By Paul G. Donohue, M.D. November 20, 2011 12:00 AM

DEAR DR. DONOHUE: In January of 2007, I was a passenger in a friend’s car when it was involved in an accident. I received two fractured vertebrae and severe bruising across my stomach. In June of 2007, I was diagnosed with Guillain-Barre syndrome. I was paralyzed from my feet to my neck, and stayed in the hospital for 63 days. Could the onset of GBS have been triggered by the stress and trauma of the auto accident? I did have a sore throat right after the accident. can GBS start in the throat? You have stated that GBS occurs one to two months after a respiratory or digestive-tract infection. is the incubation period set in stone?

Guillain (gee-YAWN)-Barre (buh-RAY) syndrome first begins as funny sensations in the feet. A paralysis then sets in, starting in the legs and moving upward in the body. the paralysis results from an antibody attack on nerves by the immune system. Antibodies are proteins that serve as ammunition for the immune attack. In 70 percent of GB patients, the ascending paralysis is preceded by a respiratory or digestive-tract infection by one to three weeks. I’m sure there are different time intervals for this; nothing in medicine is set in stone. the germ causing the digestive-tract illness is most often the bacterium Campylobacter (KAM-puh-low-BACK-tur). one of the viruses causing a preceding respiratory illness is the Epstein-Barr virus — the virus of mononucleosis, which features a sore throat as part of its symptoms. the bacteria and viruses don’t actually cause GB. They cause the immune system to produce antibodies against these germs. Those antibodies also are directed against nerves. It’s the antibodies that are responsible for GB. I cannot find information supporting stress or trauma as causing this illness.

DEAR DR. DONOHUE: my doctor refuses to prescribe prednisone for my problem. my feet, hands and knees are stiff. She says my problem isn’t bad enough. I am in pain. how should I get help?

Joint stiffness is a sign of many illnesses. Osteoarthritis is the leading cause in older people. Rheumatoid arthritis is another illness featuring stiff joints. Shortly after the discovery of cortisone (prednisone is a cortisone drug), it was used for the treatment of rheumatoid arthritis with great success. However, side effects from giving the drug in high doses for prolonged periods of time created more problems than the illness itself. Prednisone isn’t used for the more common osteoarthritis. Tylenol, Advil, Aleve and many other similar drugs are. Hot packs are another useful treatment. If you give me the diagnosis your doctor has made for your stiffness, I can expand on it for you.

DEAR DR. DONOHUE: each year, my cholesterol stays around 205. it might be 215 or 195, but mostly it hovers around 205. my HDL is 95 (2.4 mmol/L), and my LDL is 91 (2.35). do I need to be concerned about a cholesterol of 205?

You don’t need to be concerned about a cholesterol of even 215 mg/dL (5.3 mmol/L). There’s leeway in cholesterol measurement. It’s not exactly the most precise science. Rejoice at your readings, and rejoice even more at your HDL and LDL readings. both are terrific. an HDL (good cholesterol) of greater than 40 (1.04) is good and one greater than 60 (1.5) is excellent. an LDL (bad cholesterol) of 91 is very good. A value less than 100 is optimal. stop obsessing about cholesterol.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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Dear Dr. Donohue — six years ago, my sister, 67 years old, wasdiagnosed with Graves’ disease, and it has affected her eyes. Hasthere been any advancement in research with it? Where is the bestmedical facility for it? — L.B.

Answer — Chalk up another illness to an immune system that turnsagainst its own body. in this case, it’s the thyroid gland and theeyes. Graves’ disease is an enlarged thyroid gland (a goiter)that’s putting out too much thyroid hormone. The stimulation thatcauses the overproduction comes from antibodies made by the immunesystem. Not only do they lead to excess thyroid hormone, they alsolead to deposition in the orbit (the bone socket for the eyes) ofmaterial that pushes the eye outward and infiltrates the eyemuscles. that, in turn, often produces double vision. The namegiven to eye involvement is Graves’ ophthalmopathy ororbitopathy.

Your sister has to protect her eyes by using eyedrops or eyelubricants. When outside, she should wear large sunglasses withside extensions that keep wind out of the eyes.

In the early stages, if eyesight is threatened from the pressureof the infiltrating material on the optic nerve, large doses ofcortisone are given to shrink the infiltration. often, time permitsthe swelling in the orbit to regress.

Six years from the start of her illness, your sister’s eyes arestill a problem. she should be under the care of an ophthalmologistand an endocrinologist (a thyroid specialist). A number of surgicalprocedures can be done to enlarge the bony socket. if she suffersfrom double vision, eye-muscle surgery can correct that, or she canwear glasses with prisms that compensate for eye misalignment.

