-packed with vision cells necessary for high-resolution sight like reading, watching TV, distinguishing faces and driving. Wet macular degeneration comes from a sudden proliferation of fragile blood vessels blossoming in and around the macula. Those vessels leak fluid and blood, and disrupt that sensitive area of sight. Wet macular degeneration often comes on quickly and can progress rapidly. You might have heard of the vitamin-mineral mixture used for slowing the progression of macular degeneration. It consists of vitamins C and E, beta-carotene and the minerals zinc and copper. It is much more useful for dry macular degeneration. For wet macular degeneration, eye doctors can inject the eye with medicines that stop the generation and growth of new, delicate blood vessels. Lucentis and Avastin are two examples. Photodynamic therapy is another method of handling wet degeneration. Here, a drug that is sensitive to light is injected into a blood vessel. The drug localizes in the newly formed, fragile, troublemaking macular vessels. A laser is flashed on those vessels and they dry up. I don’t know if your doctor has suggested any treatment. It may be that you’re not at a stage when therapy would provide the most benefit. The booklet on macular degeneration describes the disease and its treatments. To obtain a copy, write: Dr. Donohue — No. 701W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I crave salt. I sprinkle it heavily on an egg in the morning. At noon I sprinkle it on potatoes, and in the evening on meat, corn or tomatoes. As a snack I eat raw potatoes sprinkled heavily with salt. My mother used lots of salt on her food. She lived to be 96. — B.
\ Answer: Most often, salt craving is a learned hankering. You were conditioned to grab the saltshaker by your mother, and she, probably, by her mother. You should conquer the salt habit. Even though it didn’t hurt your mother and apparently hasn’t hurt you, too much salt can raise blood pressure. Slowly wean yourself off your high-salt diet. Cook and season with things like lemon juice, lime juice, vinegar, pepper and the large array of herbs and spices found in every grocery store. In a month or so, you’ll wonder how you tolerated so much salt on your food. You’ll experience tastes that salt had been completely obliterating."; drDArticle[37] = "Dear Dr. Donohue: When I turned 24, my pierced ears started to reject (bleeding, itching, swelling) my earrings. I have used 14-karat gold, sterling silver and cheap metal earrings. What is the cause? Is there a solution? — E.L.
\Answer: That reaction suggests allergic contact dermatitis, a sensitivity your skin has developed to the metal in your earrings. Nickel is the metal most often responsible. If the gold is 14 karat, it probably contains nickel. Silver jewelry is usually safe, but the clasps and solder on it can have nickel. If this is allergic contact dermatitis, the best treatment is stopping the use of the offending earrings. To be sure that this is nickel sensitivity, a dermatologist can give you a skin test for it.
\Dear Dr. Donohue: My father is in the last stages of Alzheimer’s disease. He is in a nursing home and is bedridden for most of the day. He doesn’t recognize my mother or me. We cannot communicate with him. My mother is worried that he might be feeling pain and is unable to tell anyone. Is there some way I can assure her that he is not suffering? This is most important to my mother. — J.F.
\Answer: If your dad reacts to a pinch, he can feel pain and he can communicate the feeling as we all do — by wincing. It’s a reflex that most often remains intact even in the late stages of Alzheimer’s. The staff at the nursing home is instructed to pay careful attention to any signs that a patient is in discomfort. They take particular care to inspect all patients for any signs that the skin might be breaking down to form a bedsore. Alzheimer’s disease is an illness almost as hard on relatives as it is on patients. The Alzheimer’s booklet gives the details of this illness and its treatments. Readers can order a copy by writing: Dr. Donohue — No. 903W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: You have mentioned celiac disease more than once. You omit oats as one of the grains to avoid. I know for sure that oats throw me into trouble. You should clarify this. — P.N.
\ Answer: Celiac disease is a digestive illness where the digestive tract is thrown for a loop by gluten, a protein found in wheat, barley and rye. The symptoms are diarrhea, weight loss and bulky, foul-smelling stools. Sometimes people with celiac disease present with anemia or osteoporosis without any digestive-tract symptoms. These illnesses come on because celiac disease interrupts the absorption of minerals, vitamins and other nutrients. Oats do not contain gluten. However, they can be contaminated with gluten because they are sometimes refined with the same machinery used to refine those other grains. Many celiac patients tolerate oats well. If they don’t, they should avoid oats along with the other grains."; drDArticle[38] = "Dear Dr. Donohue: Sodium, sodium, sodium! Medical people continually tell us to cut down on it. How much is too much? Many packaged meals contain 10 percent to 40 percent. What does that percentage mean? What are the limits you suggest? — S.W.
\Answer: Most people use too much sodium (salt, sodium chloride). The upper limit on sodium isn’t my suggestion. It comes from a panel of experts, and often different panels come up with different limits. One group sets the upper daily limit at 2,400 mg of sodium. Another would like people to use less, somewhere in the range of 1,200 mg to 1,500 mg. The 2,400 mg amount is equal to one teaspoon of salt. That doesn’t mean you’re allowed to fill up a teaspoon with salt and use that whole teaspoon on food throughout the day. It indicates total sodium intake. People get 77 percent of their total daily sodium from processed and restaurant foods, things like commercial soups, frozen foods and luncheon meats. Another 12 percent comes from the sodium found naturally in foods. Six percent comes from salt sprinkled at the table, and 5 percent from salt added during cooking. You can cut 11 percent of your sodium intake by eliminating the last two sources. For salt added during the processing of foods, you have to read labels. The percentage of sodium listed on labels indicates the percent of the recommended daily sodium intake found in a serving of that food. The booklet on sodium and potassium discusses these minerals in detail. To obtain a copy, write to: Dr. Donohue — No. 202W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What can you tell me about an illness called Paget’s in the brain? A dear friend of mine was told she had it after she had a brain scan. I would like to know what to look for so I can help her without making it obvious and upsetting her. Will this kill her soon? — Anon.
\ Answer: I have to believe that your friend has Paget’s disease of the skull. Paget’s is a bone disease, and the bones most often affected are the pelvic bones, the backbones, the skull, the thigh bone and the lower leg bone. This illness affects 3 percent of those older than 40. It comes about from an acceleration of the normal daily breakdown and buildup of bones. The breakdown phase suddenly speeds up. That throws the buildup phase into high gear, and the new bone that results is misshapen and fragile. Quite often, the process occurs only in a limited section of one bone. When that’s the case, the illness doesn’t present a health threat. Paget’s disease of the skull can cause headaches, hearing disturbances or a malfunction of the nerves that come from the brain. The symptoms depend on what part of the skull is affected and the size of the affected area. Some have no symptoms. For people with symptoms, medicines used for osteoporosis are also used for Paget’s disease. Occasionally, surgery is necessary. I doubt if your friend’s lifespan will be shortened."; drDArticle[39] = "Dear Dr. Donohue: I had a triple coronary artery bypass in April 1998. The vessel used for the grafts was taken from my leg. A cardiologist tells me that the leg vessel graft needs replacement in eight years. It is not as good as grafts taken from arteries in the arm or the chest wall. I feel fine. It has been 10 years since my operation. Am I living on borrowed time? Why isn’t the leg vessel as good as the others? — W.P.
\Answer: Hold on a minute. Predictions about the longevity of grafts for clogged arteries are hazardous. The source of the graft is not the sole factor in its life span. The general health of the person getting the graft is most important. Diabetes, for example, has a negative effect on all blood vessels, including grafts. If graft recipients make major changes in how they live — watch their weight, keep their cholesterol low, get exercise, pay attention to blood pressure and don’t smoke — then their grafts are bound to stay healthy for a long time. The leg vessel you speak of is a long and large leg vein. Veins are not the same as arteries. Arteries have to stand up to pressure that is much higher than it is in veins, so arteries are tougher. At five years, 75 percent of vein grafts are functioning well, and at 15 years, 50 percent are still in good shape. Some last much longer. The “chest wall” graft isn’t from the chest wall. These grafts come from arteries within in the chest. They are directly hooked up to heart arteries, so they have long lives — as long as arteries have. Most of these grafts stay open for 20 or more years. Many heart surgeons use an arm artery as the source of their grafts. The arm does quite well with only one major artery. These grafts are better than vein grafts. They’re arteries. They have a life span between that of a vein graft and that of the inner chest artery graft. The booklet on coronary artery disease discusses this common problem in depth. Readers can order a copy by writing: Dr. Donohue — No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My question is brief. Has anyone ever had a heart attack or dropped dead while taking a stress test on a treadmill? — R.W.
\ Answer: Somewhere around 1 in 2,500 have had a heart attack while undergoing a stress test. Deaths have been reported to be 1 in 10,000. Those numbers make it sound like stress tests are dangerous. They aren’t. The heart-attack problem is actually not as great a problem as it sounds. The people who experienced a heart attack would have had one shortly and, most likely, in circumstances that might not have been favorable for treatment and recovery. A heart attack during a stress test occurs in a place where emergency treatment is readily available. The deaths are tragic and inexplicable."; drDArticle[40] = "Dear Dr. Donohue: How serious is bipolar disorder? Can you control it yourself? Is the brain lacking some element? — L.R.
\Answer: Bipolar is a disorder in which people experience spells of deep depression alternating with spells of great energy and unbridled enthusiasm. It’s an emotional teeter-totter. In the high-energy phase, people feel invincible, are constantly on the go, can do with little sleep, have grandiose and unreasonable plans and are overly sociable. They become impulsive and make hasty and poor decisions. Sometimes they hallucinate, seeing things not present and hearing things not spoken. In the depressed phase, the opposite holds. People become reclusive, feel that all is hopeless, don’t want to get out of bed and are reluctant to interact with others. Those extremes are the two poles of bipolar disorder. Yes, it is a serious illness. It can disrupt a person’s life. Brain chemistry is involved, but the exact mechanisms are not completely understood. Genes have a major role too. Bipolar disorder runs in families. People cannot control these mood swings by themselves. They will have times when the extremes of the two poles are not present but, predictably, the highs and lows return. Medicines are most helpful in restoring stability to people’s lives. Lithium is a medicine with proven good results. There are others.
\Dear Dr. Donohue: Please explain the proper care of a person who contracts shingles. Is it contagious? My doctor didn’t want me in his office. Other doctors say it’s not contagious. I received the drug Famvir at the start. Now I take Lyrica and Percocet. I am miserable. How long is recovery? I have a mild case. I pity anyone with a difficult case. — E.B.
\ Answer: When the shingles rash is brand-new and consists of many small, fluid-filled blisters, virus is present in those blisters. It is theoretically possible for an adult or a child who has never come in contact with chickenpox to catch chickenpox, not shingles, from the blister fluid. The possibility is slight, but it does exist. Most adults — more than 90 percent — have been exposed to chickenpox, so adults are not in great danger. Newborn and young infants, before they’ve received the chickenpox vaccine, are at a little greater risk. You do realize that shingles is the reawakened chickenpox virus that lives in the body from the time of infection to the time of death. You don’t have shingles now. You have the dreadful shingles complication — postherpetic neuralgia. It’s pain coming from the nerve that the shingles virus traveled down on its journey to the skin. You are getting the appropriate medicines. The pain is usually gone in months, but it can linger for years. The shingles vaccine was developed to prevent shingles and postherpetic neuralgia. The shingles booklet describes this illness and its treatment in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[41] = "Dear Dr. Donohue: I am on Lunesta, a prescription sleeping pill for insomnia. The nurse practitioner wanted me to take half a pill every third night, but that didn’t work for me. I have to take half a pill every night. Now she wants me to take half a pill every other night because she’s afraid that it will become habit-forming. What do you think of this medicine? — S.S.
\Answer: All sleeping pills should be taken for as short a time as possible. “As short a time as possible” implies that the person recovers from whatever it is that’s preventing him or her from falling asleep. In the real world, a correctable cause for insomnia often isn’t found, and then a person is faced with having to stay on a sleeping pill or stay awake for most of the night. I would choose option one, as long as the sleeping pill isn’t causing any trouble, like daytime sleepiness. From time to time, it’s in your interest to try and stop the pill. You might find that sleep isn’t as elusive as it was when you started taking it. Lunesta is one of the newer sleeping pills, tolerated well by most. It starts to work in 10 minutes, so it’s useful for those who find falling asleep difficult, and it has extended action to prevent waking in the very-early-morning hours. Lunesta has caused some users to behave differently. A normally reserved person might become quite aggressive. It also has caused a very few to do things they have no recollection of doing. A very small number of people have driven a car under the influence of Lunesta and have not realized that they did it. If a person has such experiences, then immediately stopping the pill is common sense. Have you tried nondrug approaches to falling asleep? Go to bed and wake up at approximately the same time every day. Relax before bedtime. If you don’t fall asleep within 20 minutes of lying down, get up and read or listen to music. Keep daytime naps to 20 minutes or less. Don’t use caffeine within six hours of bedtime. You can become dependent on Lunesta, as you can on most sleeping pills. Dependence means it’s hard to stop the medicine. Gradually tapering the dose can usually allow people to break any dependence. I believe that sleeplessness is worse than the prospect of dependence. Fibromyalgia is a common cause of insomnia. The booklet on this ailment explains it and its treatment. To order a copy, write: Dr. Donohue — No. 305W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Does breastfeeding protect against breast cancer or make it more likely? I have heard both sides. — C.N.
\ Answer: Many studies have shown conclusively that breastfeeding lowers the risk for breast cancer. For every 12 months a woman has breastfed, her chances of breast cancer drop by 4.3 percent. One explanation is that breastfeeding delays ovulation and the production of estrogen."; drDArticle[42] = "Dear Dr. Donohue: Our experience with my husband’s hiatal hernia was traumatic. He was 69 and in excellent health. After a day of working in the yard, we sat down to supper and within three minutes he was incapacitated with chest pain. He was taken to the hospital and was given nitroglycerin for the pain. The pain subsided as quickly as it came. It took two months to discover the real problem: His stomach was in his chest cavity and had crowded his heart and lungs. Surgery was scheduled. Before the scheduled date, the pain returned and he had to have emergency surgery. Please let people with a hiatal hernia know about this. — M.H.
\Answer: People have been led to believe that a hiatal hernia is the same as GERD, gastroesophageal reflux — heartburn; it isn’t. They are two different conditions. A hiatal hernia is a bulging of the stomach through a gap in the diaphragm muscle, the muscle that separates the chest cavity from the abdominal cavity. The gap is the hiatus, and through it, the esophagus can pass from the chest into the abdomen to join the stomach. GERD can happen to people with a hiatal hernia, and it can happen to people without a hiatal hernia. Your husband’s problem was a somewhat rare complication of a hiatal hernia. The upward bulge of his stomach, the portion in the chest, twisted and cut off its own blood supply. That’s what caused his pain. The first time, the hernia untwisted spontaneously and the pain left. The second time, the twist didn’t untwist, and emergency surgery was required. This process is called strangulation and is a very serious affair. Thankfully, it happens only to a very few. You’ve provided a chance for people to learn what a hiatal hernia is, what a strangulated hiatal hernia is and what GERD is. We’re all glad that things worked out well for your husband. The booklet on hiatal hernia, acid reflux and heartburn focuses primarily on the common heartburn problem and its treatment. Readers wanting more information can obtain a copy by writing: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have two granddaughters who bite their fingernails. Is there anything that stops this awful habit? — B.S.
\ Answer: What prompts people — children and adults — to bite their nails is often unexplainable. Stress, boredom, imitation of other nail-biters and relief of anxiety are offered as explanations for the habit, but proof is lacking for a cause in most cases. Close to 60 percent of 10-year-olds bite their nails. As children grow older, the number of nail-biters lessens. Doing nothing about it is often the best policy. If the child wants to stop, then there are ways to help him or her break the habit. When children are at home, Band-Aids over the fingers remind them not to bite. Chewing sugarless gum makes nail-biting less convenient. Readers are welcome to give us their solutions."; drDArticle[43] = "Dear Dr. Donohue: I am 37, have two children and also have fibroids. My periods are quite heavy. My doctor says that removal of the uterus is the best way to end my problem. My husband and I would like to have more children. What other options do I have? —P.S.
\Answer: The uterus is a large, hollow muscle with an internal layer that grows every month in preparation for the reception of a fertilized egg. Fibroids are noncancerous growths of the uterine muscle. They’re common, and for most women they cause few, if any, symptoms. Large fibroids can compress the bladder and provoke frequent urination. Or they can press on the colon and bring on constipation. They sometimes reduce the chances of pregnancy. They can be responsible for heavy menstrual bleeding. Their cause hasn’t been discovered, but female hormones must be involved in their appearance, because they tend to regress with menopause. If they’re not producing symptoms, they can be ignored. If they are kicking up a fuss, hysterectomy — removal of the uterus — is one solution, but not the only one. Options depend on what the woman wants. For a woman approaching menopause, the medicine Lupron is a good choice. It suppresses estrogen production, which shrinks fibroids. Since this has a time limit on use, women who will soon be menopausal are the ones who can take advantage of it. Danazol (a synthetic male hormone), birth-control pills and Depo-Provera control excessive menstrual bleeding due to fibroids. Sometimes doctors can remove a fibroid with a scope that enters the uterus through the vagina without any external cutting. Uterine artery embolization is a procedure where the doctor threads a soft tube (a catheter) to the artery feeding the fibroid. When the right position is reached, the doctor releases particles that obstruct the artery and cut off blood supply to the fibroid. It falls off. MRgFUS, magnetic resonance-guided focused ultrasound, is a new technique employing sound waves to heat the fibroid and shrink it. It can interfere with subsequent pregnancies, however. The booklet on fibroids explains these growths in detail. To order a copy, write: Dr. Donohue — No. 1106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Will you please tell me what causes hand-foot-and-mouth disease? What can be done to prevent kids from getting it? — A worried grandmother of four grandchildren
\ Answer: Hand-foot-and-mouth disease is a viral illness most often occurring in children younger than 10. The virus’s name is coxsackie virus, from the name of the New York city where it was first found. It causes tiny blisters on the tongue, in the throat and on the palate, gums and lips. The blisters break to form shallow sores. The hands, fingers, feet and groin can also break out. The illness peaks in summer or early fall. It’s usually a mild illness that’s over in one week. There is no prevention for it, and there is no medicine for it."; drDArticle[44] = "Dear Dr. Donohue: I have lived with my boyfriend for a year, and we are going to get married soon. One obstacle to marriage for me is his snoring. It’s so loud that I cannot sleep with him. He starts out with a soft snore that builds into a sound that rivals a jet engine. He says snoring is a family thing for him. He is tired all day long. He works hard, comes home, takes a nap, eats and then says he’s still tired. He sleeps a lot on weekends, too. Does snoring have anything to do with this? — B.K.
\Answer: Let me describe sleep apnea, and you judge whether it applies to your fiance. Typically, it involves snoring that gets louder and louder and then suddenly stops. Silence reigns. After a short while, the snorer makes a grunting sound and the snoring cycle repeats. The period of silence is the apnea period. “Apnea” means “no breathing.” Apnea episodes last 10 or more seconds, and they end when the snorer makes a grunting sound and resumes his snoring. During apnea, blood oxygen content dips, and the dip partially rouses the person to begin breathing. Sleep apnea is a health menace. The drop in blood oxygen has several important consequences. It affects the heart and can lead to dangerous heart rhythms. People with sleep apnea often develop high blood pressure and all the complications of increased pressure. These people do not get restorative sleep. They feel drugged during the day. The diagnosis of sleep apnea is made with special studies done in a sleep lab. Portable equipment is available for home testing. If your fiance is overweight, weight loss might put an end to snoring and apnea. He should drink no alcohol after 5 p.m. A CPAP (continuous positive airway pressure) machine keeps air flowing past the throat obstruction that blocks its entry into the lungs. Talk your fiance into discussing these matters with his doctor. The booklet on chronic fatigue syndrome includes a discussion of sleep apnea. Readers can obtain a copy by writing: Dr. Donohue — No. 304W, Box 536475, Orlando, FL 38253-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Sometimes I jerk awake just before falling asleep. Why? Can anything be done about it? — J.A.
\Answer: That happens to lots of people, and sometimes it happens when a person is just wakening. There’s a temporary disconnect between the brain and muscles at those times, and it results in a short jerk. It’s not a sign of any illness. I don’t know of any treatment for it. Most people fall asleep shortly after it happens.
\Dear Dr. Donohue: Is eating cereal with added vitamins and minerals as good as taking a vitamin pill each day? — M.L.
\ Answer: Sure it is. A well-balanced diet provides all the needed vitamins and minerals. The catch lies in eating such a diet. Our ancestors survived pretty well without taking vitamin pills."; drDArticle[45] = "Dear Dr. Donohue: Both my left and right breasts have many lumps. They scared me, so I saw an OB/GYN doctor. She spent a long time examining my breasts and told me I had fibrocystic breast disease and that it was nothing to worry about. I had a mammogram, and no cancer was seen. I still worry. Does this turn into cancer? -- V.B.
\Answer: Fibrocystic breast disease shouldn't be called a disease. It has been renamed "fibrocystic changes." "Disease" is not a word that can be used when 60 percent of premenopausal women have the condition. "Fibro" refers to strands of scar tissue. Cysts are fluid-filled sacs. With fibrocystic breast changes, both breasts are usually involved, something that rarely happens in cancer. The cysts are soft and feel like they're made of rubber. They can be painful, especially in the days before a menstrual period. Cancers are solitary, hard masses that cannot be pushed around, like a cyst can. Fibrocystic breast changes are not cancer and don't become cancer. If they do become painful, take Tylenol or one of the anti-inflammatory medicines like Aleve or Advil. Some women find that eliminating caffeine eliminates the pain of fibrocystic breasts. Others have gotten relief by adopting a high-carbohydrate, low-fat diet. You can put this issue to rest. Breast cancer is on every woman's mind. The booklet on it describes it, its detection and treatment in detail. Readers can obtain a copy by writing: Dr. Donohue -- No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My wife has been going through menopause for the past eight years. We have not been intimate through these years. When I bring up the subject of intimacy, she quickly states that she doesn't want to talk about it. She won't even hug me. My wife is only 53 years old. It seems like she will be going through menopause for the rest of her life. I have been patient, but I would like to have my wife back. If you could give me some advice, it would be greatly appreciated. -- J.T.
\Answer: Menopause can lessen sexual drive, but it shouldn't completely eliminate it, and menopause doesn't usually drag on for eight years. Sexual desire is a complex process that involves hormones, nerves, blood vessels, general health and the brain. The brain is, perhaps, the most important element. Your wife needs professional help. Her total lack of sexual desire at a young age and for so long could be a physical problem, so the family doctor is the place to start. If, as is more likely the case, it is a psychological problem, the doctor can start treatment for that, or can refer her to a specialist. You have been more than patient.
\Dear Dr. Donohue: Does regular running cancel the danger of smoking cigarettes? My boyfriend says it does. -- K.H.
\ Answer: Your boyfriend is delusional."; drDArticle[46] = "Dear Dr. Donohue: I retain fluid in my ankles and feet. They swell during the day. After a night's sleep they're normal size. I have taken a diuretic for a whole year, but it's no better. Why? My doctor has thrown his hands up at this. -- M.P.
\Answer: The swelling will get better only if you find its cause. If both feet and ankles are swollen, the possibilities include heart failure, kidney disorders, liver cirrhosis, medicines and, strangely enough, the overuse of diuretics (water pills). One-sided ankle and foot swelling has another list of causes. The swelling gets better at night because when you're in the horizontal position, fluid returns to the circulation. With heart failure, people have other symptoms -- breathlessness when they're up and about. Often, they awaken at night, panting for air. Kidney disease is detectable with a few simple lab tests. Liver cirrhosis can be confirmed by a physical examination and lab testing. Medicines that cause swelling (edema) constitute a pretty long list. On that list are the popular NSAID drugs, like Advil, Aleve, Motrin and Indocin. Female hormones also can bring on swelling. So can the blood pressure medicines called calcium blockers. Diuretics, when used for a long time and for inappropriate reasons, lead to fluid retention, just the opposite of what they're supposed to do. On your own, cut way back on salt, not just saltshaker use but salty foods like luncheon meats and commercial soups. Elevate your legs as many times during the day as you can and for as long as you can. Wear elastic hose. Ask your doctor if it would be all right to take a vacation from your diuretic. And have you given any thought to finding a doctor who keeps his arms down? The booklet on swelling -- edema -- explains this common condition, its causes and treatments. To obtain a copy, write: Dr. Donohue -- No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Allow four weeks for delivery.
\Dear Dr. Donohue: You have written about sunken sternum several times, but my 18-year-old son has the opposite. He has pigeon breast. He refuses to be seen without a shirt on. I tell him to do push-ups, but he won't. I too have pigeon breast. All he'll do is play video games and stay home. What can I do for him? -- S.S.
\ Answer: Ask the family doctor for a referral to a chest (thoracic) surgeon. Surgery for this deformity usually produces excellent results. Your son has become so self-conscious that a correction is needed for his psychological health. The operation will give him a new lease on life. Push-ups won't help. Pigeon breast is a marked, outward protrusion of the breastbone (sternum). It often runs in families. It's less common than funnel chest, an inward dip in the breastbone. Both are correctable."; drDArticle[47] = "Dear Dr. Donohue: A commercial I saw on TV had a grandparent and grandchild talking about peripheral artery disease. It got me wondering if I have it. I got the idea that many older people do. I am 78. What are its signs? -- K.M.
\Answer: Peripheral artery disease, PAD, also goes by the name peripheral vascular disease. It is a common condition in older people, but not every senior citizen has it. Close to 15 percent of those over 70 do. Here "peripheral" refers to the legs. "Artery disease" is artery clogging, the same process that goes on in heart arteries and culminates in a heart attack. High blood cholesterol, blood fats, blood protein and platelets aggregate on an artery wall, and as the buildup grows, it blocks circulation to the tissues fed by that artery. Blood doesn't reach leg muscles in a sufficient amount to support those muscles when they're active. The common sign of PAD is calf pain while walking. The pain leaves when the person stops walking. Many people with PAD can tell, almost to the inch, when the pain will begin. The pain indicates leg muscles aren't getting enough blood. A simple office test to detect PAD is to compare blood pressure taken at the ankles with blood pressure taken in the arms. The two readings should be close. With PAD, the ankle blood pressure is lower than arm pressure due to the obstruction to blood flow. Management of PAD is similar to management of clogged heart arteries. Blood cholesterol has to be lowered, blood pressure normalized and blood sugar controlled. Weight reduction, if indicated, is important, as is daily exercise, -- even though pain occurs during walking -- has to become routine. Cigarette smoking, of course, is out of the question. If the doctor does confirm a diagnosis of PAD, prescription medicines help blood get around artery blockages. Aspirin, Plavix and Pletal are examples of such medicines. When the obstruction is sizable, then leg arteries can undergo the same kinds of treatments as heart arteries -- bypass surgery or stents. The booklet on peripheral artery disease discusses this topic in detail and its treatment. Readers can order a copy by writing: Dr. Donohue -- No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: How soon after taking medicine is it OK to drink alcohol? I say an hour is enough time. My wife thinks it should be four hours. Who is right? -- B.N.
\ Answer: First you should make sure your medicine is compatible with alcohol. Some medicines aren't. In that case, you shouldn't drink alcohol at all while taking the medicine. It takes the stomach about four hours to empty its contents. Medication, however, doesn't stay in the stomach for that long. If your medicine is compatible with alcohol use, the answer is a compromise: You should be safe if you wait about two hours after taking it."; drDArticle[48] = "Dear Dr. Donohue: When my brother was 47, he died of a stroke caused by bleeding in his brain. He was fine one minute, and the next he was in a coma. An autopsy showed he had had an aneurysm that ruptured. I have four other brothers and three sisters. Should we all be checked for an aneurysm? I am now 66. -- W.C.
\Answer: An aneurysm is a weak spot on an artery wall. It looks like a blister. Aneurysms can develop on any artery, but they are mostly found on the aorta and on brain arteries. Should the aneurysm break, bleeding can be catastrophic. Ruptured brain aneurysms account for 10 percent of strokes, and frequently they occur in younger people, ones not thought to be at risk of a stroke. The story is much like your brother's. A person, apparently in good health, complains of having the worst headache ever. Then he might lapse into unconsciousness briefly. He might have a seizure. The mortality of a ruptured brain aneurysm is high, more than 50 percent. First-degree relatives of a person who had a brain aneurysm have an increased risk of also having one, but the risk is relatively small, about 1 percent to 4.7 percent. A first-degree relative is a parent, brother, sister or child. The best way to detect a brain aneurysm is a special kind of scan called magnetic resonance angiography. It's a magnetic resonance imaging -- MRI -- scan with dye injected into the arteries to outline any aneurysm. Most authorities don't recommend screening first-degree relatives, because their risk is small and the procedure carries an equally small danger. The booklet on stroke explains this common and sometimes crippling condition. Readers can obtain a copy by writing: Dr. Donohue -- No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I recently read that nausea and gas are symptoms of pancreatic cancer. I have both. Could I have pancreatic cancer? I am 79. -- E.B.
\ Answer: Pancreatic cancer's average age of onset is 65. The risk of coming down with it increases with age. About 34,000 new cases of it occur yearly in the United States. It is the fourth leading cause of cancer deaths. What makes pancreatic cancer such a peril is its lack of signs and symptoms in its early stages. Symptoms, when they do arise, include loss of appetite, a drop in weight, stomach discomfort or pain, nausea and a sensation of fullness after taking only a few bites of food. As the cancer grows, it blocks the drainage of bile, and the skin and whites of the eyes turn yellow. Your symptoms are common to many things, and pancreatic cancer is not high on the list. However, I have learned one thing about medicine: When a person brings up a diagnosis, I can't dismiss it, no matter how remote the chances of having it are. See your doctor. You and I will sleep better if you do."; drDArticle[49] = "Dear Dr. Donohue: I have never been diagnosed with asthma, but when I drink cold beverages or eat ice cream and when I work out in cold weather, I start wheezing and get extreme chest pain. Is this asthma? What can I do? -- R.K.
\Answer: You can't give a better description of asthma. Asthma is a relatively sudden constriction of the lungs' bronchi, the airways. The constriction is reversible, but the amount of time it takes to reverse varies from person to person and from situation to situation. Airway narrowing makes it tough for air to get into and out of the lungs. In addition, during an attack the airways are inflamed and they secrete thick mucus. Both add to the difficulty for air to move through them. Wheezing is a classic asthma sign. The wheezing noise indicates air is meeting with resistance in its passage through the breathing tubes. Coughing is another asthma sign, as is bringing up thick, sticky sputum. During an attack, asthmatics often have chest tightness and pain. A person need not have all these signs and symptoms to have asthma. Wheezing and chest pain are enough. Exercising in cold, dry air is an asthma trigger for many. The loss of heat and moisture from the breathing tubes brings on an attack. I haven't heard that drinking cold beverages or eating ice cream can precipitate an attack, but I can see how they might. What can you do? Get to the family doctor. The doctor can confirm the asthma suspicion by testing your lungs' function. Medicines can prevent attacks as well as put an end to them. As for the cold drinks and ice cream, don't you think it would be a good idea to avoid them? Readers who would like more information on asthma can order the booklet on that topic by writing to Dr. Donohue -- No. 602W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Will pomegranate juice or pomegranate juice mixed with blueberry juice lower cholesterol? I am a heart patient. -- R.F.
\Answer: Pomegranates and their juice have risen to the level of nutritional stardom. They contain substances that stop the oxidation of LDL cholesterol, the kind of cholesterol that clings to artery walls and leads to their obstruction. Oxidation is like rusting. Oxidized LDL cholesterol breaks apart and leads to clogged arteries. Pomegranates stop this process. Blueberries are another nutritional star. They prevent oxidation too. I don't know that mixing them doubles their effect, but I suppose it might.
\Dear Dr. Donohue: I am 63 and have a condition that people call "turkey neck." The skin under my neck hangs down. How can I get rid of it without surgery? It's not a double chin. I do exercises for it, but they aren't working. -- A.L.
\ Answer: How can I break this to you gently? I don't know of any way to get rid of that redundant, drooping skin without resorting to surgery."; drDArticle[50] = "Dear Dr. Donohue: I have heard a lot about MRSA. Can you give me some more information about it? What can we do to prevent getting it? I am a student at San Jacinto High School in California. -- J.R.
\Answer: "MRSA" is short for "methicillin-resistant Staphylococcus aureus," a common bacterium found all over the place and a common inhabitant of the skin. "MRSA" is pronounced "mersa," as though it were a word. In the early days of penicillin, it could kill many germs, including the staph germ. That germ is a wily creature. It soon learned how to dodge the killing power of penicillin. Clever scientists came up with a new model of penicillin called methicillin. It was effective against those resistant staph germs. This happy situation came to an end when staph learned how to evade methicillin. These are the MRSA bacteria. We do have antibiotics that can deal with MRSA bacteria. However, the lesson is that antibiotics must be restricted only to infections by bacteria that respond to them. Using antibiotics indiscriminately paves the way for the development of resistance. MRSA can cause all kinds of infections, but the most common are skin and soft-tissue infections. Soft tissues are the tissues just below the skin, the subcutaneous tissues. Outbreaks of MRSA infections are common in high-school football players and wrestlers because of the skin-to-skin contact that occurs in those sports. Anyone, athlete or not, can come down with this infection. Frequent hand-washing is the best defense against MRSA. All skin wounds should be covered with a bandage of sterile, dry gauze and inspected daily to see if they are becoming infected. Athletes should launder their playing clothes after each use and should not store dirty clothes in a locker. They should shower immediately after a practice. No one should share towels, brushes or combs.
\Dear Dr. Donohue: My mother's neighbor "candles" her ears when they fill with wax. I am not acquainted with this procedure. My mother believes it is an excellent treatment, and she won't discuss it with me. What is your opinion? -- H.M.
\Answer: My opinion on candling gets me in trouble with aficionados of the practice. It involves inserting the narrow end of a cone-shaped device into the ear canal. The other end is lit. Heat is supposed to soften the wax and create a vacuum that draws it out of the ear. I think it is dangerous. The FDA doesn't approve of it.
\Dear Dr. Donohue: I have gotten in the habit of taking Tylenol before seeing my dentist. I have a phobia about needles, and seeing the dentist come at me with a syringe puts me in a cold sweat. I have it in my mind that the jab will be painful. Taking the Tylenol works for me. Is there anything wrong with doing this? -- R.C.
\ Answer: There's nothing wrong with taking a Tylenol before seeing the dentist. If it gets you through what you imagine might be painful, three cheers for Tylenol."; drDArticle[51] = "Dear Dr. Donohue: What are the symptoms of colon cancer? Are there any? -- B.P.
\Answer: The colon is about 5 feet long. It begins in the lower-right side of the abdomen, ascends on the right to just below the liver, crosses over the abdomen to the left side and then descends to the rectum. Symptoms of colon cancer depend where the cancer is located. Cancers on the right side often cause open sores that bleed. Since it takes a while for undigested food to reach the rectum from the right side of the colon, the blood often is seen as tarry, black stool. Cancers of the section of colon that spans the upper part of the abdomen from the right to the left sides can cause obstruction of the bowel. Cancers of the left side of the colon, the most common site for colon cancer, can lead to narrow stools, cause stomach cramps and discharge bright-red blood into the stool. Weight loss is a sign of colon cancer, regardless of its site. Don't wait for symptoms to check for colon cancer. This cancer has a number of excellent screening tests, and it can be detected early, when it's treatable and curable. Everyone at age 50 should have a colonoscopic exam, a scope exam of the colon. The examining doctor sees every inch of the colon and spots any cancer or any polyps, the precursors of colon cancer. X-rays called double-contrast barium enemas are another way of detecting colon cancer. The booklet on colon cancer deals with its detection and treatment. Readers can order a copy by writing: Dr. Donohue -- No. 505W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have a serious problem. I say "serious" because I have had a doctor laugh at me for asking the following question, for which, incidentally, I paid $25. For about six years, I can hear my heartbeat loudly in my left ear. No one can tell me why. I hear it 24/7. I am about to lose my sanity. I pray you can help. -- D.M.
