DEAR DR. DONOHUE: My best friend has been diagnosed with septic arthritis. He has been in the hospital for one month and has been on antibiotics since the first day of hospitalization. I would appreciate it if you would explain what form of arthritis this is, how long it lasts, its usual treatment and if it is possible to regain complete usage of the leg. The doctors just told him he will stay on antibiotics for another 20 days. – B.G.

ANSWER: The word “arthritis” means joint irritation and inflammation. Uric acid crystals in a joint cause gouty arthritis. An immune-system attack on joints by the body causes inflammation and rheumatoid arthritis. The wearing away of joint cartilage causes joint irritation and osteoarthritis. Septic arthritis is a joint infection.

Infections settle in a joint in a number of ways. Bacteria can be carried by the blood from a distant point of minor infection. Once inside the joint, they multiply and cause redness, swelling and intense joint pain. The knee, hip and shoulder are joints most often infected, but any body joint can be the target of septic arthritis.

In addition to the joint signs and symptoms, septic arthritis often gives people a fever that might be interspersed with periods of shaking chills.

Septic arthritis is an emergency. Treatment must be started quickly, because the products that result from infection can destroy a joint permanently. Early antibiotic treatment saves the joint and makes it possible for the joint to recover completely most of the time. Septic arthritis is usually treated in a hospital, where antibiotics can be delivered to the patient through an intravenous drip. Intravenous antibiotics attain high blood levels rapidly and get to work quickly.

Your friend’s hospital time is not surprising. Treatment lasts for four or more weeks.

DEAR DR. DONOHUE: My daughter, age 57, recently underwent a modified breast mastectomy for breast cancer. My question is, What is the difference between a modified and a radical mastectomy?

My daughter lives more than 1,500 miles from me, and it is difficult to question her about the details. – S.R.

ANSWER: A radical mastectomy is extensive surgery. The tumor, the involved breast, all the axillary (under the arm) lymph nodes and the chest wall muscles (the pectoralis major and minor) are removed. Radical mastectomies are not as common as they once were.

A modified mastectomy is removal only of the tumor, the breast and the axillary lymph nodes.

The pamphlet on breast cancer details its many treatments. Readers can order a copy by writing: Dr. Donohue – No. 1101, 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.

DEAR DR. DONOHUE: In three weeks, my friend will be having his gallbladder removed. It has stones and is badly swollen. He is 34. Is this problem unusual for someone of his age? Why have his doctors opted for surgery instead of dissolving the stones? What is the recovery time after the operation? – L.R.

ANSWER: Age is a major factor in gallstone formation, so, yes, 34 is a young age to have them. Even though your friend is in a select group, he is not the only 34-year-old to have had gallstones. People can get them at even younger ages.

Many gallbladder operations are done today with a laparoscope, a viewing instrument inserted into the abdomen through a small incision. Through another small incision instruments are inserted that can cut the gallbladder away from its attachments and grasp it for removal from the body. Recovery from laparoscopic surgery is rapid. People are often back to work within a week and doing most of their normal activities in two weeks. If the more traditional surgery is done, it takes weeks before going back to work.

Dissolving gallstones with medicines has its place, but it also has its drawbacks. The medicines have to be taken for a long time, and recurrences can happen after they are stopped.

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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