DEAR DR. DONOHUE: My 21-year-old granddaughter was diagnosed with endometriosis four years ago. She is in constant pain, making it impossible for her to work or attend college. I read your column every day and hope you can recommend something for her. – H.M.

The endometrium is the lining of the uterus. Each month, on cue from the cyclic production of female hormones, the endometrium grows to provide a home for a fertilized egg. If no egg is fertilized, then the endometrium is shed. That is a menstrual period.

Some women have endometrium in locations other than the uterus. Pieces can lie on the ovary, on or in the fallopian tubes, on pelvic ligaments or even in such distant places as the lungs and rectum. This transplanted endometrium responds to hormones exactly as it would if it were in the uterus. It, however, cannot be shed, and that causes pain. It might also cause infertility and painful sexual relations.

Proof positive that endometriosis is responsible for pain is obtained by seeing the displaced endometrial tissue with a laparoscope, a viewing instrument that can be introduced into the pelvis.

For some women with mild pain, drugs such as Advil, Motrin or Nuprin can bring relief. For other women, birth control pills create an environment that causes the endometrial tissues to shrivel. Other women find a remedy in danazol, a male hormone that counters the action of female hormones. Another treatment employs leuprolide, another hormone that slows the production of female hormones. Surgical removal of transplanted endometrial tissue can put a halt to its pain.

Your granddaughter’s case is an extreme one. She should contact the Endometriosis Association. Its Web site is, and its phone number is 1-414-355-2200. The association can provide her with up-to-date information on available treatment.

Readers who would like more information on this somewhat common problem can order the pamphlet on this subject by writing: Dr. Donohue – No. 1105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I wish to know all I can about rosacea. I have just started using MetroGel for it. – V.R.

Rosacea (row-ZAY-shuh) begins as a reddening of the tip of the nose or the cheeks. Less frequently, it is found on the chin or forehead. The skin reddening is followed by the emergence of a tangle of dilated, small blood vessels with the appearance of a spider’s web. The next stage is an outbreak of pimples on the involved skin. Look at former President Clinton’s nose. He has rosacea. So do 14 million other North Americans.

The medicine you mention, MetroGel, can often keep the process in check and can sometimes reverse it. Azelaic cream, an acne medicine, is another commonly prescribed treatment. The oral tetracycline drug doxycycline is an antibiotic that can rescue people from the throes of rosacea.

Don’t drink hot beverages or eat spicy foods. They worsen rosacea. So does sunlight.

Let me introduce you the National Rosacea Society. It is prepared to send you all the information you ever wanted on this condition. Call the society at 1-888-NO-BLUSH.

DEAR DR. DONOHUE: I was disappointed in your article on chickenpox. You did not mention encephalitis, one of its complications. My 11-year-old daughter nearly died of it in 1978. Mentioning this will alert parents to be on the lookout for it. – P.S.

Encephalitis – brain inflammation – can be a consequence of chickenpox infection. Thankfully, it happens to only a very few. As many as 20 percent of children who develop encephalitis can die, and another 15 percent are left with permanent disabilities.

The chickenpox vaccine protects children from getting chickenpox and its complications. Parents should make sure their children get the vaccine – a proactive step to prevent encephalitis.

DEAR DR. DONOHUE: My wife is 67 years old. In the past six months she has lost much weight and looks gaunt. She says she feels OK, but her appetite is poor. I want her to see a doctor, but she refuses. I think something is wrong. Perhaps she’ll listen to you. What do you think? – R.C.

ANSWER: I am with you. I think something is terribly wrong.

Loss of appetite and unintentional loss of weight are significant warnings that all is not well. The list of causes for those symptoms is large. Of course, the worst is cancer. Delay in getting a cancer diagnosis can turn a curable illness into an incurable one.

A large number of illnesses called malabsorption syndromes are as common as cancer, but most respond to treatment. In these illnesses, the digestive tract cannot absorb nutrients from food as it passes through the tract. That’s the reason for weight loss, which is often profound. Almost all of them can be treated successfully.

Mrs. R.C., listen to your husband and me. See a doctor quickly.

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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