\ Answer: Lots of people hear their heartbeat in one or both ears. The condition is called pulsatile tinnitus. One of the biggest causes for it is artery hardening, something that comes with age. Blood flowing through less flexible arteries near the ear becomes noisy. People hear their own heartbeat. Caffeinated beverages make the beating louder. Put a radio at your bedside and tune it to soothing music at night. The music can often muffle the heartbeat sound. If music doesn't work, then turn the radio to a location where you hear static. Static often gets rid of the heartbeat noise. Sometimes changing the head position abolishes the beating sound. A few rare conditions produce pulsatile tinnitus -- a narrowed neck artery, an artery-vein malformation, a damaged aortic heart valve and high blood pressure are examples. I would guess these conditions would have been discovered in the six years you have had the problem."; drDArticle[52] = "Dear Dr. Donohue: I read a cover story in a national magazine that claimed there is much question about the need to lower cholesterol and to prescribe statin medicines. I can't believe this story wasn't front-page news, since 18 million Americans take statin drugs. People taking statins are exposed to the risks of muscle pain, memory loss and sexual dysfunction. My husband experienced these firsthand. His doctor ignored all his complaints and changed only the brand of statin drug. I hope you look into these reports on cholesterol and statin drugs and get the truth out to your readers. -- R.B.
\Answer: I know that voices of dissent arise about every medical theory and over every drug developed to correct what most consider a health hazard. Numerous studies have confirmed the proposition that high blood cholesterol and high blood LDL cholesterol lead to heart attacks and strokes. Most of the worldwide medical community subscribes to that proposition. Similarly, innumerable articles have demonstrated that lowering cholesterol and LDL cholesterol prevents heart attacks and strokes, prolongs life and can possibly reverse artery-hardening. All of this has been done by rigorous scientific investigations. Statins are the most powerful medicines for the lowering of cholesterol. (Statins are: Zocor, Pravachol, Crestor, Lescol, Mevacor and Lipitor.) Muscle pain occurs in 1 in 1,000 users. Muscle damage occurs in much fewer. Memory loss and sexual dysfunction are very rare. Most of the side effects of statins are reversed with discontinuation. Every doctor I know believes in the cholesterol theory and in the benefits of statin therapy. I put my money where my mouth is. I take a statin. To be fair, the magazine should present the other side of the story. The pamphlet on cholesterol tells the whole story in detail. Readers can obtain a copy by writing: Dr. Donohue -- No. 201W, Box 536475. Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My husband wears his belt so tight that it leaves a deep mark on his skin. He has constant heartburn, for which he takes Tums by the handful. I tell him to loosen his belt and he won't have so much heartburn. He says his pants fall down when he does. He has a big stomach. Do you think the belt has anything to do with his heartburn? He also has a hernia. How about that? -- C.N.
\Answer: Anything that constricts the stomach can encourage the upward spurt of stomach acid into the esophagus, where it causes heartburn. Your husband should at least try belt-loosening as a possible solution. If his pants are falling down, buy him suspenders. The tight belt isn't likely to have any influence on his hernia.
\Dear Dr. Donohue: What causes bags under the eyes? -- L.B.
\ Answer: In younger years, tough fiber strands under the eyes form a grill that keeps fat from bulging forward. In older years, those strands give way and fat protrudes to make undereye bulges -- bags."; drDArticle[53] = "Dear Dr. Donohue: I am a 78-year-old female, active and in good health -- or so I thought. I eat right and never smoked or drank alcohol. Yesterday, a colonoscopy showed severe diverticulosis. The doctor prescribed Benefiber, then left and never returned. I am stunned. What do I do now? Will I have this forever? Am I unhealthy? How does one develop diverticulosis? What the difference between "osis" and "itis"? -- S.K.
\Answer: Your world isn't collapsing. You're healthy. You'll have diverticulosis forever. By age 60, half of the people in North America have it. By age 80, two-thirds have it. A diverticulum is a bulge of the inner colon lining through the colon's muscular wall to its outer surface. A diverticulum looks like a small soap bubble. It's only 1/5 to 2/5 inches (0.5 to 1 cm) in diameter. You can thank our diet for diverticulosis. We refine flour and throw away its bran -- the outer coat of grain. In countries where whole grains (including the bran) are commonly used, diverticulosis is a rarity. Bran and other fiber hold water in undigested food. Without fiber, the food residue dries and becomes hard. The colon muscles have to generate a great deal of force to keep it moving. That force causes the colon lining to pop through the colon wall as a diverticulum. For most, diverticulosis is a silent condition that remains silent for life. For a few, the diverticulum breaks and causes a local infection in the colon -- diverticulitis. The pain of a diverticulitis attack is usually felt in the lower left corner of the abdomen, and sometimes people have fever and chills along with the pain. The attack is treated by resting the tract and by giving antibiotics. We're supposed to get 30 grams of fiber a day. Fruits (especially those with edible skins), many vegetables and whole-grain products are the source of dietary fiber. If people cannot get enough fiber in their diet, then commercial products like the one you're taking fill the gap. Metamucil, Perdiem, Citrucel and Fiberall are other examples. The booklet on diverticulosis explains the ins and outs of this very common disorder. To order a copy, write: Dr. Donohue -- No. 502W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My husband has chronic blepharitis and frequently develops hard buildups in both eyes that cause great discomfort. The doctor must remove them two times a month. What can be done to prevent them? -- S.R.
\ Answer: Blepharitis (BLEF-uh-RYE-tiss) is inflammation of the eyelid margins, which become red and crusty. The crust can build up into hard deposits. A twice-a-day program of lid cleansing might eliminate the crusts. Have your husband apply warm compresses (a wet washcloth) to closed lids for five to 10 minutes and then massage the lids. After the massage, he cleanses the lid margins with a cotton-tipped applicator dipped in a solution of one part baby shampoo and one part water. The doctor might have to prescribe an antibiotic ointment."; drDArticle[54] = "Dear Dr. Donohue: I have gout in my big toe, and it's very, very painful. I have to walk in my socks. Are there any pills for gout? What food causes the pain? -- L.K.
\Answer: Gout results from too much uric acid in the blood. Uric acid is a byproduct of daily cell chemistry. When the uric-acid level rises, crystals of it penetrate the joint. The joint swells, the skin over it turns red, and the joint feels warm. It hurts beyond words. Early on, gout comes in attacks, with the intervals between attacks being free of pain. As time passes, the joint can hurt all the time. The joint at the base of the big toe is often the first joint affected, but it might not be the only joint. The heel, ankle, knee, fingers, wrists and elbows also can be targets. Doctors make the diagnosis of gout by examining the affected joint and finding a high blood uric acid. The most telling evidence lies in looking at joint fluid through a microscope and seeing uric-acid crystals. Are you positive it is gout that you have? Many conditions cause swollen, painful joints. For acute gout attacks, nonsteroidal anti-inflammatory medicines like Indocin work well. Another time-honored gout medicine is colchicine. If neither of these works, cortisone drugs come to the rescue. Zyloprim (allopurinol) turns off the production of uric acid and prevents gout attacks. Benemid (probenecid) facilitates the excretion of uric acid into the urine. It, too, prevents attacks. Diet was the sole treatment of gout in the bad old days. Organ meats -- liver, brain, sweetbreads and kidneys -- are foods to avoid. Gravies are not good for those with gout. Beer should be restricted. Bing cherries can bring the blood level of uric acid down. The gout pamphlet deals with this topic in greater detail. Readers can obtain a copy by writing: Dr. Donohue, No. 302W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have wax buildup in my ear. The doctor told me that. He didn't tell me what to do for it. Will you? -- A.C.
\Answer: Warm some baby oil or mineral oil. Put one or two drops in one ear and let it remain there for 10 minutes. This will soften the wax. Next, using a rubber-bulb syringe found in drugstores, gently flush the ear with warm water. Tilt the head to drain the water out of the ear, and the wax should come out with it. If it doesn't, repeat the procedure. Don't do this procedure if you have a hole in your eardrum or an infection of the ear canal. If this procedure is too much to handle, have the doctor do it.
\Dear Dr. Donohue: Sometimes you hear that people who have a heart or liver transplant take on the personality of the person who donated the organ. Is this true or not? -- N.N.
\ Answer: That's fantasy, stuff of fictional literature. It doesn't happen."; drDArticle[55] = "Dear Dr. Donohue: My husband had blood work for a cholesterol study. It included something called lipoprotein (a), something we never heard of. It was over the normal value. I called my doctor, but he was on vacation, so I left word for the covering doctor. A phone call came from his secretary, who said: "He didn't say anything, so I guess it's OK." I want answers. Will you explain this to me? -- F.
\Answer: Lipoprotein (a), spoken as "lipoprotein little a," is another cholesterol fraction that is an independent risk for artery clogging and heart attacks. It's different from LDL cholesterol (bad cholesterol) and HDL cholesterol (good cholesterol). Frankly, at the present, doctors find it hard to counsel patients about lipoprotein (a), so most don't order it. Now emphasis is placed on lowering LDL cholesterol (your husband's value is very good) and raising HDL cholesterol (again your husband's was very good). I will trade places with him if he wishes, and I'll take his lipoprotein (a) reading to boot. I can tell you what lowers lipoprotein (a). Niacin does. There is no proof, however, that lowering it lowers the risk of a heart attack. Daily exercise of 30 minutes also brings it down, if the doctor approves of exercise for a person. As does losing weight if that applies. A low-fat diet high in vegetables, fruits and grains is another way of reducing lipoprotein (a). From his other cholesterol values, I'd say he must be doing some of this anyway. All of this, except for niacin, is the much-preached recipe for heart health regardless of lipoprotein (a). Until told otherwise, put lipoprotein (a) on a back burner. The booklet on cholesterol explains this topic that is talked about to excess. Readers can obtain a copy by writing: Dr. Donohue -- No. 201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: None of my 21 grandchildren has had their tonsils out. All of my seven children did. Is this no longer done? I wish doctors would make up their minds about these things. -- B.B.
\Answer: When your children were young, it was almost standard practice to remove tonsils as a way to protect against strep throat. We now know this isn't necessary, and we now have antibiotics to treat strep throat. Children who have repeated strep throat infections still have their tonsils removed, but the operation is no longer done for prevention.
\Dear Dr. Donohue: I work out at home on an exercise bike and a treadmill. On days my knees are bothering me, I don't do either. One doctor suggests that I cease the exercise bike but use the treadmill. The other says just the opposite. They both can't be right. Who is? -- R.G.
\ Answer: You can answer this one for yourself. Which hurts your knees? I find that bike pedaling is harder on my knees. Others find running a bigger source of pain."; drDArticle[56] = "Dear Dr. Donohue: I am a 78-year-old male who recently experienced a breaking out on my face and around my nose. Pimples came up. My physician diagnosed it as rosacea. He prescribed tetracycline and MetroGel ointment. The area cleared up. I wonder if I can stop taking the prescriptions. Perhaps you might explain what rosacea is. -- O.L.
\Answer: Rosacea (rose-A-shuh) can happen to anyone, but it particularly singles out people who were or are prone to blush easily. The tip of the nose, the cheeks and the chin are the places where the skin stays red and on which pimples break out. In time, tangles of small blood vessels also appear on those places. Without treatment, the nose can become disfigured. For an image of end-stage rosacea, think of the nose of W.C. Fields. Eye involvement is an unappreciated aspect of rosacea. The eyes feel gritty, water and become bloodshot. In a few cases, the eyes are the only manifestation of this disorder. Most often, rosacea is a chronic illness requiring chronic treatment. You can stop your medicines if your doctor agrees. The worst that can happen is that it will return. Stay out of the sun, and always wear sunscreen when going outside. Don't drink alcohol. Stay away from spicy foods. Hot beverages encourage breakouts. Contact the National Rosacea Society. The society is more than willing to answer any questions that might arise about rosacea. Its toll-free number is 888-NO-BLUSH, and its Web site is www.rosacea.org.
\Dear Dr. Donohue: I have been suffering from pain that spreads from my left shoulder blade, around my side and to just below my left breast. There is no skin rash. I wonder if this could be shingles. Do the shingles ever not come to the surface? If it is shingles, what is the treatment? -- B.K.
\ Answer: A rare form of shingles called zoster sine herpete causes shingles pain without any skin rash. Its diagnosis is difficult. Proof lies in documenting a rise in antibodies to the shingles virus. A blood specimen has to be taken at the onset of the pain and again one or two weeks later. If the level of antibodies has risen, that's evidence that shingles has occurred without a rash. How long have you been suffering from the pain? Shingles pain that continues for more than a month after the appearance of the rash is postherpetic neuralgia and comes from nerve damage. Even though you never had a rash, if your pain has been going on for six weeks, you might have postherpetic neuralgia. The Lidocaine skin patch can often alleviate this pain. Oral medicines like amitriptyline, Neurontin and Lyrica are also effective for some people. The shingles story is told in the booklet on that subject. Readers can obtain a copy by writing: Dr. Donohue -- No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery."; drDArticle[57] = "Dear Dr. Donohue: During the night and mostly early in the morning hours, my heart speeds up to 200 beats a minute. There is no pain, but it wakes me up and seems to happen if I am lying facedown. I sit up and take my pulse, which is about 70 to 72. I feel my heart slowly return to normal in two to three minutes. I have worn a Holter monitor for 24 hours. My doctor says not to worry about it. Do you think I have anything to worry about? -- S.
\Answer: For readers: A Holter monitor is a device worn externally that records all heartbeats in a given time period. They can be worn for three or more days. The doctor sees on the recording what kind of abnormal heartbeats occurred. I have to clear something up with you, S. Is your pulse 72 beats a minute when you feel your heart beating fast? The heartbeat and the pulse are one and the same. How are you counting your heartbeat? If the episodes occurred while you were being monitored and did not last long, then the doctor can dismiss it as not being worrisome. He should name the rhythm; ask what it is. If the fast heartbeats occurred at times you weren't wearing the monitor, you need to wear it longer so that the rhythm can be identified for what it is. The booklet on heartbeat irregularities describes the more common kinds of these beats and how they are treated. Readers can order a copy by writing: Dr. Donohue -- No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: None of my 21 grandchildren has had their tonsils out. All of my seven children did. Is this no longer done? I wish doctors would make up their minds about these things. -- B.B.
\Answer: When your children were young, it was almost standard practice to remove tonsils as a way to protect against strep throat. We now know this isn't necessary, and we now have antibiotics to treat strep throat. Children who have repeated strep throat infections still have their tonsils removed, but the operation is no longer done for prevention.
\Dear Dr. Donohue: My husband and I take Lipitor. We take it before dinner in the evening. We eat half a grapefruit after breakfast. Is that OK? -- M.L.
\ Answer: You can take Lipitor any time of the day, and you can take it with or without food. It's one of the statin drugs -- the drugs that are such effective cholesterol-lowerers. Grapefruit and Lipitor are not a good combination. Grapefruit can increase the blood concentration of this drug. It does the same with a few other medicines. This effect of grapefruit lasts for 24 hours, so even letting 12 hours pass before taking the drug after eating grapefruit doesn't lessen the chance of this interaction occurring."; drDArticle[58] = "Dear Dr. Donohue: Please save my life. I was diagnosed with hepatitis C five years ago. Tests now say I need treatment. I am scared to death of treatment, about which I have heard horror stories. I have an older husband who will not make it without me. I feel great and have terrific energy. I am 59. Is there something other than the standard treatment I can take? -- S.D.
\Answer: Infection with the hepatitis C virus leads to chronic liver infection in 85 percent of patients. However, illness doesn't appear until 10 to 20 years after infection. At that time, about 20 percent of infected people develop liver cirrhosis, and 1 percent to 4 percent come down with liver cancer. That means 75 percent of patients do not develop serious liver disease. Treatment is necessary when evidence of the virus can be found in the blood and when the liver shows changes that indicate cirrhosis will be a likely outcome. Most of the time, that's determined through microscopic examination of liver tissue obtained by a needle biopsy. Who has given you the horror stories of treatment? It's not a picnic, but it isn't as terrifying as it has been portrayed to you. Ribavirin is one of the drugs used. Its worst side effect is anemia, a drop in the red blood cell count. Stopping the drug just about always returns the count to normal. Peginterferon is the other drug used in treatment. Its most common side effect is flulike symptoms: headache, muscle pain, fever, nausea and vomiting. Appropriate medicines can control these symptoms. It also can produce a drop in both the white and red blood cell counts. It has aggravated depression and given a few people thoughts of suicide. Hair-thinning is another possible side effect. The list of potential side effects is long. Most resolve when the drug is stopped. And most patients complete therapy without having to greatly modify their activities during treatment. Peginterferon is injected under the skin once a week. People learn how to inject themselves. There are no other effective treatments. The booklet on hepatitis describes hepatitis A, B and C, and their treatments. Readers can obtain a copy by writing: Dr. Donohue -- No. 503W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I would appreciate any information on lipomas. In recent years, I'm getting more of them. I am 79 and did not have them until five or six years ago. I have a large one in the middle of my back and a couple on my thighs. I have recently gotten two small ones on my lower arm. -- M.B.
\ Answer: Lipomas are noncancerous fatty tumors. About 1 percent of the population has one or more of them. No one knows the cause, so preventive treatment also remains unknown. However, if they cause pain by pressing on adjacent structures or if they are unsightly, they can be removed without much trouble, often as an outpatient."; drDArticle[59] = "Dear Dr. Donohue: About three years ago, I had a procedure to reduce the size of my prostate. It was Greenlight PVP laser procedure. My doctor did it on an outpatient basis. Since then, I have a normal flow for someone who is 79 years old. I sleep through the night without having to get up to go to the bathroom. Perhaps you could comment on this treatment. -- L.M.
\Answer: Prostate gland enlargement -- benign (noncancerous) prostate hyperplasia or hypertrophy -- is something that happens to just about all men. Fifty percent of men between the ages of 51 and 60 have some gland enlargement, and by age 80, more than 80 percent have it. Not all these men have to deal with its exasperating consequences -- frequent urination, nighttime urination, difficulty starting the stream -- but enough do that it is a quite common problem. Sometimes medicines can relax the chokehold that the big prostate has on the urethra, the tube draining the bladder, and there also are medicines that shrink the gland. When medicines strike out, a large number of invasive procedures are readily available. The standard operation, TURP -- transurethral resection of the prostate -- is done with a scope and instrument passed into the urethra and advanced upward to the gland. The doctor shaves away portions of the gland. TUNA -- transurethral needle ablation; TUMT -- transurethral microwave therapy; and TUIP -- transurethral incision of the prostate are procedures done very much like a TURP, but they employ different techniques for reducing the gland's size. Some are done in the doctor's office. Greenlight Laser Photovaporization is a technique in which the prostate gland is downsized by vaporizing the excess with a laser that emits a green light. One big advantage this offers is a reduction of bleeding. The green-light laser seals blood vessels in the process. I am sure many men readers will appreciate your bringing up the topic. The booklet on the prostate gland, both enlargement and cancer of, summarizes treatments for these conditions. Readers can order a copy by writing: Dr. Donohue -- No. 1001W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I found myself in my car, stopped at a stop sign, just blocks from my home. I wasn't quite sure where I was or how I got there, and did not remember where I was headed. Things did return to normal. Since then, my short-term memory has been questionable. Is it too early (age 48) for Alzheimer's disease? -- D.K.
\ Answer: Forty-eight is too young for the more common Alzheimer's variety. Your story suggests transient global amnesia, a temporary loss of memory with disorientation. An affected person is befuddled by the locale, why he's there and what he's doing. Such an episode isn't a warning of future problems. Others things can cause a similar reaction -- a tiny stroke, a migraine or even a seizure originating in the temporal lobe of the brain. Play it safe by consulting a neurologist."; drDArticle[60] = "Dear Dr. Donohue: Please talk about lockjaw. I grew up on a farm, and it was something I heard about all the time. You were supposed to be careful when you were in a barn to spot any rusty nails you might step on. Is that so? I don't hear much about it anymore. Why? -- L.S.
\Answer: I heard the rusty nail/lockjaw story as a kid too, and I didn't grow up on a farm. Frankly it's a seldom-seen illness since routine immunization against it has been in effect for many years. The real name of lockjaw is tetanus, and just about everyone has gotten a tetanus immunization. The tetanus bacterium, Clostridium tetani, is found throughout the world in soil and in animal feces. A number of cases develop after a puncture wound when the bacterium is introduced deep into tissues. Rusty nails are only one way the germ gets into the body, and they are not the most common way. The tetanus germ makes a poison that causes muscles to go into violent and painful spasms. Spasms of the jaw muscles are how tetanus came to be known as lockjaw. Patients can't open their mouths. Tetanus also causes generalized muscle spasms, with the patient awake during the spasms. The slightest stimulation -- a loud noise, for example -- can trigger muscle spasms, so tetanus patients are kept in darkened, quiet rooms. Penicillin, human tetanus immune globulin and medicines that control muscle spasms can get most patients through this harrowing illness. I don't want to scare people about tetanus. It is uncommon. However, everyone, at every age, should keep their tetanus immunizations up to date. They have to be obtained every 10 years. Only one-third of the adult population of the United States and Canada is adequately protected against tetanus.
\Dear Dr. Donohue: Every spring I have hay fever so bad that I am virtually housebound. I have used antihistamines, nasal sprays -- including steroid nasal sprays -- cleansing my nose with saltwater flushes and many, many other medicines, but I do not get any relief. My primary care doctor suggests I see an allergist for allergy shots. Do they really work? Would you advise them? -- H.M.
\Answer: Allergy shots, also known as hyposensitization, work for most. An allergist first has to determine exactly what a patient is allergic to and then has a serum compounded that contains the allergic materials. The shots are then given in a series of weekly and in increasingly concentrated doses until a maintenance dose is reached, and that dose is then injected monthly. The shots stop mast cells from emptying themselves of chemicals that spur allergy symptoms like sneezing, itching and running nose when allergic material lands on them. I would advise anyone with severe allergy symptoms that do not respond to medicines to have allergy shots.
\Dear Dr. Donohue: I take a fish-oil supplement daily. Can you tell me if these tablets contain mercury, as some fish do? -- P.C.
\ Answer: Take your fish-oil supplement without fear. Such supplements contain negligible, if any, amounts of mercury. They won't make you sick. They could make you well."; drDArticle[61] = "Dear Dr. Donohue: In 2004, I had a scope put down my throat and into my stomach. The doctor said I had a hiatal hernia and signs of acid reflux. He put me on Prilosec. It stops my heartburn very well. I have been on it ever since. If I miss two doses, the heartburn returns. Is it safe to take this medicine for long periods of time? -- L.K.
\Answer: Prilosec (omeprazole), Aciphex, Protonix, Nexium and Prevacid are proton-pump inhibitors, the strongest medicines for decreasing stomach acid production. The manufacturers of these medicines suggest a four-to-eight-week course of medicine. The medicines don't cure heartburn. They suppress it as long as a person takes them. So what's a person to do when heartburn returns after a course of therapy? Another kind of medicine, like Zantac, can be used. Common antacids often work. Avoiding foods that stimulate acid production is another way to control symptoms. However, if acid reflux is severe, then the proton-pump medicines are the best. Evidence suggests that long-term use might make a person more apt to have a hip fracture. That danger can be partially offset by taking calcium and vitamin D. Many people remain on these medicines for extended periods. You have to make this decision for yourself. The booklet on hiatal hernia, acid reflux and heartburn focuses primarily on the common heartburn problem and its treatment. Readers can obtain a copy by writing: Dr. Donohue -- No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I would like to know about the side aches I get when I walk or run. Why do they occur? Do I walk them off or take a break until they go away? -- E.H.
\Answer: What you call side aches, others call side stitches. Everyone gets them. Some feel they are spasms of the diaphragm - the large, thin muscle that serves as a partition between the chest and abdominal cavities and the muscle that is the principal breathing muscle. Or they might be due to too much food or fluid in the digestive tract. Some believe a decreased blood flow to the diaphragm is the cause. In truth, no one knows. One way to get rid of them is to raise both your arms overhead while taking a deep breath. Then lower your arms while exhaling and simultaneously contracting your abdominal muscles. Another favored treatment is to bend the knee on the side of the pain while pressing your fingers into the painful area.
\Dear Dr. Donohue: I have what doctors call black hairy tongue. Can you tell me about it? -- Anon.
\ Answer: Black hairy tongue, aside from its looks, is an innocent condition that comes from the elongation of tongue papillae, tiny projections from the tongue's surface. Gently brushing the tongue three times a day with toothpaste, baking soda or 3 percent hydrogen peroxide can usually get rid of it. If it's not gone in a month, return to the dentist or doctor for a follow-up exam."; drDArticle[62] = "Dear Dr. Donohue: My daughter, who is 41, has been getting really bad migraine headaches just before her periods. Is it due to menopause? -- V.M.
\Answer: Her headaches are not due to menopause. They come from her menstrual cycle, and they're called menstrual migraines. A migraine sufferer often can identify things that give rise to a headache -- foods, alcohol, physical exertion, too little sleep, too much sleep, hunger, bright lights and loud noise. For quite a few women, menstrual periods trigger the headache. The sudden drop in the female hormone estrogen that takes place at the time of a menstrual period precipitates headaches in these women. Your daughter can take medicine prior to her anticipated menstrual period to prevent the headache. Naprosyn or one of the many other nonsteroidal anti-inflammatory drugs, taken two days before the period begins, often can avert menstrual migraines. They should be taken for as long as the headache has lasted in the past. Another approach is birth-control pills. The ones that stop periods for six months to a year are particularly useful. Seasonale and Lybrel are two such preparations. Most migraine sufferers are aware of the triptan drugs -- medicines that have had a huge impact on migraine treatment. There are seven such drugs, and I won't mention them all. Maxalt and Relpax are two of these drugs. The triptans should be used as the anti-inflammatory drugs are used -- two days before onset of periods and continued for the length of the usual migraine. The headache booklet describes the common kinds of headaches and their treatment. Readers can order a copy by writing: Dr. Donohue -- No. 901W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My 21-year-old grandson has weighed 130 pounds for the past six years in spite of drinking protein shakes, taking weight-gain pills and eating rich, calorie-laden foods. He is 6 feet 1 inch tall. Why can't he gain weight? His self-esteem is zero because of his appearance. He loves to swim but is ashamed to appear in bathing trunks. A doctor told him to live with it. Is that the answer? Any help you can give will be appreciated. -- D.T.
\ Answer: Your grandson isn't on the lean side. He is truly skinny. If this isn't a family trait, it needs to be looked into more seriously. Malabsorption syndromes should be considered. These are illnesses where nutrients cannot pass through the intestinal wall into the body. Celiac disease is an example. There are many more. Granted, most of these illnesses have other symptoms but, at times, those other symptoms can be so mild that they're ignored. Trouble with endocrine glands is another possibility. The thyroid gland, the adrenal glands, the testes and the ovaries have important roles in growth and development. Genetic illnesses constitute a group of disorders that can manifest with nutritional signs. I have many pat answers on how to gain weight. Your grandson needs more than pat answers."; drDArticle[63] = "Dear Dr. Donohue: What's the best way to treat sunburn? I get one every year. I know it will happen this year too, and I want to be prepared. -- D.J.
\Answer: The best way to treat sunburn is not to get one. What makes you think you'll get one this year? You're doing something wrong. I have to repeat things that should be common knowledge, so bear with me. Don't go out into the sun during the hours of its greatest intensity -- 10 a.m. to 3 p.m. I have a feeling this is a rule observed more in its breach. Always wear sunscreen with an SPF -- sun protection factor -- of 15. If you are very sensitive to sunlight, use one with an SPF of 30. Apply it 15 to 30 minutes before going outside, and reapply it at least every two hours. Each application requires about 1 ounce. If you go into the water or are sweating heavily, apply the sunscreen more frequently. With a sunburn, in about three hours after exposure, the skin reddens and becomes painful and hot. Taking aspirin relieves pain and can lessen the damage done to the skin. Don't give aspirin to young children -- they can take Tylenol. Cool baths or cool compresses make a person more comfortable. Apply a skin moisturizer, but don't use butter or petrolatum. If blisters form, don't break them. If they're extensive, see a doctor.
\Dear Dr. Donohue: For the past six months, I have had no energy. I teach third grade. My doctor checked my thyroid gland, and it turns out it's not working well. I am now taking replacement thyroid hormone. How long does it take for me to recover my former energy? Also, my cholesterol was high. Is that part of this deal? -- M.O.
\Answer: It can take three to six months for your hormone level to reach a normal plateau. That's when you'll feel like your old self again. A person with low thyroid hormone often has a rise in blood cholesterol. The level will fall as soon as the replacement hormone is working. The booklet on thyroid problems discusses both under- and overactive thyroid glands. Readers can order a copy by writing: Dr. Donohue -- No. 401W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am 83, and following hip surgery I developed a dropped foot. All I hear is that it is something I have to live with. Is there another answer? -- D.K.
\ Answer: It takes a long time for an injured nerve to heal. Sometimes it never does. However, that doesn't mean something can't be done for a dropped foot. Any number of braces can make walking much easier for a person with a dropped foot. I'd see about that now and bide my time, hoping the nerve will regenerate."; drDArticle[64] = "Dear Dr. Donohue: I have osteoarthritis of the hands, and my fingers have bony knobs on the knuckles. They look bad and hurt part of the time. I was a registered nurse and did lots of lifting of patients. Is the arthritis genetic or from the lifting? I go to the gym two to three times a week and have been doing so for two years. Am I making it worse? -- C.S.
\Answer: Osteoarthritis is the most common kind of arthritis. At age 65, one-third of people have evidence of knee osteoarthritis, and close to 100 percent of women have evidence of osteoarthritis of their hands and fingers. Not all these people have symptoms. The tiny bumps on the knuckle below the fingernail are part of the arthritis picture. Genes are involved. Age, misalignment of bones and injury are other contributors. Exercise is not responsible. Continue your exercise program. Strong muscles protect joints, and exercise keeps them limber. Only if an exercise is painful should you stop it. A joint is the place where two bone ends meet. The ends are covered with cartilage, and the entire joint is surrounded by a tough covering called the joint capsule. Cartilage makes it possible for one bone end to move over the other painlessly. Joint fluid, contained in the joint by the joint capsule, oils the joint and also keeps it operating without friction. In osteoarthritis, the joint cartilage begins to fray and crumble, and the joint fluid thins. There is no cure for osteoarthritis; there are treatments. Tylenol is one of the best and safest drugs. Aspirin and nonsteroidal anti-inflammatory medicines (Aleve, Advil, Motrin, etc.) are widely prescribed. They can cause ulcers, so they have to be used in moderation. Voltaren gel is an anti-inflammatory applied to the skin over an affected joint. Less is absorbed this way, so it has fewer side effects. The doctor can inject a bothersome joint with cortisone. Artificial joints are always worth consideration when arthritis severely limits motion and is quite painful. The joint at the base of the thumb is often bothersome in women. An operation that inserts a small piece of cartilage or other synthetic material can cushion that joint and bring great relief. The arthritis booklet discusses osteoarthritis, rheumatoid arthritis and lupus. Readers can obtain a copy by writing: Dr. Donohue -- No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Have clubfeet disappeared? When I was a child, I knew several children who were born with them. Now I never hear about it. I am 92. -- R.T.
\ Answer: Clubfeet have not disappeared. It happens to about one in every 1,000 newborns. This is something that happens during fetal development. The foot bones are misaligned. The result is the soles of the feet turn to face each other, like the position of praying hands with palm against palm. Taping, strapping and casting are some of the ways used to treat clubfeet. Some infants require surgery to attain normal foot alignment."; drDArticle[65] = "Dear Dr. Donohue: I come from a family of six girls, and I am the youngest. My five sisters all have had gallstones and have had their gallbladders removed. Am I doomed to the same fate? My sisters are large-bodied. I'm not. Could their weight have influenced gallstone formation? -- E.H.
\Answer: Family history of gallstones is a definite factor in the risk of coming down with stones. Your family proves the point. However, it's not the sole factor, so you're not doomed to having gallstones. Obesity is a strong influence on stone formation. On that score, you're in a safe zone. A high-calorie, high-fat diet disposes a person to gallstones. Rapid weight loss is another factor that favors the development of stones. Cholesterol is the main constituent of most gallstones. Rapid weight loss mobilizes cholesterol from body storage depots, and that's why it can bring on gallstones. Estrogen is another contributor to stones. It increases the uptake of cholesterol from food, and it increases the amount of cholesterol in bile. Bile is made by the liver. It aids in digesting fat. When bile becomes saturated with cholesterol, stones form. You're home clear on most of the things that contribute to stone formation. You're not destined to be a victim.
\Dear Dr. Donohue: Some time ago you had a recipe for a natural laxative. I cut it out and used it, and it worked. I stopped using it, but now I need it again and I can't find it. Would you please, please repeat it? I am in bad shape now. -- R.K.
\Answer: It's not my recipe. I got it from someone else. You mix 2 cups of bran with 2 cups of applesauce and 1 cup of unsweetened prune juice. Bran is the stuff removed from grains during refining. It's great fiber. Fiber keeps undigested food moist as it moves through the digestive tract. You can buy bran in health-food stores. Refrigerate the mixture, and take 2 or 3 tablespoons twice a day. You can add any ingredient you want to this mixture to make it more to your liking -- fruits, nuts, raisins, whatever. Constipation is endemic in countries where refined grains are in vogue. The booklet on this topic is a discussion of how best to deal with it. Readers can order a copy by writing: Dr. Donohue -- No. 504W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What does "essential" in front of "hypertension" mean? My doctor writes it down as my diagnosis on every form I give him. I say I have high blood pressure, and that always does it for me. -- J.T.
\ Answer: Essential hypertension is the common kind of hypertension -- high blood pressure. It means there is no other process going on that's raising blood pressure. "Secondary" hypertension indicates that blood pressure has risen because of some other illness, like an adrenal gland tumor."; drDArticle[66] = "Dear Dr. Donohue: I am taking my two teenage boys backpacking in the Southwest this August. It will be hot and dry, and I am preparing for those conditions. I need some guidance on what fluids to drink. I was taught that drinking plain water is the best way to stay hydrated. My older son says his class was told not to drink plain water, because it could cause brain damage. What is this all about? -- F.W.
\Answer: It's all about becoming sodium-depleted and having the brain swell as a result. The condition is hyponatremia. It used to be taught that, when exercising in hot weather, people should guzzle water at every opportunity, even when they don't feel thirsty. That can be dangerous if the exercise lasts for hours and hours and if the only liquid drunk is water. Too much water dilutes body sodium. That, in turn, can cause brain swelling and, in the extreme, death. Up-to-date advice is to let thirst be a rough guide for how much liquid you drink. If people are engaged in prolonged exercise, it is good to include some salt in the program. Half a teaspoon of salt and half a teaspoon of baking soda (sodium bicarbonate) in a quart of water can keep body sodium levels from dropping. For you and your sons, it would be advisable to salt your food and to eat some salty snacks -- another way to ensure body sodium doesn't bottom out. Hyponatremia is uncommon. Dehydration is common. For most, drinking water as a replacement fluid in hot weather is fine. It's not going to lead to a dangerous drop in body sodium. Only those who lose lots of sweat for long periods of time run the risk of hyponatremia by drinking pure water. This is advice that doesn't apply only to athletes or backpackers. It applies to all those who are out working in hot weather and sweating up a storm.
\Dear Dr. Donohue: I have hypertension, and I go to the beach often. Can salt in salt water get through the skin as medical patches get through the skin? My doctors have increased my dose of medicine and have added additional medicines without much improvement in my blood pressure. Could the salt water I swim in be keeping my blood pressure high? -- G.S.
\ Answer: G.S., I know I answered this question before, but you must not have seen it. I'll do it again. The salt in salt water doesn't get through your skin. Swimming in salt water doesn't raise blood pressure. It improves it. All exercise does. If you miss the answer this time, G.S., I have to drop the question. People will think I'm obsessed with it. The booklet on hypertension provides more details on this epidemic illness. Readers can obtain a copy by writing: Dr. Donohue -- No. 104W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery."; drDArticle[67] = "Dear Dr. Donohue: I am a woman in her mid-40s with significant bone loss (osteopenia). I was completely unaware that bone loss can occur in premenopausal women. I was stunned by my poor bone-density score. Why doesn't the medical community inform the public that bone loss can be an issue for premenopausal women? -- E.M.
\Answer: Osteoporosis happens mainly to women after menopause, when there is a sudden and precipitous drop in their production of estrogen, the female hormone that works to preserve bone health. However, women attain their peak bone strength in their late 20s and early 30s. From that time on, bones begin to lose their calcium and become more fragile and prone to fracture. Osteoporosis can occur at younger ages. You don't have osteoporosis. You have osteopenia. It's a marker on the road to osteoporosis. At young ages, girls should be on a program of building a bank deposit of calcium and strong bones by meeting the daily requirements for calcium and vitamin D, and by not doing things that lead to bone demineralization, like smoking. Daily exercise is another requirement for strong bones. The booklet on osteoporosis explains the prevention and treatment of this debilitating disease. Readers can order a copy by writing: Dr. Donohue -- No. 1104W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: This past winter I lost 50 pounds and am quite proud of myself. Now I have all sorts of ugly stretch marks. I thought I would look stunning on the beach. I probably will look stunning, but not for the reasons I thought I would. Can't something be done about these things? -- C.C.
