DEAR DR. DONOHUE: I have an 18-year-old grandniece who has hepatitis B. Is this serious and life-threatening? How does one get infected, and is there treatment for it? – J.L.

ANSWER: More than 350 million people on earth are infected with the hepatitis B virus, and more than half a million die from it yearly. That makes it serious and life-threatening, but not for all.

People catch the virus in a number of ways. At one time, blood transfusions were a main source of transmission. Since the advent of a test for the virus and since all blood is now checked for it, blood transfusions are rarely the cause of infection. Needles contaminated with the virus are a source of spread. That’s why illicit-drug users often catch it. Sex with multiple partners is another potential route of passage. Health-care workers who are constantly exposed to infectious blood and other body fluids are at risk of contracting it. There are many instances when the source of infection cannot be found.

Unlike hepatitis C, hepatitis B becomes a lifelong liver infection in only a relatively few patients – some good news about this infection.

Chronic infection with the virus can lead to liver cirrhosis, and that is one cause of death. It can also lead to liver cancer, another cause of death.

Currently, there are five approved drugs for treatment, but not every infected person needs treatment. The decision to initiate medicine is based on whether a patient’s liver-function tests are abnormal and whether these people have high counts of the virus in their blood.

One bright side of the hepatitis-B story is the development of the hepatitis-B vaccine, which became available in 1992. Since its appearance, the number of infections has greatly declined.

The booklet on hepatitis A, B and C explains the way these viruses are transmitted and their treatment. Readers can order a copy by writing: Dr. Donohue – No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have pain on the balls of both of my feet. My podiatrist has diagnosed it as Morton’s neuroma and recommends low-heeled shoes with support and cortisone injections. What do you know about Morton’s neuroma? Does it ever go away? And what do you think of surgery for it? – E.H.

ANSWER: Morton’s neuroma is a very common foot problem. One of the nerves on the ball of the foot becomes enmeshed, on its way to the toes, in an encircling ball of fibrous tissue like a scar. That’s the neuroma, which compresses the nerve and causes pain that often travels to the adjacent sides of the toes served by that nerve. People often say they feel like they’re walking with a stone in their shoes.

You have to wear low-heeled shoes if you want pain relief. High-heeled shoes increase pressure on the balls of the feet and on the nerve. Sometimes anti-inflammatory drugs like ibuprofen can ease the pain. Cortisone injections almost always do.

When nothing works and the pain is intolerable, then surgery should be considered.

Morton’s neuromas don’t usually go away on their own.

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.