DEAR DR. DONOHUE: I am a 35-year-old, divorced woman with no children and have just gotten the shock of my life. I had my yearly gynecologic exam two weeks ago, and the doctor called to tell me I had an abnormal Pap test. He said I probably have a viral infection that could lead to cancer. He scheduled me for a scope exam. Please put all this into perspective for me. I am quite worried. What is the treatment? – S.A.

ANSWER: Your Pap test must have shown cell changes that are typical of infection with the human papillomavirus – HPV – the cause of genital warts. There are more than 100 different varieties of HPV. Some cause the ordinary finger and foot warts. About 20 can cause genital warts. Genital warts can be the forerunner of cancer of the cervix. Cervical cancer, therefore, can be considered an infectious disease.

The scope exam your doctor has in store for you is an examination of the cervix with a device that looks a bit like a microscope. It’s called a colposcope. Before inspecting the cervix with the colposcope, the doctor applies acetic acid (vinegar) to the cervix. Any infected area turns white, and the doctor can easily biopsy that section for a definitive diagnosis.

Treatment of HPV infection covers a huge amount of material. For warts that are external and visible, liquids, creams or gels can be applied by the patient to the warts. When there is infected tissue on the cervix, the doctor can freeze it off with liquid nitrogen, destroy it with electric current, eradicate it with a laser or inject a substance called interferon into the infected tissue. And those are only a few of the treatments available.

Understandably, the news is unsettling. Your condition has been discovered and is going to be treated, so you do not have to view this with alarm and dread.

The cervical cancer and Pap smear stories are told in the pamphlet on those topics. To obtain a copy, write to: Dr. Donohue – No. 1102, 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: My doctor has told me I have a right bundle branch block. I have had it for two years. It was discovered on an electrocardiogram. I am a 69-year-old woman. My doctor says we will watch it and that no treatment is needed now. What is it that I am watching? I don’t feel and never have felt sick. What am I supposed to look for? – G.H.

ANSWER: The two heart “bundles,” right and left, are cables of special tissue that work just like electric cables. They conduct the electric impulse generated by the heart’s natural pacemaker to the lower heart chambers — the ventricles. When the impulse reaches those two chambers, they contract and pump blood out of the heart.

A right bundle branch block is a short circuit in that bundle. The heart’s electric signal still reaches the right ventricle, and it still pumps exactly as it should, but the signal must take a detour.

A right bundle branch block almost never indicates any serious heart problem. It almost never evolves into a serious heart problem. You don’t need to be watching for anything. You can forget about it. Worry over a right bundle branch block is a greater health risk than the block itself.

DEAR DR. DONOHUE: What’s the significance of a porcelain gallbladder? I had an abdominal ultrasound, and the porcelain gallbladder was seen on it. My doctor wants me to have surgery. Is that necessary? I really don’t have any symptoms. I have had no pain, no indigestion and no digestive problems at all. – C.W.

ANSWER: A porcelain gallbladder is one whose walls are filled with calcium.

Most likely your gallbladder had a low level of inflammation – not enough to cause you any pain, but enough that the body reacted by plastering the walls of the gallbladder with calcium.

Most doctors would agree with your doctor. Porcelain gallbladders ought to be removed. They can evolve into 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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