\Answer: Stretch marks are scars. Your former weight stretched the skin beyond its limits, and the skin tore. Scars formed where the tears occurred. Time is one of the best treatments for them. They lighten up and blend in with the rest of the skin. How long that takes is unpredictable, but it happens. Retin-A -- an acne medicine -- has been suggested as a treatment for stretch marks. I can't tell you if it's successful all the time or how much of the time.
\Dear Dr. Donohue: I walk half an hour each morning. Lately, I have experienced chest pain, followed by gas and sometimes heartburn. The same thing happens when I shovel snow. I am 81 and do not take any medicines. I have had all the lung and heart tests without any problems showing up. What do you think this is? -- F.O.
\ Answer: When you say "all the tests," does that include a stress test, the test taken while you walk ever faster on a treadmill and an EKG is constantly taken? If not, you need one. In fact, even if you have had a stress test, go back to the doctor. Undiagnosed chest pain that comes with exertion makes me leery of heart disease. Don't give up the pursuit of trying to find an answer."; drDArticle[68] = "Dear Dr. Donohue: I have had vertigo for one month. I can function with it as long as I am sitting up straight. When I lie down, I get dizzy. The doctor says that this has to run its course. Is there a diet I can follow? I am a completely healthy 53-year-old woman with no other ailments. Do you have any thoughts? -- P.T.
\Answer: Your brand of vertigo strongly suggests benign positional vertigo, dizziness that comes on with head motion. Looking up or down, moving the head from side to side, lying down or getting up brings on a sensation of whirling around. A series of head movements sometimes can put an end to the dizziness. The movements are the Epley maneuvers. Sit on the side of a bed -- preferably a twin bed, since your head has to extend past the opposite side of the bed when you lie down. Turn your head a 45-degree angle to the side that brings on dizziness. Keeping the head in that position, lie down and let the head bend downward about 20 degrees over the edge of the bed. Then turn the 90 degrees to the opposite side and hold there for 30 seconds. Roll over onto that side while turning the head another 90 degrees, so you face the floor, and stay there for 30 seconds. Then get back into the upright sitting position with the neck bent slightly downward for another 30 seconds. If the dizziness persists, you can repeat the procedure as needed. I admit this is a little complicated, and if you find it too involved, have the family doctor or an ear, nose and throat doctor put you through the exercises. What these movements do is shift tiny crystals from one part of the inner ear, where they shouldn't be, back to the part where they belong. Benign positional vertigo is only one kind of vertigo. Epley maneuvers don't do a thing for other causes, like viral infections or Meniere's disease. For viral-caused dizziness, medicines like Antivert, Dramamine or Transderm Scop (the patch worn to prevent seasickness) can make dizziness less severe. A low-salt diet is helpful for Meniere's disease. The booklet on vertigo and balance explains this dizzying disorder in detail. Readers can order a copy by writing: Dr. Donohue -- No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have white spots and lines on my fingernails. What causes them? Is it a vitamin deficiency? -- D.
\ Answer: Those spots and lines indicate a brief pause in nail production. They're not a sign of vitamin deficiency. Trauma to the nail can do this, and the trauma can be so slight that it never registers on your consciousness. It takes six months for a fingernail to grow from base to tip. Your spots and lines are halfway up the nail, so they should be gone in another three months. Thanks for the photo. It helped me."; drDArticle[69] = "Dear Dr. Donohue: This summer I am running a basketball camp for teenagers. I have not done this kind of work before, and I am a bit leery on a number of issues. One that bothers me is heat injuries. Could you supply some guidelines that I could follow? -- R.W.
\Answer: Heat-caused injuries rank third as the cause of death in high-school athletes. That might sound overblown, but it's true. There are not that many sports-related high-school deaths, so that's one reason heat deaths are ranked so high. One such death is one too many, as heat-related deaths are preventable. It takes up to 10 days to fully acclimatize to heat. You should assume your campers are not acclimatized. Have them take it very easy in the first few days. Practice sessions on days one to three should be held in the early-morning hours, should be limited to three hours and should not be all that strenuous. Be sure that water is accessible at all times. In more extended practices, have sports drinks that contain sodium and potassium also available. If you can obtain the wet-bulb temperature index, use it. It was devised by the United States Marines and takes into account temperature, humidity and wind speed. At wet bulb indexes of 90 and greater, practices should be suspended. If you cannot obtain this information, there are many charts readily attainable that correlate temperature with humidity and indicate when physical exertion is dangerous. Exertional heatstroke is the most serious heat injury. Affected boys or girls might be sweating profusely or have dry skin. They're weak, dizzy and often complain of headache. Body temperature is 104 F (40 C) or higher. This is an emergency and, if you don't have the facilities to handle it, make advance arrangements for quick transportation to a hospital. The child should be taken to a cool place, and all constrictive clothing should be removed. He or she should be covered with wet sheets or sprayed with cold water and be exposed to fans. In the best of circumstances, the child should be put in a tub of cool water. Mental changes are one of the hallmarks of heatstroke. If the child isn't able to drink fluids, intravenous fluids should be administered.
\Dear Dr. Donohue: I have a plantar wart. What do I do for it? -- C.R.
\ Answer: A plantar wart is wart on the bottom of the foot (the planta). It's the work of a virus from the same virus family that causes all warts. Try one of the proprietary remedies found in all drugstores: DuoFilm, Trandermal patch, Mediplast, Sal-Acid and Compound W. They contain salicylic acid, a fairly reliable wart remover. Or you might want to try the duct-tape remedy. Cover the wart with duct tape and leave the tape on for six days. Remove it and soak the foot in warm water to soften the wart. Then file the wart gently with a pumice stone or emery board, both drugstore items. Repeat the sequence until the wart is gone. Are you certain this is a wart? If you're not, get a doctor's opinion."; drDArticle[70] = "Dear Dr. Donohue: I had an EKG in preparation for surgery. The doctor said it was abnormal. I was sent for a stress test. I could not do the physical stress test, so I had a chemical one. I was told that the results were OK. No one told me why the EKG was abnormal. I am very concerned. Is it OK just to go on living as I have been, or do I need to do something? I have searched the Internet for information but can find none. -- M.D.
\Answer: A resting EKG is a good test, but it's not the ultimate heart test. Things can look strange on a resting EKG. In order to find out if those strange-looking things are significant, the next step is to do a more sophisticated heart test, one that is more sensitive in detecting true changes and more specific in eliminating EKG changes that look odd but don't truly represent heart disease. That's where a stress test comes in. During a stress test, the person exercises, usually on a treadmill. All during the test, an EKG runs. It shows changes if the stressed heart isn't getting enough blood when it has to pump harder. You didn't have the treadmill variety of a stress test; you had one where a drug stressed your heart. The end result is the same. Your stress test must have removed the suspicion of heart disease that arose from the resting EKG. Do you play cards? Your stress test trumped your resting EKG. It's OK for you to go on living just as you have been. If something was wrong, the doctor would be obliged to tell you so. Stress tests are done to detect coronary artery disease, the illness that brings on heart attacks. The booklet on that subject explains what coronary artery disease is, how it's detected and how it's treated. Readers can obtain a copy by writing: Dr. Donohue -- No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I was recently diagnosed with the swallowing disorder Zenker's diverticulum. I am scheduled for surgery. Can you discuss it and its treatment? I am interested in the recovery process because I am a teacher and use my voice all day. My doctor has chosen surgery that involves going through my mouth. -- B.H.
\ Answer: A Zenker's diverticulum is a pouch that bulges from the lower part of the throat. The pouch can cause swallowing problems. Food can get caught in it and remain there. When it finally leaves the pouch, it has a most unpleasant odor. There are many surgical procedures to remove the pouch and shore up the throat tissue. Scopes are used by some doctors. Recovery is quicker with the scope. After surgery, you will not be allowed to eat or drink for a day or so, longer for the standard operation. The results are almost always excellent. The voice is not commonly affected."; drDArticle[71] = "Dear Dr. Donohue: I have recently been diagnosed with fibromyalgia. Before I was diagnosed, I enjoyed playing many sports and was a very physically active person. Since then, I have had to stop most of my activities. I wish I could be as active as I once was. Every time I try to play or exercise, my muscles ache unbearably. How can I get back to where I was? -- R.C.
\Answer: (R.C. is a high-school-age young woman.)
\
Fibromyalgia causes people to retreat from their usual activities and makes them yearn for the days before it struck. It's a peculiar disorder, with more unknown about it than known. Its cause hasn't been discovered. More women come down with it than men -- another unexplained fact. No lab test detects it. X-rays, scans and ultrasound show no abnormality. People afflicted with it complain of widespread body pain. They hurt all over, especially muscles, bones and joints. Exercise aggravates the pain. Joints are stiff early in the morning. Fibromyalgia patients are tired all the time. They never get a decent night's sleep, and that adds to their fatigue. During an examination, doctors can detect tender points, specific body sites where pressure of the examining finger elicits pain out of proportion to the pressure. There are 18 of these sites, nine on each side of the body. More than 70 medicines have been used in treating fibromyalgia. Tylenol and anti-inflammatory medicines such as Aleve, Advil and Motrin are helpful for some. Cymbalta and Lyrica are two medicines that have won Food and Drug Administration approval for treatment of this condition. Exercise is important, but it must be started at a low level and gradually increased. Water exercises are well-tolerated. If a person can't keep up with the rest of the class, he or she shouldn't try to do so. Keep exercise at a level that's tolerable. The booklet on fibromyalgia deals with it in greater depth. To order a copy, write to: Dr. Donohue -- No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
Dear Dr. Donohue: I have what the doctors call black hairy tongue. Can you tell me about it? -- Anon.
\Answer: Black hairy tongue, aside from its looks, is an innocent condition that comes from the elongation of tongue papillae, tiny projections from the tongue's surface. Gently brushing the tongue three times a day with toothpaste, baking soda or 3 percent hydrogen peroxide can usually get rid of it. If it's not gone in a month, return to the dentist or doctor for a follow-up exam.
\Dear Dr. Donohue: We were told to drink six to eight glasses of water a day. A doctor on television said to drink water only when you are thirsty. Which is the right advice? -- R.L.
\ Answer: It's not necessary to drink six to eight glasses of water a day. Most people can let thirst be their guide. In very hot weather, a couple of extra glasses of water keep a person hydrated."; drDArticle[72] = "Dear Dr. Donohue: You mentioned a solution to prevent swimmer's ear. How do you apply it? -- J.R.
\Answer: The mixture is made with equal parts white vinegar and rubbing alcohol. The alcohol keeps the ear dry. The vinegar prevents proliferation of harmful bacteria. One or two drops are instilled in the ear with a dropper and allowed to stay in place for half a minute to a minute. The head is then tilted toward the shoulder to empty the ear canal.
\Dear Dr. Donohue: I have been diagnosed with congestive heart failure. Three months after the diagnosis, I began to become fatigued after slight exertion, and was short of breath. I've had to have a pacemaker implanted. I was told I probably have amyloidosis, the senile form. Is there any hope of my living a near-normal life? -- L.M.
\Answer: Amyloid is a protein produced by bone marrow cells. It can infiltrate a number of body organs. Many forms (20) of amyloidosis exist, and they all have distinctive longevity projections. Senile amyloidosis does not affect as many organs as do the other forms of this illness, so that is one thing in your favor. In this illness, when the amount of amyloid in the heart is great, the heart's pumping action falters, and congestive heart failure is a consequence. Amyloid deposits often interfere with the generation and transmission of the electric signals that regulate heartbeats, so a pacemaker can be needed. I can't give you a prediction about the length of life. Of course, your life span is bound to be affected, but how greatly, no one can tell with certainty. Lifestyle, physical activity and diet can all be important in limiting how serious congestive heart failure can become. To learn more, order the congestive heart failure booklet by writing to: Dr. Donohue -- No. 103W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: In my 58 years, I never have had any problem with my scalp. My hair has turned a salt-and-pepper color. Due to vanity, I have been coloring it for the past several years. I have never experienced any problems. Recently I have had a rash of pimples forming on my scalp at the hair shaft. They hurt when the scalp is touched or the hair brushed. I had a good friend look at my scalp with a magnifying glass, and he says they look like small pimples. He removed a hair with tweezers and a small discharge came out of the pimple. I am considering letting my hair grow back to its natural color to see if the dye has anything to do with this. Any suggestions? -- N.N.
\ Answer: I like your approach. The dye might be irritating your scalp, and the hair follicles might have become infected secondary to the irritation. If things don't clear up after going dyeless for a couple of months, have a doctor take a look. You might need an antibiotic prescription."; drDArticle[73] = "Dear Dr. Donohue: I am 81 and have been getting mammograms for as long as I can remember. My doctor insists I continue to get them. At my age, is it really necessary? -- A.C.
\Answer: I can offer you the recommendations coming from different respected sources. They don't all agree in all particulars. Did you know that half of all breast cancers are found in women 65 and older? A considerable number are diagnosed in women in their 80s. The American Cancer Society says there are no age limits for mammograms, and women should continue to have them if they are in good health. The U.S. Preventive Services Task Force, a panel of experts, tells women to have a mammogram yearly or every other year if her life expectancy isn't limited by other diseases. The American Geriatrics Society recommends that women 75 and older get a mammogram every two to three years if they have a life expectancy of four or more years. Unless studies are done that show no benefit to continued mammograms, I go with those who favor a yearly mammogram for all women in relatively good health. Breast cancer is a topic that frightens all women. The booklet on that cancer explains it and its detection. To obtain a copy, write to:Dr. Donohue -- No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My wife has been going through menopause for the past eight years. We have not been intimate through these years. When I bring up the subject of intimacy, she quickly states that she doesn't want to talk about it. She won't even hug me. My wife is only 53 years old. It seems like she will be going through menopause for the rest of her life. I have been more than patient, but I would like to have my wife back. If you could give me some advice, it would be greatly appreciated. -- J.T.
\Answer: Menopause can lessen sexual drive, but it shouldn't completely eliminate it, and menopause doesn't usually drag on for eight years. Sexual desire is a complex process that involves hormones, nerves, blood vessels, general health and the brain. The brain is, perhaps, the most important element. Your wife needs professional help. Her total lack of sexual desire at a young age and for so long could be a physical problem, so the family doctor is the place to start. If, as is more likely the case, it is a psychological problem, the doctor can start treatment for that, or can refer her to a specialist. You have been more than patient.
\Dear Dr. Donohue: I take a fish-oil supplement daily. Can you tell me if these tablets contain mercury, as some fish do? -- P.C.
\ Answer: Take your fish-oil supplement without fear. Such supplements contain negligible, if any, amounts of mercury. They won't make you sick. They could make you well."; drDArticle[74] = "Dear Dr. Donohue: Will you talk about colon polyps? I had polyps removed during a colonoscopy. My doctor recommends another colonoscopy in three years. I have retired, and my insurer has declined to cover my colon because I had something removed from it. I will have to pay for the colonoscopy. When I was working, the insurance company insisted on colon procedures for preventive care. Please advise. -- A.C.
\Answer: Polyps are small growths sprouting from the lining of many organs. In the case of colon polyps, some of them turn into colon cancer. The problem is that a doctor looking at the polyp cannot tell if it has the cancer potential unless the polyp is removed and viewed with a microscope. More than 150,000 new cases of colon cancer occur yearly in the United States, and every year there are more than 50,000 deaths from colon cancer. Colon cancer and colon cancer death can be eliminated by removing all suspicious polyps. Guidelines urge everyone to have a first colonoscopy at age 50. If a polyp is discovered that measures more than two-fifths of an inch, if the polyp has microscopic evidence of dangerous changes or if a person has three or more polyps, that individual is told to have a repeat colonoscopy in three years. Otherwise, if all is well, the next colonoscopy can be delayed for 10 years. I don't understand your insurer's unwillingness to insure your colon, since the company is less likely to lose money on you because you have been conscientious in having the examination and its follow-up. Perhaps a telephone call to the company can get it to change its decision. If the company won't budge, I'd still have the scope exam, even if the money has to come out of your own pocket. The assurance that all is well is worth every penny. The booklet on colon cancer explains this common condition in detail and its treatment. Readers can obtain a copy by writing: Dr. Donohue -- No. 505W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What is a man to do for excessive back hair? My husband is embarrassed to take our girls (7 and 9) to the town pool because of his hairy back, and he is very self-conscious on a beach as well. I have offered to shave his back, but he's worried that the hair will come back thicker. Any suggestions? -- L.C.
\Answer: Yes. Shave your husband's back for him. The hair won't grow back thicker. That's a fable some unknown person started way back when. It's not true.
\Dear Dr. Donohue: I have been getting a monthly B-12 shot for 20 some years. I don't know why. Are these shots necessary? -- A.S.
\ Answer: They're necessary for people with pernicious anemia. Those people can't absorb the vitamin. Twenty-some years is too long to go without knowing the reason for your treatment. It's time you asked your doctor why you're getting the shots."; drDArticle[75] = "Dear Dr. Donohue: What is SVT? What causes it? What is heart ablation? My grandmother, my mother and I all have had SVT episodes. I required heart ablation. -- J.P.
\Answer: "SVT" is short for "supraventricular tachycardia." Tachycardia is a fast heartbeat. "Supraventricular" indicates that the fast beat arises in the upper heart chambers, the ones above (supra) the ventricles, which are the heart's pumping chambers. Those upper chambers are the atria. SVT covers many different conditions. Since you spoke of "episodes," I assume you had PSVT, paroxysmal supraventricular tachycardia -- fast heart-beating that comes on suddenly, doesn't last too long and stops abruptly. Causes for PSVT can involve the little electric generator that delivers a small jolt of electricity that initiates the heartbeat. Or it can come from an extra pathway that the electric impulse takes on its way to the lower heart chambers. Both conditions can be there from birth, and both can be a family affair, one controlled by genes. It sounds like yours is the genetic kind. Medicines often can keep supraventricular tachycardia controlled. Your treatment, ablation, is a permanent cure. Literally, "ablation" means "a taking away." In the case of supraventricular tachycardia, tissue that initiates the fast heartbeat is destroyed. That's done with a catheter -- a soft, thin tube advanced into the heart from a surface blood vessel. The catheter emits radio waves. When it reaches the place that gives rise to the fast beats, the radio waves are turned on, and that bit of tissue is erased, ablated. Ablation is successful in preventing resumption of fast-heartbeat attacks in a high percentage of cases. I trust your procedure was successful. The booklet on heartbeat irregularities discusses tachycardia and other heart conditions. Readers can order a copy by writing: Dr. Donohue -- No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Every evening, my wife and I take a long walk. It's our daily exercise. I attract mosquitoes, but she doesn't. Why? Is there a medical explanation for this? -- L.P.
\Answer: People who emit more carbon dioxide than others draw mosquitoes to them. The mosquitoes are attracted by it. Mosquito magnets also have other compounds on their skin that entice mosquitoes. Cholesterol on the skin seems to draw them to a person. Skin cholesterol has nothing to do with blood cholesterol. Uric acid and lactic acid on the skin are other attractants. Mosquito repellent will keep you free of mosquito molestation.
\Dear Dr. Donohue: I am a carrot eater and have been so for a long time. Someone told me that people who eat lots of carrots get cancer. Is that true? -- S.T.
\ Answer: That "someone" has confused a message about beta carotene, a substance found in carrots (and other foods). It's a precursor of vitamin A. Smokers should not take beta carotene supplements. It raises their risk for getting lung cancer. You don't have to worry about eating foods with beta carotene, including carrots."; drDArticle[76] = "Dear Dr. Donohue: I'm a 26-year-old woman with an embarrassing problem. I'm growing a mustache. What causes this? I have started to shave, but I worry that shaving is going to make the hair grow faster and coarser. I see some hair on my breasts, too. What can I do about this? -- V.K.
\Answer: Hair growth in females in places where it should be found only in males is hirsutism (HERE-suit-izm). Such areas include the skin above the upper lip, the chin, the chest, the thighs, the upper back and the abdomen. Hair in those places is sensitive to the action of male hormones. Common causes for such hair growth are idiopathic (a definite cause not found), menopause (when female hormone production dips) and polycystic ovary syndrome. Polycystic ovary syndrome is fairly common. Signs of it are a diminution or complete stoppage of menstrual periods, hirsutism, obesity and large ovaries with many cysts. One of the mechanisms responsible for some polycystic ovary symptoms is an overproduction of androgen -- male hormones. The unwanted pattern of hair growth stems from androgen excess. Idiopathic hirsutism -- hair growth without a cause found -- might be a mild form of polycystic ovary syndrome. That's a popular theory expounded by many experts. Rarer causes of hirsutism include adrenal gland overactivity, tumors of the adrenal gland or ovary, pituitary gland tumors and some prescription medicines. You're not going to solve this on your own. You need a doctor to evaluate your hormone status. The appropriate treatment hinges on finding a specific cause. When a cause cannot be found, shaving, electrolysis, depilatories (chemical hair removers) and laser treatments are options. Shaving doesn't make hair grow faster or coarser. Vaniqa cream, a prescription item, gets rid of unwanted hair quite well. Birth-control pills work when a woman needs estrogen. Spironolactone, a water pill, can counter the influence of male hormones and is often useful.
\Dear Dr. Donohue: I have a fungus infection on my left foot and toes. What causes it? How do I get rid of it? -- L.D.
\Answer: A fungus causes it. Fungi are germs that are a bit larger than bacteria. Fungi thrive in warm, moist places. Keep your feet dry. Wear sandals when you can. Change socks twice a day. Have two pairs of shoes, and alternate their use. You can find numerous medicines for athlete's foot (which is what you have) at the counters of all drugstores. Lotrimin AF, Micatin, Absorbine and Tinactin are a few names. If those medicines fail, the oral medicine griseofulvin usually can do in the fungus.
\Dear Dr. Donohue: How much are the vitamins in vegetables destroyed by cooking? Is microwaving more destructive than boiling on a stove? -- S.T.
\ Answer: Some vitamins do trickle into the boiling water from cooking vegetables. Keep the amount of water to a minimum, and bring it to a boil before you put in the vegetables. Don't cook them to death. Let them keep some crunchiness. Microwaving preserves more of the vegetables' nutrition than does boiling. Steaming is another way of keeping vitamins intact."; drDArticle[77] = "Dear Dr. Donohue: Will you please explain Hashimoto's disease? My daughter has it. What steps should be taken? -- L.S.
\Answer: Because Hashimoto's disease sounds exotic, it perceived as being a rare illness. It is not. It's an immune attack on the thyroid gland that, over time, stops the production of thyroid hormone and leads to hypothyroidism -- too little of that hormone. (Dr. Hashimoto was the Japanese physician who was the first to describe it.) The gland's destruction occurs slowly, so signs and symptoms creep up on a person almost imperceptibly. When they reach their maximum, people know for sure something is quite wrong. They are tired all the time, their skin dries, they're cold when others are warm, they gain weight without taking in additional calories, their hearts beat slowly and their hands and feet become puffy. Menstruating women have fewer periods, and sometimes no periods. Constipation is another common sign. Often, the gland enlarges -- a goiter. The proof that the immune system is to blame can be shown by examining thyroid gland tissue microscopically. Lymphocytes, one variety of white blood cells and an important part of the immune system, have infiltrated the gland. In addition, antibodies against the gland are found in the blood. Antibodies are products of the immune system. The treatment of Hashimoto's disease is straightforward. Replace the missing hormone in pill form. Once treatment starts, signs and symptoms go. The thyroid booklet deals with the major problems of this gland and how they are treated. Readers can obtain a copy by writing: Dr. Donohue -- No. 401W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What information can you give me on Huntington's disease? I am 62, and I may have it. My doctor's office said they can't help me. I went to the hospital for the genetic test, but I was told I needed counseling before and after the test. I understand it is expensive. I know the illness gives people tremors. -- J.D.
\ Answer: Huntington's disease is an inherited illness whose signs typically don't appear until a person is between the ages of 30 and 50 (but the range is between 3 and 70). The principal sign is involuntary movements of the face, trunk, arms and legs. The movements are much more than tremors. They are quite big and disruptive. Speech is often affected, and control of eye motion can be lost. Personality changes and a diminution of thinking ability also take place. The genetic test confirms the diagnosis. Since this is such a devastating illness, counseling before the test is essential, and counseling after a positive test is also required. Does this illness run in your family? It does in 97 percent to 99 percent of those who have the illness. Contact the Huntington's Disease Society of America at 800-345-4372 or on the Internet at www.hdsa.org. The people there can tell you if you are wise to pursue testing for it."; drDArticle[78] = "Dear Dr. Donohue: I have a problem with bladder infections. I have been getting one every month for the past three years. I am a 49-year-old female. My doctor gives me Cipro and the infection goes away, but it returns in a month. I have tried some other antibiotics with the same result. A doctor examined my bladder with a scope and found nothing wrong. Do you have any ideas on what I could do? -- L.H.
\Answer: Recurring bladder infections plague many women. They have to do with female anatomy. The female urethra -- the tube that drains the bladder -- is much shorter than the male urethra, and it opens to the outside world in a place where there is luxuriant bacterial growth. Bacteria can ascend up the urethra to the bladder with ease. Sexual relations contribute to the problem because contact massages bacteria into the urethra. Some steps should be taken. One is a culture of your urine to see if this is the same recurring bacterium and to determine its sensitivity to antibiotics. You might have a resistant germ, one that no longer completely responds to Cipro or the other medicines you have taken. One way of handling this problem is to stay on a small dose of antibiotic daily or three times a week for a protracted period of time so that eradication of the bacterium takes place. Bactrim (sulfamethoxazole with trimethoprim) and nitrofurantoin are two antibiotics often chosen. Or your doctor can give you a prescription for antibiotics to have on hand. You start them immediately when symptoms arise. Early treatment increases the chance of completely getting rid of the germ. A third option is to take an antibiotic after intercourse. Cranberry juice (not cranberry cocktail) has helped many to stave off repeat bladder infections. The dose is 8 ounces a day (one glass). The booklet on urinary tract infections explains this common disorder in detail. Readers can obtain a copy by writing: Dr. Donohue -- No. 1204W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My teen wears flip-flops all day, every day. We live in a fairly warm climate, and he wears them even during the winter months. I don't think this is good for his feet. Do you have any information on this? -- W.M.
\ Answer: I don't think flip-flop manufacturers intended them to be substitutes for shoes. They're for the shower room, beach and a couple of other similar places. Researchers at Auburn University have examined flip-flop use and have found that constant wearing of them can present potential problems. The foot instinctively adapts to flip-flops to keep them on the feet. Users unconsciously take shorter steps, and their feet strike the ground at a slightly different angle than shoe wearers. When flip-flop users go back to wearing shoes, these foot mechanics persist and cause foot discomfort. Flip-flops provide no arch support and very little cushioning."; drDArticle[79] = "Dear Dr. Donohue: Two years ago I had surgery for breast cancer, and lymph nodes were also removed during the surgery. I recently developed lymphedema and am quite upset about it. I don't think I ever read where you (or anyone else) discussed it. I didn't know what it was until I saw something about it on TV. It seems to be under control, but I must wear an arm sleeve, which I hate. Please comment on it. -- J.R.
\Answer: We have two circulatory systems. Everyone knows the blood circulatory system. Few know the lymph circulatory system. Lymph is the watery part of blood that oozes out of blood vessels and bathes all body cells and tissues. It provides nutrition and protection. Lymph vessels -- similar to arteries and veins but more delicate -- are open-ended affairs that suction lymph fluid and eventually return it to the circulation. On its journey back to the main circulation, lymph fluid passes through lymph nodes, which remove from it foreign material and germs. Anything that disrupts the return of fluid back to the circulation causes swelling -- lymphedema. In your case, the disruption was breast surgery with removal of lymph nodes. About 15 percent of women who undergo such breast surgery develop lymphedema of the arm on the side of the removed breast. Early treatment of lymphedema prevents permanent changes from happening. Arm elevation encourages drainage out of the arm. Elastic garments squeeze lymph fluid back into the main circulation. Compression pumps are another way to mobilize the fluid. A special kind of massage, performed by a trained therapist, can effectively promote drainage of lymph fluid. It's called manual lymphatic drainage, and practicing therapists are found in about every section of the country. The National Lymphedema Network can put you in touch with such a therapist and can provide you with information on this condition. You can reach the network at 1-800-541-3259 and on the Web at www.lymphnet.org. The booklet on edema and lymphedema provides details on both these common conditions. Readers can obtain a copy by writing: Dr. Donohue -- No. 106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My doctor has me taking two blood pressure medicines every day. There was a time when my pressure was quite high. Now it's normal. I take my pressure every day. I am retired, and I think that brought my pressure down. Can I safely stop one of my blood pressure medicines? -- D.K.
\ Answer: It would be safe for you if your doctor thinks it is a good idea. He or she probably will, if you discuss it. When you see your doctor, bring with you a record of your blood pressures. That information will carry much weight in making the right decision. Blood pressure medicine is usually, but not always, taken for life. If people make big life changes -- reduce their salt intake, exercise, lose weight, minimize life's stresses -- then it is possible to decrease the dose of blood pressure medicine and sometimes to eliminate it."; drDArticle[80] = "Dear Dr. Donohue: Please discuss peripheral artery disease. I think I have it. I get calf pain when I walk. I have seen the ads on TV where a woman and her grandson discuss this. The boy asks her if she has it. She says she doesn’t know. That’s where I am. I don’t know, but I think I might. — N.O.
\Answer: Peripheral artery disease, PAD, also called peripheral vascular disease, means that arteries in the legs — the periphery — are clogged and leg muscles aren’t getting enough blood. The proof comes from walking. People with PAD get leg pain when they walk a certain distance, and they can tell you almost to the inch when the pain will start. The pain leaves when they take a rest, but returns after they have resumed walking The site of pain depends on where the blockage occurs. Pain in the buttock or thigh indicates a blockage high in the leg arteries. Pain in the calf comes from a block from midthigh to knee, and pain in the foot comes from a lower blockage. PAD is a common malady. Five percent of men and 2.5 percent of women over 60 have it, even though some have no symptoms. A doctor can make the diagnosis in the office. If there’s an obstruction to blood flow in the leg arteries, the pulses at the ankle and on the top of the foot will be weak. Many doctors are equipped to take the ankle blood pressure. The blood pressure at the ankle should be the same as the blood pressure in the arm. If it’s much less, that indicates an obstruction to blood flow in the leg artery. People with PAD often have CAD, coronary artery disease. The same process that clogs leg arteries also clogs heart arteries. You must see your doctor. He can check the status of your leg arteries, and he can check the status of your heart arteries. There are medicines for both conditions, as well as recommendations for diet changes and exercise. The booklet on peripheral vascular disease treats this topic in great depth. Readers can obtain a copy by writing: Dr. Donohue — No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My husband is on blood pressure and cholesterol-lowering medicine. He is now trying herbal medicines ordered from a catalog. I understandd that when you are on medicines, you should consult your doctor before making changes or discontinuing them. My husband says that he is going to stop all medicines. He is 57. I always thought blood-pressure medicine was for life. What is the truth? — P.
\ Answer: The truth is that stopping medicines without consulting the doctor is foolhardy. Some people can get off blood-pressure medicine by adhering to a strict, low-salt diet, losing weight and exercising. And some people can get off cholesterol medicine by adopting a low-fat — especially low-saturated-fat — diet. Giving up medicines blindly is asking for trouble, as is substituting unproven remedies."; drDArticle[81] = "Dear Dr. Donohue: I’m just an old country woman who needs to know more about gout. I have it at least twice a year, and it’s so painful I can’t put my foot to the floor. Please list the things not to eat so that I can kind of keep it under control. — E.W.
\Answer: Uric acid crystals that bore their way into joints are the cause of gout. Uric acid is a byproduct of the daily turnover of body cells. As long as blood uric acid stays within a normal range, all is well. When its blood level rises, the uric acid infiltrates joints and causes intense joint pain, swelling, redness and heat. Gout mostly happens to middle-aged and older men and to women who have gone through menopause. The base of the big toe is often the first joint to suffer an attack. Further attacks can target the heels, ankles, knees, elbows, wrists and fingers. The definitive proof of gout is finding uric acid crystals in joint fluid. A rise in blood uric acid level is another tip. The gout diet is not very restrictive. In the days before medicines effectively controlled gout, diet was the only remedy. It’s in second place these days. The consumption of red meat and especially organ meat (kidneys, heart, liver, brain and sweetbreads) should be minimized. It’s best to avoid gravies. Seafood, especially anchovies, sardines and shellfish, should be eaten in moderation. Alcohol — beer in particular — can provoke an attack. All vegetables and fruits are permitted, and low-fat dairy products appear to prevent attacks. Gout medicines are of two varieties: ones for an acute attack and ones for prevention. Indomethacin is an example of medicine for an acute attack, as is colchicine. Zyloprim (allopurinol) and Benemid (probenecid) prevent attacks. Zyloprim decreases uric acid production, and Benemid enhances its excretion by the kidneys. The pamphlet on gout discusses this common ailment in greater detail. To order a copy, write: Dr. Donohue — No. 302W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I coach junior-varsity football. In the past three years, I have had three boys have a tooth knocked out. I am trying to prepare if this ever happens again. Can you help? — H.J.
\ Answer: A knocked-out tooth can be saved if quick action is taken. Don’t scrub or rub the tooth. Ligament tissue clings to it, and preserving that tissue is necessary to re-establish its mooring in the tooth socket. Rinse it with tap water. Keep the tooth moist. Reposition in the mouth if that’s possible. If it isn’t, put it in a container with cold milk or sterile saltwater. Transport solutions to preserve teeth are commercially available. One is Save-A-Tooth, and it would be good to keep some vials of it on hand at all games and practices. Get the injured player to a dentist promptly. Make arrangements with a dentist to be on call at home during all games and in the office during practices. Are your players wearing mouth guards? They should be."; drDArticle[82] = "Dear Dr. Donohue: During my recent physical exam, my doctor said I had a heart murmur but not to worry about it. I decided to go to my heart doctor anyway. He did an EKG — normal. I had a stress test last June — normal. He states that many people my age, 87, have heart murmurs. He said he would watch it. Do I have a dangerous heart problem? I play tennis three nights a week and exercise with weights a few times a week. My weight is perfect for my height. I sleep well. My wife cooks without salt, and we watch our sugar intake. I take one pill for high blood pressure and one pill for an enlarged prostate gland. — R.E.
\Answer: An 87-year-old with a dangerous heart problem could not play tennis three times a week and lift weights even a few times a week. You have no symptoms. You have a normal EKG and had a normal stress test. Your heart health must be good. When doctors listen to hearts with a stethoscope, they hear a “lub-dub” sound due to the closing of the four heart valves. Murmurs are noises heard between those two sounds. Often they indicate narrow or leaky heart valves. The murmur comes from a disturbance in blood flow due to the abnormal valve. It creates eddy currents in the blood, which generate sound. However, eddy currents arise for other reasons, some of which have nothing to do with heart valves. Older people often have such sounds, i.e., murmurs. Those sounds are innocent murmurs. Even if your murmur is a sign of valve damage, the damage must be slight. You have no symptoms. You are more active than people half your age. The chance that a slightly damaged valve in someone 87 years old would progress to a dangerously damaged valve is most unlikely. Readers who would like more information on heart valve disease can order the booklet on that topic. Write to Dr. Donohue — No. 105W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: For four years I have been dealing with lichen planus. Is there any new treatment? — J.P.
\ Answer: Lichen planus is most often found on the skin of the wrists, ankles and legs. It can also find its way into the mouth. The genital skin is another target. It starts as flat-topped, many-sided, small red patches that can merge into a larger patch. The color turns purple. White lines crisscross the surface of the patch. The outbreak is intensely itchy. A cause hasn’t been identified, but it might result from an immune system gone berserk. Sometimes it’s seen in conjunction with another illness, like hepatitis C. The strongest varieties of cortisone creams and ointments are the usual treatment. Many patients are free of the condition in a year or so. To prevent relapses, some have to keep applying the ointments on a less-frequent basis once the skin has cleared."; drDArticle[83] = "Dear Dr. Donohue: I am a construction worker, age 53, and have been healthy all my life. I caught what I though was an ordinary cough. It stayed and stayed, and it really disturbed my sleep. I would wake up many times through the night, coughing my lungs out. Finally I saw a doctor, who had me get an X-ray, which was normal. He gave me cough medicine that didn’t work. I saw another doctor. This doctor took blood and swabbed my throat. I had whooping cough. Isn’t this a kid’s illness? — H.C.
