DEAR DR. DONOHUE: My son, age 27, has vitiligo. He has large white spots on his hands, arms and legs. Information on the illness suggests it might be immune-system-related, and that sounds dire. I have lupus, another immune disease. I worry that he might have inherited the problem from me. – G.B.

Melanin, a pigment inside special cells called melanocytes, imparts color to the skin. Dark skin has many melanocytes. Sunlight stimulates proliferation of melanocytes, and the effect is a tan.

With vitiligo, there is a loss of melanocytes and melanin, and the skin has patches of whiteness. When the process occurs on the scalp, hair turns white.

Vitiligo patches can occur anywhere, but they are most frequently found on the face, neck, under the arms, on the genitalia, around the mouth and nose and on the backs of the hands.

The depigmentation of vitiligo is believed to be caused by the immune system. T cells – immune system warrior cells – infiltrate the skin and attack melanocytes. This kind of immune illness does not leave people vulnerable to infections, as does the immune disturbance that characterizes AIDS.

In some vitiligo patients, immune-related diseases pop up. Thyroid and adrenal gland diseases, pernicious anemia and diabetes are examples. Most people with vitiligo do not have any of these associated illnesses.

Your lupus has no bearing on your son’s vitiligo.

There are many treatments for vitiligo. If a person is not bothered by it, then it can be left alone. Rather than give you a list of vitiligo therapies, let me direct you to the National Vitiligo Foundation at 611 South Fleishel Ave., Tyler, TX 75701. Its Web site is The foundation will provide you and your son with the latest information on causes and treatment of this not-uncommon skin problem.

DEAR DR. DONOHUE: Could you tell me if it is possible for one to give him- or herself the Heimlich maneuver? If so, how? – W.L.

All of us owe a huge debt of gratitude to Dr. Henry Heimlich (HIME-lick), a Cincinnati surgeon who devised a simple maneuver that can save the life of a person choking on food or any foreign object trapped in the airway.

Seeing a person struggling for air and unable to inhale, the rescuer wraps the arms around the choking person’s abdomen just above the navel. He or she makes a fist with one hand, puts that hand next to the abdomen and grasps the fist with the other hand. Then the rescuer makes a forceful, rapid thrust inwardly and upwardly. The thrust generates enough pressure to expel the airway obstruction.

The Heimlich maneuver can be done on oneself. Make a fist as done above, put it in the same place, bend over a hard surface like the back of a chair, and make the inward and upward thrust. The thrust can also be made using only the back of the chair without putting a fist between the abdomen and chair.

If this description is not clear, you’ll find many books in the public library that have drawings or pictures of how to perform the maneuver. You can also find instructions and illustrations at

DEAR DR. DONOHUE: I have a brother-in-law, age 50, who has manic-depression and is overweight. He takes lithium for the manic-depression but seems to be getting worse. My sister took him to a practitioner who said he has parasites – generations of them, and probably since he was a child — and this is the reason for all his medical ailments. My sister was also found to have a liver parasite. Both are on strict diets of only fruit until noon and then only vegetables. Both take colonic irrigations at the same time. Does any of this have any validity, especially when the claims are a cure for everything including manic-depression and cancer? – D.R.

You probably know already what my response will be. It’s a free country, and people are entitled to believe anything they want, but the chances of this treatment curing anything are as close to zero as anything can come. That’s my opinion. Your brother-in-law should not abandon the medicine he takes.

DEAR DR. DONOHUE: My 16-year-old granddaughter spent two weeks with my husband and me this past summer. She is a healthy, cheerful, active and delightful girl, but I suspect something is wrong with her. On more than one occasion when I passed the bathroom, I heard her throwing up. I asked if she was sick, and she brushed it off by smiling and saying “no.” Should I tell her mother about this? – C.R.

Your granddaughter has the earmarks of a serious eating disorder called bulimia, or bulimia nervosa. Young women around your granddaughter’s age indulge in eating binges where they gorge themselves with food. In order not to gain weight, they then force themselves to vomit or take large doses of laxatives or water pills.

Unlike anorexia, bulimia does not make its victims skeletally thin. Bulimia patients generally appear healthy and of normal weight.

Serious complications can arise from repeated vomiting or overuse of laxatives and water pills. The body’s acid-base balance is upset. Its finely tuned relationship between sodium and potassium is lost. Vomiting can cause tears in the esophagus, the swallowing tube. It can lead to tooth decay. Regurgitated material can drip into the lungs and produce a chemical pneumonia.

Yes, tell the girl’s mother what you heard. If the girl has bulimia, an eating-disorder expert needs to step in. The family doctor can give her mother a referral. Talk therapy and medicine rescue many from the grip of this illness.

I made bulimia sound like it is the exclusive domain of young women. It is not. Women or men of any age can be caught in this trap of binge-purge cycles.

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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