DEAR DR. DONOHUE: Please tell me all about emphysema. How do you get it? What can you do for it? Does house dust, mice or cats cause it? – Y.Z.

ANSWER: Emphysema causes the lungs to lose their normal elasticity. Emphysematous lungs cannot expand or contract normally when a person breathes in and out. Furthermore, the delicate lung sacs, the alveoli, are destroyed or damaged. Without functioning alveoli, oxygen cannot pass into the blood, nor can carbon dioxide – one of the body’s waste products – leave the blood.

The result is what you would expect. Emphysema patients struggle to get enough air. They cannot move about freely since they are so short of breath. The loss of lung elasticity makes these people have barrel chests.

Cigarettes are responsible for the lion’s share of emphysema, but they are not the only cause. A condition known as alpha-1 antitrypsin deficiency is an inherited emphysema cause. Alpha-1 antitrypsin is an enzyme found in the lungs, and it regulates lung cleansing. Without the enzyme, the cleansing mechanism goes wild, lays waste to lung tissue and leads to emphysema. Chronic exposure to some chemicals is another possible cause. Air pollution contributes to it.

House dust can precipitate asthma attacks, but it is not directly implicated in causing emphysema. Neither are mice and cats.

Once emphysema occurs, the damage is done and cannot be undone. However, emphysema can be treated. Medicines and supplemental oxygen alleviate many emphysema symptoms. Pulmonary rehabilitation is an often-underemphasized and neglected treatment. Therapists teach patients what exercises can keep them active and how to go about performing the exercises. They also teach breathing techniques that alleviate symptoms. If emphysema patients are not on such a program, they ought to ask their doctors how they can get on one.

DEAR DR. DONOHUE: I have a 50-year-old neighbor lady who has rheumatoid arthritis. Is there anything she can take for its pain? Is heat better than ice? – K.V.

ANSWER: The medical community owes your neighbor an apology. No one should have to contend with the pain of rheumatoid arthritis without some treatment. The number of medicines for this disease has multiplied many times in just the past few years.

Tylenol and aspirin can control minor pain symptoms. For more intense pain, the painkilling and anti-inflammatory drugs are useful. Voltaren, Naprosyn, Relafen, Celebrex, Vioxx and Bextra are the names of a few of these drugs.

Other drugs, called disease-modifying anti-rheumatic drugs (DMARDs), are often successful in stopping the progression of joint destruction. Rheumatrex, Arava, Enbrel and Remicade are examples.

You or your neighbor can call the local hospital or the local county medical society for the name of a rheumatologist. Rheumatologists are specialists in arthritis and all forms of joint disease. Your neighbor is missing out on effective treatment.

The heat-or-cold question is a perennial one. Heat usually limbers swollen joints and reduces pain. Some people, however, get better results with ice. This is a choice that can be made only through personal experimentation.

DEAR DR. DONOHUE: My lower eyelid is pulling away from the eye and exposing the inner red surface of the lid. What do you suggest I do? – J.H.

ANSWER: Your problem has a name – ectropion – and it’s not a rarity. With age, the muscles of the eyelid become limp. The edge of the lower lid turns downward. Many complications can arise. One is a drying of the eye, since the lid cannot keep tears from dripping down the cheek. Without a film of tears, the eye itself is subject to irritation.

I suggest you see an eye doctor without delay. Lubricating ointments help keep the eye moist, but the ultimate cure for ectropion is surgery to restore the lid to its normal position.

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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