\Answer: In most everyone’s mind, whooping cough is a childhood disease, but it strikes adults too. It seems that these days more and more adults are coming down with it. Childhood whooping cough is a three-stage illness. The first stage, which lasts about a week, features symptoms similar to an ordinary cold — runny nose and a slight cough. The second stage is heralded by outbursts of violent coughing. At the end of a cough, children draw in air and make a whooping sound. This phase lasts from one to six weeks. The third stage is the convalescent period, where the cough gradually abates and eventually resolves in two to three weeks. Adult whooping cough doesn’t usually go through these stages, and adults rarely make the whooping sound so characteristic of this condition in children. They have a cough, like yours, that just won’t go away. Everyone with a long-lasting cough should consider the possibility of whooping cough. Your second doctor did the test that establishes the diagnosis. He took a swab of the throat (or the nose) and sent it to a lab, where the whooping cough germ was identified. If caught in its earlier stages, antibiotics can shorten the course of the illness.
\Dear Dr. Donohue: I have used aluminum waterless cookware since 1958. When I simmer tomato sauces in it, I notice that the pot is shiny afterward. Yikes! Does that mean aluminum has gone into the sauces and into us? Is that harmful? Does it lead to Alzheimer’s disease? — L.P.
\Answer: Traces of aluminum have been found in the brains of some Alzheimer’s patients. To date, there has been no conclusive link between aluminum and Alzheimer’s. Furthermore, aluminum cookware releases very little of this metal into the food cooked in it. Most experts do not advise people to stop using such cookware. Alzheimer’s disease is a tragedy for the patient and the patient’s family. The booklet on it describes what it is and how it’s treated. Readers can order a copy by writing: Dr. Donohue — No. 903W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What causes skin tags? They hang from my neck and under my arms. — D.H.
\ Answer: Their cause isn’t known. Your doctor can clip them off without any fuss. By age 69, 60 percent of us have one or more of them."; drDArticle[84] = "Dear Dr. Donohue: Through a CT scan, I have been diagnosed with extensive diverticular disease. You’ve mentioned that a lack of fiber as the cause. All my adult life, I have eaten whole-wheat bread, lots of fruit and vegetables, and plenty of fiber. I can’t remember ever being constipated. I was shocked by the diagnosis. My maternal grandmother finally succumbed to it. Could I be genetically predisposed to it? Would eating yogurt containing live bacterial cultures provide any value? — B.S.
\Answer: A diverticulum is a small bulge on the outer colon wall. It’s smaller than a small grape, being only about 0.4 inches (1 cm) in diameter. What’s bulging is the lining of the colon. High colon pressure pushes the colon lining through the colon’s muscle wall and onto its outer surface. The colon has to generate great force to move along undigested, hard and dry waste matter. Fiber keeps stool soft and moist. In societies where grains are refined and where fiber is scant, diverticulosis is rampant. To give you an idea of how widespread diverticulosis is, 50 percent to 70 percent of the elderly population has it. I can’t explain why a fiber-conscious person like you developed extensive diverticulosis. I suppose there might be a genetic predisposition. Keep in mind that most people with diverticulosis — 70 percent — never suffer a single symptom. If the diverticula become inflamed, then the condition is diverticulitis, and that is painful. Pain usually arises in the left, lower side of the abdomen, where most diverticula are found. People are feverish, lose their appetite and feel nauseated, but they rarely vomit. With a more severe attack, the temperature is quite high, and the abdomen becomes very tender. Sometimes an attack of diverticulitis is signaled by painless rectal bleeding. Treatment involves resting the digestive tract by taking only clear fluids and antibiotics. For more serious attacks, hospitalization with intravenous fluids and antibiotics is required. You may never face these possibilities. Most people with diverticulosis never do. Yogurt will not help. The pamphlet on diverticulosis gives a more lengthy discussion of this topic. To order a copy, write: Dr. Donohue — No. 502W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Three years ago, my husband had a pacemaker put in his chest. Since then he has anchored himself to his easy chair. He’s afraid to do anything that requires even slight exertion. He gets up, eats breakfast, reads the paper in his chair, comes to lunch, eats again, takes a nap, watches TV, eats dinner and goes back to his chair for the evening. This is living? Will you talk some sense into him? — T.R.
\ Answer: Unless his doctor has told him not to do anything physical — and that would be most unusual advice — your husband’s inactivity harms his heart. He needs daily exercise, and a pacemaker isn’t a reason not to exercise. He can have his doctor verify this. Physical activity is one of the cornerstones of heart health and is as important as cholesterol control."; drDArticle[85] = "Dear Dr. Donohue: About three years ago, I had a procedure to reduce the size of my prostate. It was Greenlight PVP laser procedure. My doctor did it on an outpatient basis. Since then, I have a normal flow for someone who is 79 years old. I sleep through the night without having to get up to go to the bathroom. Perhaps you could comment on this treatment. — L.M.
\Answer: Prostate gland enlargement — benign (noncancerous) prostate hyperplasia or hypertrophy — is something that happens to just about all men. Fifty percent of men between the ages of 51 and 60 have some gland enlargement, and by age 80, more than 80 percent have it. Not all these men have to deal with its exasperating consequences — frequent urination, nighttime urination, difficulty starting the stream — but enough do that it is a quite common problem. Sometimes medicines can relax the chokehold that the big prostate has on the urethra, the tube draining the bladder, and there also are medicines that shrink the gland. When medicines strike out, a large number of invasive procedures are readily available. The standard operation, TURP — transurethral resection of the prostate — is done with a scope and instrument passed into the urethra and advanced upward to the gland. The doctor shaves away portions of the gland. TUNA — transurethral needle ablation; TUMT — transurethral microwave therapy; and TUIP — transurethral incision of the prostate are procedures done very much like a TURP, but they employ different techniques for reducing the gland’s size. Some are done in the doctor’s office. Greenlight Laser Photovaporization is a technique in which the prostate gland is downsized by vaporizing the excess with a laser that emits a green light. One big advantage this offers is a reduction of bleeding. The green-light laser seals blood vessels in the process. I am sure many men readers will appreciate your bringing up the topic. The booklet on the prostate gland, both enlargement and cancer of, summarizes treatments for these conditions. Readers can order a copy by writing: Dr. Donohue — No. 1001W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My 3-year-old granddaughter wakes up within a few hours of going to bed. She screams, and nothing consoles her. It’s like watching “The Exorcist.” I understand this is called night terror. Any suggestions? — C.S.
\ Answer: Many children suffer from night terrors. They usually occur in the first hours of sleep. The child suddenly screams, is wide-eyed, has a fast heartbeat, might be sweating, could thrash about or get up and walk zombielike. The child has no recollection of this the next day. The episodes are terrifying to onlookers. Speak to the child soothingly until he or she goes back to sleep. Night terrors peak between ages 5 and 7, and then tend to disappear. The child’s doctor should be informed of these so an exam to rule out any serious condition can be done."; drDArticle[86] = "Dear Dr. Donohue: My 31-year-old son-in-law is 6 feet tall, weighs 185 pounds and is in good physical condition. His concern is triglycerides. His measure more than 600. His cholesterol is just a bit high. He eats very healthily, with little fast food. He drinks only diet soda and skim milk. He uses sugar substitutes in his coffee. He eats much Indian food. Any help is appreciated. — B.W.
\Answer: Total cholesterol, LDL cholesterol (the bad kind) and HDL cholesterol (the good kind) have star billing when it comes to artery hardening and heart disease. The spotlight has begun to shine on triglycerides, and now they are sharing billing with cholesterol. Triglycerides are fats. The whitish, yellowish stuff you see in a cut of meat is triglycerides. Guidelines tell us that a triglyceride level below 150 mg/dL (1.7 mmol/L) is ideal; levels between 150 and 199 (1.7-2.2) are borderline bad; levels from 200 to 499 (2.2-5.6) are bad, and anything over 500 (5.6) is very bad. Your son-in-law is in the “very bad” category. For overweight people, weight loss is the first step in bringing down triglycerides. This doesn’t apply to your son-in-law. He should severely limit rapidly absorbed carbohydrates, like sugar. They raise triglycerides. He also should cut back on red meat and full-fat dairy products. He has to steer clear of trans fats, found in some commercially prepared foods, particularly baked goods and many fast-food deep-fried items. He has to limit alcohol. Your son-in-law is doing all this, but his levels still are too high. Three hours of weekly exercise can lower triglycerides. If this doesn’t get the job done, then he should consider the medicine route. Niacin and gemfibrozil can bring down the triglyceride reading. Diabetes, a low output of thyroid hormone, kidney disease and some medicines like beta blockers and thiazide diuretics raise triglyceride levels. Very high triglyceride levels can inflame the pancreas — pancreatitis. Your son-in-law is at the threshold of that complication. The cholesterol booklet explains triglycerides and their link to heart disease. Readers can obtain a copy by writing: Dr. Donohue — No. 201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I need to know what is considered normal when it comes to menstrual cycles. Please tell me. — R.K.
\Answer: Most women have cycles that last from 21 to 35 days. For 90 percent of menstruating women, bleeding lasts seven days. A little more than 1 ounce of blood (30 to 35 ml) is lost with each cycle. That amount of bleeding requires three to five pads a day.
\Dear Dr. Donohue: I have diabetes, and a while back lost 25 pounds almost overnight. I cannot gain it back. What can I do? — Anon.
\ Answer: A sudden, unintended loss of 25 pounds demands an explanation. If your diabetes was out of control, that might explain it. All the same, you must report this to your doctor right away so a search for a cause can begin."; drDArticle[87] = "Dear Dr. Donohue: I am writing to ask if you would give me information on interstitial cystitis. I was told I had this after I had a polyp removed from my bladder. I know it has to do with the lining of the bladder wall. What causes it? What’s the treatment? Does it get worse? — J.M.
\Answer: Interstitial cystitis is also known as painful bladder syndrome. It’s a fairly common condition that is commonly misdiagnosed. It affects more women than men. It occurs at any age, but typically, the onset is around age 40. Frequently, a woman has symptoms for years and years and is told she has repeated bladder infections. Antibiotics, however, provide no relief. Trips to the bathroom are numerous, and nighttime urination disrupts sleep. Bladder pain can be severe. Urination often relieves the pain temporarily. Intercourse also can be painful. One explanation says the protective covering of the bladder lining has thinned or has disappeared, and urine irritants come in contact with the sensitive bladder lining to produce pain. How this comes about is something that isn’t known with certainty. Symptoms can get worse, but treatments exist. One is the oral medicine Elmiron. Amitriptyline and gabapentin are also used for pain control. If you find that a particular food causes increased pain, stay away from it. Spicy foods, citrus fruits and juices, tomatoes, chocolate, coffee, tea, carbonated drinks and alcohol are some things on the list of irritants for many with this problem. If you feel lost about the diagnosis and its treatment, contact the Interstitial Cystitis Association (800-435-7422; www.ichelp.org) for information on treatment and support for this mystifying ailment that can completely throw life into turmoil.
\Dear Dr. Donohue: My doctor prescribed niacin to lower my cholesterol. After a month and a half, I developed shingles. Could niacin have caused this? — J.
\Answer: I can assure you, without equivocation, that niacin did not cause your shingles. Shingles comes from the chickenpox virus that stays in the body from the time of its entrance until the time of that person’s death. Mostly at older ages, the virus leaves the nerve cell it found a home in, travels down the nerve root to the skin and produces the typical shingles rash and pain. Older people should consider getting the shingles vaccine. Shingles is a painful experience, and the pain can last long after the rash has gone. The shingles booklet explains this common problem and how it’s treated. To obtain a copy, write: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Do you consider toe-touches a good flexibility exercise? — L.F.
\ Answer: They don’t do a whole lot for me. You can stretch leg muscles in other ways that are easier on joints and on the back."; drDArticle[88] = "Dear Dr. Donohue: This past week, our 29-year-old daughter was diagnosed with type 1 diabetes. Our family is devastated. We thought this was a juvenile illness. What is the long-term prognosis for this disease? Should pregnancy be avoided? She was hoping to start a family. — B.N.
\Answer: Type 1 diabetes used to be called juvenile diabetes because it often strikes at young ages, but it doesn’t do so exclusively. The name change reflects that fact. It also was called insulin-requiring diabetes because almost all type 1 diabetics must inject insulin for blood sugar control. The long-term prognosis for diabetes is good if the person can keep blood sugar controlled. Diabetes has many complications — kidney disease, heart disease, artery disease, nerve disturbance and eye problems — but good control of blood sugar can usually keep these complications to a minimum. Most people with type 1 diabetes lead the kind of lives they wish to lead, and most can be as active as they desire. Nowadays, people with diabetes check their blood sugar routinely and frequently adjust their insulin dose accordingly. New varieties of insulin make it easier to keep blood sugar within norms. Your daughter can have children unless her doctor has told her otherwise. It’s very important for a potential diabetic mother to maintain near-normal blood sugars at the time of conception and throughout pregnancy to prevent any disturbances in the growth and development of the embryo and fetus. These goals are usually achievable. The diabetes booklet gives an overview of this common condition and its treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 402W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Will you discuss the best way to take multiple medicines in a 24-hour period? I have a friend who downs 13 pills at the same time. Does mixing numerous medicines change their effectiveness? — N.A.
\Answer: It’s hard not to imagine that, in a batch of 13 different medicines, one or two, at least, would be incompatible with the other 11 or 12. The incompatibility might be a lessened drug absorption in the digestive tract or it might be that some of those drugs react chemically with others in the blood. Your friend should get this straightened out with the doctor or with the pharmacist.
\Dear Dr. Donohue: In my family when I was growing up, Epsom salts were used for everything. I never hear people say they use them these days. Why not? Don’t they work? — S.M.
\ Answer: Epsom salts come from the mineral waters of Epsom, England. When the water evaporates, magnesium sulfate is left. Local entrepreneurs promoted the salts as a cure-all for many ailments. One use was soaking sore muscles or joints. No harm comes from using the salts for that. Others used Epsom salts as a laxative. That’s not a terrific idea. They’re too harsh on the digestive tract."; drDArticle[89] = "Dear Dr. Donohue: I would like to give my 10-year-old grandson some conditioning advice. He loves basketball. It has occurred to me that upper-body strength is helpful in shooting long shots and in positioning for rebounds. In high school, I had a well-developed lower body but a poorly developed upper body. This handicapped me when shooting long shots. I have added pushups to my daily exercises, and this has helped me in shooting three-pointers. My questions are: When is a good time for a boy to start building muscle? Are there any exercises you would recommend for upper-body strength building for a 10-year-old? — J.M.
\Answer: The sports community, until recently, frowned on strength training (weightlifting, muscle building, resistance exercise) for children who had not reached puberty. They thought that children, before the male hormone surge that takes place at puberty, would not benefit from it. It’s been shown that they do, and that children as young as 7 show improvement in strength. The sports community also feared that weightlifting posed a health threat to young children whose bones are not completely calcified. Young bones have growth plates, sections of bone that have yet to become real bone. Growth plates permit bone elongation. These areas are areas of weakness. A well-supervised, well-designed weightlifting program doesn’t injure growth plates. In fact, such a program protects children from common sports injuries. All this applies to girls as well as boys. Your grandson can do the same exercises you do — with less weight. Your pushups are a good example. Body weight is the weight being hoisted. Chin-ups are another strength-building exercise in which body weight is the stimulus for muscle growth. He also can lift barbells and dumbbells. He should start with a weight that he can lift 12 consecutive times without straining. When he can perform two sets of 15 consecutive lifts, you can increase the weight by one to 3 pounds and go back to the 12 lifts. Barbell and dumbbell curls and bench presses are good upper-body strength-building exercises. A visit to the local library will pay off with books that show the details of many strength-building exercises. The booklet on fitness outlines aerobic exercise (not strength-building exercise) in detail. To order a copy, write: Dr. Donohue — No. 1301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: A TV doctor claimed it is better to eat a big meal at lunchtime. If you eat a big meal at dinnertime, you go to bed without burning it off. I thought weight depended on total daily calorie intake versus total daily calorie burning, without regard for the time of the day. Am I wrong? — B.B.
\ Answer: I’m with you. This advice is similar to the advice not to eat anything after 6 p.m. because those late-in-the-day calories aren’t burned when you sleep. Calorie-burning is a round-the-clock business, and calories eaten at 10 p.m. can be burned the next day at 10 a.m."; drDArticle[90] = "Dear Dr. Donohue: I have burning tongue syndrome. At times, it is almost unbearable. The only thing that helps somewhat is a saltwater mouth rinse. My dentist, my internist and a neurologist haven’t offered any relief. I also get sores in my mouth and on my tongue. Any insight? — P.H.
\Answer: Burning tongue syndrome is also known as burning mouth syndrome because the gums, roof of the mouth and lips also can feel like they are on fire. It happens mostly, but not exclusively, to women after menopause. Although painful and disturbing, it’s not a health threat. No one knows the exact cause, but it might be that nerves serving the tongue and mouth are malfunctioning. Let me give you a few home remedies for it: rinsing the mouth with cold apple juice; and combining equal parts Benadryl elixir and Kaopectate as a mouthwash. Don’t swallow these rinses, and use them four times a day. Another remedy is six drops of hot pepper sauce (Tabasco sauce) in a teaspoon of water and swishing it around in the mouth four times daily. It might increase the burning at first, but after a day or so it should lessen it. If it doesn’t, abandon it. Don’t eat or drink spicy or acidic foods or beverages. Don’t use mouthwashes with alcohol in them. Change your toothpaste brand. Chew sugarless gum. When burning mouth fails to respond to the above, the medicines Klonopin, Elavil or Neurontin might help. Have your doctors looked for things like dry mouth, B vitamin deficiencies, anemia, diabetes, lichen planus, thyroid problems and Sjogren’s syndrome? Sores on the tongue and in the mouth are not ordinarily a part of burning tongue syndrome. Get to a doctor when the sores are present. You might have recurrent canker sores and not burning mouth syndrome.
\Dear Dr. Donohue: Will you please define claudication? Is there any treatment for it? — R.L.
\ Answer: Claudication is leg pain that comes on with activity and is due to clogged leg arteries. Depending on where the clog is, the pain can be felt in the buttocks, hips, thighs or calves. The medical name of this condition is peripheral artery (or vascular) disease. Quite often, pain arises in the calves. Affected people have an uncanny ability to predict how far they can walk before they have to stop because of pain. Resting relieves the pain, and walking can then resume. Plenty can be done for it. Medicines can sometimes keep the pain from developing. Another way to attack claudication is to open the clogged artery with a balloon-tipped, slender, pliable tube (catheter), just as they do for clogged heart arteries. Or the same kind of heart artery operation in which grafts replace the obstructed artery can be done for leg arteries. The booklet on peripheral artery disease explains this illness and its treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[91] = "Dear Dr. Donohue: I developed rheumatoid arthritis four years ago. I am still working, lifting 70 pounds and pushing up to 150 pounds in a handcart, and I work 10 hours a day. I had been on methotrexate, but it made me sick. Then I went on hydroxychloroquine. Next was Enbrel, and now rituximab. I am a 47-year-old woman and have worked 22 years at my job. My insurance company is denying me coverage for rituximab because I don’t take methotrexate. So I have hit a wall. People tell me to write to you for a cure. Is there one? — G.G.
\Answer: There isn’t a cure for rheumatoid arthritis, but so many newer treatments exist that control of it is possible for most patients. Rheumatoid arthritis is the less common kind of arthritis. It usually strikes between the ages of 35 and 50, and more women have it than men. Rheumatoid arthritis, unlike osteoarthritis — the common kind of arthritis — is more than a joint disease. It’s a systemic disease. That means the entire body is affected by it, and many organs can be involved — the lungs, the lung coverings, the heart, blood vessels, eyes, spleen and bones. Systemic symptoms include fatigue and weakness. The hands, wrists, knees, feet, elbows and neck are the joints most affected. They become swollen, red, hot, painful and often deformed. The goals of treatment are relief of pain, reduction of inflammation, stopping joint destruction and maintaining joint function. There are some things you can do on your own. Exercise is important, but your job calls for exhausting physical labor, something that’s not good for rheumatoid arthritis. Will your employer switch you to another position? Rest stops the stress on joints. You can try taking omega-3 fatty acids, found in fish and obtainable in pills. It has helped some. Nowadays, the trend is to start rheumatoid arthritis patients on the most powerful drugs so joints don’t become permanently damaged. You have taken some — methotrexate and Enbrel. Rituximab (Rituxan), usually combined with methotrexate, has been quite effective for rheumatoid arthritis that’s unresponsive to other medicines. Perhaps your insurer will reconsider its position with a letter from your doctor explaining why you are not also taking methotrexate. The arthritis booklet deals with osteoarthritis and rheumatoid arthritis. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have glaucoma. I use eyedrops daily. Does caffeine cause eye pressure to rise? — A.G.
\ Answer: Glaucoma comes about from a rise of fluid pressure in the eye and from damage to the optic nerve at the back of the eye. Lowering fluid pressure — often with eyedrops — preserves the optic nerve and vision. Caffeine can slightly raise eye-fluid pressure for a limited amount of time. I would stop using it until I saw my doctor again. Then I would question the doctor, who can determine if the rise of pressure would be significant for you."; drDArticle[92] = "Dear Dr. Donohue: I play basketball — a lot. My right knee has started to hurt. It hurts the most when I start to play, and then it eases off. My coach and dad say it is jumper’s knee. My coach says to play through it. My dad says I should rest it. What do you say? — B.J.
\Answer: Give me a break. What do you think I’m going to say? I side with your dad. At the start of every basketball season, I get many letters asking about jumper’s knee. It’s a common malady of that sport, but it affects players in many other sports, like volleyball. The forces on the knees and the knee tendons when a jumper lands on the ground can be greater than nine times body weight. That’s a great deal of force. Jumper’s knee is an inflammation of the tendon that runs from the bottom of the kneecap to the top of the lower leg bone. The inflammation comes from too much use with too little rest. It gradually builds up over two to three weeks before a player starts to complain. Early on, the knee hurts the most when a player starts to move around and gradually lessens as he or she continues to play. If you don’t let the inflammation quiet down, the pain will worsen and last longer. At its worst, it is present even when you’re sitting. If you press on the area beneath the kneecap, you’ll find it is tender if you have jumper’s knee. A week or two of rest is all that’s needed in the early phases. Combining rest with Aleve, Advil or Motrin can speed the healing. When you get back to playing, apply heat to the knee for 10 or 15 minutes before you start. After you play, ice it for the same amount of time. I respect both your dad’s and your coach’s diagnostic abilities, but, if things don’t turn around shortly, I’d have a doctor examine your knee. Too many other things cause similar pain.
\Dear Dr. Donohue: When you are obese and then lose weight, how does fat leave your body? Does it go through the digestive system? Does it pass through your gallbladder, liver or kidneys? I recently lost quite a bit of weight through hard work. I have had two attacks of digestive distress since I began to lose the weight and wonder if they were gallbladder attacks. My husband says the fat fairy puts weight on and takes it off. I was looking for a more scientific explanation. — M.B.
\ Answer: Fat is a fuel, just like the gasoline in your car’s gas tank. When we need energy to power physical movement, much of the energy for it comes from fat. Carbon dioxide is one byproduct of fat-energy burning, and we exhale that. Other byproducts leave in the urine. We also burn stored fat when we reduce our calorie intake. Rapid weight loss can lead to gallstones and gallbladder attacks. How quickly did you lose the weight? I like your husband’s explanation. It’s poetic and mystical."; drDArticle[93] = "Dear Dr. Donohue: I went to the doctor because of headaches. On examining my eyes, she discovered that my pupils don’t constrict and dilate. She sent me to an eye doctor. He said I have an Adie’s pupil. Is this a disease or a syndrome? Can this be causing my headaches? He told me it was nothing. My headaches feel like there’s a tight cap on my head. Please enlighten me on these things. — G.S.
\Answer: An Adie’s (AID-ease) pupil is one that is slightly larger than the other pupil and it narrows very slowly when a bright light is shined on it. It’s not an indication of illness and has nothing to do with your headaches. If other signs are present, like a loss of the knee-jerk reflex when the knee tendon is struck with a rubber hammer, then you call the mix Adie’s syndrome. Your headaches fit the description of tension headaches, the most common kind of headache. People who have them say they feel like a tight band encircles their head or that a weight is on their head or that their head is squeezed or, as you say, that they are wearing a tight cap. Pain is felt on both sides of the head, and rarely is it throbbing pain, as it is with many other headaches. The pain lasts from half an hour to seven days. These headaches are called tension headaches because at one time they were believed to result from contraction of the scalp muscle. Now the explanation is that innocent brain signals are misinterpreted by the brain as pain signals. If that explanation helps you, it doesn’t do much for me. Start treatment of your headache without drugs. Heat packs to the neck or head might ease them. If heat doesn’t do the trick, try ice. Massage sometimes work, especially neck massage. Get enough sleep, but not too much. Too much is as bad as too little. Popular tension headache medicines are aspirin and Tylenol (acetaminophen). If they aren’t effective, tablets that combine them with caffeine can be. Caffeine enhances their painkilling properties. Ibuprofen (Advil, Motrin), naproxen (Naprosyn) and Ketoprofen (a prescription drug) have a good batting average against these headaches. Don’t overuse medicine. Constant use promotes constant headaches. The headache booklet deals with the common headaches and their treatment. To order a copy, write: Dr. Donohue — No. 901W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Allow four weeks for delivery.
\Dear Dr. Donohue: My son is almost 3. He reaches for everything with his left hand. I want to train him to use his right hand. Being left-handed is such a drag. What are your thoughts? — G.S.
\ Answer: Who says being left-handed is a drag? The 10 percent to 15 percent of the population who happen to be left-handed adjust to it without any great physical or psychological trauma. Leonardo da Vinci, Pablo Picasso, J.S. Bach and Sandy Koufax were lefties. They did all right for themselves. I’d let your son accept what nature has dealt him."; drDArticle[94] = "Dear Dr. Donohue: I am 42 and have an anemia. My doctor thinks it results from my menstrual bleeding, which is quite heavy. I have been taking iron pills, but I am still anemic. The doctor says I should have my fibroids removed, and that will stop the excessive bleeding. I have no other symptoms — no pain. Will you explain what fibroids are? They aren’t cancer, are they? — E.B.
\Answer: Fibroids are not cancer. They’re growths of the uterine muscle. The uterus is mostly muscle, with an inner lining designed to nourish a fertilized egg. Quite often, fibroids don’t cause any problems. Large ones can lead to heavy menstrual bleeding, which, in turn, gives rise to an anemia. They also can put pressure on the adjacent urinary bladder and bring on the need to urinate frequently. Sometimes they produce pelvic discomfort, and they might be involved with infertility. About two-thirds of women in their 40s have one or more fibroids. What causes them is still a matter of speculation. Female hormones make them grow. That’s why menopause, with its drop in hormone production, usually shrinks fibroids. They also run in families, so there is a gene influence. The best treatment for fibroids depends on their location in the uterus and their size. Sometimes removal is achieved with instruments introduced into the uterus through the vagina — no skin incision. Recovery from this procedure is fast. Laparoscopic surgery — surgery done with a scope and instruments inserted through small incisions — is another technique that permits quick recuperation. At times, the entire uterus has to be removed. A newer and popular treatment is uterine artery embolization. Here a slender, pliable tube is threaded from a surface artery to the artery that supplies the fibroid with blood. When the tube arrives at that artery, the doctor releases tiny pellets that promote the formation of a clot (embolus). Without nourishment, the fibroid shrinks and is eventually shed. The booklet on fibroids gives greater details on this common condition. Readers can obtain a copy by writing: Dr. Donohue — No. 1106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My doctor told me that I have costochondritis. I have had it for five days, and my chest is sore to the touch. It makes me short of breath. I am on ibuprofen, but it doesn’t seem to help. Is there anything else I can take? — D.H.
\ Answer: The “costo” of costochondritis is “ribs”; the “chondr,” is “cartilage”; the “itis,” inflammation. It’s an inflammation of the cartilage attaching ribs to the breastbone. Costochronditis is especially painful when taking in a breath or when twisting the chest. No one is sure what the cause is. Your medicine and similar ones are the standard treatment for this condition. Heat, in the form of warm compresses or heating pads, eases the pain. Some find that cold works better. If the pain persists, the doctor can inject the area with cortisone. That usually brings quick relief. Most are well in weeks to months."; drDArticle[95] = "Dear Dr. Donohue: I remember reading something you wrote a long time ago about the proper way to breathe for people with chronic obstructive pulmonary disease. I didn’t need the information then. I do now. Until recently, I smoked more than a pack of cigarettes a day, for 35 years. It caught up with me all of a sudden. I have COPD. I need you to repeat those recommendations again. Will you? — T.R.
\Answer: Sure. (For readers: Chronic obstructive pulmonary disease, COPD, is emphysema and chronic bronchitis.) Pursed-lip breathing is one technique that helps. Draw your lips into the whistling position when you breathe out. The lips are in the right position if the outgoing air makes a hissing sound as it passes through them. Pursed-lip breathing keeps the airways opened so all stale air is emptied from the lungs. In people with COPD, on exhalation, the airways collapse. That leaves them partially filled with old air containing little oxygen. By getting all the oxygen-low air out of the lungs, fresh air fills them and a person isn’t shortchanged on oxygen. Exhale slowly, twice the length of time it takes to inhale. You have to train yourself to use your diaphragm to its maximum capacity. The diaphragm is the horizontal muscle that separates the chest from the abdomen. It’s the principal breathing muscle. When the diaphragm moves downward, air rushes into the lungs. To make sure you’re using your diaphragm, lie on your back with your hands on your abdomen. Breathe normally. When you breathe in, your hands should move out as the diaphragm descends. You have to consciously use the diaphragm with each inhalation until it becomes second nature for you. Another trick that makes more room for air in the lungs is to bend a bit forward at the waist when you stand or walk. The booklet on chronic obstructive pulmonary disease explains emphysema and chronic bronchitis in depth, and how they’re treated. To obtain a copy, write: Dr. Donohue — No. 601W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I worry about my daughter. She is on her own at age 25 and works a demanding job that requires lots of overtime. She seems to catch every illness that comes along. I think her immune system isn’t working. Can you suggest a food, supplement or vitamin that could build it up? — C.R.
\ Answer: The immune system is often referred to and often misunderstood. White blood cells are part of it. Some white cells attack incoming germs. Others make antibodies that coat germs and lead to their death. Lymph nodes, the spleen and the liver trap germs and inactivate them. These are some of the parts of the immune system. I don’t know of a vitamin, a supplement or a food that bolsters the immune system unless the body has a specific vitamin deficiency. A well-balanced diet, banal as that advice is, keeps immunity in top performance. Your daughter sounds like she could stand some rest. Constant stress weakens immunity."; drDArticle[96] = "Dear Dr. Donohue: I am a 42 year old male who has had high blood pressure for the past two years. I have been on many medicines, but my pressure doesn’t go much lower. I don’t smoke or drink. No one else in my family has high blood pressure. I am about 25 pounds overweight. My doctor mentioned that I might have secondary high blood pressure. What is that? — R.B.
\Answer: Ordinary high blood pressure, or hypertension, is essential hypertension — high blood pressure that comes on its own. Secondary high blood pressure is an elevation of pressure due to another process. A leading cause of secondary high blood pressure is a narrowed kidney artery. Because of the narrowing, the kidney thinks body’s blood pressure is too low. It begins to turn out large quantities of renin, a kidney-made chemical that raises blood pressure. This kind of high blood pressure is known as renovascular hypertension. It can be cured by relieving the blockage in the kidney artery. Adrenal gland tumors, Cushing’s disease and a very unusual tumor called a pheochromocytoma are other causes of secondary high blood pressure. The bright side of secondary high blood pressure is its curability when the “secondary” process is treated. Your young age and the fact that your pressure doesn’t respond to the drugs well are two factors that suggest a secondary process might be going on Even though you didn’t ask, you can help yourself by losing the extra 25 pounds of weight you carry. Diet and exercise do work. You also can do yourself good by reducing greatly the amount of salt in your diet. Proof of secondary high blood pressure involves some complicated tests, so don’t be surprised if your doctor arranges them for you. Readers interested in ordinary high blood pressure can order the pamphlet on this common condition by writing: Dr. Donohue — No. 104W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have jogged for many years. It’s kept my weight down, and I do feel really fit. Twice I have sprained an ankle by stepping in a pothole I couldn’t see. What’s the right way to treat a sprained ankle? — G.R.
\ Answer: I can’t improve on the time-honored RICE recipe. “R” is for rest. Don’t put weight on a joint whose pain increases by so doing. “I” is for ice. A good way to apply ice is to put it in a plastic bag and then put a thin towel between the bag and the injured joint. Keep the ice in place for 15 minutes. Repeat the icing three or four times in the first day or two. Then switch to hot packs. “C” stands for compression. An elastic wrap does just fine. “E” is for elevation. If it’s the ankle that’s injured, the leg should be propped up. All these steps are done to prevent bleeding and swelling during the first two days of an injury. Use pain medicine as needed. Tylenol is a good choice."; drDArticle[97] = "Dear Dr. Donohue: I am 20 and need your help. I felt a lump in my right breast. I told a friend about this, and she said breast cancer never happens to anyone my age. If that’s the case, I am relieved. If it’s not the case, what should I do? How can you tell a cancer lump from one that isn’t cancer? This is on my mind all the time. — L.G.
\Answer: Breast cancer does happen to young women. It’s often said that it does not, but that’s misinformation. It’s true that breast cancer is more prevalent at older ages and that the risk for it increases the longer a woman lives. So someone your age is less likely to have it, but youth doesn’t make you immune to it. Size, how the lump feels and whether it is tightly fixed in place are some of the qualities that sway a doctor into judging a lump as being cancerous. Cancer lumps are hard. They’re firmly anchored to the tissue beneath them; you can’t move the lump. Cancer lumps have irregular borders. Frequently, the overlying skin of a cancer lump is drawn down toward it to form a little dimple. This sounds like it’s easy to tell if a lump is or isn’t cancer. It’s not. If a doctor, after examining the breast, cannot be sure, then he or she usually has the patient come back in a month or two to see if the lump has changed in size. If doubt still exists, an ultrasound in a woman less than 35 and a mammogram in an older woman usually can settle the matter. Should either of these tests not provide a definite answer, the next step is to obtain material for microscopic examination. That might be done with a very thin needle, with a larger bore needle or with a scalpel. Self-examination is good for discovering a lump. Self-diagnosis is foolish for proclaiming the lump benign or cancerous. You have to let the doctor do that; see yours today. Incidentally, it is better to have a breast exam one week after a period. At the time of a menstrual period, many breast lumps enlarge and become tender, and this can make a difficult diagnosis more difficult. The booklet on breast cancer explains the details of this illness and its treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am a 41-year-old woman, very petite, 5 feet 1 inch tall, and weigh 95 to 105 pounds. I am being bullied about this by my doctors. Have they supersized the height-weight tables to accommodate our increasingly obese population? I am lightweight but have no health problems. Your thoughts are welcome. — L.N.
\ Answer: Your body mass index is 18.9, which puts you in the normal weight category but at its lower end. If you feel healthy and eat a balanced diet, bully those doctors back."; drDArticle[98] = "Dear Dr. Donohue: Can you give me a good definition of “heart disease”? I find the phrase very confusing. — A.T.