Dear Dr. Donohue — Will you please explain a rectocele? Issurgery advised? I am 82 years old and concerned about surgery. —C.D.

Answer — A rectocele (RECK-toe-seal) is a downward bulging ofthe rectum into the vagina. A similar bulge of the urinary bladderis a cystocele, and of the uterus, a uterine prolapse. all threeare referred to as pelvic organ prolapse — “prolapse” meaningfalling downward.” The ligaments and muscles supporting thesestructures give way with aging and childbearing.

Surgery for a rectocele is advised if it causes symptoms likestraining to evacuate, or is painful or causes loss of bowelcontrol.

If you don’t want surgery, then try a pessary, a device thatcomes in many shapes and that’s inserted into the vagina to prop upthe fallen organ. your doctor can suggest one best suited to yourproblem.

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

Last Updated: January 12. 2011 1:00AM Dr. Paul Donohue: Your Health

Dear Dr. Donohue: in 1970, when in college, I had a friend who bruised so badly that she looked like a battered woman. The doctor at the health care center told her to take vitamin C because it strengthens cell walls. she did, and the bruising stopped.

My father died of ischemic stroke and had suffered from heart disease. My mother has had several hemorrhagic strokes. I am 60 and started taking baby aspirin. I am bruising more. I am thinking about adding vitamin C to my program. will it interfere with the baby aspirin’s blood-thinning effect?

Dear N.L.: Ever hear of scurvy? It’s not seen much these days, but in the 15th through 18th centuries, it was a common disorder and was rampant among sailors. Dr. James Lind, a British naval surgeon, experimented with groups of sailors, giving them a variety of treatments. The group given a daily lemon and two oranges recovered quickly from all the signs and symptoms of scurvy. those signs are small and large bruises, bleeding from the gums, coiled hairs, joint pains and impaired wound healing. perhaps this was behind the college doctor’s prescription of vitamin C for your friend.

Vitamin C is involved with the synthesis of collagen, one of the major support tissues in the body. It’s a powerful antioxidant, neutralizing oxidants, which are byproducts of cell metabolism that wreak havoc in the body. It aids in the absorption of iron. It keeps the immune system healthy. It stops the bleeding and bruising of scurvy by strengthening capillaries, the smallest of blood vessels. I find no information that it interferes with aspirin’s anti-platelet effect. Platelets form clots that sometimes occur in arteries and obstruct blood flow. The result can be a heart attack or a stroke.

With your mother’s history of hemorrhagic (bleeding) strokes, you should consult your doctor before launching into daily aspirin.

Dear Dr. Donohue: My 51-year-old son has been diagnosed with a Zenker’s diverticulum. he has seen many specialists, but none has spoken of a cure. he has difficulty swallowing. Is there any relief?

Dear M.F.: The loss of tissue elasticity, along with weakening of the swallowing muscles, sets the scene for the bulging of the throat lining through the throat muscles to create a pouch. That’s a Zenker’s diverticulum. Food gets caught in the pouch, and no effort on a person’s part can dislodge it. Difficulty swallowing and an increased production of saliva result. Food decomposes in the pouch. Eventually it’s regurgitated into the mouth and creates a foul odor.

Surgery corrects the situation. A newer technique is the use of a flexible scope, introduced through the mouth, that permits repair without an incision.

Dear Dr. Donohue: I am a 63-year-old male. I work out three or four times a week, doing aerobic exercise and weight training. during a routine physical, I was diagnosed with low testosterone. My doctor scheduled me for bimonthly injections in his office.

Recently a friend told me that her husband was diagnosed with low testosterone and that his doctor prescribed a pill. Is testosterone available as a pill?

Dear T.V.: Testosterone is available as a pill. however, oral testosterone isn’t the best way to correct a deficiency. It doesn’t reliably provide sustained blood levels of the hormone. To overcome this obstacle, doctors choose other methods of delivering it or prescribe a testosterone that has been chemically altered.

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

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Last Updated: December 23. 2010 1:00AM Dr. Paul Donohue: your Health

Dear Dr. Donohue: my husband is 66 years old and has been diagnosed with hyponatremia. He has high blood pressure and takes medicine for it. He is also an alcoholic, eats very little and has lost a lot of weight.

Will you please discuss hyponatremia? I’m at my wits’ end because he looks so bad. He sees a kidney specialist, and I found “hyponatremia” on a piece of paper he brought home from the doctor.

J.B.

