DEAR DR. DONOHUE: I was diagnosed with sarcoidosis in January of this year. I really do not know much about this disease. Every two months I take a breathing test. The doctor says that I will have to go on steroids if things do not improve. I do not want to do this because of steroid side effects. What else can I do? – V.S.

ANSWER:
Sarcoidosis (SARE-coy-DOE-suss) is a mystery illness that is neither common nor rare. It’s somewhere in between.

Many people have it and do not have a single symptom. They need no treatment.

Since the lungs are the usual place where it turns up, symptoms, when they occur, are commonly a dry cough and shortness of breath. Breathing tests help determine the severity of the illness. Chest X-rays also help determine the extent of disease.

The lungs are not the only organs that can be involved. Eyes can be a target. When they are, bright lights are uncomfortable, and vision often blurs. Nerves and the spinal cord are other possible targets. Nervous system involvement brings on a host of symptoms. One of them is a paralysis of facial muscles. Painful, red lumps, most often on the shins, are another sign of sarcoidosis.

Biopsy proves the diagnosis. With a microscope, the pathologist sees granulomas. Granulomas are heaps of warrior cells that have died battling sarcoidosis’s unknown cause.

The cortisone drugs are the ones used for treatment. They can produce many unwanted side effects, but treatment is not usually lifelong, and the side effects go away when treatment stops.

Azathioprine, cyclophosphamide and methotrexate are other potential treatments. Many people have a spontaneous remission within two years of diagnosis without any treatment.

There is nothing you can do on your own to hasten a remission from this illness.

DEAR DR. DONOHUE: After having a Pap smear, my daughter-in-law has been diagnosed with ASCUS. I remember you writing about this before. Would you please repeat it? – M.J.

ANSWER:
ASCUS – atypical squamous cells of undetermined significance – is seen on many Pap smear reports. It’s the kind of report that leaves doctor and patient in limbo. It doesn’t say that a woman has cancer, but it doesn’t say she might not have it. Most woman who have an ASCUS report don’t have cancer.

One way to handle this dilemma is to wait four to six months and repeat the Pap smear. In that period of time, harmless atypical (abnormal but not too abnormal) cells revert to typical (normal).

Another approach is an immediate check of the cells to see if they contain HPV – human papillomavirus. If the cells have no HPV, the chances that they will become cancerous are slim – less than 1 percent. If the cells do contain HPV, the doctor usually performs a culdoscopic examination. A culdoscope is a viewing device with a magnifying lens that gives the doctor a clear view of any suspicious area. The doctor can biopsy that area for a microscopic examination of those cells. That answers the ASCUS question quickly.

DEAR DR. DONOHUE: My grandson has epididymitis (EP-ee-DID-uh-MY-tuss). He has a lot of pain, and pain pills and antibiotics have not helped. He has had this for seven or eight years. What is the cause? He is 34. – M.H.

ANSWER:
Seven or eight years? That’s most unusual.

The epididymis (EP-ee-DID-uh-muss) is a coiled tube that’s plastered to the testicle. Uncoiled it would stretch for 15 to 20 feet. It is very narrow. Its diameter is only 1 millimeter (0.04 inches). It serves as a storage bin for sperm, and it provides them with a haven where they can mature.

Acute epididymitis is an inflammation usually caused by a bacterium. The scrotal skin becomes red. The testicle itself is painful, and the man might also have abdominal pain with a fever and often with painful urination. Antibiotics and a testicle support usually resolve the symptoms in two days.

Some men have a chronic infection of the epididymis, but a seven to eight year infection is out of the ordinary. Your grandson needs to see a urologist. Surgery might be the answer for a cure.

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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