DEAR DR. DONOHUE: I was recently diagnosed with lupus. My medical dictionary doesn’t give me answers to my questions. Could you address this illness? My joints are always painful. – S.M.

ANSWER: Although the cause of lupus has not been identified, evidence points to the immune system coupled with hormones and genes as being integral to its onset, which is usually between the ages of 16 and 55.

Lupus erythematosus, its official name, is remotely related to rheumatoid arthritis. Both target joints. Lupus, however, affects many other organs: skin, lungs, heart, kidneys, red and white blood cells, the brain and nerves.

Signs and symptoms correspond to which organs are involved. Frequently a red rash appears on the cheeks, and it crosses the bridge of the nose to connect the cheek rashes. It looks something like the silhouette of a butterfly. Hair can thin, and bald patches can appear on the scalp. The kidneys might fail. Red blood cell numbers drop, and that produces anemia. White blood cells also take a dip that leaves the person vulnerable to infections. Fever and fatigue engulf patients. Of course, joints are painful and often swollen.

Strange antibodies, products of the immune system, are found in the blood, and they serve as lab markers of the disease.

Serious as the diagnosis of lupus is, modern treatment can generally control it and allow patients a long and active life.

Many lupus patients must protect themselves from prolonged exposure to sunlight, since it can worsen symptoms.

Anti-inflammatory drugs such as indomethacin are prescribed for mild involvement. For others, hydroxychloroquine or prednisone can often control symptoms.

Readers who would like more information on lupus (and rheumatoid arthritis) can order the pamphlet on those illnesses by writing: Dr. Donohue – No. 301, 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: I have a diverticulum in my esophagus. I wonder how common this is. – R.B.

ANSWER: Not terribly common – about 1 percent of the population have one. If, however, you take 1 percent of the population of North America, you come up with a sizeable number of people.

The diverticulum is a pouch formed by the protrusion of the lining of the upper esophagus through its muscular wall. It looks like a small balloon.

The pouch traps food that is later disgorged and often makes its way back into the mouth. As a result, breath smells bad. The pouch can interfere with swallowing.

If the diverticulum is small and not kicking up a fuss, it can be left alone. If it is large and presents problems, a surgeon can correct the situation with scalpel and sutures.

The official name of this anatomic oddity is Zenker’s diverticulum. The diagnosis is often made by having a patient swallow barium to outline the pouch on X-rays.

DEAR DR. DONOHUE: Why are flu shots and pneumonia shots given in the back of the hand? – J.H.

ANSWER: What? The back of the hand is not the usually recommended place to inject flu or pneumonia vaccines.

The flu shot should be given into a muscle, and the muscle most often chosen is the large one that caps the shoulder and upper arm.

The pneumonia shot can be given either under the skin or into a muscle. The spot chosen is often the same muscle used for a flu shot but on the other side of the body.

Injecting these shots into the back of the hand is quite strange.

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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