DEAR DR. DONOHUE: In 2000, my wife was diagnosed with polymyalgia, temporal arteritis and rheumatoid arthritis. Prednisone gave her some relief. In 2002, she developed a mild but persistent cough, which was explained as a medication side effect. In 2003, she had X-rays for back and leg pain, which was ascribed to arthritis. In 2004, now age 78, we requested a scan to look deeper into her complaints. The scan showed she had advanced lung cancer, which had spread to her liver, brain, back and knee. She died five months later. How could this cancer not have been detected in an earlier stage, when it might have been successfully treated? – J.C.

ANSWER: No words can suitably convey my sympathy to you and your family, and I can’t offer you a suitable explanation why it took so long for your wife’s cancer to be diagnosed, but such is often the case with lung cancer. By the time that many lung cancers are diagnosed, the cancer has often spread to distant body sites – brain, bone, liver and lymph nodes.

Medicine has failed to come up with a good screening test for early lung-cancer detection. The chest X-ray is not a great screening test. It misses too many small cancers. There is hope that a special kind of CT scan, a spiral CT scan, might prove to be the answer to this problem of finding lung cancer in its early stages, when it can be more successfully treated.

I can’t say if your wife’s cough in 2002 was the first sign of the cancer. If it was, a chest X-ray at that time should have shown it. As for her bone and joint pains in 2003, X-rays should have demonstrated cancer spread if those pains were caused by it.

I don’t have a good answer for you. I can’t make excuses for something that seems like it should not have happened. I can say, without trying to gloss over this tragedy, that many lung cancers behave in the same way your wife’s did. They go undetected until very late stages.

DEAR DR. DONOHUE: My husband, 65, had a drug reaction to Levaquin. The tendons that connect his calf muscles to his heels got so sore, he could hardly walk. Also, his thigh muscles were painful. He called the doctor’s office and was told: “It can’t be from the drug. We use it all the time.” Another man my husband talked to had the same side effects.

Is there any way to reverse this problem? Have you heard of it? – G.E.

ANSWER: Levaquin (levofloxacin) belongs to a family of antibiotics called fluoroquinolones. A rare but known side effect of this antibiotic family is tendon inflammation. The Achilles tendon – the heel cord – is the one usually affected, but it can happen to other tendons, too, such as shoulder and hand tendons.

In a small number of users, the tendon actually tears apart.

Joint and muscle pains are other possible side effects of these drugs.

For most, rest leads to recovery, and recovery is usually seen in two to four weeks. Some take as long as two months to recover, and a very few can take a year or more.

Why would drugs with such side effects be on the market? The first reason is that they are very valuable antibiotics that can come to the rescue when all other antibiotics fail. The second reason is that these side effects are quite infrequent, and almost everyone has a quick recovery from them when they do occur.

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. Readers may also order health newsletters from www.rbmamall.com.