DEAR DR. DONOHUE: My husband has been treated for Parkinson’s disease for two years. A new doctor, a neurologist, has diagnosed him as having something called progressive supranuclear palsy. I am quite upset by this. I don’t understand the new diagnosis, and I feel we have lost valuable time with a wrong diagnosis. Have we? – L.L.

ANSWER: Progressive supranuclear palsy – PSP – lacks immediate recognition by the public. However, it is not an uncommon illness, and as more people are diagnosed with it, the more well-known it will become.

In many respects it looks like Parkinson’s disease. PSP patients often have the rigid muscles and jerky movements that Parkinson’s patients have. Like Parkinson’s patients, they tend to move slowly, and they appear to be clumsy. Unlike Parkinson’s patients, PSP patients rarely have a tremor. A big tip-off of PSP is an inability to look downward. With progression of the disease, the ability to look upward is also lost. PSP patients have a propensity to fall. Their faces are usually frozen into an expression of being constantly startled, with eyebrows upraised and eyes staring straight ahead.

Dudley Moore, the actor, comedian and musician, was a PSP patient, and his notoriety has helped PSP gain more press coverage.

I can understand your chagrin in learning that your husband went two years without a correct diagnosis, but that is often the case with PSP. He has not lost any ground by not having been diagnosed sooner. Medicines used for Parkinson’s disease are also used for PSP, but without as good a result.

More important than medicines for your husband is the input of an occupational therapist. These people are experts in outfitting patients with devices that help them cope with movement disorders and in educating patients and their families about how best to tackle the problems of daily life with an illness such as PSP.

Do contact the Society for Progressive Supranuclear Palsy at 1-800-457-4777. Its Web site is Canadians might have to dial 1-410-486-3330 to reach the society by phone. It provides valuable information for PSP patients.

DEAR DR. DONOHUE: I take Zocor to lower my cholesterol. It has done a good job for me. I was told I need to watch my liver enzymes. How do I do that, and what are the normal numbers for liver enzymes? – Z.K.

ANSWER: Zocor is a statin drug, a family of drugs that are quite effective in bringing down cholesterol numbers. The names of the other statin drugs are: Mevacor, Lipitor, Pravachol, Lescol and Crestor.

All have the potential to damage liver cells, small as that potential is. Damaged cells release enzymes into the blood. Enzymes speed up the many metabolic processes that take place in all body cells. Some enzymes are unique to a particular organ. The liver enzymes, AST and ALT, are examples. When their blood levels rise, the message is that the liver has suffered an injury.

Many laboratories set the upper limit of normal for AST and ALT at 35. Different labs might have different values. Normal values are almost always printed alongside test results.

You should not be involved in interpreting your liver tests. Your doctor is in charge of seeing to it that the tests are done and that they are normal. All you should have to do is present yourself to the lab according to the schedule given you.

DEAR DR. DONOHUE: My hair is coming out in handfuls. I am only 24. How can I tell if this is normal? – R.V.

ANSWER: A full head of hair has around 100,000 individual hairs. Of those 100,000, 90,000 are actively growing and should be firmly adherent to the scalp. The remaining 10,000 are in a resting phase, and between 50 and 100 of them fall out every day. You can do a daily hair count to see if you’re losing more than you should.

Often there is an accentuation of the normal daily loss brought on by physical or mental stress. Childbirth is an example. This accentuation is transient and begins about two or three months after the stressful event. This sort of hair loss is almost always replaced in time.

If you are in doubt, see your doctor, who can pretty well tell by examining your hair if resting or growing hair is being shed.

DEAR DR. DONOHUE: What makes body sodium levels fall? Twice in the past year I have been extremely weak and had to go to the emergency room. They did blood tests, and both times they told me my sodium was low. They also gave me an IV with sodium. What is going on? – T.Y.

ANSWER: Sodium – the same sodium in sodium chloride, or table salt – has innumerable body functions. Along with potassium, chloride and bicarbonate, it keeps the body in electrical balance. Without sodium, nerves would not fire and the heart wouldn’t beat. It is involved in maintaining blood pressure. And these are only a sample of its many jobs. Low sodium levels make people weak.

Sodium can be falsely low when the body retains too much water. The lab report will show a low level of sodium. In this case, the total body sodium content is not low. It looks like it’s low only because it has been diluted by excessive amounts of retained water. Congestive heart failure is an instance where sodium is reported as low but it is falsely low.

The adrenal glands make hormones that are intimately involved with sodium balance. When those glands are not working, body sodium levels plummet.

Another gland, the pituitary gland at the base of the brain, can bring about a drop in sodium. This gland makes antidiuretic hormone, a hormone that stops the kidneys from ridding the body of water. When antidiuretic hormone is inappropriately made, too much fluid stays in the body, and the sodium level falls – much as it does in the first example.

Your question demands a vigorous search for a cause of your low sodium. Running to the emergency department for intravenous sodium is, at best, a temporary measure.

Sodium, potassium and chloride are misunderstood body minerals. They are discussed at length in the pamphlet on body minerals. Readers can order a copy by writing: Dr. Donohue – No. 202, 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.

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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