Last Updated: February 08. 2011 1:00AM Dr.. Paul Donohue: your Health

dear Dr. Donohue: this winter my dad complained that his hat was too tight for him. My dad wears hats year-round. he happened to mention this to the doctor when he had his annual physical. the doctor did a special blood test and told my dad he might have Paget’s disease of bone. he sent him to a specialist, who confirmed the diagnosis. Is this treatable? Is it crippling?

H.D.

Dear H.D.: Dr. Paget was an English doctor who died in 1899. Three illnesses bear his name, a feat that would land him in the Medical Hall of Fame, if there was one. Paget’s disease of bone, although many are not familiar with it, affects almost 4 percent of adults older than 40.

Bones are in constant flux. They undergo daily remodeling — breaking down and being rebuilt with fresh materials. In Paget’s disease, the demolition process suddenly accelerates. That’s countered by accelerated rebuilding. However, the rebuilding is done with such haste that it produces overgrown and malformed sections of bone. These bone areas are fragile. most people with Paget’s don’t know they have it, because they have no symptoms. Symptoms, when they appear, are bone pain, bone deformities and bone fractures. Or the overgrown bone can press on adjacent structures like nerves and interfere with their function.

The cause isn’t known. Genes are involved, since close relatives have a tenfold increase in the chances of coming down with it. Evidence suggests that viruses also could be involved.

The blood test the doctor ordered for your dad was an alkaline phosphatase test. Alkaline phosphatase is an enzyme found in bones. Elevations of it indicate that frantic activity is taking place in bones.

Your dad lives in a time in which medicines are available to contain the Paget’s progress.

They’re the same drugs used for osteoporosis: Reclast, Actonel, Fosamax and Aredia.

Your father and you will be richly rewarded by contacting the Paget Foundation at (800) 23-PAGET or on the Internet at paget.org.

Dear Dr. Donohue: For no good reason, I feel my heart suddenly beating hard and fast. I try to take my pulse, but can’t feel most of the beats. the whole thing lasts a brief time, and I feel fine while it’s happening.

My doctor says it’s just some irregular heartbeats. What do you say?

K.O.

Dear K.O.: It might be nothing more than a few premature heartbeats, but I would like to see proof of that.

People with your problem have another problem: They can’t predict when the heart will speed up next. Furthermore, since the episodes are short, they have no opportunity of getting to a doctor or hospital in time for an exam. That makes a valid assessment mostly guesswork.

There is a way around this obstacle. You can wear a Holter monitor. It’s a device about the size of a deck of cards, worn on a cord around the neck or fitted into a pocket. It records all heartbeats during the time it’s worn. It provides accurate proof of what the heart speed-up is.

Write to Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475.

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