DEAR DR. DONOHUE: This is the fifth letter I have written in hope that you would write something about my illness, interstitial cystitis. I would appreciate any information on symptoms and treatment. – L.G.

ANSWER: Interstitial (IN-tur-STISH-ul) cystitis is often mistaken for a bladder infection because both have somewhat similar symptoms. An affected woman must run to the bathroom innumerable times throughout the day and night to empty an only partially filled bladder. Passing urine can be painful, and for some women intercourse becomes uncomfortable.

I used “women” deliberately, since they comprise 90 percent of the patients. However, men and children can have the disorder. L.G. happens to be a man.

One explanation of what’s going on says that the bladder lining loses its protective covering. Without that protection, urine bathes the lining, and that is the source of pain. In addition, the bladder shrinks. Its limited capacity adds to the need for frequent urination.

Some patients benefit by eliminating caffeine, chocolate, tomatoes, alcohol and acidic fruit juices from the diet. Another self-help treatment is to deliberately hold off voiding for three to five minutes and gradually, through months and months of training, lengthen the time between urination.

Elmiron is an oral medicine that has been a helpful addition to treatment. Atarax, an antihistamine, can also calm the irritated bladder by neutralizing histamine, a body chemical partially responsible for the bladder pain. These two medicines are sometimes combined. Detrol or the Oxytrol skin patch can often end bladder spasms. For diagnosis and treatment, hydrodistention of the bladder can frequently bring relief. The bladder is filled with water, and its walls show telltale changes of interstitial cystitis. Bathing it with a substance called DMSO can soothe the irritated bladder walls.

Rather than bog you down with more treatments and diagnostic tests, let me put you on to the Interstitial Cystitis Association. It can provide you the latest in diagnostic tests and treatment. The toll-free number is 1-800-435-7422, and the Web site is www.ichelp.org.

DEAR DR. DONOHUE: Please do a piece on chronic lymphocytic leukemia. My wife has it. – Anon.

ANSWER: I promised a man in Victoria, British Columbia, that I would answer his question about lymphocytic leukemia, but I lost the letter and had to substitute the above. Please forgive me.

Leukemia is cancer of white blood cells, something that sends chills down everyone’s spine. Chronic lymphocytic leukemia, however, often is not a grim diagnosis. Many times it is discovered when a routine blood count is ordered. The number of lymphocytes – one kind of white blood cell – is greatly elevated, and the diagnosis is made.

Most people, early on, have no signs or symptoms. They are simply watched, and treatment is withheld until symptoms appear. In time, the spleen and liver can enlarge, as can lymph nodes; anemia can develop; and platelets (the clot-forming blood cells) can diminish. At this stage, patients often have a fever and feel ill. Then, treatment with chlorambucil is generally initiated, and sometimes it is given in conjunction with prednisone.

In a few instances, the course of chronic lymphocytic leukemia is rapid. The height of the lymphocyte count and the appearance under the microscope of the lymphocyte’s chromosomes give an indication of what sort of course the illness is going to take.

DEAR DR. DONOHUE: I have taken lovastatin (Mevacor) for seven years. I am starting to get leg pain. Do you think the lovastatin is to blame? – B.M.

ANSWER: Lovastatin can cause muscle pain and can actually damage muscles. However, the number of times it does so is quite small. Talk to your doctor. I am sure he or she will not hesitate to have you stop the medicine for a short time and see what happens. Your cholesterol will not skyrocket during a short period without the drug.

DEAR DR. DONOHUE: I am 43, and this is the year that has turned me into an old man. My back hurts, and I can do only a fraction of the things I used to do. My doctor says I have to tough it out. He told me to take Advil, and it has helped some. Should I try resting in bed? – D.H.

ANSWER: Low back pain strikes just about everyone. The average age for its appearance is 40, so you fit right in. Telling you to do nothing more than take Advil, your doctor must not have detected anything that could lead to permanent problems.

The causes of low back pain are numerous. The cushioning disks that are sandwiched between two backbones are often the source of pain. They have a jellylike core that can push through the tough cartilage that serves as the outer wall of the disk. When it does, it often impinges on a nerve, and that hurts. Arthritis of the backbone joints is another cause. Back muscles and ligaments are other sources of back pain.

Bed rest is a bad idea. If the back hurts so much that all movement is torture, then one or two days of bed rest can lessen the pain. Staying in bed any longer leads to weakness of back muscles and loss of bone calcium.

Most of the time, backs heal on their own and back pain leaves without having to submit to many expensive tests. A drug like the one you are taking, heat or cold applied to the back (whichever feels better), and perhaps a muscle relaxant get most people through a spell of low back pain.

If the pain does not leave in two or three weeks, special studies are needed to pinpoint the cause of trouble. For most of the 20th century, X-rays provided information that led to the discovery of a cause. Now CT and MRI scans give a much clearer picture of the back — bones, ligaments, joints and muscles.

The pamphlet on back pain outlines its many causes and treatments. Readers who would like a copy can write to: Dr. Donohue – No. 303, 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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