DEAR DR. DONOHUE: Would you please discuss CJ disease? I believe it is Creutzfeldt-Jakob disease. What causes it? How does it affect a person? – J.W.

ANSWER: Not many years back, a mention of Creutzfeldt-Jakob (KROITS-felled YAH-cope) disease would bring only puzzled looks, even in medical circles. It was first described in the 1920s by the two gentlemen whose names it carries. It’s a rare disease – around one case in every million people – yet today it is recognized with more frequency because doctors are more aware of it.

It’s caused by a unique germ: a prion, which is a protein. In most instances, how people catch it is not known, but it is not passed from one person to the next. The illness resembles Alzheimer’s disease in some respects. Affected people lose their memory. They suffer spells of disorientation and hallucinations. A sudden noise or a flash of light causes patients to make a jerk that looks like an exaggerated startled response. Death usually occurs within a year or two after symptoms appear.

A special kind of CJ disease is variant CJ disease. It has similar symptoms to classic CJ disease, but it comes on much earlier in life. When mad cow disease appeared in England, variant CJ disease appeared in tandem with it. The two are linked – that was an unsettling bit of news. Panic about it has quieted down with closer restrictions on the use and processing of beef products.

There is a third kind of CJ disease that runs in families.

All forms of this illness are most uncommon. No one needs to be constantly on vigil for CJ disease or mad cow disease.

There is no medicine for any form of this ailment. That strikes fear in people’s hearts, but it is true of very many illnesses.

DEAR DR. DONOHUE: Will you explain why Coumadin is better than aspirin in the treatment of atrial fibrillation, since they are both blood-thinners? My doctor’s explanation went right over my head. – E.D.

ANSWER: Both medicines prevent clots forming in blood vessels. The popular term to describe that action is “blood-thinning.”

They do so in different ways. Aspirin stops blood platelets from sticking to each other. When they do attach to one another, a blood clot is born. Aspirin’s effect on blood platelets has been proven in more than one study to prevent recurrent heart attacks. It probably is effective in preventing all heart attacks and strokes.

Coumadin works in a different way. It stops the production of proteins known as clotting factors. Without those factors, even though platelets might stick to each other, a clot is not born. Coumadin is a howitzer; aspirin is a rifle.

Having atrial fibrillation means the upper heart chambers, the atria, are not contracting. They are quivering. As a result, blood pools in the atria. Pooled blood favors clot formation. The most feared consequence of atrial fibrillation is a stroke from clots that have formed in the atria and have been taken by the circulation to brain arteries. The clots clog brain arteries. Blood flow to a section of the brain stops. A stroke follows. Aspirin is only half as effective as Coumadin in preventing strokes resulting from atrial fibrillation. That has been shown in many studies.

DEAR DR. DONOHUE: Statin drugs such as Lipitor and Mevacor are the most effective drugs to lower cholesterol. Just as any aspirin is an aspirin, aren’t all statin drugs, including Mevacor, the same? I take Mevacor, and it is far less expensive than the first statin drug I took. Isn’t it just as effective as the more expensive one? – W.N.

ANSWER: There are six statin drugs: Mevacor, Pravachol, Lipitor, Zocor, Lescol and Crestor. They have a similar chemical structure, but they have significant differences, too — like children in the same family. They are the most potent cholesterol-lowering drugs available. The one that a person should use is the one that gets his or her cholesterol to the desired level with the least expense and fewest side effects. If Mevacor does that for you, it’s the drug for you.

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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