DEAR DR. DONOHUE: Please explain pulmonary hypertension. Can it be corrected or treated? Can this condition be detected with a pulmonary test? — L.D.

ANSWER: Lungs have their own blood pressure, separate and distinct from body blood pressure. Their blood pressure is only about one-fifth of what body blood pressure is. The lungs are such delicate structures that they cannot tolerate even moderate blood pressure.

Pulmonary hypertension – lung high blood pressure – comes about for a number of reasons. People with emphysema develop a rise in lung blood pressure. That’s called secondary pulmonary hypertension. It’s a consequence of, or secondary to, another problem, often a lung problem.

You speak of primary pulmonary hypertension, a rise in pressure that comes without a known cause. Symptoms include constantly being tired and chronically being short of breath. Swollen ankles are another sign.

Pulmonary function tests can hint that a rise in lung blood pressure is the cause of symptoms, but the only certain way of measuring it is by inserting a catheter into right side of the heart, the site of origin for lung blood pressure. Decent estimates can be obtained by taking Doppler sound wave pictures of the heart, the lungs and the blood flowing through the two.

Medicines are helpful. Diuretics can lower the pressure. So can drugs called calcium channel blockers, including nifedipine. Often blood thinners are administered, because pulmonary hypertension predisposes a person to clots in the pulmonary blood vessels. Epoprostenol, a drug that must be infused into a vein from a pump, can bring the pressure down, as can bosentan, an oral relative of epoprostenol. Lung transplant is an option opened to those who don’t respond to medicines.

This is one condition for which exercise is not recommended. It makes matters worse.

DEAR DR. DONOHUE: Please tell me about balanitis. I am a 70-year-old male and enjoy great health. I am uncircumcised.

About a year ago, I had my first attack. The doctor gave me antibiotics, and they got rid of the infection. I just had another attack. One doctor advised immediate circumcision. Another doctor said it should not be needed, and he prescribed an antibiotic, which gradually worked. I am a nudist when possible.

Do I need to have a circumcision? Is nudism helpful? – J.W.

ANSWER: Balanitis is an infection of the tip of the penis (the glans; also called the balanus, hence “balanitis”) and, in uncircumcised males, the covering skin – the prepuce.

The infection is more common in uncircumcised males, but it can happen to circumcised men too. It’s caused by bacteria and sometimes the yeast candida.

Prevention comes through daily cleaning, which involves retracting the prepuce.

If the infection recurs, your doctor might agree to prescribe for you an antibiotic ointment that you can keep on hand to apply at the first signs of an infection.

Worldwide, most men are not circumcised. If they come down with balanitis, they usually do not require circumcision. Only if infections return time and again or if infections are not readily controlled would it be necessary to submit to a circumcision. You are the one who makes that decision. I don’t know the answer to the nudist question.

DEAR DR. DONOHUE: I am one of those people who take a laxative every day to have a soft stool. Recently you published a recipe for a natural laxative that’s made with bran, applesauce and prune juice. What is bran? – R.T.

ANSWER: Bran is the outer coat of a grain, the stuff that is removed while refining grains. You can find bran at some grocery stores and at all health food stores.

Incidentally, there are some unrefined grains that still have their bran coat.

DEAR DR. DONOHUE: Two winters ago, I bought a pair of gloves. Last winter I had a terrible time getting them on my hands. They’re too small. I know they haven’t shrunk. Could I have grown? Does this suggest anything to you? – M.D.

ANSWER: It screams acromegaly, a condition involving too much growth hormone. Growth hormone comes from the pituitary gland at the base of the brain. Throughout life, growth hormone stimulates protein synthesis and muscle building. In children whose bones have not yet fused (turned completely into bone), growth hormone regulates linear growth, so children attain the stature programmed by their genes.

If a pituitary tumor puts out too much growth hormone in children, they can attain the size of giants. Adult overproduction causes a number of changes. The lower jaw enlarges and juts out, causing a misalignment of the teeth. The brow thickens, and the nose and lips grow larger. Facial features coarsen. The hands and feet widen, necessitating a change in glove and shoe size.

Other symptoms include profuse sweating, headaches, impotence, a diminution or loss of periods in women, and, often, vision disturbances.

The blood level of a hormone called IGF (insulin-like growth factor) serves as a surrogate marker for growth hormone, whose levels fluctuate widely and unpredictably throughout the day. Scans of the pituitary gland disclose any tumor.

An endocrinologist is the doctor you should see. That doctor specializes in disorders of the endocrine glands – the pituitary, thyroid, adrenal and parathyroid glands – along with the pancreas, the ovaries and the testes.

Treatment consists of removal of a tumor and/or medicines to suppress growth hormone production.

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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