DEAR DR. DONOHUE: My son, age 16, died on Jan. 2, 2004. He was a big boy, 6 feet 4 inches tall and 250 pounds. He was always drinking soda, water and iced tea. Two days before he died, he had flu symptoms and was tired, thirsty and going to the bathroom a lot. It was New Year’s Day, so I told him we would go to the doctor the next day. I woke up in the morning to find him dead on the bathroom floor. No autopsy was done, but blood work was, and his blood sugar was very high. I feel that I have failed terribly as a mother. There are days when I really want to die. I should have helped him somehow. My heart is truly broken. – N.B.

ANSWER: Your son had diabetes. Excessive urination, excessive thirst and excessive appetite without weight gain are signs of it. Most people would not recognize those signs in their children, and most would have made the same decision you made. Up to 40 percent of children with diabetes are not discovered to have the illness until it progresses to the state of ketoacidosis, which is a prelude to coma. Most of those children do not die as your son did. His case is quite unique. Symptoms of childhood diabetes usually progress over a matter of weeks and give parents plenty of time to bring the child to medical attention. You were not given such leeway. His illness progressed so rapidly that you did not have the chance to respond to it.

If you assembled 100 doctors in a room and asked them if they had nightmares about decisions they’d made on patients in the past, 99 of them would admit they did. The one who denies any past mistakes is delusional. We are all human.

I don’t have words to mend your broken heart. I can assure you that you are not responsible in any way for your son’s death. His illness took such a uniquely swift course that no one without a medical background would have responded any differently from you.

DEAR DR. DONOHUE: Would you please explain how Fosamax works? I have a prescription for it, but I am leery about taking too many medicines. – C.C.

ANSWER: Bones undergo constant remodeling from the day of birth till the day of death. Osteoclasts are bone cells that tear down old bone, which is then replaced by new bone made by bone cells called osteoblasts. Fosamax (alendronate) slows down the bone destruction by osteoclasts. That tips the balance in favor of bone buildup.

With age, bone regeneration is not as great as it was in youth. One of the consequences of that is osteoporosis. Fosamax can reverse osteoporosis. It and its related drugs are truly wonder drugs.

Fosamax has to be taken first thing in the morning and at least half an hour before eating or drinking in order to facilitate its absorption into the blood. It should be swallowed with a full glass (6 to 8 ounces) of water. A whole glass of water keeps the pill from sticking in the esophagus. If it does get hung up there, it can irritate the esophagus’s lining.

Fosamax does not interfere with any of your other medicines (mentioned in a deleted part of your letter). You don’t have to be leery about taking it. It’s going to keep your bones strong.

DEAR DR. DONOHUE: I am 73 years old. I have prostate cancer and osteoporosis. My doctor told me to take calcium supplements for the osteoporosis. However, I saw a report that claims calcium can be dangerous for a man with prostate cancer. Your comments, please. – H.B.

ANSWER: Some studies hint that there is a relationship between calcium and prostate cancer. However, the risk is modest, and the dose of calcium that influences prostate cancer is quite high. I can tell you what I do about all this. I take the recommended amount of calcium, 1,200 mg a day, for men 51 and older. I will stop taking it if there is a universally agreed-upon warning not to do so.

DEAR DR. DONOHUE: I would like to hear what you have to say about the artificial sweeteners Splenda and Neotame.

I have diabetes, and I am on a strict diet. I have to take insulin, and I check my blood sugar at least twice a day — sometimes more if I am not feeling right.

I have not used sugar since becoming a diabetic. I do use other artificial sweeteners. My cousin is also a diabetic. He uses the above sweeteners and sings their praises. – B.R.

ANSWER: Splenda has been around for some time, and there has been no hue and cry about it causing any serious problems. It is calorie-free, and it is about 600 times sweeter than sugar.

Neotame is a more recent addition to the list of artificial sweeteners. It is 7,000 to 13,000 times sweeter than sugar. Only a tiny amount gives a sweet taste.

Both sweeteners can withstand heat, so they can be used in cooking and baking, something that could not be done with older sweeteners.

If you want to give them a try, feel free to do so.

DEAR DR. DONOHUE: This might seem like a stupid question, but what happens to body fat when one loses weight? Where does it go? And what happens to all the toxins that are supposedly stored in body fat? Can it be dangerous to lose weight if those toxins are released into your bloodstream? My doctor mentioned something about fat being metabolically inactive. What does that mean? – E.K.

ANSWER: Fat is stored in cellophanelike sacs that collapse when fat is burned for energy. There should not be any toxins in fat. When toxins are stored in fat, they can present a problem unrelated to weight loss, as some fat cells are metabolized every day. “Metabolically inactive” means fat just sits there. Muscle, on the other hand, burns calories even when a person is resting.

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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