Dear J.B.: Hyponatremia (HI-poe-nuh-TREE-me-uh) is a low blood level of sodium. It’s not really an illness. It’s a sign of many possible disorders. something in the body has gone wrong and makes the body retain too much water or lose too much sodium (salt). Excessive sweating, drinking way too much water, burns, vomiting, diarrhea, adrenal gland abnormalities, pituitary gland problems, liver and kidney diseases, and congestive heart failure are some of the things that lead to a blood sodium drop.

A frequent cause, and perhaps your husband’s cause, is diuretics — water pills. They’re often used for control of high blood pressure. many of them induce a loss of sodium. This is corrected by adjusting the diuretic dose.

Most of the time the sodium drop isn’t that great, and no symptoms are generated. I have to believe that applies to your husband. his doctor would not have let him come home if his sodium level was too low.

dear Dr. Donohue: I have a Baker’s cyst behind my left knee. I have been told it can be cured when I have my knee replaced. However, that is impossible because of another physical condition. I can get very little information about this disorder. I was told to wear an elastic stocking, which I do and which seems to help. what is a Baker’s cyst? are there things I should be doing?

W.K.

dear W.K.: ever hear of bursas? They’re small, pancake-shaped affairs that are wedged between bones and tendons to prevent friction when the tendon rubs against bone. a Baker’s cyst is a swelling of a bursa behind the knee. It’s actually connected to the knee joint by a tunnel. The tunnel has a one-way valve that closes as fluid from the knee finds its way to the bursa. The bursa swells. The basic problem, most often, lies with the knee itself — arthritis, torn cartilage or other joint problems. Baker’s cysts are quite common.

What’s this about needing a knee replacement to fix it? That’s not true. a doctor can drain the cyst with a needle and syringe. often, the cyst reforms. Injecting cortisone into the cyst after drainage lessens the chance of recurrence. Elevation of the leg and a compression bandage are helpful. So are anti-inflammatory medicines if you can tolerate them. In stubborn cases, a doctor can surgically remove such a cyst.

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

order health newsletters from rbmamall.com.

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Dear Dr. Donohue — I suffer from uterine fibroids. they causeheavy, prolonged bleeding and pain. I have decided to go for theprocedure called uterine fibroid embolization. are there any sideeffects regarding the pellets that are used to block off bloodsupply to the fibroids? Do you know of any long-term side effects?— C.I.

Answer — I know of no medical procedure or medicine that iswithout side effects. Uterine artery or uterine fibroidembolization is a safe procedure that has no more complicationsthan surgical treatment of fibroids. Long-term complications fromthe particles used in this treatment are few and far between. Ican’t find any specific reference that cites them. Driving to thehospital for the procedure poses greater danger than the proceduredoes.

Fibroids are growths of the uterine muscle projecting into theuterine cavity. for many women, they’re completely quiet andproduce no symptoms. for others, they cause heavy menstrualbleeding, painful periods, pelvic pain, pain with intercourse andinfertility.

An embolus is a clot. Embolization involves introducing aflexible tube into a surface artery in the groin and advancing thetube to the uterine artery serving the fibroid. When the doctor hasit positioned there, he or she releases small particles about thesize of grains of sand. those particles are inert, sterilematerials. they promote formation of a blood clot. cut off from ablood supply, the fibroid shrinks.

This isn’t a new technique. in the 1980s, doctors began usingembolization to stop uterine bleeding. in the 1990s, they adaptedit for treatment of fibroids. It’s a method that has two to threedecades of experience with a complication rate that is very low.Anytime the body is breached, infection is possible. A few cases oflung blood clotting have been reported because the blood, followingthe procedure, is believed to have an increased tendency to clot.those instances have been extremely rare.

The booklet on fibroids discusses the treatments at length.Obtain a copy by writing: Dr. Donohue — no. 1106, Box 536475,Orlando, Fla. 32853-6475. Enclose a check or money order (no cash)for $4.75 with the recipient’s printed name and address. Pleaseallow four weeks for delivery.

Dear Dr. Donohue — I am a woman who loves tropical fruits.Instead of a salad for supper, I eat low-fat cottage cheese andtropical fruit. The fruits include pineapple, red papaya, guava andbananas. am I doing something wrong? — S.L.

Answer — Not if you’re getting other food groups, like proteinsand unsaturated fats in your other meals. you need some grains,vegetables and protein sources such as lean meat and beans. Youalso need the vitamins and minerals those foods contain.

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

Dear Dr. Donohue • my 52-year-old daughter, who has been healthyall her life, now has gastroparesis. Can you give me someinformation on this disease? is it curable? — M.M.

