DEAR DR. DONOHUE: My wife has abdominal ascites so severe that it has broken open two scars on her abdomen. I have read on the Internet that a procedure called paracentesis can remove the fluid quickly. Doctors to whom I have brought this up ignore me when I ask them about this. What would you do? – E.K.

The first thing I would do is to try to discover why she has ascites (uh-SITE-ease) – fluid in the abdomen. If it comes from heart failure, then treatment is directed to getting the heart to beat more vigorously. If that can be accomplished, the ascites leaves. Ascites can also stem from infections, cancer or pancreas problems.

Frequently the cause of ascites is a liver that has shrunken and hardened – cirrhosis. Everyone jumps to the conclusion that cirrhosis is always from alcohol abuse, but that simply is not true. There are many other causes of it.

The rock-hard, shriveled liver makes it impossible for blood to get back to the heart. Pressure in veins rises, and the rise causes fluid to leak out of blood vessels and pool in the abdomen. The amount of fluid can be so great that it makes people look like they have swallowed a whole watermelon.

Often the fluid can be drained with medicines. Water pills, especially spironolactone, can frequently stimulate the kidneys to produce more urine and thereby get rid of the unwanted fluid. Infusing proteins into a vein helps mobilize the fluid, since proteins draw fluid from the abdominal cavity. Shunning the use of anti-inflammatory medicines (aspirin, Advil, Motrin, Aleve and the many others) also adds to the effort of getting rid of ascites.

Paracentesis (PARE-uh-sin-TEE-suss) is draining the fluid with a tube that has been placed within the abdomen through a needle puncture site. It gets rid of the fluid immediately. The problem is it almost always returns. However, in extreme cases, when the swollen abdomen causes discomfort or interferes with normal functions, the procedure is justified.

DEAR DR. DONOHUE: My 15-year-old has a mild case of acne, but to hear him tell it he is greatly disfigured by it. I don’t think he needs to see a doctor, but I would like to start him on a program so he knows that I am not fluffing this off. How do I go about it? – F.S.

Acne is an inflammation of skin oil glands. During puberty, the increased supply of sex hormones causes oil glands to enlarge and produce large volumes of oil. The oil glands’ ducts become plugged. Bacteria that feast on oil multiply within the gland and irritate it. That is the birth of a pimple.

If your son is scrubbing his face raw, tell him to stop. The skin should be kept clean with two or three daily washings with mild soap. Scrubbing adds to the irritation of acne.

On the counters of your local drugstore you will find many gels or lotions that have benzoyl peroxide. Use it strictly by the instructions on the package. It unplugs plugged glands and controls bacterial growth. Tell the boy that it does not treat pimples currently present. It prevents formation of new ones, so he should have patience and wait about six to eight weeks before declaring the treatment a failure.

He does not have to alter his diet. Chocolate and greasy foods were once believed to contribute to acne. They do not. However, if a person can identify a particular food that leads to an acne breakout, then that food ought to be avoided.

If no progress is made, then a visit to the doctor for prescription medicines is unavoidable.

DEAR DR. DONOHUE: Who is right, my husband or I? He says more women die of lung cancer than of breast cancer. I say breast cancer is women’s No. 1 killer. We need a referee. – C.B.

Lung cancer causes more female deaths than does breast cancer because breast cancer is usually detected earlier than lung cancer. Early treatment of breast cancer can often bring a complete cure.

Women get breast cancer more often than lung cancer. Women’s No. 1 killer, however, is heart disease.

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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