DEAR DR. DONOHUE: My elbow has a bump on it the size of a quarter and about a half-inch deep. The first time it happened, my doctor drained it with a needle and syringe, and it receded. The second time he drained it (five years later), it went down again, but now it’s back. Any suggestions? – T.C.

ANSWER: If you’re willing to settle for a guess, I’d say you have olecranon bursitis. The olecranon (oh-LEK-ruh-nun) is the elbow bone. On top of it is a bursa. Bursas are small, pancake-shaped disks that act like ball bearings so tendons can glide over bones without friction. Housemaid’s knee – the large, soft, usually painless lump that pops out below the knee – is bursitis of a knee bursa. Olecranon bursitis is the elbow’s version of that.

Bursitis can come from trauma, even trauma so trifling as constant resting of the elbows on a desk. More sinister causes are things like infections, but you are not likely to have an infection. An infected bursa is red, hot and painful, and the fluid that comes from it is filled with pus.

Draining a swollen bursa immediately flattens it, but the swelling often returns. A compression wrap might shrink it. With repeated returns, surgical removal of the bursa is the answer. If it’s not bothering you and not interfering with arm motion, you can choose to ignore it.

DEAR DR. DONOHUE: I would appreciate it if you would give me some information about Paget’s disease. My doctor informs me that I have osteoporosis, and I take Fosamax for it. I am 89 and feel pretty well. My mother had Paget’s disease, so I wonder if that might be my trouble. What is a good medicine to take to prevent it? – H.N.

ANSWER: Paget’s bone disease is much less common than osteoporosis. Every day, from birth to death, bones undergo remodeling. Cells called osteoclasts nibble at bone. They’re the bone demolition crew, getting rid of old bone. On their heels come osteoblasts, cells that build new bone – the bone construction crew. In Paget’s disease, the remodeling process gets out of hand. The demolition crew goes on overtime. In response, the construction crew lays down new bone in a frenzy. The new bone is haphazardly put together, is weak and is often deformed. Usually only a section of bone is involved, and the bones most often affected are the pelvis, backbone, skull and hip bone.

Paget’s disease does run in families. About one-fifth of patients have a relative who has or had the illness. That’s a far cry, however, from saying that every child of every Paget’s patient will come down with it.

Osteoporosis, an almost universal consequence of women who are past menopausal age, comes from a deficiency of bone calcium. It’s a generalized bone malady.

It happens that the medicine you are taking for osteoporosis, Fosamax, is also used for Paget’s disease. I don’t believe you have Paget’s. The diagnosis is easily made with an X-ray. You can take some consolation in knowing your medicine works for both conditions. I know of no medicine that prevents Paget’s disease.

DEAR DR. DONOHUE: I am scheduled to take a pharmacologic stress test. I will be given adenosine, which will “stress” my heart the same way exercise does. My concern is that I have an irregular heartbeat. Won’t I be put at high risk during this test by the stress placed on my heart? – C.N.

ANSWER: “Pharmacologic” indicates that drugs are used to stress the heart. Pharmacologic tests can detect blockages in heart arteries in people who are unable to walk or jog on a treadmill or ride a bike.

Adenosine doesn’t speed the heart as exercise does. It dilates normal heart arteries. Heart arteries that are partially clogged with a buildup of cholesterol don’t dilate. That’s how the test works. After adenosine is given, a radioactive tracer is injected. The tracer passes through the newly dilated, normal heart arteries but not through the undilated, partially clogged arteries. Pictures of the heart show where the clogging is.

Pharmacologic stress tests are safe even for those with irregular heartbeats. During stress tests, including pharmacologic tests, a doctor is right on hand. If anything develops that presents a danger to the patient, the doctor can reverse the process.

The above advice applies to people with a hiatal hernia who also have heartburn. If medicines fail people with hiatal hernia , there are a number of surgical procedures that can help them.

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.