DEAR DR. DONOHUE: I have a friend who is about 30 and says she has emphysema. She does not and has never smoked. She does get a little short of breath when she walks with me through the mall. Isn’t this young to have emphysema, and doesn’t it happen only to smokers? – J.L.

ANSWER: In emphysema, the millions of delicate, tiny air sacs found in the lungs are in disarray. It is through those air sacs that the oxygen we inhale can pass into the blood to nourish and energize the entire body. One outstanding symptom of emphysema is breathlessness even on slight physical exertion. The emphysema patient is in a constant struggle for air. Cigarettes are the major cause of emphysema, but they are not the only cause.

An inherited form of emphysema is due to a missing enzyme. When any harmful material finds its way into the air sacs, a cleanup crew gets to work and scrubs the involved air sacs. The enzyme – alpha-1 antitrypsin, which is made in the liver – also rushes to the air sacs to stop the cleaning job before it injures the air sacs. A deficiency of that enzyme is the basis for the inherited form of emphysema – alpha-1 antitrypsin deficiency.

Emphysema is a common illness. Emphysema due to alpha-1 antitrypsin is relatively rare. However, when a nonsmoking young person comes down with emphysema, doctors’ antennas go up, and they begin the investigation for this condition.

There is therapy for antitrypsin deficiency. It consists of supplying the missing enzyme. The enzyme has to be given through an intravenous infusion.

In addition to lung damage, some affected people also suffer liver damage.

The last time I wrote about this, I received a letter from a young woman who took issue with me for emphasizing the rarity of antitrypsin deficiency. She had the illness and had been misdiagnosed for many years.

DEAR DR. DONOHUE: I am 76, and about three years ago I had carotid artery surgery to remove blockage in that artery. There was no problem with surgery. More recently I had surgery on the other carotid artery. Afterward, I couldn’t sign my name. I have weakness in my legs, but I walk, ride a stationary bike and use a treadmill. My legs remain weak. My doctor says it takes time. How much time do I need? – G.K

ANSWER: For readers: The right and left carotid arteries are large vessels in the neck that provide blood to the brain. Blockage of a carotid leads to a stroke.

If there was a temporary disruption of blood flow to the brain during surgery, as there often is, the weakness could be due to minor damage to the brain cells that control muscle action. The most rapid recovery from such an injury occurs during the first three months after it happened. For older people, the recovery can take six months or longer. From that point on, there is continued improvement for the next few years.

Weakness in both legs is an unusual result for a disruption of blood flow to the brain. Such a disruption affects one side of the body, not both. Maybe the weakness you now have comes from deconditioning, and recovery from that is a slow process.

You need to be in an exercise program supervised by physical therapists who can tailor the program to your specific needs.

You also need to seek the help of an occupational therapist. Occupational therapists help people master all the aspects of daily life, such as dressing, bathing and cooking. They can teach people how to use a variety of devices that make living livable.

DEAR DR. DONOHUE: Is burping normal, or does it always mean a digestion problem? In some countries it is a compliment to the cook. – T.K.

ANSWER: Burping seldom means a problem. It occurs when there is a sudden rush of air or food into the stomach. A burp decompresses the stomach. Only in unusual circumstances – heartburn, ulcers, asthma – is burping a sign of illness. Give me the names of those countries where burping is a compliment. I will send my brother, a professional burper, there as a goodwill ambassador.

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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