\Answer: It’s confusing because it covers so much territory and deals with so many different conditions. The most prevalent form of heart disease is coronary (heart) artery disease — CAD, a buildup of cholesterol, fat and other materials in the arteries that supply the heart with blood. The buildup obstructs blood flow to the heart muscle, and the result is angina (chest pain) with partial obstruction, or a heart attack with complete obstruction. Heart-valve disease constitutes another group of heart ailments. The heart has four valves that keep blood moving from one heart chamber to the next and prevent backflow of blood into the chamber it just left. A valve can narrow and present an obstacle to the free flow of blood, or it can leak and allow backflow of blood. For example, a narrowed mitral heart valve is mitral stenosis; a leaky mitral heart valve is mitral regurgitation. The heart is a muscle. Diseases that directly affect the heart muscle are cardiomyopathies (“cardio” is heart; “myo,” muscle; “pathy,” disease). Some are inherited. Others develop on their own. This is another large group of heart diseases. Congestive heart failure arises when the heart becomes such a weak pump that blood backs up into the lungs, causing shortness of breath, and into the rest of the body, causing ankle and feet swelling. Congestive heart failure may result from any of the above three heart conditions. Heartbeat disturbances — arrhythmias (uh-RITH-me-uhs) — come about from a misfiring of the inborn electrical activity of the heart. Atrial fibrillation is a common arrhythmia. Arrhythmias often disturb heart pumping and lead to heart malfunction. Congenital heart disease is another group of heart diseases. They are defects in the way the heart formed during embryonic and fetal development. Holes in the partitions that separate the heart chambers are examples of congenital heart disease. Congestive heart failure, a common consequence of heart disease, is discussed at length in the pamphlet on that topic. Readers can order a copy by writing: Dr. Donohue — No. 103W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am very worried about my 68-year-old boyfriend. He has type 2 diabetes. He eats sugar without control — cakes, ice cream, regular soda pop. Most of the time, his sugar is over 300, sometimes over 480. He takes medicine for his diabetes, so he thinks he can eat whatever he wants. What can happen? — G.A.
\ Answer: You have justification to be worried. So does your boyfriend. Uncontrolled diabetes leads to artery hardening, strokes, heart attacks, nerve damage, kidney failure and blindness. Medicine is only a part of the treatment. Diet is the other part. He must limit his total daily carbohydrates, not just sugar. Carbohydrates are starches and sugars. The only way he’ll come to grips with this is to talk to a dietitian or a certified diabetes counselor. He should do so quickly."; drDArticle[99] = "Dear Dr. Donohue: My friend and I have an ongoing discussion about how we catch colds. I believe the only way is by being exposed to a germ. My friend agrees, but also says you can become chilled, and that results in a cold. Please settle this once and for all. — L.G.
\Answer: The only way to catch a cold is to meet up with a cold virus. But let’s kick this around a little while it lies there quivering. Rhinoviruses are responsible for many colds. This virus is passed from one person to another most often via the hands and fingers. An infected person invariably will have virus on his or her hands and fingers. If that person touches another person’s hands or fingers, the virus is transferred. All the second person has to do is touch his or her nose or eyes and the virus has found a new home. (The drainage channel for tears siphons viruses into the nose.) It’s also possible to spread a cold through sneezing or coughing, but that’s a secondary route. Many colds are preceded by a body chill. That’s part of the infection symptoms, and that might be what your friend refers to. Once a virus lands in a person’s nose, the time till the development of cold symptoms is short — eight to 12 hours. Runny nose, nasal stuffiness, scratchy throat, cough and sneezing are typical symptoms. They peak in 48 hours and are gone in about one week. A person is most contagious during the first three days of symptoms, when nasal discharge is at high volume and when it contains the most viruses. If by “chilling” your friend means being in a cold blast of air or getting your feet wet in frigid weather and shivering as a result, she has a slight point. That kind of chilling constricts the nose’s blood vessels and decreases mucus production. It might, therefore, permit cold viruses to mount a more effective attack and can contribute to the ease of catching a cold. All the same, without the virus there is no cold.
\Dear Dr. Donohue: I am 34 and have been jogging for 10 years. I do it year-round. I’ve noticed this winter that my knees feel stiff before I run. They don’t hurt during the run or after. Could this be a sign that I’m getting arthritis? — B.C.
\Answer: It’s not likely that at age 34 you’re coming down with arthritis. It’s more likely a weather thing. Cold weather thickens joint fluid. That makes joints stiff. Warming the fluid by exercise relieves the stiffness.
\Dear Dr. Donohue: As a calorie counter from way back, will I lose weight if I eat 1,500 calories a day? How about if I eat 1,200 calories one day and 1,800 the next? — K.T.
\ Answer: If you burn more than 1,500 calories a day but take in only 1,500 calories, you should lose weight. You can still lose if one day you take in slightly more and the next day slightly less. You can count the calorie deficit over a week’s time."; drDArticle[100] = "Dear Dr. Donohue: My 50-year-old daughter has been diagnosed with fibromyalgia. She is in a great deal of pain, and medications have provided no relief. She has been told there is no cure. Exactly what is fibromyalgia? What causes it? — E.F.
\Answer: Fibromyalgia is a baffling illness whose two principal symptoms are pain and fatigue. The pain is body-wide, on both sides and above and below the waist. For diagnosis, the pain has to have been present for three or more months. The fatigue of this condition is overwhelming, so much so that the simplest of daily tasks becomes a formidable challenge. Patients also suffer from sleep that does not refresh, and they often find it difficult to concentrate. Its cause remains a great unknown. Specific tests for fibromyalgia don’t exist. However, tender points — areas on the body where finger pressure elicits pain out of proportion to the pressure applied — aid in making a diagnosis. There are 18 such points, and for a diagnosis, 11 should be present. Other illnesses — such as rheumatoid arthritis, lupus, Sjogren’s syndrome and hepatitis, which have similar symptoms — have to be excluded, so testing for those conditions becomes part of the fibromyalgia workup. Your daughter is right. No cure has been found, but sometimes symptoms improve on their own. Exercise is important. It sounds ridiculous to ask a person who is hurting and exhausted to exercise. At the start, exercise intensity can be modest, just walking. The goal is to extend exercise to 20 or 30 minutes of daily exercise and to pick up the tempo gradually. The Food and Drug Administration has approved three medicines to ease fibromyalgia symptoms. They are Lyrica, Cymbalta and the newest, Savella. The booklet on fibromyalgia provides more information on this baffling illness and its treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 305W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My friend’s toenails are white. What cause that? — E.B.
\Answer: Fungal infections of the nail often turn them white. Proof of fungal infections comes from a doctor examining scrapings of the nails with a microscope. Many medicines are on the market for treatment of such an infection. Some can be painted on the nail — Penlac is an example. The success rate is not breathtaking. Oral prescription medicines are also available. They are expensive, and they don’t always work. Lots of people prefer to live in peace with such nail infections by ignoring them.
\Dear Dr. Donohue: My stomach sags around the belly button. My doctor says it’s an umbilical hernia. There’s no discomfort or pain. Will 100 sit-ups a day fix this? — L.W.
\ Answer: A thousand sit-ups a day will not fix it. Sit-ups could make it worse. Only surgery can fix it. Any exercise that increases pressure within the abdomen can make the hernia protrude more. If this bothers you, get a surgeon’s opinion."; drDArticle[101] = "Dear Dr. Donohue: I have had acid reflux for quite some time, and doctors have prescribed different medicines, the last being omeprazole. Medicines were not relieving the burning pain. The best advice came from an online message board that said to “sleep on your left side.” Figuring it wouldn’t hurt to try this method, I began sleeping on my left side. Once my body learned to stay in that position, the pain does not bother me now at all at night. Why don’t doctors share such simple methods for relief rather than prescribing medications? Please pass this information on to others. — N.S.
\Answer: When it works, a change in sleeping position is a simple way to deal with a big problem. It doesn’t work for everyone. In fact, it works for only a few, but it’s still valuable advice and is something that should be suggested more often. A change in sleeping position also can work for snoring. Sleeping on the side, right or left, can open up the throat and stop snoring. Redundant throat tissue, like a reed in a wind instrument, lies behind snoring. Sewing a pocket in the back of the pajamas and putting either a tennis ball or a marble in it keeps snorers off their backs. Other self-help tips for GERD (gastroesophageal reflux disease, heartburn or acid indigestion — all are the same condition) include staying away from foods that cause it. Onions, garlic, coffee, carbonated beverages, alcohol, chocolate, fried and fatty foods, citrus fruits and juices, tomato sauces, peppermint, spearmint and spicy foods are notorious troublemakers. Sleeping with the head of the bed elevated is another way to keep stomach acid in the stomach. Prop 6- or 8-inch blocks under the posts at the head of the bed. In this position, gravity keeps stomach acid in the stomach.Chewing gum stimulates saliva production, and saliva is a natural antacid.Don’t wear tight garments or tight belts, both of which promote acid reflux. I managed to get through this answer without mentioning a single medicine, not even Tums.The booklet on GERD — heartburn — provides an insight into this common malady and its treatment. Readers can order a copy by writing: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: There seems to be a vaccine for everything except strep throat. My kids get it at the drop of a hat. Their pediatrician claims that tonsillectomies don’t work. Is there a possibility of a vaccine? — K.T.
\ Answer: There is a possibility of a strep vaccine. Doctors currently are working on it. Is the doctor sure that these repeated sore throats are strep throats? The only definite proof is a culture of the throat or specific tests for the strep germ. Most sore throats are viral-caused. If a child has severe and frequent strep throats, removing the tonsils lessens the number of infections. “Frequent” means seven or more infections in one year or five or more in the preceding two years."; drDArticle[102] = "Dear Dr. Donohue: I have varicose veins on both of my legs. I wear only long dresses and slacks to hide them. My legs don’t hurt, but I would like to be rid of these veins. What can I do for them? At this point, I am not interested in surgery. — L.H.
\Answer: Leg veins face a Herculean task. They have to return blood to the heart in the face of gravity, which works to keep blood from moving upward. They couldn’t accomplish their task if they didn’t have valves. As blood moves upward in the vein, its valves close so that it can’t fall back down. The problem with varicose veins is a valve problem. Their valves no longer work. Blood stays in the leg veins, distends them and stretches them out of shape — varicose veins. Varicose veins can make the legs ache or cause them to tire quickly. Sometimes, the pooled blood leaks fluid out of the veins, so the ankles and feet swell, and open ulcers — most often around the ankle — might form. And then there is the cosmetic aspect, about which I’m not qualified to comment. Things you can do for varicose veins are limited but worth trying. One is compression stockings. The very best stockings are the ones with graduated compression, with the compressive force greatest in the lowermost part of the leg and with lesser force in the upper parts of the leg. Compression moves blood upward. Another way to keep blood from pooling is lying down with your legs higher than your heart. That position empties blood out of leg veins. Admittedly, you can’t spend the entire day with your legs elevated, but elevate them as often as you can. Never stand for long in one place. If you have to stay still, contract your calf and leg muscles to push blood out of the legs. Should you change your mind about surgical vein removal, you should know that today there are many methods of getting rid of these veins. Endovascular lasers, radiofrequency catheters and sclerotherapy are recent-vintage techniques. Surgical removal has been refined to the point that most patients return home on the day of operation.
\Dear Dr. Donohue: I have mucus that drains down into my mouth and throat constantly. I hope you can offer some help for me. — H.E.
\ Answer: You’re describing postnasal drip, the irksome trickling of mucus into the back of the mouth and throat. It is thick, gluey and tastes awful. The mucus often comes from chronically infected sinuses. Try saltwater irrigation of the nose to clear up some of this mucus. Boil some water, and into a cup of boiling water add a quarter-teaspoon of salt. Let the water cool. With a bulb syringe, available in drugstores, gently flush both nostrils. Before going to bed, take a drug that contains both an antihistamine and a decongestant. Drixoral Cold and Allergy Tablets is one such drug. It can slow the trickle at night, when it’s usually at its worst. You might have to enlist the help of an ear, nose and throat doctor, who can inspect your sinuses and tell you if you need more intensive treatment."; drDArticle[103] = "Dear Dr. Donohue: Is it possible to get wet macular degeneration from a scratch on the left eye during cataract surgery, or could it have been a cyst that caused wet macular degeneration? I am 85, and my right eye is perfect. I had cataract surgery on that eye also. — C.
\Answer: A scratch on the eye isn’t likely to cause macular degeneration. The possibility of cataract surgery leading to macular degeneration is a remote one. More than 6,000 people who had had a cataract removed were followed for five years after the operation. Slightly more people who had the operation developed macular degeneration, dry or wet, in the operated eye than did a similar group of people who had not had an operation. This isn’t proof that cataract surgery leads to macular degeneration. The same risks that cause cataracts also cause macular degeneration. The numbers that do develop it after cataract removal are small. A cause-and-effect relationship has not been proven. I am not clear what you mean by a cyst causing the degeneration. In what part of the eye was the cyst? I have not seen a link between cysts and macular degeneration. The retina is the back layer of the eye, the layer that converts incoming images into nerve signals that can be transmitted to the brain so we can see. The macula is a small, round area of the retina where there’s an aggregation of cells that are essential for central vision — the kind of vision needed to read a paper, watch TV and drive. Dry macular degeneration, accounting for 85 percent to 90 percent of cases, is a wasting away of macular cells. Wet macular degeneration results from a sprouting of blood vessels in that region. Those newly formed blood vessels leak fluid and destroy macular vision. Procedures are available that can halt the progression of wet macular degeneration. The booklet on macular degeneration explains both kinds and what is available to help those with this common eye problem. Readers can obtain a copy by writing: Dr. Donohue — No. 701W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I need some basic facts about the pulse. First, what’s considered a normal rate? I have trouble finding my pulse. I feel all over my wrist, but it’s hard for me to detect. Is there some other place where I can feel it better? — C.M.
\ Answer: The pulse rate and the rate of the heartbeat are one and the same. When the heart beats, it ejects blood into arteries. The force of that ejection runs down all artery walls and is the pulse beat. A normal pulse (or heart rate) is 60 to 100 beats a minute. You feel the pulse on the thumb side of the wrist. Maybe you’re pressing too hard and obliterating it. If you can’t find it there, you can feel it in the neck, slightly below the angle of the jaw. Or you can put your hand over your heart and count the heartbeats."; drDArticle[104] = "Dear Dr. Donohue: I got a sudden attack of dizziness that landed me in bed. I couldn’t stand. Finally, with the help of my husband, I got to the doctor, who said I had a viral infection called vestibular neuritis. I am taking medicine and am somewhat better, but the dizziness isn’t completely gone. Will it go? When? — L.T.
\Answer: I have to warn readers that the causes of dizziness are diverse, and vestibular neuritis, while common, is only one of many causes. The vestibule of the inner ear has three fluid-filled canals that work like a carpenter’s balance, that gadget whose center contains a fluid-containing tube with a bubble in it. The balance tells the carpenter if a piece of wood is aligned. The inner ear canals tell people if they are aligned. They send signals to the brain that keep us balanced. A viral infection of those canals or of the nerve that sends signals to the brain makes people feel like they’ve been put in the spin cycle of a washer. Not only are affected people dizzy, they become nauseated and often throw up. Symptoms of vestibular neuritis lessen in two to three days, but full recovery can take up to six or more weeks. A cortisone drug taken within the first three days of illness can ease symptoms. And medicines like promethazine relieve dizziness and nausea, but they make some people so drowsy that they prefer the dizziness. The booklet on dizziness discusses vestibular neuritis as well as the other dizziness causes. Readers can obtain a copy by writing: Dr. Donohue — No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Can you give an explanation of and recommendation for cure of a health problem I have? Being over the age of 65 and in reasonably good health, I suffer every winter from painful cracks in my fingertips and the soles of my feet. — R.V.
\Answer: The cracking indicates your skin is drying out. You can restore moisture to your fingertips with a light coat — just a dab will do you — of petroleum jelly (Vaseline or another moisturizer) before going to bed. Put Band-Aids over your fingertips, and leave them on all night. You can do the same during the day, but it’s a bit inconvenient. In about three days, the cracks should be filling in. Continue this treatment every third or fourth night. The same thing works for the feet. You don’t use Band-Aids, but you do cover your feet with socks before going to sleep. Don’t apply petroleum jelly during the daytime. It might make you somewhat unsteady. It takes longer for feet to heal.
\Dear Dr. Donohue: Does the consumption of foods packaged or wrapped in aluminum foil pose a risk for contracting or accelerating Alzheimer’s disease? — M.E.
\ Answer: The answer is no. The brains of some Alzheimer’s patients have more than the usual amount of aluminum. Some have interpreted that as indicating aluminum as a cause. Few scientists hold to that theory."; drDArticle[105] = "Dear Dr. Donohue: I need information on how to avoid flare-ups of diverticulitis. I am a 53-year-old female. I was diagnosed with diverticulitis in 2008 after suffering for months from discomfort that finally became unbearable. The doctor gave me an antibiotic that cleared the problem up. What I need to know is this: How long after eating a problem food does discomfort ensue? I’ve tried to tie discomfort to a particular food. I just can’t figure out which ones cause the problem. For instance, if I have a problem on Tuesday afternoon, would that be from food I ate Tuesday morning, or the day before, or the day before that? — D.F.
\Answer: You need a clearer picture of what causes diverticular pain. You’re barking up the wrong tree. Diverticula are small bulges on the colon’s outer wall. The bulges are the lining of the colon that has been pushed through the muscular colon wall and has popped out on its outer surface. They are pea-size to marble-size. When the necks of diverticula become obstructed, bacteria within the diverticula causes swelling and pain. Prevention of diverticula formation and diverticula obstruction centers on a high-fiber diet. A particular food isn’t usually the culprit. A lack of fiber is the troublemaker. Fiber holds on to water and keeps the food residue soft. If the residue hardens, the colon has to generate great force to move it along, and that force is responsible for diverticula formation. You need to get 25 grams to 30 grams of fiber daily. Fruits, vegetables and whole grains are fiber sources. Whole grains are grains that haven’t been refined. They retain their outer coat — bran. Bran is excellent fiber. Diverticulitis — inflamed diverticula — produces pain, most often felt in the lower left side of the abdomen. Sometimes it leads to rectal bleeding. An attack of diverticulitis calls for a change in diet, either to a liquid one or one with soft foods. If you still want to track a particular food as the cause of a diverticulitis attack, I’ll give you the rough time sequences of food passage. It takes one to two days for food to pass from mouth to the end of the colon. At most, it takes three days. Anything beyond that time is abnormal. The booklet on diverticulosis explains this common malady in detail. To order a copy, write: Dr. Donohue — No. 502W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Several months ago, I fell. X-rays indicate that I have arthritis in my left hip. When I resumed my exercise program, I had pain on raising my left leg about 12 inches off the ground. Do I increase or decrease my exercise? Is there a painkiller or vitamin I should take? — B.W.
\ Answer: Pain is a signal to stop doing whatever it is that causes it. Perhaps arthritis is the cause. A cause has to be found before continuing any exercise that brings it on. Don’t blunt the pain with medicines until you find the cause. Vitamins will not help."; drDArticle[106] = "Dear Dr. Donohue: My father is 88 and quite headstrong. He has taken a daily dose of mineral oil for years and years. He says it keeps him regular. Should he continue to do this? Could it harm him? — K.H.
\Answer: Mineral oil was once a favorite treatment for constipation and for its prevention. It’s not a great way to combat either. It interferes with the absorption of vitamins A, D, E and K, and it can block absorption of other nutrients. He should take it before eating or before taking any medicines or vitamins. If it goes down the wrong way — into the lungs rather than the stomach — it causes pneumonia. Your dad is 88. I take it he is in reasonable health. He’s been taking mineral oil for years and years without facing any consequences. I would mention to him that this isn’t a good idea. However, he is at an age when he can do most anything he wants. If he objects, I wouldn’t push matters too hard. The booklet on constipation and its treatment deals with this common problem in depth. Readers can order a copy by writing: Dr. Donohue — No. 504W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: If a person is all alone and choking from something caught in the throat, this person cannot perform the Heimlich maneuver on himself. Would it be good for that person to insert a finger into the back of the throat to provoke regurgitations and clear the airway? — C.
\Answer: If food or anything else gets caught in the windpipe (the trachea), a solo person can dislodge it by bending over a sturdy chair so the abdomen, just above the navel (bellybutton), rests on the top of the chair. A kitchen chair with a wooden back is a good choice. Then the person pushes the abdomen with an inward and slightly upward thrust against the top of the chair. It should generate a burst of air through the windpipe to dislodge whatever is stuck there. Repeat the thrust as many times as necessary. If a chair is unavailable, then make a fist with one hand and cover it with the other hand. Put the fist in the same location, above the navel, and make a forceful inward and upward thrust. Repeat as needed. The forced vomiting idea isn’t a good one. Vomited material leaves the stomach and enters the mouth through the esophagus. It doesn’t unblock the trachea.
\Dear Dr. Donohue: Do you lose more nutrients from vegetables when you cook them in a microwave than when you cook them on a stove? — A.T.
\ Answer: You lose fewer vitamins and minerals when you microwave vegetables than when you cook them on top of a stove. Little water is needed when microwaving, so nutrients don’t pass out of the vegetables and into the water."; drDArticle[107] = "Dear Dr. Donohue: My wife, 78, has had headaches, some memory problems and confusion. A brain scan showed hydrocephalus. We were referred to a neurosurgeon, and he ordered an infusion study. We have waited six weeks for that appointment. At an earlier appointment, we met someone who had had the infusion study and then had a shunt placed. He said he got his life back. Someone else told us that 10 percent of people diagnosed with Alzheimer’s disease really have normal pressure hydrocephalus, which is fixable. What is your reaction to this? — J.R.
\Answer: Dementia is a fog that descends on the brain, erasing memory and impairing many other mental functions. Alzheimer’s disease is the major cause of dementia. However, there are other causes, and one of them is normal pressure hydrocephalus. I can’t vouch for the statement that 10 percent of Alzheimer’s patients have NPH, but I am sure there are a few who do. I don’t want to raise false hopes for Alzheimer’s patients. In NPH, the balance between the production and absorption of cerebrospinal fluid is lost. The volume of fluid within the brain increases and compresses it. That leads to the signs and symptoms of NPH. The three major indicators of NPH are an abnormal walk, a diminution of memory and other mental functions (dementia) and an urgency to empty the bladder with frequent loss of bladder control. The NPH gait is one where steps are taken slowly, in short strides and with the legs wide apart. People look as though their feet are glued to the ground and they have difficulty turning themselves. A person doesn’t need all three criteria to merit the diagnosis. If signs, symptoms and tests, including a brain scan and the infusion test your wife is going to have, point to normal pressure hydrocephalus, then drainage of the excess brain fluid often can restore a person’s life, as the man you met in the doctor’s office said. A thin, plastic tube (a shunt) drains the fluid to other body sites where it is absorbed. Alzheimer’s disease is far and away the leading cause of dementia. The booklet on Alzheimer’s disease describes it and its treatments in detail. To order a copy, write to: Dr. Donohue — No. 903W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: When my son was 10, the doctor gave him a nasal spray to stop his bedwetting. It worked well. He told us to use it only when the boy was going to be away for the night. My son is now an adult and is 6 feet 8 inches tall. Did that inhaler make him grow so tall, a height that is uncomfortable for him? — B.P.
\ Answer: The medicine in the inhaler was a synthetic version of a pituitary gland hormone called antidiuretic hormone, a hormone that slows urine production. It has nothing to do with growth. I guess the world can be inhospitable to the very tall, but many of us wouldn’t mind trading places with them."; drDArticle[108] = "Dear Dr. Donohue: Sixty-two must be the age when everything falls apart. I’m there. My latest body part to give way is my back. I have back pain a considerable amount of the time. It finally brought me to a doctor, who tells me I have spinal stenosis. I have been told to take Aleve for my pain, and I’m scheduled for physical therapy. I don’t have great hopes of a cure. What exactly is this? What else can be done for it? — T.R.
\Answer: Spinal stenosis accounts for about one-third of all cases of low-back pain. It’s an elusive concept that calls for an anatomy lesson. The backbones (vertebrae, spinal column) have a tunnel running through them — the spinal canal. In that canal or tunnel is the spinal cord and spinal nerves. Spinal stenosis signifies that the spinal canal has narrowed and is pressing on the spinal cord or spinal nerves. That, in turn, produces back pain that can spread to the buttocks, the back of the thighs or the lower leg. The pain worsens on standing or waking, and goes away when the person sits. Aging is the most important factor in developing spinal stenosis. Back ligaments, which hold the backbones in place, thicken and calcify. Arthritic changes in the backbones sprout bone spurs that impinge on the canal. Back discs — the spongy shock absorbers between adjacent backbones — degenerate and crumble, and that narrows the canal and exerts pressure on the spine and spinal nerves. Nonsurgical treatment employs physical therapy to strengthen and stretch back muscles in an attempt to relieve pressure on the spine and its nerves. Anti-inflammatory medicines like your Aleve control pain. You might need stronger pain medicines. Epidural injections of cortisone ease inflammation and give the spinal canal and spinal nerves more room. “Epidural” means the injection is made into a space in the spinal canal above its covering membrane. Surgery is a solution when these measures fail. The pamphlet on back pain discusses the many conditions that lead to one of medicine’s biggest problems. It describes different conditions and their treatments. To obtain a copy, write to: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Will you repeat the article on a runny nose when eating? My husband has it, and it’s embarrassing to him. — J.W.
\ Answer: Some explain why noses run upon eating by invoking sensitivity to temperature changes, i.e., hot or cold food. Or it could be that spices start the nose dripping. Chewing might trigger a reflex that makes the nose run. And, in all truth, the reason could be something that remains a mystery. Atrovent nasal spray, a prescription item, can sometimes stanch the drip. A drying antihistamine taken an hour before meals is another way to keep the nose dry. People shouldn’t resort to medicine before every meal. They should save it for occasions when a drippy nose is a source of embarrassment. This curiosity has a name, gustatory rhinorrhea."; drDArticle[109] = "Dear Dr. Donohue: For men with BPH, would you recommend the Prolieve System for treatment? It involves reducing the prostate with heat. Must it be done periodically to maintain symptom improvement? Any information will be appreciated. — Anon.
\Answer: BPH — benign (not cancer) prostate hypertrophy (overgrowth) — is a common condition of older men. The urethra — the bladder’s drainage tube — runs through the prostate. A large gland acts like a vise, squeezing the urethra and making it impossible for the bladder to completely empty. Large glands make men get up many times during the night to visit the bathroom. They make it difficult to start the urinary stream, and they can reduce the stream to a dribble. Minimally invasive procedures, many done right in the doctor’s office, pare the gland so that a free urine flow is re-established. The Prolieve System (a trademark name) delivers microwaves to the gland to shave the excess growth. In this and in similar techniques, instruments are inserted into the urethra by way of the penis and passed upward to the level of the prostate gland, where the microwaves are then activated. Yes, I can recommend it. Quite often, the procedure need be done only once. However, it is possible that a repeat will be necessary to trim the gland again should it regrow to the size where it compresses the urethra. Other procedures include the Green Light laser, in which a laser beam reduces prostate size in a similar manner. TUNA — transurethral needle ablation — is another minimally invasive procedure, done in a like way. It employs radio waves to reduce prostate size. All of these methods work. The most important element in making a choice is the doctor’s skill in the technique. Medicines are another possible route for handling an overgrown gland. Drugs can relax tight muscles in the prostate and in the outflow tract of the bladder to permit better urine flow. Flomax and Uroxatral are two examples. And medicines like Proscar and Avodart shrink the gland, but they can take months to work. The booklet on this gland and its problems discusses these issues in greater depth. To obtain a copy, write: Dr. Donohue — No. 1001W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I always heard that one must fast before being tested for cholesterol. My doctor always told me to do so. At my last visit, he had his nurse draw my blood for a cholesterol check. I told him I had not fasted, but he said it didn’t matter. Have things changed? — D.S.
\ Answer: You don’t have to fast for an accurate cholesterol reading. However, you do have to fast, preferably for 12 to 14 hours, for an accurate triglyceride reading. Triglycerides often are checked along with cholesterol. A new trend is developing for triglycerides. Many now feel that a more accurate picture of triglycerides is obtained by not fasting before blood is drawn. Whether this technique wins universal approval is something we’ll have to wait to see."; drDArticle[110] = "Dear Dr. Donohue: Would you address plantar warts? I’ve been told they’re from a virus in the body and that nothing can be done for them or keep them from recurring. Is this so? — D.W.
\Answer: All warts, wherever they are, come from an infection with one of the more than 100 human papillomaviruses — HPV. Individual members of the HPV family have a preference for particular body sites. Some head for the soles of the feet to cause plantar warts. “Plantar” is derived from a Latin word meaning “sole of the foot.” If a plantar wart isn’t kicking up a fuss, it can be left alone. It’s not going to do any harm. Many such warts disappear without any treatment. Some can return, and there is not a whole lot to do about preventing a second visit. However, there is much to do about a plantar wart that hurts. The method chosen for wart removal must not leave a scar. A scar on the bottom of the foot causes more trouble than does a wart. Look on the shelves of any drugstore for wart-removal products that contain salicylic acid, and follow the directions for application carefully. Be patient. It takes more than one application to get rid of the wart. Duct tape sometimes works. That’s right — duct tape, the tape you buy in a hardware store. Cover the wart with a piece of it for six days. Remove the tape, soak the foot and then gently rub the wart with a pumice stone, obtainable in drugstores. Reapply the tape after 12 hours. You might have to repeat this procedure for two months before the wart leaves. If home remedies bring no success, the family doctor can step in with more involved treatments.
\Dear Dr. Donohue: For the past six months, I have had no energy. I teach third grade. My doctor checked my thyroid gland, and it turns out it’s not working well. I am now taking replacement thyroid hormone. How long does it take for me to recover my former energy? Also, my cholesterol was high. Is that part of this deal? — M.O.
\Answer: It can take three to six months for your hormone level to reach a normal plateau. That’s when you’ll feel like your old self again. A person with low thyroid hormone often has a rise in blood cholesterol. The level will fall as soon as the replacement hormone is working. The booklet on thyroid problems discusses both under- and overactive thyroid glands. Readers can order a copy by writing: Dr. Donohue — No. 401W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: What causes skin tags? They hang from my neck and under my arms. — D.H.
\ Answer: Their cause isn’t known. Your doctor can clip them off without any fuss. By age 69, 60 percent of us have one or more of them."; drDArticle[111] = "Dear Dr. Donohue: I have to run to the bathroom all day long. If I don’t make it in time, I have an accident. This has made me so nervous that I have given up on all thoughts of a social life. It’s ruining my life. If we go to a restaurant, I must have a table near the restrooms, or I won’t sit down. What can be done? I’ll try anything. — P.G.
\Answer: Your condition is an overactive bladder. Sudden, inappropriate and forceful contractions of the bladder wall muscles make it imperative for you to rush to the bathroom or you lose control of urine. Such bladder muscle contractions shouldn’t occur until the bladder is full or nearly full. For some reason, your bladder reacts violently when it’s only partially full. Conditions like a bladder infection can be a cause. Often, however, muscle contractions take place without any cause ever being found. You have to see a doctor who can look for things that are easily treated, like an infection. If no cause is discovered, then you can reprogram your bladder to not react like this when it’s only partially filled. For two days, time the intervals between bathroom visits. Add 5 minutes to the shortest interval and hold off on urinating for that time interval for a week. On week two, increase the interval by 15 minutes. Keep this up for a month, and then increase the interval by half an hour. Every two weeks, add another half hour to the interval between bathroom visits. When you reach three hours, you can stop. You also can ask your doctor for prescription medicines that quiet bladder muscles. Detrol, Sanctura, Vesicare and Enablex are names of some of these medicines. Another technique involves injecting the bladder muscles with Botox. Botox weakens the force of bladder muscle contractions and allows you to hold urine for more-normal intervals. In extreme circumstances, a gynecologic urologist can advise you if a battery-operated device attached to the bladder is something you could consider. It stops frequent, unwanted and unneeded bladder contractions.
\Dear Dr. Donohue: What causes hangnails? I have a crop of them. I know this isn’t a pressing medical question, but what can you recommend to prevent them? — L.B.
\Answer: Hangnails form when the skin dries. Dry skin at the borders of the nails cracks to form a hangnail. Prevention comes from the daily use of moisturizers. Even though it’s tempting to pull a hangnail off, don’t. Cut it with small, sharp scissors.
\Dear Dr. Donohue: Please explain what complex carbohydrates are. I see this term on all diet instructions. I don’t have a clear idea of what it means. What makes them complex, and how are they healthier than other carbs? — W.L.
\ Answer: Carbohydrates are starches and sugars. Fruits, vegetables and most grains (flours) are carbohydrates. Complex carbohydrates are long chains of carbon molecules. Starches are complex carbohydrates. Sugars are simple carbohydrates. Complex carbohydrates don’t raise blood sugar as quickly as do simple carbohydrates, so they don’t provoke a great demand for insulin. That’s what makes them more desirable."; drDArticle[112] = "Dear Dr. Donohue: I’ve had severe high blood pressure for many years. I have tried all the medicines you can think of. I am 62 and have had one ministroke. I’m not looking for another. I used to weigh 235 pounds. I lost 100 pounds. I watch my salt. I have tried everything. My family has a history of high blood pressure. Can you recommend anything? — F.
\Answer: Blood pressure that doesn’t drop by making life changes (weight loss and diet) or by taking three or four blood pressure medicines is called resistant high blood pressure (hypertension). Your weight loss is admirable. It should have reduced your pressure. Watching your salt intake is also important. That entails more than not using the salt shaker. It requires you to carefully look for the salt content (listed as sodium or sodium chloride) of all your foods. Commercial soups, frozen dinners, many canned goods and luncheon meats often have a high salt content. Your diet should be one of fruits, vegetables, whole grains (unrefined wheat, barley, rye and oats) and one where meat and fats are eaten sparingly. Increase foods with lots of potassium in them: tomatoes, potatoes, prunes, lima beans, kidney beans, navy beans, bananas, oranges and orange juice, spinach, peaches, cantaloupe and broccoli. Potassium lowers blood pressure. Exercise for 30 minutes every day. Get your doctor’s approval first, and start out modestly. Brisk walking is fine. For resistant high blood pressure, your doctor has to look for the less-common causes of it. Sleep apnea (loud snoring with pauses when there is no breathing), adrenal gland tumors, Cushing’s syndrome, narrowed kidney arteries and rare tumors such as pheochromocytoma are cases in point. Go over your medicines. Some medicines raise pressure. Nonsteroidal anti-inflammatory drugs are an example — Aleve, Advil, Motrin, aspirin and other NSAIDs. Don’t drink more than two alcohol drinks a day. More than 30 blood pressure medicines are on the market. I bet you haven’t tried all 30 or combinations of them. Some brands come with two medicines in one pill, easing the burden of pill-taking. A new medicine, one completely different from all other medicines, is now available. It is Tekturna. Something must be done for your pressure. The booklet on high blood pressure gives the story of this very common malady. To receive a copy, write: Dr. Donohue — No. 104W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Allow four weeks for delivery.
\Dear Dr. Donohue: When I walk upstairs, my knees make noises. They sound like bowls of Rice Krispies, snapping, crackling and popping. My wife thinks this has to be a sign of serious trouble. I have no pain. My knees are not stiff. I play 18 holes of golf three times a week. Should I make a big deal of this? — R.K.
\ Answer: If your knees are not bothering you, then knee noises usually do not indicate any serious problems. Tendons gliding over bones make snapping noises. So do bursting air bubbles in joint fluid. No, you don’t need to make a big deal of this."; drDArticle[113] = "Dear Dr. Donohue: I’m beginning to get little knobs on my finger joints. I believe this is arthritis, and I have seen it in the advanced stages. What can I do to prevent it from getting worse? — Anon.
\Answer: The knobs on the finger joints below the fingernail are Heberden’s nodes, named after an English doctor who died at the start of the 19th century. Knobs on the middle finger joints are Bouchard’s nodes, named after a French doctor who died in the early years of the 20th century. Both of these knobs are signs of osteoarthritis — the common kind of arthritis, the kind that most seniors have at least a touch of. They’re similar to bone spurs seen on backbones and other bones, another consequence of osteoarthritis. Osteoarthritis comes from fraying of the cushioning cartilage inside joints. How extensive or how incapacitating it will be is unpredictable. Most people manage to get along in spite of it. However, it can be a great burden to others. There is no preventive medicine to stop osteoarthritis in its tracks. It has a predilection for the fingers, hips, knees and spine. Should it strike larger joints like hips, knees and backbones, muscle strengthening will serve you well. Strong muscles protect joints. The exercise should not be so vigorous that it causes pain, but it should be vigorous enough to encourage strength building. Being overweight increases the stress on knees and hips, so you should strive to stay on the lean side. Many people swear to the effectiveness of chondroitin and glucosamine, both of which are available without a prescription, and often they come in combination. Not a lot of evidence exists to endorse them wholeheartedly, but if you want to give them a try, they won’t hurt you. The arthritis booklet deals with osteoarthritis, also called degenerative arthritis. Readers can order a copy by writing: Dr. Donohue — No. 301W, Box 536475 Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: For quite some time, my right shoulder has hurt. I saw an orthopedic doctor, who says I have a tear of my rotator cuff. He suggested surgery. What do you think of surgery for this? I am scared that I could be worse off after the operation than I am now. I am only 44 and am quite active. — K.M.
