DEAR DR. DONOHUE: My 14-year-old son was just discharged from the hospital after being treated for subacute bacterial endocarditis. I don’t understand how he got it. The doctor said he must have had rheumatic fever in his younger days, but I don’t ever remember that. How is rheumatic fever related to endocarditis? What does the future hold in store for him? – S.B.

ANSWER: Endocarditis is an infection of the heart lining, of one or more heart valves or of both. Acute endocarditis comes on rapidly, makes a person quite ill quickly and causes rapid heart damage. It often happens to a normal heart. Subacute endocarditis, while a very serious infection, does not carry as dire a prognosis as acute endocarditis does. People with it often are up and about but don’t feel up to par. They have a low-grade fever that lingers and lingers. Their heart lining and valves are infected with bacteria that often come from somewhere within their own body, like the mouth.

With subacute endocarditis, bacteria home in on already-damaged heart valves. That’s why the doctor suggested your son might have had rheumatic fever. Rheumatic fever is a strep throat that induces the formation of antibodies that can damage heart valves. Only a very few strep infections can do that. If your son had rheumatic fever – and that’s a supposition at best – it could have been so mild a case that it went unrecognized.

Subacute bacterial endocarditis is almost always successfully treated with intravenous antibiotics. Treatment can be prolonged – one or two months.

The future for your son hinges on what kind of damage has been done to his heart valve. If it’s not major and the valve is not leaky or narrowed, then he can expect to lead a normal life. Even if major damage has been done to the valve, surgical correction of such valves almost always allows a person to have a normal life span and lead a very active life.

DEAR DR. DONOHUE: My husband, even when eating out, belches so loudly that it’s most embarrassing. Heads turn when he does this in a restaurant. He says he can’t stifle the belch, and I believe him, because he’s as embarrassed as I am. Do you know how he might be able to stop this? We would both greatly appreciate it if you can help. – W.S.

ANSWER: Ninety-nine times out of 100, belching is traced to swallowing a large amount of air when swallowing food or drinking beverages. Fast eaters are notorious belchers because they draw in a huge volume of air while wolfing down food. Your husband must eat very slowly, chewing longer than he is used to and swallowing smaller amounts of food.

If he keeps his teeth opened just a bit while swallowing, less air goes down the throat and into the stomach. Many years ago I read a trick that I have passed on to other belchers, and they tell me it works. Your husband can practice this at home. After he has thoroughly chewed his food, have him put a pencil’s eraser between his teeth before he swallows. Then, with eraser between the teeth, he can swallow. That allows air to escape from the mouth and not go rushing down into the stomach. In time it will become his habitual way of swallowing.

In addition, he should stop chewing gum, smoking, or drinking carbonated beverages – if he does any of those things. They fill the stomach with air.

DEAR DR. DONOHUE: I had a papilloma removed from my right breast. What caused it? I was scared half out of my mind because my nipple was leaking blood. I was positive I had cancer. The doctor said it wasn’t cancer, but could it turn into cancer? – C.C.

ANSWER: Papillomas are tiny, wart-like growths in the milk ducts beneath the nipple. Nipple bleeding is the chief sign. Every woman with nipple bleeding immediately thinks of cancer, but rarely does it indicate cancer. All the same, it is something that must be brought to the doctor’s attention.

Papillomas are not cancer and do not become cancer.

The cause? No one knows.

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.