Answer • normally the stomach takes two to four hours to empty.Liquids pass through it even more quickly. The stomach has to grindsolid foods to reduce them to small pieces and to soften them sotheir nutrients and calories can be absorbed. Gastroparesis is asluggish stomach. “Paresis” means “partial paralysis.” Foods takeforever to leave a stomach stricken with gastroparesis. Diabetes,Parkinson’s disease, scleroderma, thyroid troubles and many otherconditions are causes of it. For a large number of sufferers, acause can’t be found. it just happens.

Nausea, abdominal pain, vomiting and a feeling of fullness afteronly a few bites of food are some of the consequences ofgastroparesis.

After an overnight fast, a scope examination of the stomachshows it still to be full of food. Scans can help make thediagnosis. The patient eats food that includes a safe radioactivematerial. Serial scans show the radioactive material stays in thestomach for an inordinate amount of time.

“Curable” is too strong a word for this condition. Treatableisn’t. If an underlying illness is found as the cause, treatment ofthat illness usually treats gastroparesis. When no illness isresponsible for it, ways to increase the transit of food throughthe stomach are possible. one is to increase the amount of fluidstaken with meals. Decreasing the fat and fiber content of meals isanother way to speed the passage of food. Frequent, small meals areanother strategy that’s helpful. Metoclopramide (Reglan) often canease symptoms.

Your daughter ought to take vitamins. People with gastroparesiscan develop vitamin deficiencies.

To Readers • Women will find answers to their questions onfibroids in my booklet. To order a copy, write: Dr. Donohue — no.1106, Box 536475, Orlando, Fla. 32853-6475. Enclose a check ormoney order for $4.75 with the recipient’s printed name andaddress.

Dear Dr. Donohue • do you have anything on fatty liver? Mydoctor told me that I have a fatty liver. — M.K.

Answer • Alcohol is one big cause for fat to infiltrate theliver. Fat also can be found in the livers of people who nevertouch a drop of alcohol. That condition is nonalcoholic fatty liverdisease, NAFLD, and it’s quite common. NAFLD can progress to NASH,nonalcoholic steatohepatitis, a serious condition. It’s aninflammation of liver cells and can result in liver cell death. Thedead cells lead to liver cirrhosis.

Many NAFLD people are overweight. If these people lose weight,their livers lose their fat. ??

Write Dr. Donohue at P.O. Box 536475, Orlando, FL32853-6475.

Last Updated: August 12. 2010 1:00AM Dr. Paul Donohue: Your Health

Dear Dr. Donohue: Do your readers a favor by telling them about Cushing’s syndrome. it took six years before I was diagnosed. the delay cost me my job and my fiance. I gained weight and had stretch marks all over. Doctors told me to lose weight by dieting and exercise. I did both, but continued to gain weight. Then my blood pressure rose. Finally, a doctor, to whom I owe my life, came up with the correct diagnosis. I had an operation, and my life has changed for the better.

P.A.

Dear P.A.: Cushing’s syndrome is an overproduction of cortisone. our adrenal glands, sitting above the kidneys, turn out this hormone, which is essential to life.

At first, an overproduction of cortisone produces signs and symptoms that are quite subtle and go unrecognized. As time goes by, weight is gained, the face becomes round and red, the arms and legs remain thin, the chest and abdomen expand. the skin thins and is easily injured. Purple stretch marks appear. Menstrual irregularities occur. Women sprout facial hair. Muscles weaken, as do bones (osteoporosis). Blood sugar rises, and so does blood pressure. all of this comes from having too much cortisone.

The trouble can lie in either of two places, the pituitary gland on the underside of the brain, or the adrenal glands (above the kidneys) that make the hormone. the pituitary gland produces a hormone that stimulates adrenal-gland production of cortisone. Tumors of the adrenal gland, independent of the pituitary gland, can rev up their production of cortisone on their own.

It’s treated by turning off cortisone production. Surgery is the answer to both causes of Cushing’s. With the pituitary gland, the approach can be through the nose or roof of the mouth to reach the pituitary gland and destroy the tumor. When the adrenal gland is the cause, surgery is more involved.

Dear Dr. Donohue: my artificial sweetener has a warning saying it contains phenylalanine. why? is it a dangerous material?

K.S.

Dear K.S.: Phenylalanine is an amino acid, one of the bricks from which the body builds proteins. it is not a dangerous material. However, a few individuals are born without the ability to metabolize this amino acid. Discovery soon after birth is important so that phenylalanine can be eliminated or severely limited in these babies’ diets.

Write to Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from rbmamall.com.