DEAR DR. DONOHUE: My mother is losing her sight due to macular degeneration. I need to know if and when she will be completely blind. Secondly, is this inherited? Am I destined to have it? – K.R.

ANSWER:
The macula, which is no larger than a printed “o,” is the most sensitive part of the retina. The retina is the backmost eye layer, and it transmits vision to the brain. The macula provides clear, central vision, the kind needed to read a paper, sew and watch television.

The first inkling of macular degeneration might be a slight smudge in the center of the visual field. When looking at a paper with intersecting vertical and horizontal lines, lines in the middle of the paper look wavy. It can progress to the point where there is a large blind spot in the middle of the visual field. How fast or how extensive it will progress is impossible to predict. Vision off to the side is retained, so most patients are never completely blind.

A little stir of hope in the macular degeneration story is the finding that a combination of beta carotene, vitamin C, vitamin E, zinc and copper might slow its progression. For me to infer that this is a major breakthrough would be unconscionably cruel. It’s a somewhat feeble attempt to stem the advance of macular degeneration, and how much it helps an individual is another matter that cannot be predetermined. I deliberately omitted the doses of those nutrients. They are higher than recommended doses. People should have a heart-to-heart talk with their eye doctors before beginning such a program.

The question of inheritance is not clear-cut. If one or both parents have macular degeneration, their children are genetically predisposed to coming down with it, but that is a far cry from saying that all children of such parents will have the same problem.

The macular degeneration pamphlet provides a more detailed exposition than what is given here. Readers who would like a copy of it can order one by writing: Dr. Donohue – No. 701, 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: My doctor has been monitoring my high sed rate, which now runs at 11. What causes a high sed rate? How can I help it come down? I am managing polymyalgia rheumatica with 2 mg of prednisone a day. – J.B.

ANSWER:
The sed rate — aka sedimentation rate, or erythrocyte (red blood cell) sedimentation rate – is a simple test where a small amount of blood is put into a calibrated tube. The distance the red blood cells fall from the top of the tube in one hour constitutes the sed rate. Elevated sed rates are an indication of inflammation somewhere in the body.

A normal sed rate for women is 20 or less; for men, 15 or less. Yours is admirable.

Your last sentence cleared matters for me. You have PMR – polymyalgia rheumatica. Pain and stiffness of the hip and shoulders are trademark symptoms of it. There is inflammation in muscle tendons and in bursa, and the inflammation causes an extraordinary rise in the sedimentation rate. The illness and the sed rate respond rapidly to treatment with the cortisone drug prednisone. When the sed rate returns to normal, then the dose of prednisone can be lowered. You are currently taking a very modest dose.

Are your symptoms gone? They should be, for your sed rate shows great improvement in body inflammation.

I must mention one more fact. Temporal arteritis – artery inflammation, not arthritis – can sometimes go hand in hand with polymyalgia rheumatica. The danger in temporal arteritis lies in the possibility of it affecting eye arteries and leading to blindness. Fortunately, it too responds well to prednisone.

DEAR DR. DONOHUE: I was brought up not to drink any liquids while eating in order not to dilute digestive juices. Is this reasonable? I’m not sure if I should forbid my children to drink with their meals. – S.S.

ANSWER:
Liquids do not interfere with the stomach’s digestion of foods.

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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