DEAR DR. DONOHUE: I would like to tell you my story, which begins with the dentist. He had to perform some routine dental work on me, and my gums started bleeding. He applied firm pressure for 10 minutes, and the bleeding stopped. That evening I began to bleed again, and the amount was alarming. I went to the ER and from there was admitted to the hospital with a diagnosis of idiopathic thrombocytopenic purpura. Will you please say something about this? I am on prednisone now. Do I stay on it for life? – M.O.

ANSWER: “Thrombocytes” is another name for blood platelets, the small blood cells that initiate a clot when a blood vessel breaks. Thrombocytopenia is a shortage of platelets.

A normal platelet count runs from 150,000 to 450,000. When the numbers drop, the skin often breaks out in bruises – purpura – from a minor bump or even without a provocation. Daily we break tiny vessels without knowing it because the platelets are so efficient in sealing off breaks.

The “idiopathic” of idiopathic thrombocytopenic purpura (ITP) indicates medicine’s ignorance of why this condition occurs. It is known, however, that the immune system begins to make antibodies against platelets, and the antibody-coated platelets are then destroyed by the spleen. What turns on the immune system is the missing piece of information. ITP is something that happens mostly to young women, another unexplained fact.

Treatment is initiated either when the platelet count drops to below 30,000 or when bleeding cannot be stopped. If the count is above 30,000 and there is no bleeding, then careful observation is the indicated treatment.

The treatment usually is prednisone, one of the cortisone drugs. When the platelet count rises to 100,000 (some use 50,000 as the goal), then the dose of prednisone is reduced. Sometimes the process relapses. For those with frequent relapses, removal of the spleen can often put an end to platelet destruction.

These remarks apply only to adult ITP. Childhood ITP is similar, but it has important variations.

DEAR DR. DONOHUE: I am a myocarditis patient. I spent two weeks in the hospital and was home at rest for a full month. I am back to work. I tire more quickly than I did before. Is this usual for someone who has suffered from myocarditis? – N.G.

ANSWER: Myocarditis is an inflammation of the heart muscle, and quite often its cause is a viral infection. Some people have such a mild infection that they never experience any symptoms. You, on the other hand, had a most serious infection. Inflamed heart muscle does not make a good pump for blood. A decrease in the heart’s blood output makes for fatigue. A marker for how well the heart is pumping is the ejection fraction. It indicates how much of the blood in the heart is pumped out of it with each beat. An ejection fraction of 55 percent is acceptable.

You probably had an echocardiogram when you were in the hospital. Ejection fractions can be obtained from the information obtained on those sound wave pictures of the heart. I am certain your ejection fraction was low.

Your heart must be pumping better now, or you would not have been allowed to go back to work, but your fatigue can still be traced to myocarditis. It can take six or more months for your heart to return to normal function. If you still are fatigued then, an ejection fraction will show if the heart has not fully recovered. Until then, don’t attempt to equal your pre-hospitalization output. If your employer doesn’t appreciate the seriousness of your illness, show him this.

DEAR DR. DONOHUE: How frequently should a woman douche? I was raised by my grandmother, and she instructed me to douche every week. I have done so from the time I started menstruating until now. Is this necessary? – F.S.

ANSWER: Unless specifically instructed by their doctors, women never need to douche. Douching removes the protective layer of mucus lining the vagina, and that can make a woman susceptible to infections. Nature provided women with a constant douche in the form of an imperceptible shedding of vaginal cells and mucus.

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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