\ Answer: The rotator cuff is a band made up of the tendons of four back muscles. The tendons wrap around the topmost part of the upper arm bone, the humerus, to keep the bone in the shoulder socket. Tears of the rotator cuff are a common problem and one of the principal causes of shoulder pain. Small tears can heal on their own. Larger tears almost always require surgical correction. All surgical procedures demand respect. Something can always go wrong. Most people who have had surgery to correct a rotator cuff tear are glad they had it. By most, I mean more than 95 percent. I would not hesitate to have this surgery."; drDArticle[114] = "Dear Dr. Donohue: What can you tell me about a low sodium level? My visiting friend (from England) was refused embarkation on his cruise because he was acting belligerent and confused. The ship’s doctor sent him to a hospital. He had scans, an EEG and numerous blood and urine tests. Everything was normal except he had low sodium. His insurance carrier sent a doctor from England to accompany him on a flight back to London. He has since seen his own doctor. His sodium level has risen. What happened to him? — B.L.
\Answer: Sodium has many functions. It keeps body fluids at the right level. It maintains blood pressure. It’s essential for muscle contractions. It participates in generating the heartbeat. It carries a positive electric charge, so it balances the negatively charged body substances. A drop in blood sodium leads to fatigue, nausea and weakness. If the level dips farther, people become confused and dizzy. At very low levels, they could have a seizure and lapse into a coma. Your friend’s doctor has the task of finding out why your friend’s sodium level fell. In quite a few instances, it comes about from an inappropriate release of a body hormone called ADH, antidiuretic hormone. This hormone stops kidney urine production. The result is too much water in the body. The extra water dilutes sodium and produces a low reading. Liver diseases, troubles with the adrenal glands and a sluggish thyroid gland are other causes for a lowering of blood sodium. Restoring the body’s sodium content is not too difficult. Tracking the reason why it dropped is. Has your friend’s mental function normalized now that his sodium level has returned to normal? If it has not, then his doctor has to look for explanations of his erratic behavior that have nothing to do with his sodium. The booklet on sodium and potassium explains why these minerals are so important and what happens when they are out of kilter. Readers can order a copy by writing: Dr. Donohue — No 202W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have been eating ice cream and cookies sweetened with Splenda for about four years, enjoying them very much and not experiencing any bad side effects. Then someone told me that Splenda is really bug poison and that it has made a lot of people sick, so I stopped using it. I have noticed no improvement, but I didn’t have anything wrong in the first place. I miss Splenda foods. What is your opinion? — N.B.
\ Answer: Splenda is not bug poison. It’s made from sugar. It’s a product that is 600 times sweeter than sugar. It is not absorbed, so it contributes no calories to those who eat it. It’s FDA-approved, and I trust the people at the Food and Drug Administration more than I trust your informant. There’s no reason for you not to use it. Some people delight in passing on alarming information. Your “someone” has to be one of them."; drDArticle[115] = "Dear Dr. Donohue: What is the amount of exercise recommended for a man or woman of 55? I was always under the impression that 15 minutes of aerobic exercise three times a week was a sufficient amount of time for heart health. Am I wrong? — R.K.
\Answer: That used to be the recommended amount of exercise time for an adult. For readers, aerobic exercise is the kind of exercise that is tailored for the heart. It’s exercise that employs the continuous use of large muscles for a somewhat protracted period of time, at least 10 minutes. Jogging, biking, walking, swimming and dancing are examples of aerobic exercise. The latest advice for adults, if their doctors say they are fit enough to exercise, is to get 150 minutes of moderate-intensity aerobic exercise a week. That’s 20 minutes of exercise seven days a week or 50 minutes, three times a week. You can divide it any way you wish, but the minimum amount of one session of exercise has to be 10 minutes. If you are a novice, take your time to reach 10 minutes. A single session can be longer if you choose. Moderate-intensity exercise is walking at a pace of 3.5 miles an hour, a brisk walk. Or if you want to devote less time to exercise, you can if you make it vigorous exercise. Vigorous exercise for 75 minutes a week fulfills the requirement for heart health. If you’re up to it and if you want even greater results, double those times — 300 minutes of moderate exercise a week or 150 minutes of vigorous exercise a week. I want to issue the warning again. Get doctor approval for any of this. Strength-training exercise — weightlifting — also is strongly recommended for all adults regardless of age. The booklet on aerobic exercise explains how to benefit your heart in clear language. Readers can order a copy by writing: Dr. Donohue — No. 1301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am an 80-year-old woman, and I’ll never be able to wear a bikini again because my body is covered with ugly red spots. The doctor calls them cherry angiomas. They are beginning to appear on my trunk and over my thighs and upper arms. I’d like to know how much longer I can expect to play host to them. — J.H.
\ Answer: Cherry angiomas are tiny, round, firm, smooth, red skin projections that are growths of small blood vessels. People can have a few or hundreds. Mostly they spring up on the trunk and upper arms. They have no impact on health. You can expect to be host to them forever. If they bother you, there are a number of ways to get rid of them. A doctor can dry them up with an electric current or with a laser. I don’t know why they happen. They just do. And they occur mostly in senior years."; drDArticle[116] = "Dear Dr. Donohue: Please say something about migraine headaches. I think that’s what I have. They come on fast, and the pain feels like something is pulsating in my head. I throw up with every headache. Bright lights make things worse. Does all this sound like a migraine to you? Someone told me there’s always a warning before a migraine starts. I have no warning. I’ve used Tylenol, but it doesn’t do much for me. What is the treatment? Can they be prevented? — L.G.
\Answer: Your headaches have many of the characteristics of a migraine headache. The warning mentioned to you is an aura. The aura usually precedes a migraine. It can be flashing zigzag lines, peculiar sensations — often in the hands — trouble finding the right words to speak or weakness of a group of muscles. Only 20 percent of migraine patients have an aura, so it’s not an indispensable migraine sign. Nausea and vomiting are common migraine symptoms. Seventy percent of migraine patients have a one-sided headache that they describe as throbbing or a dull ache. It lasts from four hours to three days. People with migraines are very sensitive to light and sound, so they seek a dark, quiet room to lie down. Stress, overexertion, sleep deprivation and hunger can provoke a migraine. Some foods and drinks can do the same. Alcohol (especially red wine); caffeine; pickles; bananas; yogurt; avocados; aged cheeses; pickled or marinated chicken, beef or fish; salami; pastrami; bacon; pepperoni; hot dogs; and the taste enhancer monosodium glutamate are on the list of possible migraine inducers. Medicines for treating a migraine abound. Tylenol, aspirin and drugs like ibuprofen take care of mild migraines. For more severe ones, triptans are the standard treatment. They include Imitrex, Axert, Frova, Zomig, Amerge and Maxalt. An older medicine, ergotamine, still has a place in treatment For migraine prevention, propranolol, verapamil and amitriptyline are prescribed if the headaches occur often and disrupt life. The headache booklet discusses the causes and treatment of the more common kinds of headaches. Readers can obtain a copy by writing: Dr. Donohue — No. 901W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Tonight my wife choked on a piece of corn. She jumped up gasping, and looked at me as if I should have done something. Her gasping stopped, and she could breathe. She asked me why I didn’t jump up and hit her back. I heard if you hit somebody choking on the back, it could force the food farther down. Did I do the right thing? — R.M.
\ Answer: The Red Cross has changed its instructions on how to handle a choking adult. It now recommends leaning the person forward and giving five blows to the back between the shoulder blades with the heel of the hand. If that doesn’t dislodge the food, then start the Heimlich maneuver. Dr. Heimlich was never in favor of back thumps. He believed it could cause the food to drop farther down the windpipe — the trachea."; drDArticle[117] = "Dear Dr. Donohue: A 50-year-old friend of mine was diagnosed with leiomyoma of the uterus. Does this have anything to do with fibroids? She has fibroids, but her doctor says they are best left alone, since they shrink at menopause. What causes leiomyoma? Can it become cancer? What treatments are available? — L.B.
\Answer: “Leiomyoma” (LIE-oh-my-OH-muh) is the medical word for “fibroid.” Fibroids are noncancerous growths of the uterine muscle. The uterus basically is a muscular sack with a lining designed to nourish a fetus. The cause of fibroids hasn’t been determined. They’re extremely common. By age 35, 40 percent to 50 percent of women have one or more. By age 50, 70 percent to 90 percent have at least one fibroid. For most of these women, fibroids cause no trouble and can be ignored. Large fibroids might cause pelvic pain, and they can press on adjacent structures such as the bladder. When that happens, a woman has a need to empty her bladder frequently. Heavy menstrual bleeding is a sign of fibroids. They also can bring painful menstrual periods, and sometimes they make sexual relations uncomfortable. Infertility is cited as a possible effect, but infertility due to fibroids is rare. Transformation into cancer is possible, but not probable. If a fibroid grows rapidly, that’s a sign of cancer change and must be investigated. Most fibroids shrink with menopause. Doctors can treat fibroids in a number of ways. One is removal of the uterus — hysterectomy. If a woman wants more children, sometimes removal of only the fibroid is possible, and this can be managed in some cases with a scope and special instruments. Uterine artery embolization is a newer treatment in which a slender, soft tube (a catheter) is passed from a surface artery to the uterine artery. When it’s at the precise spot, the doctor releases sand-size synthetic particles that clog the artery and cut off the fibroid’s blood supply. It withers and is shed. The booklet on fibroids describes them in detail. To order a copy, write: Dr. Donohue — No. 1106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I don’t think you will consider this a health problem. It isn’t, but it is still a problem for me. It is freckles. They cover my face in the summer, and they really bother me. How do I stop them? I am 16, and freckles are ruining my life. — L.M.
\ Answer: Sunlight causes freckles. In the winter, when the sun is less intense, they fade. In summer, the stronger sunlight activates skin cells to produce melanin, the dark pigment responsible for tanning — and for freckles. Sunscreens with an SPF — sun protection factor — of 15 or higher afford a good defense against the sun’s ultraviolet rays. You shouldn’t go outside without applying it, and you should reapply it as often as the label directions say. If you can find it, get a sunscreen with protection against both ultraviolet A and B. A hat provides shade for the face and is another protection against freckles."; drDArticle[118] = "Dear Dr. Donohue: Recently, my daughter attended a sweet-16 birthday party for one of her best friends. She is a beautiful girl. When my daughter showed me pictures of her friend, I was shocked. Her face and arms were deeply tanned. I have no idea how many hours she must have spent under a tanning machine. I am very concerned about her. Would you write about the dangers of tanning? — Anon.
\Answer: Ultraviolet light, the kind of light we don’t see, has powerful effects on the skin. Ultraviolet A rays constitute 95 percent of the UV light that makes its way to earth. UV A rays do not burn and tan skin as much as UV B rays, but they do damage skin. They cause skin wrinkling; they dry skin; and they produce age spots (liver spots). And they also add to the risk of skin cancer. Ultraviolet B rays are more destructive. They are the burning rays, and they have a greater effect on skin cancer production. Both A and B reduce the skin’s innate immunity. Exposure to both UV A and UV B injures the skin cells’ DNA, and that’s what sets the scene for future skin cancer. Humans have learned to cope with UV light by tanning. A tan offers some protection against further damage. UV light activates melanocytes, and they pass their melanin — a dark pigment — to other skin cells. That has the effect of providing an umbrella for the skin. However beneficial that might be, the fact remains that in obtaining a modicum of protection with a tan, skin-cell DNA has been dealt a major blow. No tan can be considered healthy. Sun exposure in adolescence might be the most dangerous time for ultraviolet damage. Tanning booths and tanning beds are considered a threat equal to the sun for promoting future skin cancer. People of all ages should protect their skin from exposure to UV light. Such exposure happens every time a person goes outdoors. Cloud cover is a poor absorber of UV rays and offers little skin protection. Sunscreen application should become a habit.
\Dear Dr. Donohue: What’s considered ideal pool-water temperature? In our apartment complex, we have a large pool that is so cold I rarely use it. I am getting a thermometer to measure its temperature. I would like to have a reference temperature to present to management if the water is colder than it should be. — N.U..
\Answer: Pool water is comfortable for most when its temperature is between 82 and 86 degrees F (28-30 C). The water is cool enough to keep strong swimmers from overheating, but warm enough to keep floaters from freezing.
\Dear Dr. Donohue: What’s the purpose of ear wax? I seem to produce tons of it. I can’t find an answer to this question, so I thought I would write to you. — C.N.
\ Answer: Ear wax keeps the ear canal moist. Without it, the canal’s lining dries up and itches. It also traps foreign debris, including bacteria, viruses and fungi that find their way into the ear canal."; drDArticle[119] = "Dear Dr. Donohue: I have had acid reflux for quite some time, and doctors have prescribed different medicines, the last being omeprazole. Medicines were not relieving the burning pain. The best advice came from an online message board that said to “sleep on your left side.” Figuring it wouldn’t hurt to try this method, I began sleeping on my left side. Once my body learned to stay in that position, the pain does not bother me now at all at night. Why don’t doctors share such simple methods for relief rather than prescribing medications? Please pass this information on to others. — N.S.
\Answer: When it works, a change in sleeping position is a simple way to deal with a big problem. It doesn’t work for everyone. In fact, it works for only a few, but it’s still valuable advice and is something that should be suggested more often. A change in sleeping position also can work for snoring. Sleeping on the side, right or left, can open up the throat and stop snoring. Redundant throat tissue, like a reed in a wind instrument, lies behind snoring. Sewing a pocket in the back of the pajamas and putting either a tennis ball or a marble in it keeps snorers off their backs. Other self-help tips for GERD (gastroesophageal reflux disease, heartburn or acid indigestion — all are the same condition) include staying away from foods that cause it. Onions, garlic, coffee, carbonated beverages, alcohol, chocolate, fried and fatty foods, citrus fruits and juices, tomato sauces, peppermint, spearmint and spicy foods are notorious troublemakers. Sleeping with the head of the bed elevated is another way to keep stomach acid in the stomach. Prop 6- or 8-inch blocks under the posts at the head of the bed. In this position, gravity keeps stomach acid in the stomach. Chewing gum stimulates saliva production, and saliva is a natural antacid. Don’t wear tight garments or tight belts, both of which promote acid reflux. I managed to get through this answer without mentioning a single medicine, not even Tums. The booklet on GERD — heartburn — provides an insight into this common malady and its treatment. Readers can order a copy by writing: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have an adult son who has had a sore on the side of his nose for many months. I have pestered him to see a doctor, but he won’t. He says it stays there because he picks at it. Is that a suitable explanation? — W.M.
\ Answer: Any sore that doesn’t heal deserves a doctor’s examination. A nonhealing sore is a sign of skin cancer. I’ve told the story of my grandfather many times. He had a sore on the side of his nose, and he neglected to take care of it. He put a salve on it that he got from a traveling salesman. The sore was a cancer, and he lost that side of his nose. My other advice to your son is to stop picking the sore."; drDArticle[120] = "Dear Dr. Donohue: I have read your column for many years, but I haven’t seen anything about stomach flu. Will you write about it? Someone in my family of seven gets it every year, even in the summer. Does the flu shot protect you from it? — H.H.
\Answer: At one time, I conducted a crusade to erase the term “stomach (or intestinal) flu” from the English language. I didn’t get very far, so I gave up on it. Real flu — influenza — is a respiratory illness, not an intestinal illness. The flu shot provides protection only against true flu, not “stomach” flu. Four viruses are the usual culprits of stomach flu, and, for adults, the one that leads the pack is norovirus. Vomiting, diarrhea, fever and often headache are the main symptoms. It comes on suddenly, about one or two days after the virus enters the body. The sickness lasts only one to three days. A slight increase in number of cases occurs in the winter, but it comes in all seasons. Norovirus infections usually spare infants. Older people have the worst symptoms, and they are the ones who can die from an infection, but death is rare. This is the illness that sweeps through cruise ships and can infect an entire nursing home. It’s also common in military settings and sports teams. The virus is passed in contaminated food and water, and it can live for long times on inanimate objects — another possible source of transmission. No medicines kill the norovirus. Replacing fluid lost through diarrhea is the most important aspect of treatment. A homemade replacement solution is a mixture of half a teaspoon of salt, half a teaspoon of baking soda (sodium bicarbonate) and four tablespoons of sugar in a quart (about one liter) of water. Commercial fluid replacements also are available, and drinks like Gatorade are suitable for infections that are not prostrating. Bismuth subsalicylate (Pepto-Bismol) controls diarrhea. Immunity to norovirus is not long-lasting, so second infections occur. Many bacterial illnesses, like Salmonella, also lead to diarrhea, but that’s a subject for another day.
\Dear Dr. Donohue: How can I get rid of bags under my eyes? — B.L.
\Answer: In younger years, people don’t have bags under their eyes because a strong meshwork of tissue holds fat in place. With age, that meshwork loses strength, and fat pushes its way outward in the area under the eyes. That bulging fat is bags. I wish I had a simple answer for you. The only way to get rid of those bags is surgical removal.
\Dear Dr. Donohue: Since I was 12, I have played tennis. I still do, four times a week, and I am 77. I have had to cut the time I play tennis in half because I’m getting short of breath. What kind of lung exercises can I do? — R.K.
\ Answer: Forget lung exercises. See your doctor, and you should do that as soon as you can. Becoming breathless doing things you used to do without any trouble can be a sign of many serious illnesses."; drDArticle[121] = "Dear Dr. Donohue: Please write something about bladder infections. Can you have a bladder infection with no symptoms? — A.
\Answer: The signs and symptoms of bladder infections are the same for men and women. The irritated, infected bladder demands frequent, urgent trips to the bathroom so it can be emptied. People have a burning sensation when passing urine. Pain is felt in the bladder area. Sometimes blood appears in the urine. Men have far fewer bladder infections than women. Women have a shorter urethra than men. The urethra is the tube that empties the bladder of urine. Women’s urethras open in an area that has a large bacterial population. Bacteria can ascend the female urethra without trouble. It’s harder for them to climb the male urethra. And men’s prostate glands secrete substances that have antibacterial properties. The presence of bacteria in the urine without any signs of bladder infection is called asymptomatic bacteriuria. Doctors treat pregnant women with asymptomatic bacteriuria to prevent symptoms from arising, as they often do during pregnancy. Infected urine, even without symptoms, can lower the birth weight of babies who were in the uterus during that period. Otherwise, asymptomatic bacteriuria in women or men, at any age, usually does not require treatment. In women, bacteria in the bladder are often transiently there. They disappear many times on their own. Treatment can lead to the development of resistant bacteria and can produce side effects. Furthermore, it is costly. The guidance from most experts, therefore, is not to treat asymptomatic bacteriuria. Exceptions exist. Diabetics might benefit from treatment. The topic of urinary tract infections and their treatment are covered in the booklet on that topic. Readers can order a copy by writing: Dr. Donohue — No. 1204W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I would like to know why you lose flesh with age, but not bone, nor skin, nor fat. One doctor told me that’s why people get colder when they get older. I am rapidly losing flesh. — L.J.
\ Answer: People lose muscle with age. The process is called sarcopenia (SAHR-coe-PEA-knee-uh). I never thought of it until you brought it up, but it could be a reason why older people chill quickly. Muscles generate heat, and they serve as insulation. Shivering is a response to a cold environment. Shivering muscles give off heat. Lots of unpleasant things happen with aging. Metabolism slows, and that’s another reason why older people complain of the cold. Our bodies don’t repair themselves as well as they did when we were young. Bones do lose strength and size with age. Growing old is not for the faint of heart. Sarcopenia and bone loss can be kept to a minimum and possibly reversed if people exercise. The kind of exercise they must do is “resistance” exercise — lifting weights. It sounds nutty, but it’s for real. Weights don’t have to be of the same magnitude that people use to prepare for a bodybuilding contest. You can start with one-pound weights and gradually increase the poundage when you become comfortable with that amount of weight."; drDArticle[122] = "Dear Dr. Donohue: About six years ago, I had a heart attack. The doctor said there was hardly any damage. Is it likely that I will have another heart attack? I am overweight and have a hard time losing weight and keeping it off. — C.P.
\Answer: The chance of a recurrent heart attack for men is 21 percent; for women, 33 percent. Looked at in the opposite way, the chances for not having a second heart attack are very good. Figures like these are deceptive when applied to an individual. A person’s efforts to decrease the risks of having another attack are the keys to not having one. Those risks include dealing with obesity. Even though weight loss is difficult for you, you must make an effort to reduce your weight. A dietitian can help you with the diet part. You have to increase your physical activity. Inactivity is an invitation to artery clogging and heart attacks. Ask your doctor what kind of exercise is safe for you. Walking is permitted for most, and walking is a way to strengthen your heart, clear your arteries and lose weight. You also have to watch your cholesterol in all its forms. HDL cholesterol keeps heart arteries free of plaque buildup, and LDL cholesterol encourages it. You have to keep an eye on your blood pressure, another ingredient for heart attacks. The fact that your doctor said little damage was done to your heart puts you into a class of heart-attack patients who are at low risk for having another. The booklet on heart attacks discusses all aspects of this common problem that takes so many lives. Readers can obtain a copy by writing: Dr. Donohue — No. 102W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am 23, just graduated from college and have my first full-time job. In high school, I ran track, both distance and sprints. I am trying to get myself back into condition. I can still run distances pretty well, but I can’t sprint. My legs hurt after a very short time. Why? Can I overcome it? — P.M.
\Answer: Pain from sprinting comes from the buildup of lactic acid, a byproduct of anaerobic exercise, exercise done without the benefit of oxygen. If you haven’t been sprinting for four years, you can’t expect your body to do what it could back then. It takes time for it to gear up to lactic acid. You can overcome it by continuing to practice sprinting at a reduced pace.
\Dear Dr. Donohue: I have been taking acetaminophen for pain, as well as an aspirin every day. Is it safe to use both together? — H.B.
\ Answer: It’s safe if you’re not exceeding the recommended doses of each. In fact, tablets are available with the combination of acetaminophen and aspirin. Excedrin is one such tablet. Have you found out the cause of your pain? Do so. Don’t just mask it with medicines."; drDArticle[123] = "Dear Dr. Donohue: I started treatment for asthma for the first time at age 80. At first I took prednisone and albuterol. Then I had a Pulmicort inhaler. Now I am on Symbicort. The material that comes with this medicine advises that this LABA (long-acting beta agonist) may increase the chance of death from asthma. Exactly what is this telling me? — E.S.
\Answer: With asthma, there is a sudden constriction of the breathing tubes (bronchi), along with the production of thick mucus. Both block the flow of air into the lungs, and both cause asthma symptoms — shortness of breath, wheezing and coughing. Asthma changes are reversible. Asthma medications come in three major categories. One is quick-action medicines, the kind that get to work fast to open the breathing tubes. Many of these medicines are SABAs, short-acting beta agonists. Albuterol is one example. Beta agonists dilate bronchi. Too-frequent use of the short-acting beta agonists indicates poor asthma control. They should be used only for an acute attack, and attacks should be infrequent. The second category is cortisone drugs, the potent suppressors of inflammation. They calm airways and prevent their constriction. They also decrease mucus production. Taken by mouth, cortisone drugs have unpleasant side effects when used for long periods in high doses. Taken by inhaler, the side effects are few. Pulmicort is a cortisone-inhaler drug. The third category of drug is long-acting drugs, drugs that keep the airways less twitchy for prolonged periods. Long-acting beta agonists, LABAs, belong in this category. LABA drugs have been noted to increase the risk of serious asthma attacks, which ended in fatalities for a few. That was in the days when they were used alone. Now they have been incorporated into preparations combined with cortisone drugs. Since these dual preparations have come to the market, no drug-related asthma fatalities have been reported. The warning still exists because a LABA is part of the drug. You don’t need to worry about your medicine, Symbicort. It’s a dual medicine. The asthma booklet explains in detail this common malady. To order a copy, write to: Dr. Donohue — No. 602W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: A while back, you had information in your column about ear trouble while on a plane. This spring, we went on an airplane for my grandson’s graduation. On the flight back, my granddaughter got a terrible earache. I had the same trouble a year previously. She was crying, and we didn’t know what to do. What causes this, and what can be done for it? — B.L.
\ Answer: The earache comes from an imbalance of pressure on the outside and inside of the eardrum. It happens on ascent and descent, but it’s more common on descent. The pressure imbalance pushes the eardrum inward. That is painful. Hundreds of readers wrote to me about EarPlanes Ear Plugs, found in many drugstores. These earplugs lessen pressure on the eardrum. I’m convinced they work well. Other tricks to equalize pressure include repeated yawning, gum-chewing and plugging the nose between thumb and index finger while forcing air out of the nose."; drDArticle[124] = "Dear Dr. Donohue: Exactly what is prickly heat? Do adults get it? If they do, I think I have it. -- M.K.
\Answer: Adults do get prickly heat. It looks like red dots or tiny blisters on the skin. The rash itches or feels "prickly." Sweat ducts have become plugged. Prevention comes with dressing as coolly as possible in light cotton clothes. Air-conditioning is the ultimate answer. Second best is having a fan blowing on you. If you have a breakout, cool-water compresses take away the itch or prickliness, as do cortisone creams, which are found in all drugstores.
\Dear Dr. Donohue: My husband has some kind of sleep disorder. He doesn't believe he has a problem. I know about restless leg syndrome, but he has something beyond that. About four nights a week, his legs kick all over, and he throws his body in every direction. The bed bounces like a trampoline. In one month, he made large holes in two quality flannel sheets. Several times, he has hit me across the face. What is this problem? -- M.L.
\Answer: You describe periodic limb movements of sleep, PLMS, which used to be called nocturnal myoclonus. Most of the time, only the legs are involved. The toes, ankles, knees and hips involuntarily bend and straighten during sleep. The movements happen every 20 to 40 seconds, and each episode lasts from a few minutes to hours. Restless leg syndrome is a crawling sensation beneath the skin of the legs. The person has to get up and walk around to put an end to the annoying sensations. Sometimes it is associated with iron deficiency, and sometimes restless leg patients also experience periodic limb movements. Pramipexole or ropinirole treat both conditions. Your husband should see a doctor. The booklet on restless leg syndrome and nighttime leg cramps explains these conditions and their treatments. Readers can obtain a copy by writing: Dr. Donohue -- No. 306W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address.
\Dear Dr. Donohue: I play softball for my company. Last week, while rounding second, I felt like I stubbed my toe. It hurt, and it still does. People tell me it is turf toe. What is that, and how long does it go on? -- M.L.
\ Answer: Turf toe happens when the big toe is forcefully bent upward. That motion sprains ligaments at the base of the toe. Every time you take a step, your big toe propels the body forward. Limit your walking to give the toe a rest. Splinting the toe with tape is helpful. Shoes with a sturdy sole also protect the toe. If the ligaments have only been stretched, your toe ought to feel fine in two weeks. If the ligaments are torn, it will take six weeks. You and I are going on "people's" diagnosis. If there isn't a major turnabout shortly in how the toe feels, have a doctor confirm the diagnosis."; drDArticle[125] = "Dear Dr. Donohue: I would like to call your attention to a question you answered about emphysema. I think you should have mentioned alpha-1 antitrypsin deficiency. It would have been a good opportunity to bring this condition to the public’s attention. I have it and was diagnosed at age 53, after having been misdiagnosed for eight years. I have been on Prolastin, which has stabilized my lung capacity. While more doctors are aware of this condition, there are some who are not. — D.C
\Answer: Lungs come equipped with their own janitorial crew. They inhale lots of foreign debris, and they create trash in their work of transferring oxygen into the blood and carbon dioxide out of it. The cleanup crew is trypsin, an enzyme. Trypsin, however, can go overboard, so another enzyme, called alpha-1 antitrypsin, stops it from overdoing the trash collection and destroying air sacs in the process. Emphysema is destruction of those delicate structures. Cigarette smoking is the No. 1 cause of emphysema, also known as one of the chronic obstructive pulmonary diseases, COPD. Symptoms of emphysema, regardless of cause, include shortness of breath with little physical exertion, cough and increased sputum production. The delay in your diagnosis of alpha-1 antitrypsin deficiency is par for the course. On average, the diagnosis takes eight years from the time a person first visits a doctor for emphysema symptoms. This illness should come to mind when a relatively young person or a person who has never smoked develops emphysema. A simple blood test for the level of the antitrypsin enzyme can secure the diagnosis. Treatment is the same as treatment for smoking-caused emphysema. However, there is an additional treatment for alpha-1 antitrypsin deficiency emphysema. Intravenous infusions of the missing enzymes can benefit those with the deficiency. Your Prolastin is one such product. The booklet on emphysema and chronic bronchitis, the two chronic obstructive pulmonary diseases, discusses the more-common variety in detail. To obtain a copy, write: Dr. Donohue — No. 601W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am inquiring about sebaceous cysts. During the past 20 years, I have had between eight and 10 of them on my back. They were removed surgically. My former family doctor, now retired, said there may be some prescription pills that can stop them from returning. I would like some insight from you. — W.M.
\ Answer: Sebaceous cysts are also known as epidermal cysts. Often found on the back, they’re firm, round lumps that grow slowly. They can be pushed a little from side to side. Their cause is unknown. If they’re inflamed or painful, they can be cut out without a lot of trouble, usually in the doctor’s office. The cyst wall must be taken too, or the cyst will return. Simply draining one of the pasty, greasy material contained inside doesn’t end the problem. Everyone would love to know of a pill that prevents or gets rid of them. I don’t know of one, and I don’t believe there is one."; drDArticle[126] = "Dear Dr. Donohue: I, like the letter-writer P.G., had to run to the bathroom constantly in order not to have an accident. I wanted to see my grandson graduate from college, so I consulted a urologist. He sent me to a place where treatments with an electrical probe were given. I went for six weeks and also did Kegel exercises. The quality of my life changed for the better, and now I square dance and do aerobics. Incontinence is no longer a problem. — E.M.
\Answer: Electrical stimulation of the pelvic muscles has successfully allowed many women to regain bladder control. It doesn’t work for all, however. The stimulation strengthens muscles that keep the bladder closed, and controls overactive bladder wall muscles that contract forcefully and frequently. Another technique is a device that delivers electric current to spinal nerves in the lower back. If those nerves respond to the current and keep the bladder closed, then a small unit is implanted under the skin for a permanent solution to this problem. One such device is called the InterStim.
\Dear Dr. Donohue: I have an EKG done every year. I also have worn a monitor that records heart activity for three days. Everything is fine. When I fall asleep most nights, I wake after about 10 minutes with a rapid heartbeat, and sometimes it takes quite a time before it settles down and I can get back to sleep. I rarely have such a rapid beat at any other time of the day. Do you know what causes this, or what it might be? I am 57. — S.B.
\Answer: If I had to make a guess, it would be paroxysmal atrial tachycardia, a sudden heart speedup for no reason. It’s usually not a serious condition, and it doesn’t indicate heart disease. If the rate is really fast or if the episode lasts for a prolonged period, then treatment would be needed. No one can be sure unless the rhythm comes on when a doctor is present or when you are hooked up to an EKG machine. That monitor you wore for three days can be left on for longer stretches of time. Or you could have someone take you to the emergency department of a hospital if you can reach it somewhat quickly. You can’t obtain a diagnosis without such information. The booklet on heartbeat disorders discusses their more common forms. Readers can order a copy by writing: Dr. Donohue — No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My wife, 76, has degenerative arthritis of the spine. Can you tell me if this condition will progress to total disability? — J.D.
\ Answer: Degenerative arthritis is another name for osteoarthritis, the most common kind of arthritis. Almost every 70-year-old has a touch of it. It can be in the back, knee, hip, hand, fingers and ankle, or any of these locations. The rate of progression is unpredictable. A good many can continue to do most of the activities of life with minimum disruption."; drDArticle[127] = "Dear Dr. Donohue: I am confused about how much water to drink when exercising in hot weather. I learned that you should drink all the time during exercise, even when you aren’t thirsty. Now they tell me that drinking too much affects your brain and can cause death. What’s the story here? — M.F.
\Answer: This has to be one of those “it depends” answers. How much water or any other fluid is needed in hot water depends on how hard is the exercise, how long you do it, how heavily you sweat, how hot it is and how acclimatized you are to heat. It takes two weeks to acclimatize to heat. After two weeks, less sodium and potassium are lost in sweat. Formerly, the advice for fluids was to drink frequently even if you didn’t feel thirsty. That’s overkill. You can let thirst be your guide most of the time. Older people have a somewhat blunted thirst sense, so they might have to remind themselves to drink in exceptionally hot weather. To stay hydrated during heavy physical activity or exercise, drink 12 to 16 ounces of fluid three to four hours before exercise. The fluid can be plain water. It’s also a good idea to take a salty snack before exercise — pretzels, peanuts or crackers. During activity, drink about every 20 minutes, as much as your thirst tells you. If your activity lasts longer than two or three hours and if you sweat heavily, then you have to pay attention to your salt intake. Marathon runners taught us this. A few marathoners died from drinking only water during hot-weather races. Doing so lowers body sodium. That’s hyponatremia, and it can be serious. Headache, vomiting, swollen ankles and feet, fatigue far out of the fatigue usually felt and disorientation are some of the signs of hyponatremia. Sports drinks with sodium in them can prevent hyponatremia. You can make your own replacement fluid by adding 1 tablespoon sugar, 1/8 teaspoon salt and 1 tablespoon orange juice to an almost-filled 8-ounce glass of water. You have to make enough to last for the whole exercise session.
\Dear Dr. Donohue: My right ear began to throb so bad that I had to see a doctor. She said I have otitis externa, and gave me prescriptions for eardrops and pain medicine. She didn’t say much to me about this. She was in a hurry to see other patients. Will you explain to me what otitis externa is? — P.P.
\ Answer: It’s an infection of the ear canal, that small tunnel (about 1 inch long) that runs from the external ear to the eardrum. It’s the place where wax forms. Infections of the canal come about for a variety of reasons. They always hurt, and they sometimes cause a foul drainage. Be sure to use the eardrops — which, I’m sure, are antibiotic drops — for as long as the prescription says to. Don’t stop when the pain leaves, or the infection can return. I know what you mean about the doctor being busy. Managed care has doctors on such tight schedules that the doctor-patient relationship is often lost."; drDArticle[128] = "Dear Dr. Donohue: Is it possible to get wet macular degeneration from a scratch on the left eye during cataract surgery, or could it have been a cyst that caused wet macular degeneration? I am 85, and my right eye is perfect. I had cataract surgery on that eye also. — C.
\Answer: A scratch on the eye isn’t likely to cause macular degeneration. The possibility of cataract surgery leading to macular degeneration is a remote one. More than 6,000 people who had had a cataract removed were followed for five years after the operation. Slightly more people who had the operation developed macular degeneration, dry or wet, in the operated eye than did a similar group of people who had not had an operation. This isn’t proof that cataract surgery leads to macular degeneration. The same risks that cause cataracts also cause macular degeneration. The numbers that do develop it after cataract removal are small. A cause-and-effect relationship has not been proven. I am not clear what you mean by a cyst causing the degeneration. In what part of the eye was the cyst? I have not seen a link between cysts and macular degeneration. The retina is the back layer of the eye, the layer that converts incoming images into nerve signals that can be transmitted to the brain so we can see. The macula is a small, round area of the retina where there’s an aggregation of cells that are essential for central vision — the kind of vision needed to read a paper, watch TV and drive. Dry macular degeneration, accounting for 85 percent to 90 percent of cases, is a wasting away of macular cells. Wet macular degeneration results from a sprouting of blood vessels in that region. Those newly formed blood vessels leak fluid and destroy macular vision. Procedures are available that can halt the progression of wet macular degeneration. The booklet on macular degeneration explains both kinds and what is available to help those with this common eye problem. Readers can obtain a copy by writing: Dr. Donohue — No. 701W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My son-in-law insists on lifting his small children by their arms. I am terrified that he will pull their arms out of joint. I know this isn’t the proper way to lift children. Would you give your opinion about this so I can show him? Maybe he will listen to you. — A Worried Grandpa
\ Answer: Sons-in-law should listen to their fathers- and mothers-in-law. They have experience in child-rearing. Lifting young children by grabbing onto their hands or arms can cause the radius (the larger of the two lower arm bones) to slip away from the ligament that keeps it in place. This disruption has the name “nursemaid’s elbow.” I guess nursemaids must have lifted children in this way. It’s painful for the child, and the bone has to be manipulated back in place. Children who are 5 and older aren’t in danger of this happening."; drDArticle[129] = "Dear Dr. Donohue: What causes sunspots? They appear even when we have not been exposed to the sun. — Anon.
