DEAR DR. DONOHUE: A close relative is in the early stages of multiple myeloma. He has no symptoms and is still quite active. He plays golf and takes long walks. He is 79. He is not under treatment. Please explain what this disease is. Can it be cured? Is research being done on it? – I.J.

ANSWER: Multiple myeloma is a cancer that begins with a single renegade cell in the bone marrow. That cell begins to multiply at extremely fast rates and has a prolonged longevity. The progeny of that single cell crowd out other cells in the bone marrow, and that leads to all the complications of this disease.

Anemia is common, because myeloma cells disrupt red blood cell production. The same happens to white blood cells. Infections are a common consequence because of the drop in white blood cells and because there’s a diminished production of antibodies. Myeloma can affect the kidneys.

The cause of this cancer, as is true of so many other cancers, has eluded detection.

Symptoms of myeloma include bone pain, especially back or rib pain. Bones are weakened by the rampant growth of myeloma cells, and they break easily. Another consequence of bone involvement is a rise in blood calcium, and the high levels of calcium can create their own problems.

Anemia symptoms are part of the myeloma picture. Fatigue and breathlessness are two examples.

The cure for myeloma has not yet been discovered, but there are treatments that slow its course, make patients more comfortable and can prolong life. Chemotherapy drugs are the usual treatment.

Your relative has not reached the point that calls for treatment. It’s usually begun when people develop symptoms or when there is a rise in a blood protein that is generated by myeloma cells. Research on myeloma is being conducted throughout the world.

DEAR DR. DONOHUE: I would like all the information you have on skin cancer, as I have been diagnosed with it. – M.R.

ANSWER: Basal cell cancer is the most common kind of skin cancer. It starts out as a small, red, scaly, slightly raised bump that looks a bit like a patch of psoriasis or eczema. It almost never spreads to lymph nodes or distant organs, but it can burrow deeply into the skin and produce a nonhealing sore. Basal cell cancers can be cut off, dried with an electric current, vaporized with a laser or painted with the chemotherapy drug 5-FU. They are usually curable.

Squamous cell skin cancer is the second most common skin cancer. It usually presents as a red nodule that becomes an open sore. It can grow more rapidly than a basal cell cancer, and it can spread to lymph nodes. Excision of these cancers pretty much assures cure. One way of treating a squamous cell cancer is the Mohs’ technique, in which the doctor removes a layer of skin, examines it with a microscope and continues to remove skin layer by layer until no cancer cells are seen with the microscope. (The Mohs’ technique can be used for basal cell cancers too.)

The third and most deadly skin cancer is melanoma. It is a dark brown to black patch with irregular borders and a diameter larger than that of a pencil’s eraser. Differentiating a melanoma from a mole can be tricky business, and, if there is any question, the call should be made by a doctor. Melanoma is a topic that deserves separate treatment.

There are eight other kinds of skin cancers, but they are quite rare compared with the above three.

DEAR DR. DONOHUE: I could go on and on but will choose the short route. Any information on lichen sclerosus et atrophicus would be appreciated. – G.S.

ANSWER: It’s a skin condition that starts out as smooth, pink or ivory, flat-topped, slightly raised skin lesions that can merge to form large oval patches with a smooth, white wrinkled surface. It can be intensely itchy.

Steroid creams or ointments – clobetasol being a frequent choice – are the most useful control drugs. Sometimes acne creams or ointments are useful to assist in control.

DEAR DR. DONOHUE: I found the enclosed ad in a magazine. Can you tell me more? – M.N.

ANSWER: (The ad says that aspirin can trigger an asthma attack in 20 percent of asthmatic adults.) Some asthma patients are very sensitive to aspirin, and it can cause them to have a severe asthma attack. The actual percentage of asthmatics who are so affected is more often quoted to be in the range of 5 percent.

Asthmatics who are aspirin-sensitive often have difficult-to-manage asthma. Along with that, they frequently have nasal polyps. The reason why this is so is obscure, but it is a fact.

DEAR DR. DONOHUE: I read your explanation of cellulitis, and I have a couple of questions not covered in your answer.

Can cellulitis be caused by trauma such as a fall or injury? What determines the treatment? It seems that the majority of cases are in the legs. Since the symptoms are similar, is there any link with gout? – H.F.

ANSWER: Cellulitis is an infection of skin cells and the tissues immediately beneath the skin. It is a bacterial infection, usually with the strep or staph germ.

The germs have to gain entrance to the skin. They can do so by an insignificant scratch or by more severe trauma such as a fall or injury.

Treatment is always with antibiotics, ones that are effective against staph and strep germs.

The legs are frequently the sites of cellulitis, but they are not the only sites. Legs are subject to more bangs and cuts than any other body location.

Cellulitis and gout are not related in any way.

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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