DEAR DR. DONOHUE: My doctor just shocked me by telling me I have hepatitis C. I don’t do drugs. I have been faithful to my wife. How could I have gotten this? Can I pass it to my wife and children? What’s the treatment? – B.V.

Ready answers to people’s questions about hepatitis C are not always available. One avenue of transmission is sharing needles in drug injections. Some people became infected through blood transfusions before there was a test to detect this virus. Health care workers can become infected if they get stuck by needles used on hepatitis C patients. Sexual transmission, while possible, is quite rare, and transmission to household members is even rarer. You might never discover how you came down with this virus.

Most infections are discovered because a person happens to have a battery of blood tests done and the liver enzymes are found to be elevated. I suspect that’s how your diagnosis was made.

In up to 80 percent of patients, the infection becomes chronic, as the virus remains alive in liver cells. Hardly anyone has symptoms during this latent infection. However, between 2 percent and 20 percent of the chronically infected will develop liver cirrhosis 20 to 30 years after initial infection.

That presents a dilemma. Should a person who has no symptoms and only mildly elevated liver enzyme levels be treated or be left alone? The decision to treat or not to treat is made based on the blood level of hepatitis C virus and on the present state of the liver. Often that can be assessed only by having a liver biopsy and examining the liver tissue microscopically.

Treatment involves weekly infusions of the drug interferon alpha and the daily oral medicine ribavirin.

All the hepatitis infections – A, B and C – are explained in the hepatitis pamphlet. Readers can obtain a copy by writing: Dr. Donohue – No. 503, 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 am currently under treatment for something called lichen sclerosus. I forgot to ask the doctor if this is a cancer or precancer. Is it? Any information you can give would be appreciated. – T.N.

Lichen sclerosus sounds like a rare condition. It is not. It also sounds like it should have something to do with the lichen family of fungi that grows on rocks and trees. It does not.

It usually begins as raised, white patches of skin that often contain black plugs. The patches are sometimes surrounded by a red or purple halo. Itching can be severe.

It occurs in both sexes, and it frequently involves genital skin. It can also be found on the chest, upper back and even in the mouth.

In the early 1900s lichen sclerosus was considered to be closely associated with the development of skin cancer. However, in only about 5 percent of people with lichen sclerosus does it precede squamous cell cancer of the skin, particularly the genital skin.

Powerful cortisone ointments and creams can most often keep it under control. They are applied twice a day at first and then tapered to once or twice weekly. That minimizes the undesirable side effects of cortisone. Lichen sclerosus can come back, however.

DEAR DR. DONOHUE: I take Tums as a calcium supplement. Since starting it, I have noticed that my stools are loose. I don’t actually have diarrhea, just very soft stools. Is that an effect of Tums? – C.F.

Soft stools are not a usual consequence of using Tums.

Tums is a preparation of calcium carbonate. Calcium carbonate can constipate some users.

Take yourself off Tums for a week and see if your stools revert to normal. If they do, then you can implicate Tums. If they don’t, then a change in stool consistency warrants a visit to the family doctor.

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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