DEAR DR. DONOHUE: My daughter is a freshman in college, and she lives in a large dormitory. There has been an outbreak of meningitis in her dorm. Everyone has been put on medicine, and they have been advised to get a meningitis vaccination. We are not familiar with all this and would appreciate anything you have to say. – N.R.

ANSWER: The meninges are three membranes that cover the brain and spinal cord. Meningitis is an infection of those meninges. Because of their close proximity to the brain, meningitis is a potentially dangerous infection that can be deadly.

There are a variety of bacteria and viruses that cause meningitis, but the most common in situations like your daughter’s is meningococcal (men-IN-go-KOCK-al) meningitis, the kind caused by the meningococcus (men-IN-go-KOCK-us) germ.

The usual story of its spread entails the coming together of people from distant parts of the country, such as military recruits or college students. Some of those recruits or students carry the germ in their throats or noses without being sick. When they congregate with people never before exposed to the germ, the newly exposed can come down with meningitis.

Fever, headache and stiff neck are classic symptoms. Early detection and treatment can usually pull people through the infection without their suffering brain damage or death.

When an outbreak occurs, all the exposed individuals are given antibiotics to ward off infection.

Public health officials recommend that all college freshman be given the meningococcal vaccine. It is best given before they arrive at college, for it takes two weeks for the body to gear up its defenses against the germ. Encourage your daughter to take the medicine and to get the vaccine.

DEAR DR. DONOHUE: Is cod liver oil good for arthritis? I have heard that it is. The oil is supposed to lubricate joints. Would I be in any danger from taking it? — Q.P.

ANSWER: I have heard of cod liver oil being used for one kind of arthritis – rheumatoid arthritis. Omega-3 fatty acids in the oil lessen joint inflammation. It doesn’t really lubricate the joints.

Keep an eye on the amount of vitamins A and D in the oil so you don’t surpass the recommended daily doses for those vitamins. Cod liver oil has a good supply of both. Other than an overdose of those vitamins, the oil won’t put you in any danger. The adequate daily dose of vitamin D for adults up to age 50 is 200 IU; for ages 51-70, 400 IU; and for those over 70, 600 IU. The recommended daily allowance of vitamin A for adult men is 900 micrograms, and for adult women, 700 micrograms.

You can try it. There is not, however, enough evidence to urge people with rheumatoid arthritis to take it.

DEAR DR. DONOHUE: I am an active, healthy, 34-year-old male, and I have a lump in the area near my left nipple. It doesn’t hurt, even when I press on it. I think I might be getting overwrought about this. It can’t be cancer, can it? Do men get breast cancer? – T.T.

ANSWER: Men can and do get breast cancer, but not in the same numbers as women do. For every man who comes down with breast cancer, 100 women will have it.

Most male breast cancer begins as a painless lump under a nipple. The lump is generally hard and difficult to push around. It feels like it is anchored in one place.

The average age for men to have breast cancer is 68.

Your circumstances in many respects argue against cancer, but this is a matter you should not take into your own hands. Every man with a breast lump should see his doctor. If the doctor, who is experienced in feeling such lumps, has any doubt about the possibility of cancer, then a mammogram or a biopsy of the lump can lay the issue to rest.

DEAR DR. DONOHUE: I am 53 and have flat, wide feet and the start of a bunion. My wife insists that going barefoot – something I love to do – is bad for my feet. I say hogwash. Who is correct? – J.A.

ANSWER: Going barefoot is not bad for your feet. It won’t make them any flatter, and it won’t make a budding bunion bloom.

DEAR DR. DONOHUE: My mother is in her 90s. She has been experiencing swallowing problems. After an endoscopy exam and a barium swallow that revealed dysphagia, the doctor advised her to eat slowly, to take small bites and to sip water. I never heard of dysphagia. Could you tell me what caused it, and do you have any further advice? I have enclosed her reports. – A.P.

ANSWER: Words that begin with “dys” denote trouble or difficulty. “Phagia” is taken from the Greek word for eating. Dysphagia is difficulty swallowing, something you and your mother knew she had before she went for the test.

A barium swallow is an X-ray procedure where many pictures are taken after a patient swallows a gulp of barium, a substance that the radiologist can clearly see as a white mass on X-rays. The entire swallowing process can be seen as it progresses from the upper throat down to the stomach. The X-rays did reveal a bit of a hang-up in the throat and a problem with contractions of the esophagus’s muscles.

The doctor inspected her esophagus with a scope and found no serious problems, such as tumors.

A third test might help your mother. It is called manometry, and it records the pressure of esophageal contractions and how well the esophageal sphincter performs. The sphincter is a sturdy muscle that keeps the lowermost portion of the esophagus closed until food is swallowed.

Achalasia (AWK-uh-LAY-zhuh) is a condition that consists of weak esophageal muscle contractions and too-strong, too-constant contraction of the sphincter. Achalasia is a condition in which dysphagia is a prominent symptom. Perhaps it is you mother’s trouble. Medicines such as Isordil relax the sphincter muscle. Dilating the muscle with balloons or injecting it with Botox, a medicine that eases the tightly contracted sphincter, can help.

Candidly, I’m only guessing. Her doctor can resolve the achalasia issue.

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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