DEAR DR. DONOHUE: A day or so before a menstrual period, I have terrible cramps and pain in my lower abdomen. My periods have been very heavy. I would like you to tell me what your opinion of all this is. – K.J.

ANSWER: You make a good case for endometriosis, but a reliable diagnosis will come only from a doctor examining you and ordering the appropriate tests.

The endometrium is the lining of the uterus. In endometriosis, bits of the lining have been transported to distant places: the ovaries, pelvic ligaments and even places as far away as the lungs and rectum. Those transplants react to the monthly surge of estrogen just as the endometrium in the uterus does. That accounts for the pain of endometriosis.

Sometimes the symptoms are so classic that a doctor can make the diagnosis based on them alone. The diagnosis, however, is clinched by taking a peek into the pelvis, and often that can be done with a scope inserted through a small incision.

The birth control pill is frequently used to control this relatively common condition. The idea is to create an environment in which estrogen is at low levels so the endometrial transplants shrivel. Two other medicines, Synarel and Lupron, can also lessen estrogen production and are useful treatment drugs. Surgical removal of the transplanted tissue is another way of dealing with the problem. Often that can be done with the same kind of scope used to peer into the pelvis to inspect it for endometrial transplants.

The Endometriosis Association, at 1-800-992-3636, can provide you with useful information. Its Web site is www.endometriosisassn.org.

DEAR DR. DONOHUE: I have a patch of skin near my right elbow that itches nonstop. This has been going on for more than a month, and I have used several itch creams recommended by my pharmacist. None has worked. My doctor thinks it could be related to food. Is this a usual sign of food allergy? – R.B.

ANSWER: I am sure your doctor was not talking about food allergy. He has something else in mind — dermatitis herpetiformis. (In spite of the name, it has nothing to do with the herpes simplex virus.) It’s a skin eruption that takes many forms but often presents as an island of tiny blisters on a red base. It creates an intense itch. The rash might clear up for a time, but it almost always returns and is as intensely itchy each time it comes around.

Dermatitis herpetiformis usually responds to oral medicines. Dapsone is the one commonly prescribed.

The food link involves gluten, a protein found in wheat, barley and rye. Intolerance to those grains can bring on dermatitis herpetiformis. More commonly, intolerance to gluten – celiac disease – causes diarrhea and weight loss, but the skin manifestation can spring up on its own – without any digestive tract symptoms. A diet that completely excludes gluten usually effects a cure for those with celiac disease. The same diet can also bring dermatitis herpetiformis under control. That’s the reference your doctor made to food.

DEAR DR. DONOHUE: I had blood in my urine, and the source of it was traced to bladder cancer. A urologist removed the bladder tumors through a scope. He now wants me to have BCG treatments. A nurse friend told me this is used to vaccinate against TB. How does it help bladder cancer? – M.M.

ANSWER: BCG is a tuberculosis vaccine used in many parts of the world, but not often in North America for vaccine purposes. The BCG germ in the vaccine is a relative of the TB germ.

For some bladder cancers, BCG in solution is instilled into the bladder to bathe its walls, the site of bladder cancer. It stimulates bladder immunity to cancer cells. It has been shown to lessen the chances for bladder cancer recurrence, and it has also been shown to reduce deaths from bladder cancer.

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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