DEAR DR. DONOHUE: I am 91 and exercise strenuously three or four times a week. About two years ago, my right knee began to give out suddenly, and I would fall occasionally. When questioned further, I told the doctor that I had had polio when I was 8. That led down a trail that ended in a diagnosis of postpolio syndrome. Is there any possibility of improvement in my condition? — R.W.

Having had polio years ago was a major ordeal. Dealing with it once again is more than anyone should be asked to do.

The polio virus homes in on spinal cord and brain nerves that control muscle action. When the virus destroys all nerve cells to a muscle, that muscle is paralyzed. Often it destroys only a few nerve cells, and physical therapy can teach the remaining nerve cells how to assume the function of the dead nerve cells.

Later in life, through the normal attrition of nerve cells due to aging, the cells that had assumed double duty begin to disappear. The polio survivor notices muscle weakening. Walking can become difficult. The person cannot lift loads that were previously easily lifted. Falls from having weak muscles are common.

Sure, there is a possibility of improvement in your condition. Mestinon, a drug used for an unrelated nerve disease — myasthenia — has helped some postpolio patients regain a modicum of strength in their newly weakened muscles. Parkinson’s disease medicines have also had limited success.

However, putting all hope on medicine is unrealistic. More important are physical and occupational therapy. A physical therapist can design for you an exercise program that is safe and keeps other muscles from shriveling from disuse. An occupational therapist teaches you how to overcome muscle weakness with techniques and devices that make use of functioning muscles. Get in touch with both.

DEAR DR. DONOHUE: Is there a birth control shot? I heard there is. I would like to not have to bother with daily pill-taking. Can you give the shot to yourself? — C.E.

A monthly shot of medroxyprogesterone and estradiol is a reliable method for birth control. Both are female hormones. Presently, the shot is given in a doctor’s office, but there are plans to make it a self-administered shot.

There are other nonpill contraceptive techniques. There is a hormone patch worn for three weeks and removed for one week that is a dependable contraceptive.

Vaginal rings are another effective method for birth control. The rings are small and flexible. They are inserted into the vagina for three weeks and then taken out for one week. The ring is not painful and does not interfere with sexual relations.

DEAR DR. DONOHUE: I have heard that you can coax worms out of the stomach and intestine by holding food in front of your mouth. The worms are attracted to the food and leave your body. True or false? — B.M.

False. Maybe that was an approved treatment in mankind’s early days. If it was, intestinal worms have learned to ignore the temptation. You can hold food in front of the mouth for months at a time, and no self-respecting worm will be duped into exiting the body.

Frankly, the picture of worms crawling out of the mouth sickens me.

DEAR DR. DONOHUE: I am a 78-year-old male who recently received a chest X-ray report that said: “Minimal to moderate perihilar fibrosis.” Will you please explain what that means?

The hilum is the place where the breathing tubes enter the lungs to deliver oxygen and to cart away carbon dioxide. There is a right and a left hilum, and they are located at about midchest level.

“Perihilar” refers to the region around the hilum. “Fibrosis” indicates scarring.

Nearly every 78-year-old would show minimal to moderate perihilar fibrosis. No treatment is needed. You can dismiss this report.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. 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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