DEAR DR. DONOHUE: I have just moved to an area that, I am told, has lots of Lyme disease. I have two active boys, ages 8 and 10, and I am scared to death that they might catch it. How do I recognize it if they do, and what can I do to keep them from getting it? I feel like making them stay inside until winter. – H.J.

ANSWER: Lyme disease can be a serious illness, but it should not drive people into seclusion to avoid it. When it is treated, more than 90 percent have a completely successful outcome. By being in a Lyme area, your community doctors will know how to recognize and treat it.

The Lyme germ is passed to humans by an infected tick. Avoiding ticks is the most important preventive measure for avoiding Lyme disease. When out and about in wooded areas, your family should wear long-sleeved shirts and long pants tucked into the socks or high-topped boots. Apply an insect repellent containing permethrin to clothes (not to skin). For the skin, use DEET. Inspect yourself and your children daily for ticks. They’re small, only about 1 mm (.04 inch) in size, so you need a keen eye to spot them. A magnifying glass helps. It takes more than 36 hours of attachment for the tick to inject the Lyme germ into its host, so daily tick removal lessens the risk of transmission.

Often the illness starts out as a small red spot at the site of the tick bite. The spot expands to a ring-shaped affair that ranges from 2 to 15 inches in diameter. The outer border of the ring is red, and the central area usually is blanched or skin-color. It is not painful, but on a few occasions, it can be slightly itchy. Other signs of infection include joint swelling and pain (often in the knee) and nerve involvement, one indication of which is an inability to close one eye.

You don’t have to keep your boys in, and you don’t have to fret about this.

If the boys do catch it – and their chances are not great – effective treatment is readily available.

DEAR DR. DONOHUE: I am 78 and recently had an echocardiogram. My doctor informed me that I have a mild stenosis of one heart valve. When I questioned why, how, what or when, I was advised that he would keep tabs on it. I am very concerned and puzzled. What is stenosis of a valve? Can it be treated? Will it worsen and bring on a stroke or heart attack? – N.E.

ANSWER: The heart has four valves that keep blood flowing from one heart chamber to the next. Closure of the valves prevents blood backup when the heart contracts.

Stenosis of a valve means that the opening of the valve has narrowed. Narrowed openings make it difficult for blood to pass between heart chambers and out of the heart and into the general circulation.

Mild stenosis is not usually a problem. Such a change can come from normal aging, from previous valve infections or from a congenital abnormality of the valve. So long as there is no serious impediment to blood flow through the heart, mild stenosis is not going to cause you trouble now or in the future. You can trust your doctor on this. Your mild stenosis will not give you a stroke or heart attack.

Stenotic valves, when necessary, can be surgically repaired, and advanced age is not a contraindication to repair. My mother had a stenotic aortic valve replaced at age 76.

DEAR DR. DONOHUE: In the past year, my voice began to quaver. I mentioned it to my doctor, and he said it was a family tremor. Really? Nothing else on me shakes. My hands are as still as a sheet of ice. Is there treatment for this? – R.J.

ANSWER: Familial tremor, also known as essential tremor, usually involves the hands. They shake when performing a specific task, like bringing a cup of coffee to the mouth.

Muscles control vocal cords, and familial tremor can, therefore, lead to a quivering voice.

If treatment is truly necessary, you might try a beta-blocking drug like Inderal.

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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