DEAR DR. DONOHUE: I started having skipped heartbeats and severe chest pain while working in the yard. It was so bad, it took me to the ground. I had an ECG that was slightly suspicious. They made me come back the next day, and the ECG showed abnormal. I have never gotten an answer, even after spending $3,500 of insurance money. I also have a hard time breathing, often at night. I wonder if you think I should investigate this further – or might it be nothing to worry about? – N.Y.

You need to investigate this further, and you need to do it right away.

The chest pain you describe, which comes on when you garden, sounds suspiciously like angina. Angina is chest pain that comes from a partial blockage of arteries that deliver blood to the heart muscle. It usually appears during activity and usually disappears upon resting. It is something that cannot be ignored. It is often a harbinger of a heart attack.

Your skipped beats are most likely premature ventricular contractions — PVCs. Everyone has a few PVCs, and ordinarily they are not a sign of trouble. However, people who have blocked heart arteries and PVCs are in a danger zone. In this situation, PVCs can be a prelude to abnormal heart rhythms — rhythms so abnormal that they can prove fatal.

Finally, your shortness of breath is another disturbing symptom. It can indicate that your heart beats so feebly that blood backs up from the heart to the lungs. That condition is congestive heart failure. It frequently is worse during the night. When a person lies down, fluid in body tissues returns to the circulation and overloads it. A weak heart cannot cope with the extra fluid. The result is gasping for air during the night.

I don’t know what happened to that $3,500. I believe, however, that you should not waste time in obtaining another opinion.

DEAR DR. DONOHUE: Last summer we had a scare. After being bitten by an insect, our 3-year-old’s face became swollen, and he sounded like he was having a hard time breathing. We rushed him to the emergency room, and they treated him for an allergic reaction. They said he was never in any danger of dying, but we are not looking forward to a repeat. What should we do? – D.T.

You need a consultation with an allergist. It’s nice to know that the boy had a reaction that was not life-threatening, but he still had a severe reaction. That can be a warning of worse things to come.

I believe you need to keep on hand a kit that contains emergency drugs to promptly put an end to a severe allergic reaction. EpiPen, EpiPen Jr. and Ana-Kit are three such kits. Not only do you need to have one of these kits handy, but you must learn how to use it. You do not want to try reading directions while a child is in the throes of an allergic reaction.

Don’t delay. A reaction of this magnitude is not something to be taken lightly.

The allergist might advise having the child desensitized to insect stings. That is another step I would take quickly. The season for stinging insects is here in some places and around the corner in others.

This has nothing to do with your question, but I would like to add a piece of information that often goes unknown. Young children are not the most likely group to have a severe reaction from an insect bite. The truth is that the severity of reaction to insect bites increases with age.

DEAR DR. DONOHUE: I cannot tolerate chocolate. I have found a delicious substitute in carob. I think it is a herb. Is it harmful or beneficial? – M.D.

The pods that grow on certain Mediterranean evergreens furnish the beans from which carob comes. It’s a very acceptable substitute for chocolate. Its only drawback is the calories it contains — about the same as chocolate. If you like it and can afford the calories, go for it.

DEAR DR. DONOHUE: I have just been diagnosed as having shingles. I knew it because I had shingles 29 years ago and recognized the symptoms. My current doctor insists that I could not have had shingles earlier because one occurrence gives lifetime immunity. Is that correct?

I also have been given conflicting information about whether shingles is contagious. Is it? – C.G.

Shingles is the chickenpox virus that lives in nerve cells once a person comes down with chickenpox. Almost every adult has had chickenpox or has had an infection with the chickenpox virus without coming down with the typical disease. Later in life, when the body’s immune system has a temporary shutdown, the chickenpox virus wakes up and travels down the nerve to the skin to produce the typical rash and pain of shingles. It’s possible to have repeat episodes. The virus stays with us until death.

When the shingles rash is in the early, blisterlike stage, live virus is present in the blister fluid. Anyone who never had chickenpox could be infected from the blister fluid. That person does not come down with shingles but comes down with chickenpox. This threat almost disappears when the rash dries and crusts. The possibility of transmission still exists, but it happens infrequently.

The shingles story is told in the shingles report. Readers can obtain a copy by writing: Dr. Donohue — No. 28, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 and the recipient’s printed name and address. Please allow 4-6 weeks for delivery.

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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