DEAR DR. DONOHUE: I have a 66-year-old daughter who has had rheumatoid arthritis for many years. She has lived in a Third World country for more than 20 years and never has had access to very good medical care. Now she is back home, and she is much worse off than I have ever seen her. She thinks nothing can be done for her. Could you supply her with information on any new treatments? – R.K.

ANSWER: Rheumatoid arthritis strikes mostly women in their 40s and 50s. The immune system is involved, but what triggers it is something that is as yet undiscovered. Experts speculate that a bacterium or virus might activate an immune response that attacks and inflames joints (and other tissues and organs, such as blood vessels).

Your daughter has missed two decades of radical changes that have taken place in the treatment of rheumatoid arthritis. In the past 20 years, there has been a revolution in its therapy.

Almost from day one of diagnosis, patients today are put on medicines that put the lid on the errant immune system or on the destructive chemicals released by the immune attack. Methotrexate is a prime example. Five new drugs have found their way into treatment schedules. These drugs also target the immune system and its inflammatory byproducts. Their names are Humira, Kineret, Enbrel, Remicade and Arava. These medicines have the potential not only to relieve the pain of arthritis but to alter the course of the illness, limiting its progression.

Even if you daughter is not a candidate for the newer medicines, she might benefit from the many surgical procedures that are now available to replace and repair damaged joints.

Too often, treatment of arthritis focuses on medicines. Physical therapists help patients with exercise programs that strengthen muscles and protect joints. Occupational therapists outfit patients with devices that help them regain their mobility. Your daughter has much to gain by having doctors and therapists assess what is available to her.

DEAR DR. DONOHUE: This is the third (fourth?) time I have written you about the subject of blood donations. Can the general public sell their blood? I see advertisements for people to sell plasma. Wouldn’t the sale of blood solve the problem of blood shortages? – E.B.

ANSWER: The sale of blood in the United States is not the norm. Paying donors for blood attracts people who are at high risk of having infections that can be transmitted by blood transfusions – drug addicts, for example. There are reliable tests that can detect most infectious agents in blood, but those tests are not always 100 percent reliable in the very early stages of a donor’s infection. Opening the door to even the slight chance of increasing the danger of infection is something that should not be encouraged.

In other parts of the world, where the supply of blood is in even greater shortage than it is here, the sale of blood is a standard practice.

Plasma is the fluid part of blood. It is devoid of red blood cells, white blood cells and platelets. It contains nutrients like protein, clotting factors and important enzymes. It has many medical uses. Unlike blood, plasma can be sterilized, and the threat of infection is eliminated. The buying and selling of plasma is, therefore, unrestricted.

You have provided an opportunity for me to encourage people to become blood donors. Less than 5 percent of eligible donors ever give blood. We would not be faced with blood shortages if more people would only find their way to blood banks for the donation of a most unique gift – their blood.

DEAR DR. DONOHUE: I have a curiosity question. How long can a human go without food or water? – M.J.

ANSWER: Most people can live one to two months without food. The actual time depends on how much fat is stored in their bodies at the onset of food deprivation.

People can live only four to 10 days without water.

DEAR DR. DONOHUE: I have a neighbor and friend, 33 years old, who has three small children. She suddenly became paralyzed in her legs. She is in the hospital and has something called transverse myelitis. Can she get over this? – B.K.

ANSWER: “Myelo” is a Greek prefix that sometimes means bone marrow, sometimes the spinal cord, and sometimes the insulating covering of nerves. Here it refers to the spinal cord.

It’s an inflammation of the cord and extends from one side of the cord to the other (“transverse”).

It interrupts transmission of nerve signals from the brain to muscles and from the body to the brain. The inflammation often occurs in the lower part of the cord and leaves the legs weak or paralyzed. The onset of the illness can take as long as several weeks or as little as a few hours. Initial symptoms are back pain and muscle weakness that often progresses to paralysis.

Your neighbor’s future is unpredictable. Some make a full recovery. Others never regain function. And still others regain some function but are left with a degree of permanent impairment.

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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