\Answer: The sun has nothing to do with sunspots. A fungus is their cause. The fungus depigments patches of skin so they are lighter than the surrounding skin. The sun comes into play only because it darkens the surrounding skin and the spots stand out like a sore thumb. Selenium sulfide and fungal medicines like Lotrimin, Naftin and Tinactin can usually dislodge the fungus. The depigmented skin stays light for quite some time, and people believe the medicines have not worked. In time, pigmentation returns.
\Dear Dr. Donohue: I am 76. I am the fifth of eight boys. Three had the shingles. Our parents are gone. I want to get the shingles vaccine, but was told by friends that you cannot get the shot if you did not have chickenpox. I don’t remember whether I had chickenpox. — P.
\
Dear Dr. Donohue: I recovered from shingles a few years ago. After hearing many horror stories about shingles, I wonder if I should consider getting the vaccine to prevent another outbreak. — J.V.
Dear Dr. Donohue: I am sick and tired about all this exercise talk. What proof exists that it is such a health boon? I am not into exercise, have never been into it and probably will never be into it. Can you say with a straight face that proof really exists that exercise extends life? — R.R.
\ Answer: Yes, I can. And I can do so with a straight face. The studies that show exercise improves health are too numerous to cite. A recent study showed that men (although no women were included in the study, I am sure it applies equally to them) who increased the intensity and frequency of physical exercise had their mortality cut in half from a control group that did not exercise. Consistent exercise bestows the same health benefits that come from not smoking."; drDArticle[130] = "Dear Dr. Donohue: I got a sudden attack of dizziness that landed me in bed. I couldn’t stand. Finally, with the help of my husband, I got to the doctor, who said I had a viral infection called vestibular neuritis. I am taking medicine and am somewhat better, but the dizziness isn’t completely gone. Will it go? When? — L.T.
\Answer: I have to warn readers that the causes of dizziness are diverse, and vestibular neuritis, while common, is only one of many causes. The vestibule of the inner ear has three fluid-filled canals that work like a carpenter’s level, that gadget whose center contains a fluid-containing tube with a bubble in it. The balance tells the carpenter if a piece of wood is aligned. The inner ear canals tell people if they are aligned. They send signals to the brain that keep us balanced. A viral infection of those canals or of the nerve that sends signals to the brain makes people feel like they’ve been put in the spin cycle of a washer. Not only are affected people dizzy, they become nauseated and often throw up. Symptoms of vestibular neuritis lessen in two to three days, but full recovery can take up to six or more weeks. A cortisone drug taken within the first three days of illness can ease symptoms. And medicines like promethazine relieve dizziness and nausea, but they make some people so drowsy that they prefer the dizziness. The booklet on dizziness discusses vestibular neuritis as well as the other dizziness causes. Readers can obtain a copy by writing: Dr. Donohue — No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My 17-year-old son is a baseball pitcher. Last week he came home with his pitching arm greatly swollen. I was alarmed, and I told my husband we needed to take the boy to the emergency room. My husband thought I was overreacting, but I insisted. I am glad I did. He had a blood clot in a vein that caused the swelling. They treated him with medicine to dissolve the clot and put him on a blood thinner. Will he ever pitch again? — R.C.
\Answer: I’m sure the ER doctors checked your son for things that make a person prone to form clots. He must not have had any of those conditions. He had an “effort-induced” clot, a clot caused by repetitive physical exertion. Now that the clot has been dissolved, you son should be able to resume pitching after the rest period prescribed by his doctor.
\Dear Dr. Donohue: I drink skim milk every day for its protein and calcium. I can’t stand the taste, so I add chocolate syrup to it. Now I heard that chocolate blocks calcium absorption. Is this true? — J.D.
\ Answer: Oxalate in chocolate can interfere with calcium absorption, but the amount of oxalate added to a glass of milk doesn’t significantly reduce calcium’s entry into the body."; drDArticle[131] = "Dear Dr. Donohue: Three women who were in high school at the same time I was have died of Lewy body dementia. Do only women have it? No one I have talked to knows anything about it. I would appreciate any information you can provide. — L.P.
\Answer: Dementia is a decline in mental functioning. Memory loss is prominent. Simple arithmetic skills (balancing a checkbook), expressing oneself clearly and logically, and making rational judgments are greatly diminished in a person with dementia. “Dementia” is an umbrella word that covers the loss of these basic mental functions. Alzheimer’s disease is the leading cause of dementia, but it is not the sole cause. Multiple small strokes, Binswanger’s disease, Creutzfeldt-Jakob disease and frontotemporal dementia are other causes. Second to Alzheimer’s as a cause is dementia with Lewy bodies. Lewy bodies, named in honor of the pathologist Dr. Friedrich Lewy, who first described them, are blobs of peculiar material within brain cells. They stain a striking color when special dye is applied to brain tissue viewed with a microscope. Somehow they bollix up brain function. Definite proof of dementia with Lewy bodies rests on microscopic examination of the brain after death. However, some unique signs of this illness make it diagnosable during life. In addition to the symptoms of dementia, Lewy body patients often see things that aren’t there — visual hallucinations. They have symptoms found in Parkinson’s disease — muscle rigidity, slow movement, walking disturbances with frequent falls. Patients have fluctuating alertness, periods of lucidity intermixed with longer periods of utter confusion. Men as well as women get this illness. What causes it is a question that remains unanswered. Sometimes drugs used for Alzheimer’s disease improve symptoms of dementia with Lewy bodies. Parkinson’s drugs are prescribed to lessen the features of that illness, but they do not work as well as they do in Parkinson’s disease. The booklet on Alzheimer’s disease delves into the signs and treatment of that all-too-prevalent illness. Readers can order a copy by writing: Dr. Donohue — No. 903W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Six years ago a family member said she had breast cancer. Her doctor recommended that she see a surgeon. She never saw one. She has had no chemotherapy or radiation or any other sort of cancer treatment. Six years later, she looks the same as she always did, without any sign of cancer. Does cancer ever cure itself? Could it have been misdiagnosed? Have you ever heard of someone surviving breast cancer without any treatment? — N.N.
\ Answer: I have never seen breast cancer cured without treatment. I don’t believe it happens. If others have evidence to the contrary, let me know. I would ask those people the same questions I would ask your relative: Did the doctor say it “might be” cancer? If the doctor was definite about the diagnosis, was a biopsy done, or on what evidence was the diagnosis made? I would be most interested to learn the facts."; drDArticle[132] = "Dear Dr. Donohue: I am a 78-year-old, semiretired man. I am very active and look a lot younger. I work part-time as a truck driver delivering auto parts to garages. Now I am out of work because of pain in my lower back. The pain runs down to my foot. I have been diagnosed with sciatica. My doctor sent me for an MRI, and it showed a bulging disk. What is the best remedy? I use ice packs, heating packs and hot packs. I am on crutches to take pressure off my leg. Would surgery help? — J.S.
\Answer: Back pain is one of the leading problems that send people to doctors. Most cases of back pain go away on their own, even if they’re due to things like a bulging (also called herniated or ruptured) disk. Even though your back hurts, you can be as active as your pain allows. Don’t sit for prolonged periods; sitting puts more pressure on your back than does standing or walking. Sleep on your side with a pillow between your knees. Continue with heat, cold or alternating heat and cold, whichever gives you the most pain relief. Tylenol or a nonsteroidal anti-inflammatory medicine (Aleve, Advil, Motrin, etc.) can make you more comfortable. If the pain doesn’t let up in six weeks, you have chronic back pain. Sciatica is pain that travels from the back down the leg to the foot. It comes from pressure on the sciatic nerve. In your case, the pressure most likely comes from your bulging back disk. Back disks are cartilage pads placed between adjacent backbones to absorb the shock those bones take from our walking, bending and pushing. The disk has a tough outer ring. Gelatinous material makes up the inner core. If there’s a break in the outer ring, the inner core pushes through — a bulging, herniated or ruptured disk, whichever term you want to use. If sciatica doesn’t resolve on its own, a doctor can inject the back with cortisone to reduce inflammation. That can relieve pressure on the sciatic nerve. The procedure is called an epidural. Surgeons, aided by a microscope, can remove the bulge through small incisions, about an inch long. This technique is called a microdiskectomy and usually is quite successful. The booklet on back problems covers this topic in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I can’t get rid of jock itch. I have tried over-the-counter medicines for the past six months. I still itch. What can I do? — R.P.
\ Answer: You can make certain that what you have really is jock itch, a fungal skin infection whose name is tinea cruris. A doctor can make the diagnosis for you by examining scrapings of the involved skin with a microscope. You might need prescription medicine, including oral prescription medicine. The yeast infection Candida, the bacterial infection erythrasma and psoriasis look like jock itch. You could be treating the wrong condition."; drDArticle[133] = "Dear Dr. Donohue: I carry the diagnosis of congestive heart failure. Medicines have made me feel pretty good. My wife thinks that I should do nothing. If I do much more than sit, she is all over me. A little bit of activity isn’t dangerous, is it? If I don’t do something, I am going to turn into a blob of fat. — R.K.
\Answer: You’re in a boat with 5 million other Americans who have chronic heart failure. Heart failure means the heart doesn’t pump enough blood with each beat to supply the body with oxygen. Shortness of breath on slight exertion is a principal sign. Rest used to be the rule for heart-failure patients. Too much rest, however, deconditions the body and makes it even more difficult for a heart-failure patient to do things that are part of everyday life, like walking and a few household chores. You have to ask your doctor what limits you should be bound by. If there’s a supervised exercise program for heart-failure patients in your area, join it. Many hospitals sponsor such programs. I encourage you to become active. You’ll find that regular exercise permits you to do more than you believed you could do. Congestive heart failure — a common consequence of heart disease — is discussed at length in the pamphlet on that topic. Readers can order a copy by writing: Dr. Donohue — No. 103W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: As you can see from my address, I live in the Deep South. I coach high-school football as well as teach two history classes. I worry about heatstroke in my players because of the high temperatures here. Any suggestions on preventing this? — L.P.
\Answer: Your concern is justified. Between 1995 and 2007, 25 high-school students and five college students died from heatstroke while practicing football. These fatalities occurred in the first week of practice. It takes a good two weeks for people to acclimatize to heat. My best advice is to consult these Web sites for definitive tips: www.nata.org (NATA is the National Athletic Trainers Association) and www.acsm.org (the American College of Sports Medicine). I’m positive your school has a computer.
\Dear Dr. Donohue: My son is married to a woman who has thyroid problems for which she takes medication. I think it is the type where not enough thyroid hormone is produced. He is 32, and she is 34. They have been married for four years. They both want children. Is the thyroid problem preventing them from having children? — J.J.
\ Answer: It shouldn’t. If you are correct and your daughter-in-law takes thyroid hormone in pill form to correct the hormone deficit, then the problem — hypothyroidism — is taken care of. It shouldn’t affect her fertility. Many other thyroid problems exist, so I can’t say this with absolute assurance. It depends on her thyroid condition and what kind of medicine she’s taking."; drDArticle[134] = "Dear Dr. Donohue: My adult daughter is unable to take vitamins without upsetting her stomach. She has taken them with and without food, and at different times of the day, to no avail. She takes no medicine except for thyroid. She has no gastrointestinal problems. — V.H.
\Answer: Has your daughter tried different brands of vitamins? The filler in some brands might be the cause of her stomach upset. Fillers are inactive ingredients that keep the tablet together. The question really is: Does your daughter, or anyone, need to take a vitamin (multivitamin or otherwise) daily? Vitamins are nutrients that the body doesn’t make for itself (except vitamin D). They’re needed in extremely small amounts. The era of beriberi, scurvy and rickets is all but over since the discovery of vitamins. Most doctors have never seen a case of those vitamin deficiency illnesses. Vitamins don’t pep us up and they don’t prevent heart disease or cancer as was once thought. In excess, they can be troublemakers. In spite of this, we’re conditioned to believe that we need a daily multivitamin. Half of the adult American population swallows one every day. We can meet all vitamin needs through foods, with the possible exception of vitamin D. A diet that supplies fruits, vegetables, grains, dairy products and some meat provides the necessary vitamins. Meat is the source for vitamin B-12, but vegetarians can get that vitamin in other ways. Vitamin D is a problem for many. Sunshine converts a substance in the skin into this vitamin. Many people don’t get enough sunshine exposure to achieve skin production of D, and people in northern climates can’t get enough during winter months. All it takes is 15 minutes of sun exposure on the face, arms and legs three times a week. Age is another possible factor in failing to meet vitamin demands if older people subside on a marginal diet of tea and toast.
\Dear Dr. Donohue: I had a foot reconstruction operation some months ago. The foot doctor said I had to be off Celebrex until the foot completely healed. I had been on it for several years. I have osteoporosis and rheumatoid arthritis. Since being off Celebrex for four months, I don’t have any more pain or stiffness than I did while I was taking it. Do I really need it? — V.M.
\Answer: If a medicine isn’t doing anything for you, why take it? You’ve taken Celebrex for several years and now you’ve been off it for four months with no worsening of your symptoms. I’d say you made a strong case for not continuing it. Many, many other rheumatoid arthritis medicines are on the market. It’s time for a change, or perhaps for a medicine rest if your doctor agrees.
\Dear Dr. Donohue: When patients are admitted to a hospital by ambulance and their prescriptions are given to the hospital staff, are they returned to the patients upon discharge? These are expensive medicines. — E.M.
\ Answer: The medicines ought to be given back to the patients upon discharge. If they aren’t, an inquiry should be made. If no answer is forthcoming, take the matter to the hospital administrator."; drDArticle[135] = "Dear Dr. Donohue: Will you provide information on osteoarthritis of the knee? Please include steps to take if you have it. Does it hurt a lot after surgery? Do vitamins or calcium help? — W.J.
\Answer: Osteoarthritis is the most common kind of arthritis. One-third of the population age 65 and older has it. It’s a cracking and crumbling of the cartilage inside the joint, which makes for bone rubbing against bone. The result is pain and stiffness. Age isn’t the sole factor causing it. Being overweight, heredity, misalignment of the joint bones and previous injury all contribute to its appearance. Climbing stairs, getting out of a chair and walking become challenges. A cure has yet to be found, but there are steps to take to manage it. Weight loss, if that applies to you, makes a huge difference. Loss of only 5 percent of current weight increases joint mobility and lessens pain. Exercise helps. Walk to the point of pain, rest and then continue on your way. Strengthening the thigh and hamstring muscles protects the knees. A warm shower or bath on rising decreases stiffness. Tylenol is a safe and effective pain reliever. Nonsteroidal anti-inflammatory drugs (NSAIDs) — Aleve, Advil, Motrin and many others — work well, but their downside is stomach irritation and the possible promotion of an ulcer. Simultaneously taking medicines that blunt stomach-acid production affords protection against these side effects. Prilosec and Zantac are two examples of protective drugs. Voltaren gel, an NSAID medicine that’s applied directly to the skin over the knees, reduces the threat of stomach irritation yet eases joint pain. Your doctor can inject the knee with cortisone, which often affords three or more months of relief. Calcium and vitamins don’t work. People often ask about chondroitin and glucosamine. In spite of testimonials praising them, little evidence exists for their efficacy. If you want to try them, they won’t hurt. The ultimate treatment for severe knee osteoarthritis is replacement of the joint. I know few people so happy with their treatment than are the ones who have had this surgery. Pain after surgery is not great and is not long-lasting. The booklet on arthritis deals with the common forms of this prevalent disorder. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My problem is excessive yawning. I will yawn 10 to 12 times in a minute or two, and do so as often as three to four times a day. What’s going on? — D.B.
\ Answer: Sleepy people and bored people yawn more than people who are neither. Staying stimulated decreases yawning. What are you doing during the day? You have to be doing something that keeps your brain active, or you’ll start to yawn. I don’t know an illness that provokes yawning. Yawning occurs in all members of the animal kingdom. It even occurs in birds and fishes. It does not provide more oxygen for the brain. That explanation has been disproved."; drDArticle[136] = "Dear Dr. Donohue: My mother is 69 and has, during the past few years, shown signs of memory problems. In the span of 20 minutes, she might ask the same question several times. She has trouble following the flow of conversation. I am concerned she might be forgetting her medicines. I called her physician and was told that until she forgets what things like toasters are used for, there is no real concern. Isn’t early intervention a key to treating Alzheimer’s? — M.K.
\Answer: With age, it takes more time to retrieve information from the memory than it does in youth. That’s normal. It’s also normal for older people, given a sufficient amount of time, to recall the events of the preceding day or of special occasions. They might, on occasion, find it difficult to come up with a particular word, but they should be able to continue to perform tasks like balancing a checkbook. They might misplace things, as we all do. However, they can institute a search in an orderly and methodical way. It’s not normal to forget an entire event even when they are given promptings of what has happened. Misplacing things because the things have been put in strange places isn’t normal. An example is putting the car keys in the refrigerator. Neurologists, geriatricians (doctors who specialize in the treatment of the elderly), psychiatrists and psychologists administer tests that more precisely reflect a person’s memory and thinking capabilities. Having your mother tested isn’t a bad idea, and she should not take offense at the suggestion. Four medicines constitute the bulk of prescriptions written for Alzheimer’s disease. They are Aricept, Razadyne, Exelon and Namenda. The first three are usually prescribed for the early stages of this illness. None is a cure. They can slow its progression. Dozens of new medicines are currently under investigation. The booklet on Alzheimer’s describes this illness and its treatment in understandable terms. Readers can obtain a copy by writing: Dr. Donohue — No. 903W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I haven’t seen anything in your column about fungus foot infection. We have several family members who have it on their toes. How does it start, and what can be done for it? — Anon.
\ Answer: I have to believe you’re referring to athlete’s foot, the most common kind of fungal foot infection. Few people pass through life without an encounter with the fungi of athlete’s foot. The infection spreads through contact with shed skin that contains the fungus. Fungi thrive in warm, moist environments. A change of socks twice a day and wearing an alternate pair of shoes on successive days keep the feet dry. Antifungal foot medicines abound and come as ointments, creams or lotions. It can take a month or more for results. After the skin has healed, continue to apply the medicine for another two weeks. If over-the-counter medicines — Micatin, Lotrimin AF and Tinactin are a few names — don’t put an end to the infection, prescription medicines can."; drDArticle[137] = "Dear Dr. Donohue: I hear that taking 10,000 steps a day is all that a person needs to stay healthy. Is this so? How much time does that take? Do you count all the steps you take in a day, or are these 10,000 steps in addition to what you normally take? — G.D.
\Answer: The 10,000-steps-a-day program originated in the Surgeon General’s office some years back. It’s been shown, more than once, that people who increase their total daily steps to 10,000 (counting the ones they normally take) have less body fat, lower blood sugar and lower blood pressure. There is more to staying fit than taking 10,000 leisurely steps. Strength building is also important. Ten thousand steps are approximately 5 miles (3.6 to 4.9 miles; 6 to 8 kilometers). How much time does this take? The walking should be brisk. That’s defined as taking 90 to 100 steps a minute. For the entire time involved, you can do the math. However, these steps don’t all have to be taken in one session. You can amass them throughout the day. A hundred steps a minute is a quick pace. You might not be up to it. It’s OK to start more slowly and gradually work your way to the 100-steps-a-minute goal, and not all the 10,000 steps have to be such fast ones. The goal of 10,000 steps is another thing that can take you a while to reach. Don’t try to do all this on the first day. Start out by taking an extra 200 steps a day, and gradually work your way to 10,000 over a couple of months. You can’t count these steps without driving yourself crazy. You need a pedometer, a gadget that records your steps. Pedometers range in cost from $17 to $80. They can be worn on a belt, put in a pocket or worn around the leg. They register steps by the movement of the hips or the impact of the foot against the ground. If you want to be really healthy, you have to add some resistance exercise to your program. Resistance exercise is lifting weights. The booklet on fitness explains the benefits of walking and other aerobic exercise in clear language. Readers can order a copy by writing: Dr. Donohue — No. 1301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Would you kindly advise us on fatty liver? What can be done for it? What does it lead to? — H.C.
\ Answer: The liver should have no fat. Fat infiltrates it for a couple of reasons. One is excessive alcohol. Another is nonalcoholic fatty liver disease, a common occurrence. It doesn’t always cause damage, but it can progress to something called NASH, nonalcoholic steatohepatitis — a condition that can further progress to cirrhosis. This stage is best discovered through a liver biopsy. The first treatment for liver fat, including NASH, is weight loss. For many, it’s the only treatment needed to correct the situation."; drDArticle[138] = "Dear Dr. Donohue: For quite some time, my right shoulder has hurt. I saw an orthopedic doctor, who says I have a tear of my rotator cuff. He suggested surgery. What do you think of surgery for this? I am scared that I could be worse off after the operation than I am now. I am only 44 and am quite active. — K.M.
\Answer: The rotator cuff is a band made up of the tendons of four back muscles. The tendons wrap around the topmost part of the upper arm bone, the humerus, to keep the bone in the shoulder socket. Tears of the rotator cuff are a common problem and one of the principal causes of shoulder pain. Small tears can heal on their own. Larger tears almost always require surgical correction. All surgical procedures demand respect. Something can always go wrong. Most people who have had surgery to correct a rotator cuff tear are glad they had it. By most, I mean more than 95 percent. I would not hesitate to have this surgery.
\Dear Dr. Donohue: Five years ago, my left breast was removed because of cancer. Some lymph nodes also were removed. The surgeon told me never to have blood pressure taken in my left arm. I haven’t. Sometimes I get a funny look, but I will not allow my left arm to be used. Someone asked why I can’t have my pressure taken there. I was abashed. I’m not sure why. Please tell me. — R.M.
\Answer: Removal of the breast and lymph nodes often disturbs lymph drainage in the involved arm. Lymph is fluid that comes from the blood and circulates around tissues and cells to nourish and protect them. It makes its way back to the circulation through vessels called lymphatics. Removal of lymphatics can produce swelling of the arm, as the fluid cannot find its way back to the circulation. Pressure from the blood pressure cuff could add to the disruption of fluid return to the circulation. The booklet on breast cancer presents the details of its recognition and treatment. To order a copy, write: Dr. Donohue — No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I just survived pneumonia. I was told by the lung specialist that I should get the pneumonia vaccine every year. I am 66. My sister-in-law told me that her doctor said pneumonia shots are not needed after age 65. Who is correct? — D.T.
\ Answer: The “pneumonia” shot is for one kind of pneumonia, pneumococcal (NEW-moe-KOK-ul), the most common bacterial pneumonia, one that can be quite life threatening for older people. The current recommendations call for a single shot of the vaccine for those over 65. If the vaccine was given before age 65, a second dose should be administered five years later. If people have any illness that weakens their immune system, they, too, need a booster shot of the vaccine."; drDArticle[139] = "Dear Dr. Donohue: Our basement flooded, and I was chosen to clean it. All that pushing, lifting and scrubbing did a number on my back. It’s been bothering me for two weeks. I never had a back problem before, but my dad used to have them all the time. He said it was sciatica. I believe that’s what I have. How can I get rid of it? — M.J.
\Answer: Don’t jump to conclusions. Sciatica (sigh-AT-ik-ah) is only one cause of back pain. The fact that your father had it has little bearing on your having it. Did your dad arrive at the diagnosis on his own? Many people do. Quite often, they’re wrong. The sciatic nerve is a large nerve formed by the intermingling of nerve roots coming from the lower segments of the spinal cord. It and its branches run from the lower back through the buttock and down the leg to the ankle and foot. Pressure on the nerve at any point in its course irritates it and produces the pain of sciatica. The most common cause comes from a protrusion of one of the back’s disks, which presses on the spinal cord rootlets that combine to build the nerve. Low-back, buttock and leg pain are the hallmarks of sciatica. The leg pain is on the back of the leg or its outer side. Even though the diagnosis is a bit iffy here, sciatica — and most of the other causes of low-back pain — get better in three to six weeks. You don’t have to completely rest. Strict bed rest is contraindicated. Walk around and perform the normal activities of daily life, but don’t lift, push or perform manual labor. Use heat or cold on your back, whichever you find benefits you more. Tylenol (acetaminophen) usually controls pain. If it doesn’t, one of the nonsteroidal anti-inflammatory drugs (Aleve, Advil, Motrin) can be tried. An injection of steroids into the back takes care of inflammation that adds to the pressure on the nerve. Surgery usually isn’t necessary. The long-term outlook is good. If the pain hasn’t gone by four weeks, see a doctor. See the doctor promptly if pain increases or you lose control of your bladder or bowels. The booklet on back pain provides more information on this common problem. To obtain a copy, write: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I remember your once writing about how a person with COPD ought to breathe. My dad was just diagnosed with COPD, and I would like to pass that information to him. Will you please repeat it? — S.A.
\ Answer: That is pursed-lip breathing. The person puckers the lips as though going to whistle or give a kiss. Then he inhales through his nose and exhales through the pursed lips. Exhaling should be more prolonged than inhaling. This technique keeps the airways opened to allow more air to get into the lungs and more carbon dioxide to get out of them. “COPD” stands for “chronic obstructive pulmonary disease”: emphysema and chronic bronchitis."; drDArticle[140] = "Dear Dr. Donohue: I have taught fourth grade for 20 years. This year I couldn’t wait for the summer break. I was feeling fine at the beginning of the year, but as the months passed, I could hardly make it through the day. I had no energy. My husband insisted that I see a doctor. I did. The first doctor told me I was depressed. The second one took a longer time with me and ordered a batch of blood tests. My thyroid gland isn’t working. I have a condition with a foreign-sounding name. Do you know what I’m talking about? Will you expand on it for me? — T.Y.
\Answer: I’m sure you’re referring to Hashimoto’s thyroiditis. The Hashimoto name is not recognized by most people. It is, however, in our part of the world, the most common cause of hypothyroidism — a nonworking thyroid gland. The thyroid gland is located in the lower part of the neck. Thyroid hormone keeps all body cells and organs working at their peak efficiency. In Hashimoto’s thyroiditis, the immune system has attacked the gland for reasons that are not clear. It’s yet another example of an autoimmune disease, one where the immune system turns on its own body. Signs of a lack of thyroid hormone come on gradually. Fatigue and weakness make it a heroic feat to get through the day. Hair might fall out. Skin becomes dry. Affected people feel cold when others are comfortably warm. Constipation is a common complaint. Menstrual cycles are erratic. Weight is gained in spite of a poor appetite and a decreased intake of calories. In addition to these signs, the gland often enlarges — becomes a goiter. Although Hashimoto’s thyroiditis and the resulting hypothyroidism are serious conditions, treatment is straightforward: Supply the missing thyroid hormone. Once on the pill form of the hormone, signs and symptoms disappear. It takes time, however, before a person notices big changes for the better. The booklet on thyroid disorders discusses conditions of both under- and overactive thyroid glands in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 401W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Our 21-year-old daughter has been diagnosed with peripheral neuropathy. Her finger turned a shade of blue. She went to the emergency room and got the diagnosis there. What kind of doctor should we consult to determine if this is her condition? — V.C.
\ Answer: Your family doesn’t have a history of having peripheral neuropathy, right? So let’s remove all the genetic causes of it from consideration. Twenty-one is young to come down with it. It’s more of an older person’s illness. People with diabetes and a few other diseases also are targets for it, but your daughter is in otherwise good health. A blue finger isn’t a usual sign. Your daughter should see a neurologist or a vascular specialist to confirm this diagnosis, which appears a bit strange to me."; drDArticle[141] = "Dear Dr. Donohue: What are triglycerides? What do they do to you? I am a 55-year-old male in good health, or so I thought. My lab tests have shown I have elevated triglycerides. My doctor believes I need to make funeral arrangements. He told me to cut down on fats. I have never eaten much fat. I don’t use butter. How do I get my level down? — R.F.
\Answer: Triglycerides are fats. The marbling in meat and the stuff that surrounds a cut of meat are triglycerides. In the blood, they are not solids. They’re a source of energy for body cells. Excess amounts are stored as fat. Cholesterol gets all the blame for clogging heart arteries and causing heart attacks. But triglycerides bear part of the blame. A very high blood triglyceride level inflames the pancreas — pancreatitis. That happens, but is a somewhat rare event compared with other causes of pancreatitis. The normal triglyceride reading should be less than 150 mg/dL (1.7 mmol/L). Values between 150 and 199 (1.7 to 2.2) are considered borderline high. Anything above 500 (5.6) is very high. Weight reduction almost always brings down triglycerides. Fatty foods, fatty meats and fried foods should be eaten sparingly. Surprisingly, sugar raises triglycerides, as does immoderate alcohol drinking. Omega-3 fatty acids lower them. Fish — a good source of omega-3 fatty acids — therefore, ought to be a major part of two weekly meals. If you don’t like the taste of fish, you can take omega-3 in pills. I know people must cringe when they hear exercise mentioned, as it appears to be a panacea for every ill. A half-hour of brisk walking on most days of the week reliably lowers triglycerides. You can start more modestly, and work your way to the 30-minute goal. If none of these lowers your triglycerides, medicines can. Lopid, Tricor and niacin are three reliable drugs.
\Dear Dr. Donohue: I just received a lab slip from my doctor’s office for tests that should be done before my visit. Electrolytes are circled. What are they? They sound like something to do with electricity. — M.Z.
\Answer: Electrolytes are sodium, potassium, bicarbonate and chloride. They do have something to do with electricity — they carry a charge. They’re involved in a huge number of body processes, including keeping the heart beating, facilitating nerve transmission, helping muscle contractions and maintaining the balance between acids and bases. The booklet on electrolytes describes their functions and details the things that can go wrong when one or other is deficient or excessive. Readers can order a copy by writing: Dr. Donohue — No. 202W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I have trouble with weak ankles. I am always twisting one or the other. Which is better for me — tape or an elastic brace? — T.J.
\ Answer: I take you to mean you have this problem when you’re jogging or running. An elastic wrap provides longer-lasting support for the ankles than tape does. Tape loses its gripping power somewhat quickly."; drDArticle[142] = "Dear Dr. Donohue: I am writing to inquire about the mite that invades one’s body and causes dandruff on the head. I have used Selsun Blue shampoo, but it is taking so long to see an effect. I wonder if there is an antibiotic that I could take to get rid of it faster. — M.S.
\Answer: Dandruff is one form of seborrheic dermatitis — skin inflammation, along with an overproduction of skin cells and oil. The scalp is the place most often affected, but it also can be found on the sides and bridge of the nose, the eyebrows, ears, chest and back. A mite doesn’t cause it. Some speculate that a yeast (fungus) called Malassezia might be the troublemaker. This yeast is also found on scalps of those without dandruff, but those with dandruff have greatly increased numbers of it. Quite often, nonprescription treatments work well for dandruff. Selsun Blue is a good one. If, after one month of treatment, there’s no progress, then change to another. Head and Shoulders, Nizoral A-D and T-Gel are a sample of the many products on drugstore shelves. Nizoral A-D contains ketoconazole, a medicine that is active against the Malassezia yeast. Follow directions carefully. Usually they call for daily use until there’s some improvement, and then every-other-day use for a month. From that time on, less-frequent applications are OK. The condition tends to be chronic, so a long commitment is the rule. If you’re not making any progress with over-the-counter preparations, then a doctor can provide you with a prescription for more powerful items.
\Dear Dr. Donohue: Please tell me all you know about post-traumatic stress disorder. I think someone in my family suffers from it. — A.F.
\Answer: Having faced an event that threatened life or caused serious injury is the basis for post-traumatic stress disorder. The event keeps resurfacing in the mind with a clarity that imparts terror and helplessness, and sometimes guilt. The remembrance can happen during the day or in dreams. An affected person stays in the alert mode at all times. He or she loses interest in life, neglects those around him or her, suffers from fragmented sleep, often erupts in outbursts of anger and is usually quite depressed. Soldiers, firemen, policemen and those who suffered a sexual or physical attack are people who most often develop PTSD. With the combination of talk treatment and medicines, these people can usually regain their equilibrium and resume a normal life.
\Dear Dr. Donohue: A cold front came in, and I had head/face pressure. What is that all about? — R.M.
\ Answer: A change in barometric pressure or a drop in temperature can increase the pain of arthritic joints. Weather changes also can trigger migraine headaches. I haven’t seen head pressure mentioned as occurring with weather changes, but I can imagine how it might happen. The sinus cavities of the head could be subjected to a difference between their own internal pressure and the outside barometric pressure. Perhaps you and I are headed for a Nobel prize with this discovery."; drDArticle[143] = "Dear Dr. Donohue: I’ve just hung up the phone after talking to my doctor. He has me scared out of my wits. This morning while reading the newspaper, I couldn’t hold it up. My right arm became weak. In about five minutes, everything returned to normal. I thought I had better call the doctor to see if this was serious. The doctor thinks I had a ministroke and wants me to have someone take me to the hospital ASAP. I told him I was fine. He said that doesn’t matter. I thought I would drop you a line for your opinion. I trust your judgment. What should I do? — T.R.
\Answer: I hope you listened to your doctor. You should do exactly what he told you. You have an emergency on your hands. You most likely had a TIA — a transient ischemic attack — a ministroke. Investigation should be taking place as soon as possible — immediately. A part of your brain lost its blood supply for a short time. Even a brief occurrence like the one you describe can cause permanent brain damage. Worse, it is often the foreboding of a complete stroke. You have to be checked for a blockage in one of your carotid arteries, the large neck arteries that deliver blood to the brain. You have to be examined for a clot in other body locations like the heart. Pieces of those clots can break loose and be carried to a brain artery, where they stop the flow of blood permanently. Atrial fibrillation, a common heartbeat disturbance, is often responsible for such clots. Numbness, weakness or both of a hand, arm, leg, side of the face or tongue can be a sign of a TIA. Trouble expressing oneself is another sign. So are disturbances of vision. None lasts long, but they are quite significant and serious warnings. I don’t have important background information on you. I am counting on your good sense to get you to the hospital quickly. The booklet on stroke, one of our most feared illnesses, covers the topic in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My grandparents never took vitamins and never talked about them. They both lived into their late 90s. Everyone I know takes vitamins, including me. Why? — C.N.
\ Answer: Vitamins are nutrients essential to body health and body chemistry. They’re needed only in minute amounts. No vitamin is made by the body except for vitamin D. We must get them from foods. Although the body does make vitamin D, many older people and quite a few younger ones are deficient in this vitamin. Your grandparents got their vitamins from eating a well-balanced diet. We could do the same. Vitamin-taking is a new wrinkle in human history. It does assure people that they’re getting the recommended daily intake of vitamins. Is it absolutely necessary? Probably not, but most do not get their daily dose of all vitamins through foods."; drDArticle[144] = "Dear Dr. Donohue: I am in the eighth month of my first pregnancy. I’ve a friend who keeps telling me to have a C-section. She says it’s quick and painless. I never considered this and wonder about its wisdom. What would you recommend? Does having a C-section mean all future deliveries have to be done the same way? — K.M.
\Answer: Cesarean sections can be lifesaving for the infant and for the mother. The reasons for having one don’t include speed of delivery simply for speed’s sake or for avoiding labor pain. You realize that a C-section involves surgical incisions, which, after the anesthesia wears off, are painful. And you realize that you have to recuperate from this operation as you would from any operation. Furthermore, all surgery involves potential dangers and complications. Serious bleeding is always possible. The uterus can become infected. Injuries to other pelvic organs can occur. Natural childbirth is painful, but the pain can be minimized in a number of effective ways. I believe you’ll be surprised at how tolerable childbirth is. As for future pregnancies, the standard teaching used to be that once a woman had a C-section, all her future deliveries had to be C-sections. That’s no longer true. Second deliveries after a C-section can be vaginal deliveries, depending on some important circumstances. One of those is where the incision for the section was made. Have you discussed this with your doctor? Do so. I’ll be surprised if the doctor agrees to a C-section solely to avoid pain and speed delivery.
