DEAR DR. DONOHUE: My son, who is in his mid-30s, has lost confidence in himself. He has lost the desire to find a job because he says companies prefer younger people. I think he is depressed. He sometime misses meals and talks of suicide.

He is undergoing therapy but refuses to take antidepressant medicine because he has read that it becomes habitual and causes side effects like impotence. Please give your recommendations. – R.M.

ANSWER:
There is no doubt about your son being in the grip of a severe depression. Talk therapy is useful, and it becomes more useful when use in combination with medicine. Antidepressant medicines restore normal brain chemistry. An imbalance of the brain’s chemical messengers contributes greatly to depression.

Impotence is rarely a side effect of antidepressants. Your son must realize that these medicines do have an important side effect – the lifting of an incapacitating depression.

DEAR DR. DONOHUE: I am 70 and have vitiligo. When I was 15, white patches appeared on my hands. Since then, it has covered my body. Trying to handle remarks and stares is disheartening. None of my children has it. What is its cause? Is my body lacking some certain vital thing? – M.D.

ANSWER:
The skin of a person with vitiligo lacks melanocytes, special skin cells that impart skin color. Patches of white skin herald its appearance. Sometimes those patches merge to cover most of the body. Vitiligo on the scalp gives rise to prematurely white hair.

The immune system is blamed for the shortfall of melanocytes. For some reason that is unexplained, it singles out those cells for an attack that kills them.

You mention your children as not having the condition. In only 5 percent of patients is heredity a factor. Said in another way, vitiligo has no inheritance basis 95 percent of the time.

There are treatments. Cortisone creams can sometimes coax color back into small patches of vitiligo. Psoralen drugs combined with ultraviolet light treatment are often successful in repigmenting larger areas of skin. Your involvement is extreme and, fortunately, not too common.

Cosmetics can sometimes hide this skin affliction.

In a small number of vitiligo patients, another illness is in the background. Adrenal gland failure, thyroid gland malfunction and pernicious anemia are examples of those sometimes-concomitant illnesses.

You are not too old and others are not too young to avail themselves of the service provided by the National Vitiligo Foundation, 611 S. Fleishel Ave., Tyler, TX 75701. The foundation’s Web site is www.nvfi.org. Contact it and receive the support and information it provides to so many vitiligo patients.

DEAR DR. DONOHUE: Recently I had vertebroplasty to correct a crushed vertebra. Please explain the mechanics of this procedure. – R.S.

ANSWER:
How did you crush your vertebra (backbone)? Women are the usual victims, and for them it’s usually due to osteoporosis. That is called a compression fracture, and more than 700,000 people on this continent – mostly women – suffer such fractures annually.

In performing a vertebroplasty, a doctor inserts a slightly larger-than-normal needle into the disrupted backbone and injects bone cement into it. Bone cement has the consistency of toothpaste, so the needle must have an adequate bore. The cement hardens rapidly. Often a patient comes in for treatment with intolerable back pain and leaves the same day smiling and free of pain.

Another similar procedure is kyphoplasty. Here, a needle with a slightly larger bore is directed into the collapsed backbone. When it is centered in the correct position, the doctor opens a balloonlike device contained in the needle. The device creates a cavity into which bone cement is injected. The cement not only stabilizes the bone but restores its normal height.

Not everyone with a broken backbone is a candidate for either procedure. In addition, these procedures are not available throughout North America.

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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