\TO READERS: Questions on cervical cancers and Pap smears are answered in detail in the booklet on those topics. Readers can order a copy by writing: Dr. Donohue — No. 1102W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Our 22-year-old granddaughter has developed an uncontrollable giggle. She giggles before, during and after everything she says. Each time we talk to her, the giggles and their frequency get worse. She is basically shy and appears to be nervous, and says she is not consciously aware of her giggling. She says her friends have remarked on this, too. Is this a tic disorder? Is there something a doctor can do to help her? Is there medication? — S.N.
\ Answer: Underlying anxiety, stress, shyness and social phobia set in motion reflex defenses for people who harbor these traits. It’s their way of coping with situations that generate discomfort. It’s not a tic, although it is somewhat similar. Both are involuntary. I would first talk to the young lady in a compassionate way and tell her that this behavior is misinterpreted by people and that she should make a conscious effort to suppress the giggling. Only if the giggling cannot be controlled and only if it’s causing her to suffer socially would I turn to medical people for help. Yes, there are treatments and medicines that can control anxiety and phobias, but a trial of self-treatment should come first."; drDArticle[145] = "Dear Dr. Donohue: For the past eight months, I have had a heart rhythm problem. I am on Coumadin. One day I forgot I had taken it and took another dose. My blood test showed that I had taken far too much. You wrote about ablation being a treatment for rhythm problems. Would it benefit me, and could I go off Coumadin? -- W.K.
\Answer: I'm sure your rhythm problem is atrial fibrillation, a common and serious heartbeat disturbance where the heart beats rapidly and irregularly. One consequence is a drop-off in the amount of blood pumped by the heart. The second, and the more dangerous consequence, is the formation of clots in the upper heart chambers because blood in those chambers isn't moving -- stagnant blood forms clots. Clots in the heart can be swept into the circulation and to the brain, where they block a brain artery. The result is a stroke. Coumadin prevents those clots from forming. Many times, the goal in treating atrial fibrillation is only to slow the heart so that it pumps out an adequate blood supply. Are there other ways of dealing with this rhythm problem? Yes. Ablation is one. It involves eliminating the heart tissue generating the abnormal rhythm. It's done by inserting a thin tube that's outfitted to deliver radio waves to the specific heart sites from which the abnormal beating arises. Does it sound simple to you? It isn't. It's very intensive work, and requires special training. Generally, ablation is restricted to those younger than you, but not always. I'm on your side when it comes to taking Coumadin. It's a bothersome drug, requiring frequent blood tests to be sure that enough drug is taken but not too much. Too much poses the danger of bleeding. Talk with your doctor about having a consultation for ablation. The doctor might side with you, or tell you that you're not a candidate for the procedure. At least you'll have the satisfaction of having tried. The booklet on heartbeat abnormalities, including atrial fibrillation, discusses them, their significance and their treatment. Readers can obtain a copy by writing: Dr. Donohue -- No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I think my husband is an alcoholic. He drinks far too much. He's not abusive, but his consumption of alcohol is more than a six-pack of beer a day, and sometimes whiskey. He usually falls asleep in a chair. My sister tells me the cage test can diagnose alcoholism. What is it, and where can he get it done? He won't talk about these things to me. -- C.L.
\ Answer: It's not a lab test. It's four questions. They are: 1. Have you ever felt the need to cut down on your drinking? 2. Are you annoyed when people criticize your drinking? 3. Do you ever feel guilty about your drinking? 4. Have you ever taken a drink first thing in the morning as an eye-opener? Two "yes" answers indicate alcoholism. It's a simple but reliable test."; drDArticle[146] = "Dear Dr. Donohue: I am a 50-year-old female, and I have asthma that seems to be getting worse. In October, I got the H1N1 flu and had to go to the hospital twice because of breathing problems. I get scared every time I have a simple cold. I was told that my asthma is allergy-induced, and I have been on a daily inhaler ever since. I saw an allergist, who tested me and wanted to put me on allergy shots. He said they may or may not work, but they don’t cure asthma. Then what’s the point? Does oxygen help? Are there natural ways to prevent asthma? — M.M.
\Answer: Asthma is a chronic condition. Looking for a cure is not realistic in many cases. Looking for control is realistic. It’s an inflammation of the airways — the bronchi, the tubes that bring fresh air into the lungs and remove carbon dioxide from the lungs. The inflammation makes the airways very sensitive. They constrict on slight provocation and obstruct the flow of air. Furthermore, they pour out thick mucus, which adds to airflow obstruction. Respiratory viruses do trigger attacks, and that’s why the flu virus was such a problem for you. You should be sure to get the yearly flu vaccine. Allergies can be another trigger for attacks. Allergy shots are not guaranteed to stop them, but they can lessen their intensity and frequency. You might want to reconsider your position. Remove airborne irritants from your home and bedroom by getting rid of feather pillows, shag rugs and dust mites. If you have a pet, and you notice that exposure to it brings on an attack, then you have to limit where the pet is allowed in the home. An air-conditioned home keeps outdoor allergens out of your environment. For an acute attack, you need a medicine that acts quickly to dilate airways. Albuterol (Proventil) is such a medicine. If your long-term control medicine isn’t preventing attacks, get another. The list of asthma medicines is very long. Oxygen is helpful in severe attacks. I know of no natural substance that alleviates asthma. The asthma booklet describes the many treatments for asthma. Readers can obtain a copy by writing: Dr. Donohue — No. 602W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I must have bumped my ring finger. It is painful, and the top part is swollen on the side of the nail. I think some pus is forming. What can I soak it in? I cannot go to a doctor. — B.P.
\ Answer: You describe a paronychia (PAIR-uh-NICK-ee-uh), an infection of the skin and tissues bordering a fingernail. If the skin and tissues show only mild swelling, then frequent daily soaks in hot water can bring it to a head and cause it to drain. If it is quite swollen and painful, you’ll have to see a doctor. Try an emergency-department doctor. It has to be incised to permit drainage, and antibiotics will be needed."; drDArticle[147] = "Dear Dr. Donohue: I am 56, a woman and have angina. I don’t understand it too well. I have never smoked, and I am not overweight. I’d get chest pains if I hurried to catch a bus or to get on an open elevator. When it first started, my doctor gave me a medicine to put under my tongue when the pain happened. It worked well. I don’t have to use it much anymore. Is that a good sign? Am I destined to have a heart attack? — J.A.
\Answer: Angina (pronounced ANN-juh-nuh or ann-JEYE-nuh) is squeezing chest pain that comes on when a person is active and leaves when that person rests. Being active can mean walking, jogging, cleaning, doing the washing, weeding or digging. It comes about because one or more of the heart arteries is plugged with plaque — a mound of cholesterol and fat on the inside artery wall. At rest, enough blood makes its way to the heart. With activity, the heart can’t get enough blood because of the plaque. The heart makes its lack of blood known by chest pain that also might be felt in the neck, the jaw or the arms, or only in those places. Angina, one of the signs of coronary (heart) artery disease, affects 17 million Americans. Smoking, obesity, inactivity, high blood cholesterol, high blood pressure and a family history are some of the major factors that cause its development. You don’t smoke and never did. How about your cholesterol, blood pressure and weight? If those things need to be addressed, they trump all other treatments. In spite of controlling the above factors, many still have to take medicines — medicines that dilate arteries or make the heart beat slower, or ones that lower blood pressure or cholesterol. The medicine you put under your tongue was nitroglycerin. Long-acting varieties of that medicine and long-acting other artery dilators might be the reason why you don’t need nitroglycerin as much as you did. That is a good sign. Clogged heart arteries can be opened with a balloon-tipped catheter or by bypassing the clog with an artery graft. You might not ever need such procedures. You’re not doomed to have a heart attack. The treatment you’re now getting is designed to prevent one. The booklet on coronary artery disease provides information on this No. 1 North American illness. Readers can obtain a copy by writing: Dr. Donohue — No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My grandson recently had scarlet fever. In my day, this was a very frightful disease. My daughter has taken a ho-hum attitude toward it. What are its complications? — W.B.
\ Answer: Scarlet fever is a strep throat with one addition — a red skin rash. That’s the only difference between the two. Penicillin is its treatment. When treated early, there should be no complications from it. If not treated, then it can have the same complication that strep throat has — rheumatic fever."; drDArticle[148] = "Dear Dr. Donohue: My doctor prescribed statin drugs to control my LDL cholesterol. First I took lovastatin (Mevacor) and then simvastatin (Zocor), but I had muscle pain and weakness with them. I am reluctant to start the pravastatin (Pravachol) that he now has prescribed. Are there alternatives? How about Endur-acin? CoQ10 has been suggested. — D.L.
\Answer: Statins are the most potent cholesterol-lowering drugs, including lowering LDL cholesterol — bad cholesterol, the kind that clings to artery walls. They’ve been around for 20 years, and their safety record has been good. Some people develop muscle pain. Those people can try a different statin. You did. However, you might be reacting a bit too fast in rejecting pravastatin (Pravachol). It is the statin that most infrequently is involved with muscle complaints. I don’t know any herb on the list of herbs you included (in an edited part of the letter) that compare with medicines for cholesterol control. However, there are things you can do to lower cholesterol, including reducing your saturated fat and cholesterol intake. Saturated fats are the fats found in many meats, whole-fat dairy products and many other commercially prepared foods. You have to look on the label. Omega-3 fatty acids lower cholesterol. They’re found in fish. If you cannot stand fish, take the omega-3s in pill form. Questran, Colestid, Welchol and Zetia are cholesterol-lowering drugs that are unrelated to statins. Niacin can increase HDL cholesterol (good cholesterol) and lower triglycerides, fats that also figure into artery clogging. Endur-acin is a slow-release preparation of niacin. Slow-release preparations were introduced to lessen flushing, one of the side effects of niacin. Coenzyme Q10, or CoQ10, is an antioxidant made by the body and also is available in pill form. Antioxidants counter the damaging byproducts coming from cell chemistry. I don’t see any references mentioning that it lowers cholesterol. The cholesterol booklet gives an in-depth treatment of cholesterol. Readers can order a copy by writing: Dr. Donohue — No. 201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am an 80-year-old male. I work out on a Cybex weight machine and also on a treadmill. I was diagnosed as having an umbilical hernia. Please discuss it. Is surgery recommended at my age? Will working out aggravate it? — C.R.
\ Answer: All hernias are protrusions of internal organs or tissues through a defect in the wall that’s supposed to hold them in place. In your case, the defect is the umbilicus — the navel, the bellybutton. With age, the scar that closes the umbilicus (the site where the umbilical cord from the placenta attaches to the fetus) weakens, and a hernia can form. If the hernia isn’t large, isn’t bothering you and doesn’t put a crimp in your lifestyle, nothing has to be done. When you work out, does the hernia bulge larger? If it does, you should limit the amount of weight you lift. If it doesn’t, then you can continue as you are, so long as your doctor concurs."; drDArticle[149] = "Dear Dr. Donohue: I have the worst case of postnasal drip, and it’s driving me crazy. I have a never-ending “ahem, ahem, ahem” throat-clearing. Phlegm is constantly in the back of my throat. Sometimes I clear my throat a thousand times a day. Two-thirds of my garbage is used tissues. What can be done? — J.B.
\Answer: I apologize for condensing your letter. I got the idea, and I believe readers will too. Three or four conditions account for most postnasal dripping. One is allergies. You’ve seen an allergist, and the only allergic reaction you demonstrated was to dust mites. Can you leave your home for a week or so — visit a relative? If dust mites are the cause, your symptoms should subside in a new environment. Vasomotor rhinitis is second on the list of drip causes. It’s a more-or-less permanent dilation of blood vessels in the nose, and those dilated vessels leak fluid. Throat-clearing is part of the picture. Sinusitis is another important cause. An infected sinus pours out thick mucus that drips into the back of the throat. Chronic sinusitis is best left to the treatment of an ear, nose and throat doctor. Nasal polyps provoke mucus production and dripping. An ENT doctor is equipped to deal with them, should they be found. Medicines — beta blockers, Catapres for high blood pressure, aspirin and NSAIDs — are examples of drugs that cause the nose to leak fluid down into the throat. Let me provide some general treatments that help most of these causes. You must stop clearing your throat. Sucking on throat lozenges or frequently sipping from a cup of hot tea with some honey in it will clear mucus from your throat and stop the irritation that throat-clearing causes. Flush your nose with a saltwater solution three times a day, one of those times being right before bedtime. You make the solution by adding one teaspoon of salt and half a teaspoon of baking soda to a quart of boiled water. Add the ingredients when the water is still hot. When the water cools, lean over a sink and flush each nostril gently with a bulb syringe, obtainable in drugstores. Cortisone nasal sprays — Nasarel or Rhinocort Aqua — soothe the nasal lining and reduce mucus production. If you still are afflicted after all this, do see an ear, nose and throat doctor.
\Dear Dr. Donohue: What ramifications might happen when people share drinks, table food and ice-cream cones with their dogs? They resume eating, drinking or licking the food after their pets have “sampled” it. How healthy is this? — B.A.
\ Answer: I wouldn’t think of eating food after a family member had sampled it with his or her tongue, teeth or mouth. The thought grosses me out. Every person has a slightly different bacterial population in his mouth, and we cope well only with our own bacteria. A dog’s mouth, in spite of claims to the contrary, is not cleaner than the mouth of a human. Dog bites often become infected due to the germs in their mouths. People eating food after a dog has sampled it are asking for trouble."; drDArticle[150] = "Dear Dr. Donohue: I am 25. I have a serious case of GERD. I’ve been put on four different medicines. They aren’t working. I also have palpitations throughout the day. I’ve been told by doctors and nurses that there is nothing dangerous about them. I’d like to know if this true. — J.C.
\Answer: GERD — gastroesophageal reflux disorder — is heartburn. It’s the upward spurting of stomach acid and digestive juices into the esophagus, the swallowing tube, a place that is not able to cope with these corrosive juices the way the stomach is. Eliminate or go easy on foods that make GERD worse: citrus fruits; tomatoes; onions; carbonated drinks; spicy, fatty or fried foods; chocolate; peppermint; and caffeine. If you’re overweight, weight loss lessens GERD symptoms. Don’t lie down after eating. Don’t smoke. Sleep with your head, chest and stomach on a slope by putting 6-inch blocks under the bedposts at the head of your bed. That position keeps stomach acid in the stomach. Don’t wear anything that constricts your stomach, like tight pants or tight belts. Medicines called “proton pump inhibitors” nearly completely turn off acid production. Nexium, Prevacid, Prilosec, Protonix, Aciphex and Dexilant are their names. If you still have heartburn while on these medicines, it’s OK to use an antacid along with them. If medicines fail, other causes of heartburn need consideration, things like bile reflux or eosinophilic esophagitis. If these conditions aren’t found, then surgical treatment of GERD is an option that’s open to you. Palpitations mean a thumping or racing heart. They can be felt as a thud in the chest. The cause is an extra beat — or more correctly, a premature beat — one that comes before it should. The beat after a premature beat is delayed. During the delay, the heart fills with more blood than usual, and that causes a thump in the chest when the heart empties. Premature beats are almost always innocent and need no treatment. You can believe your doctors and nurses. The booklet on GERD explains this common malady and its treatment. To order a copy, write: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Can you give me insight into the Hamman-Rich syndrome? My father passed away from it. — L.R.
\ Answer: I can tell you only a little, because only a little is known about it. It’s a lung injury that comes on suddenly, with damage to the lung air sacs (the alveoli) and the spaces between the air sacs, the interstitium. The cause is unknown. Because of such destruction, oxygen cannot get into the blood. Patients are severely short of breath, have a fever and they cough. The only medicines are ones to keep the person going as best as possible. There is no cure medicine. Even with a ventilator, death happens to more than 60 percent of these patients. It’s an illness that reminds doctors that they don’t have an answer for every malady. You and your family have my condolences."; drDArticle[151] = "Dear Dr. Donohue: My 28-year-old daughter, who has been healthy all her life, was recently diagnosed with lupus. Will she be able to live a full life, including having children. Is there a cure? How about exercise and diet? — R.K.
\Answer: In the 1950s, a diagnosis of lupus carried only a 50 percent chance of living for five more years. Sixty years later, the chance of living for at least 20 more years is 90 percent, and the majority of lupus patients have a normal life span. Pregnancy is definitely possible. Doctors tell their lupus patients to delay pregnancy until the illness has been inactive for six months. That kind of delay in disease activity occurs in almost all lupus patients. Lupus is in the same class of illness as rheumatoid arthritis. It’s an autoimmune disease, one brought on by the immune system attacking many body organs and tissues. Joints and muscles are targets. The wrists, hands, elbows, knees and ankles are the joints most often involved. Skin rashes are common. One rash is often mentioned. It’s a redness on both cheeks connected by a red bar over the bridge of the nose. This is the “butterfly” rash of lupus, seen less often than it is talked about. The kidneys, heart and nervous system can be affected. The outlook for an individual lupus patient depends on how many organs are involved and how well the patient responds to treatment. There isn’t a cure. There are many control medicines. Lupus typically has periods of worsening and periods when the illness goes into remission. Medicines make remissions longer and longer. Lupus has no special diet. Exercise is encouraged when the illness is in remission. You or your daughter can contact the Lupus Foundation of America for more information and for becoming acquainted with other patients in your town. The website is www.lupus.org, and the phone number is 202-349-1155. Readers interested in learning more about lupus can order the booklet on it and rheumatoid arthritis by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am 66. I had been a heavy smoker, and I had a brother who died of an abdominal aneurysm. My doctor insisted I have an ultrasound of my abdomen to find out if I had one. (He thought he felt one.) It turns out I don’t have an aneurysm, but I do have a porcelain gallbladder. The doctor wants me to have surgery right away. I have no pain. I feel good. He says it’s a cancer threat. Is this so? — M.Z.
\ Answer: It is so. A porcelain gallbladder must be removed because of the high risk of cancer. This kind of gallbladder got its name because calcium infiltrates its wall. The wall is inflamed, and gallstones are often the cause of the inflammation. Even though you might have no gallstones and even though you have no pain, you need to have the gallbladder taken out, so great is the threat of cancer developing."; drDArticle[152] = "Dear Dr. Donohue: What can you tell me about peripheral artery disease in my legs? How about the ballooning of those clogged arteries? Where is a good place to go for that procedure? — E.K.
\Answer: Activity causes chest pain in people with clogged heart arteries. It causes leg pain for people with clogged leg arteries — peripheral artery disease. Angina is the chest pain of heart artery clogging; intermittent claudication is the leg pain that comes from clogged leg arteries. The obstructed arteries can’t deliver enough blood to leg muscles when a person walks. The leg muscles signal they’re being shortchanged in their blood supply by rebelling with pain. The pain can occur anywhere in the legs. If the blockage is high up, then thigh pain is the result. If a bit lower down, it’s calf pain. Lower down even more produces foot pain. “Intermittent” indicates that the pain leaves when the person rests. Diabetes, cigarette smoking, high blood pressure and high blood cholesterol are some of the things that lead to artery clogging. Aging is, perhaps, the biggest contributor to it. About 17 percent of men and women older than 65 have this problem. A doctor confirms the diagnosis by measuring blood pressure at the ankle and comparing it with blood pressure in the arm. The two readings should be about equal. If the ankle blood pressure is much lower, it indicates that there’s an obstruction in the leg arteries. Treatment involves a diet that reduces the amount of fat and cholesterol; it’s essentially a diet of fruits, vegetables and whole grains, with less red meat and more fish. Although walking brings on pain, walking is a treatment, too. The person walks to the point of pain, rests and then resumes walking. Medicines like aspirin, Plavix and Pletal can be beneficial. You ask about the balloon treatment. It’s the same kind of procedure used to open clogged heart arteries. A slender tube with a deflated balloon at its tip is inched through the artery to the point of obstruction. When that’s reached, the doctor inflates the balloon to squash the obstruction. The population of your city is 50,000. I am sure many competent doctors there are versed in this procedure and can treat PAD as well as it can be treated anywhere. Ask your family doctor for a name. The booklet on PAD explains the ins and outs of this common problem in detail. To obtain a copy, write: Dr. Donohue — No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I expect sore muscles the day after I exercise hard. They tell me I had a real workout. When my muscles are sore, I take the day off. I’ve been told to exercise regardless of sore muscles. Do you agree? — M.O.
\ Answer: A low level of exercise circulates blood to aching muscles and quickens healing. All-out exercise doesn’t give the muscles a chance to fully recover. You shouldn’t do resistance exercises (weightlifting) with the same muscles on consecutive days."; drDArticle[153] = "Dear Dr. Donohue: Will you please explain vertigo? I fell asleep in a chair one evening, and when I woke, I was slightly dizzy. The next morning when I woke up and sat up, I was extremely dizzy. Everything was going back and forth. When I tried to walk, I was bouncing off the walls. The room was moving. My doctor prescribed Dramamine. I still wake up dizzy, but not as bad as the first two nights. I am 69. — E.B.
\Answer: Vertigo is a hallucination that everything is moving. It’s not. What you describe fits the definition. Many causes of vertigo can be traced to the inner ear, which has two important functions: hearing and balance, the orientation of our body to the things around it. That function is handled by the vestibular system of the inner ear. Sometimes a viral infection of the ear can trigger vertigo. The only way to handle it is to take a medicine such as you’re taking and wait for the infection to clear in about three to six weeks. Or it can come about because tiny calcium particles in the inner ear have made their way to places where they shouldn’t be. This is benign positional vertigo. When affected people move their head or change position from lying or sitting to standing, the calcium particles activate the vestibular system abnormally, and profound dizziness strikes. When you woke up and sat up, you became dizzy. You changed positions. Calcium particles activated your vestibular system. A doctor easily can prove benign positional vertigo by provoking a dizzy spell through a series of head and body movements. He or she can coax those transplanted calcium specks back to their site of origin through another series of movements, called the Epley maneuvers. The medicine you mention often lessens symptoms. Antivert is another useful drug. So is scopolamine — in its oral form, not in its patch form. I made vertigo sound like an easy diagnosis and an easy treatment; it isn’t. Many other serious conditions have to be considered by the examining doctor. The booklet on vertigo discusses this common malady in detail. To obtain a copy, write to: Dr. Donohue — No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: My teenage daughter twists and pulls her hair when she reads, watches TV or studies. She has two small bald patches on her scalp. I cannot get her to stop doing this. Is this normal? — R.T.
\ Answer: It’s not normal, but it’s pretty common. It’s trichotillomania (TRICK-oh-TILL-uh-MAY-nee-uh). Some classify it as an obsessive compulsive disorder. The hair pulling quiets an inner anxiety. It’s almost an involuntary act. If you can’t get your daughter to stop, the family doctor can recommend a therapist for her. The therapist can explain to her why she does this and how she can curtail the urge. Sometimes, medicines are prescribed for a short period. She really does need attention. Constant hair pulling can damage the hair roots and lead to a permanent bald patch."; drDArticle[154] = "Dear Dr. Donohue: Your article on arthritis was very interesting, but you did not explain about the arthritis that comes with psoriasis. I have it, and I know of two other people who have it. We don’t understand it at all. Please explain. — B.E.
\Answer: Autoimmunity is the explanation for many illnesses, including both skin and joint psoriasis. “Autoimmunity” indicates that the immune system — our protection against germ invasion and other harmful attacks — for reasons not yet understood, turns against our own bodies; in this case, it’s the skin and joints. The immune system targets joints in as many as 7 percent of those who suffer from skin psoriasis. That’s a considerable number of people when you consider that as many as 3 percent of the entire population suffers from skin psoriasis. Skin psoriasis precedes joint psoriasis most of the time, but there are instances when both occur simultaneously or when joint involvement appears before any skin manifestations. The fact that skin and joint psoriasis run in some families also points to a gene influence on these conditions. Any joint can be affected. The topmost finger joint, the one below the fingernail, is frequently targeted. Back, neck, knees, you name it — psoriasis can strike it. Like all arthritic joints, psoriatic arthritic joints are swollen, red, tender and stiff. The severity of joint involvement doesn’t always mirror skin involvement, but it does correspond to nail changes. Nails have small pits, become loosened from their attachment to underlying skin, often turn yellow and crumble. Treatment of psoriatic arthritis depends on how bad the arthritis is. For mild to moderate cases, NSAIDS do a good job. They include the familiar Aleve, Advil, Motrin and many others. For more severe involvement, doctors prescribe drugs like methotrexate. And for severe arthritis, a breakthrough has come with the introduction of drugs like Enbrel, Remicade and Humira. The arthritis booklet deals with some of the more common forms of arthritis. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: Public speaking panics me. My job requires that I do lots of public speaking. In spite of the fact that I am called on to perform often, it doesn’t get any easier for me. In fact, I think it’s gotten worse. My sister has a similar problem. Her doctor gave her a medicine that makes her actually relish getting up and addressing a crowd. Do you know the name of the drug? — S.S.
\ Answer: I’m pretty sure it’s Inderal (propranolol). It has many medical uses, like regulating the heartbeat, controlling blood pressure and abolishing certain tremors. It also controls the signs of stage fright. Many professional musicians have to use it before their performances. It’s a prescription drug, so your doctor has to agree to its use. Limit taking it to those occasions when you have to speak in public. It’s not habit-forming. It’s not a narcotic. It’s not a tranquilizer."; drDArticle[155] = "Dear Dr. Donohue: The tip of my husband’s nose and his cheeks have become noticeably red this past year. People ask me — half kidding, half serious — if he’s been drinking heavily. He doesn’t touch alcohol. This doesn’t bother him, but it bothers me. What is this? — N.D.
\Answer: The probable culprit is rosacea (rose-A-she-uh). It starts as a reddening of the nose and cheeks, and sometimes can affect the forehead. The skin also develops webs of tiny blood vessels. Pimples — which look much like acne — break out. The final stage, which should never be reached these days, is the bulbous nose of W.C. Fields. Rosacea is common. Fair-skinned people with light hair are the most susceptible. So are those who blush easily. The actual cause is a bit unclear. Some believe the skin mite Demodex is involved. It lives in hair follicles. But people without rosacea also have the mite, so a cause and effect is not certain. People with rosacea often have eye involvement, something that’s often overlooked but needs consideration. The eyes feel gritty and might burn. They, too, can become red. Rosacea isn’t a curable condition, but it is highly treatable. Your husband ought to steer clear of spicy foods, sunlight and extremes of heat and cold. That he doesn’t drink alcohol is in his favor. Metronidazole cream, gel or lotion, or Azelex (azelaic acid) cream can bring gratifying results. Over-the-counter benzoyl peroxide often works for an acne breakout. Sometimes oral metronidazole or an oral antibiotic is added to the program. You or your husband would do well to contact the National Rosacea Society, which can provide you with informative literature and keep you abreast of the latest changes in treatment. The society’s website is www.rosacea.org, and its phone number is 888-NO-BLUSH.
\Dear Dr. Donohue: Is it possible to have had a heart attack and not know it? I am a 59-year-old man and had my first-ever EKG this past week. The doctor tells me I had a heart attack. I have never had anything that felt like a heart attack. I don’t smoke and never have. Heart attacks don’t run in my family. My mother and father are alive at 85. I weigh 155 pounds and have weighed that since I was discharged from the Army, more than 35 years ago. Could this be a mistake? — R.S.
\ Answer: As many as 20 percent of heart attacks are silent, producing no pain or other symptoms. Those attacks are discovered when an EKG happens to be taken at a later date. It’s also true that the EKG might show the pattern of an old heart attack without one ever having occurred. If you want to settle the matter, consult a cardiologist. It’s probably the wise thing to do. The booklet on heart attacks explains why they happen and how to recognize them. Readers can order a copy by writing: Dr. Donohue — No. 102W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery."; drDArticle[156] = "Dear Dr. Donohue: A friend in his late 40s thought he had the flu and called his doctor for medicine. Later he had trouble breathing and went to the emergency room, where they said he was having a heart attack. Several hours later, he passed away. An autopsy showed that a virus had attacked his heart. I know there are many types of viruses, but what kind did he have? How does a person get this kind of virus? If it had been found in time, could something have been done to stop it? — R.R.
\Answer: Your friend had myocarditis, an inflammation of the heart. Viruses are one cause of it. The virus most often involved is the Coxsackie virus, named after the New York town where it was first identified. Myocarditis can be so mild that it produces no symptoms. Or it can be so overwhelming that it is fatal. It occurs at any age. Often, a respiratory infection (even a common cold) or a gastrointestinal disorder (stomach flu) might precede it. A young person — and your friend is considered young — struggling to breathe puts the doctor on alert to suspect that a failing heart is responsible and that a viral infection of the heart could be the cause. Coxsackie viruses are transmitted from one person to the next through respiratory droplets or from foods, hands or utensils contaminated with the virus. We have no medicine that kills this virus. Most of the time, none is needed, since nearly all Coxsackie infections are minor troubles. In cases like your friend’s, medicines to keep the heart beating forcefully usually can tide a person over the dangerous period of heart failure. Your friend’s story is tragic. The booklet on congestive heart failure describes the more common kinds of it, not the kind due to viral infections. Readers can order a copy by writing: Dr. Donohue — No. 103W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the reader’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am 90 years old. About three years ago I developed foot drop. A neurologist diagnosed the condition. My general health is good, considering my age. This foot drop has become debilitating. Is there anything I can do to take care of it? —M.S.
\ Answer: Foot drop isn’t really a diagnosis. It’s an observation of what’s happened to your foot. You cannot raise the front part of your foot off the ground when you take a step. The drooping foot makes it hard to walk. You have to lift the leg very high so the foot clears the ground. Finding out what made the foot drop is going to be your diagnosis. Nerve damage, back problems, stroke, diabetes and muscle illnesses are some of the causes of foot drop, and they are the actual diagnosis. Many times, the problem is nerve malfunction. Quite often, health cannot be restored to the nerve, but things can be done. One of those things is a lightweight brace that keeps the foot from flopping downward when you take a step."; drDArticle[157] = "Dear Dr. Donohue: My friend and I have an ongoing discussion about how we catch colds. I believe the only way is by being exposed to a germ. My friend agrees, but also says you can become chilled, and that results in a cold. Please settle this once and for all. — L.G.
\Answer: The only way to catch a cold is to meet up with a cold virus. But let’s kick this around a little while it lies there quivering. Rhinoviruses are responsible for many colds. This virus is passed from one person to another most often via the hands and fingers. An infected person invariably will have virus on his or her hands and fingers. If that person touches another person’s hands or fingers, the virus is transferred. All the second person has to do is touch his or her nose or eyes and the virus has found a new home. (The drainage channel for tears siphons viruses into the nose.) It’s also possible to spread a cold through sneezing or coughing, but that’s a secondary route. Many colds are preceded by a body chill. That’s part of the infection symptoms, and that might be what your friend refers to. Once a virus lands in a person’s nose, the time till the development of cold symptoms is short — eight to 12 hours. Runny nose, nasal stuffiness, scratchy throat, cough and sneezing are typical symptoms. They peak in 48 hours and are gone in about one week. A person is most contagious during the first three days of symptoms, when nasal discharge is at high volume and when it contains the most viruses. If by “chilling” your friend means being in a cold blast of air or getting your feet wet in frigid weather and shivering as a result, she has a slight point. That kind of chilling constricts the nose’s blood vessels and decreases mucus production. It might, therefore, permit cold viruses to mount a more effective attack and can contribute to the ease of catching a cold. All the same, without the virus there is no cold.
\Dear Dr. Donohue: Can you give an explanation of and recommendation for cure of a health problem I have? Being over the age of 65 and in reasonably good health, I suffer every winter from painful cracks in my fingertips and the soles of my feet. — R.V.
\ Answer: The cracking indicates that your skin is drying out. You can restore moisture to your fingertips with a light coat — just a dab will do you — of petroleum jelly (Vaseline or another moisturizer) before going to bed. Put Band-Aids over your fingertips, and leave them on all night. You can do the same during the day, but it’s a bit inconvenient. In about three days, the cracks should be filling in. Continue this treatment every third or fourth night. The same thing works for the feet. You don’t use Band-Aids, but you do cover your feet with socks before going to sleep. Don’t apply petroleum jelly during the daytime. It might make you somewhat unsteady. It takes longer for feet to heal."; drDArticle[158] = "Dear Dr. Donohue: When he was 20, my son came down with hepatitis C. He’s never said how he got it, but he was running around with a very wild bunch then. He still has the virus at age 27. Should he be treated? He never was. I wonder what’s in store for him, and if he can marry and have a family. Can he? — C.S.
\Answer: Worldwide, 175 million people are infected with the hepatitis C virus. In the U.S., 4 million carry it. Between 70 percent and 80 percent of infected people will harbor the virus for life. Of that number, around 20 percent develop liver cirrhosis in 20 years, and a smaller number are stricken with liver cancer. Hepatitis C is the most common reason for a liver transplant. People catch the virus in a number of ways. Sharing needles to inject drugs is one way. Health-care workers can get it from an accidental stick with a needle used on an infected person. Before 1992, blood transfusion was a major source of infection. Tattooing or body piercing by unlicensed practitioners or those who do not adhere to sterile techniques is another route of transmission. Sex with multiple partners is a possible way of contracting the illness. Sex with a single partner who has the virus is not a common route of passage. Your son can marry and possibly but not likely infect his wife, and will not infect his children. This young man has to establish himself with a doctor. Lab tests will show if his liver is suffering any damage, and blood tests give a reliable estimate of how great a number of viruses is circulating in his blood. Treatment will hinge on that information. A liver biopsy might be necessary. Some doctors feel all who show evidence of current infection ought to undergo treatment. He should completely abstain from alcohol. Drinking puts his liver in further jeopardy. The booklet on hepatitis A, B and C explains these common infections in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 503W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: How does someone with AIDS die? How long does one live after being diagnosed with AIDS? Can a person with AIDS cook for his or her family without fear of giving the virus to loved ones? — D.R.
\ Answer: AIDS kills in a number of ways. It so weakens the immune system that an infection brings death. Or the weakened immune system allows the growth of a cancer that proves fatal. AIDS also can interfere with the production of proteins and other body materials needed for life, and the person wastes away. The incredible progress made in the treatment of AIDS allows most infected people to live 30 to 40 years after the diagnosis is made, very close to a normal life span. This is possible in countries where people have ready access to the many AIDS medicines. People with AIDS can cook for their family without any fear of transmitting the virus."; drDArticle[159] = "Dear Dr. Donohue: Please explain why I have to take my shoes off late every day because my feet and ankles have swollen and don’t fit into the shoes. I flop around in slippers without heels. In the morning, after a night’s sleep, my feet are back to normal. I am 77 and take no medicines. — K.M.
\Answer: I can’t give you an unequivocal response because there are numerous causes of foot and ankle swelling. The medical name for such swelling is edema. Even in relatively healthy people, it occurs if people sit or stand for any length of time. Gravity pulls fluid out of the circulation, and it accumulates in the feet and ankles. This is especially true at older ages, when the circulatory system becomes somewhat leaky. For this kind of swelling, the solution is to elevate the legs when sitting. The most effective elevation is raising the legs above heart level, something that can be done only by lying down with pillows propping up the legs. Getting up and moving about is another way to prevent fluid accumulation in the feet. Heart failure is a more serious cause of such swelling. When the heart’s pumping action becomes feeble, fluid escapes from blood vessels and again accumulates in the ankles and feet. Kidney disease with retention of body fluid is another cause of edema. Liver disease does the same. Another condition called lymphedema produces the same picture. Lymph is fluid that normally escapes the circulation to percolate around tissues and organs to provide nourishment and to wash away germs. Small vessels called lymphatics vacuum up this fluid and return it to the circulation. Anything that disrupts lymphatics can lead to ankle/foot swelling. An old infection and surgery are two such disruptors. Since ankle and foot swelling is a sign of many urgent medical conditions, don’t fool around with this. See your family doctor. The booklet on edema and lymphedema clearly describe these conditions and their treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
\Dear Dr. Donohue: I am concerned about my brother, who is 63, diabetic, weighs 300 pounds and is 5 feet 8 inches tall. He falls asleep, wakes and falls asleep repeatedly at the table and when he sits down. Why? He says he’s tired. He picked a scab on his leg and blood squirted out 6 inches. What does that mean? — Anon.
\ Answer: Your brother might have sleep apnea. His body size suggests that it could be the reason for his daytime sleepiness. Spurting blood indicates that an artery was broken. No one should pick at scabs, especially a diabetic. Your brother needs medical attention. He has to lose weight both for control of diabetes and for control of sleep apnea, if that is what he has. He is at great risk of incurring the complications of diabetes — heart attack, stroke, blindness, kidney failure — if he doesn’t start paying attention to his health."; drDArticle[160] = "Dear Dr. Donohue: What brings on severe constipation?