DEAR DR. DONOHUE: My husband is 83 and has had emphysema for five years. He is getting by with the use of all the latest inhalers and prednisone. Our daughter, who works at a hospital, inquired about alternatives and was told by a lung specialist that surgery could be an option. How effective would this be? – Y.L.

ANSWER: Emphysema destroys the tiny air sacs in the lungs. It’s through those sacs that oxygen passes into the blood to nourish the body and through which carbon dioxide, a waste product, leaves the body. The walls of emphysematous air sacs are stretched out of shape, and some actually burst. The lungs become distended, and air cannot enter and leave them properly.

People with emphysema have crowded chests, and their diaphragms – the chief breathing muscle – cannot draw air into the lungs as they should. All of this leaves the body in a state of oxygen deprivation, so patients are constantly breathless.

Lung-reduction surgery for emphysema removes the most affected sections of the lungs. That gives normal lung tissue a chance to expand and accept more air. It also gets the diaphragm muscle working more effectively.

This kind of surgery is limited to a few select patients, usually those whose emphysema is located in the upper lobes of their lungs. For these people, it does work.

It won’t hurt your husband to see if he qualifies for such surgery, but don’t get his hopes too high. Only a few are suitable candidates.

DEAR DR. DONOHUE: I am a widow. I live alone and hope you can help me. Three years ago my doctor found that I had pernicious anemia. I took B-12 shots regularly. I have had to change doctors, and the new one gives me a B-12 shot only once a month. Now I am getting weak. Is one shot a month enough? – P.C.

ANSWER: Pernicious anemia – the result of vitamin B-12 deficiency – most often results from a lack of intrinsic factor. It’s a substance made by the stomach. It takes B-12 by the hand and leads it into the blood so it can reach the bone marrow, where red blood cells are made. Without B-12, red-blood-cell production falters, and anemia develops.

When the diagnosis of pernicious anemia is first made, doctors give the patient a series of weekly B-12 shots for eight weeks. That restores the body’s supply of the vitamin, and red-blood-cell production resumes. From that point on, the vitamin is given monthly to maintain body stores, and that is usually more than sufficient. Your doctor can order a red-blood-cell count and a B-12 blood-level test for you to see if you have enough. You most likely do. Your weakness, in all probability, is due to some other condition.

DEAR DR. DONOHUE: My daughter has a 3-1/2-month-old daughter. She read a book that claims vaccinations cause autism, brain damage and many other problems. Please advise what the overall recommendations for vaccinations are. – M.P.

ANSWER: One of medicine’s greatest gifts to us is vaccinations. They have spared millions the consequences of death and crippling illnesses like polio, hepatitis, meningitis, measles, mumps and chickenpox, to mention but a few. Recommendations for the timing of vaccinations have been carefully studied and are in every doctor’s office, and states have laws requiring childhood vaccinations for school admission. Exceptions are rare. A few complications have resulted from the shots, but they are few and far between. Not having children immunized puts them at great risk.

DEAR DR. DONOHUE: Please relate any information on vertebral-artery dissection. My 18-year-old son had one. – M.B.

ANSWER: An artery dissection is a split in its wall. The vertebral arteries ascend to the brain through the neck backbones — vertebrae. A dissection of the artery in the neck region usually seals itself without causing a dangerous bleed. Within the first two weeks of the onset of symptoms, serious complications, like a stroke, are common. After that, the danger lessens. The split heals on its own. Recurrences are rare. Trauma, as you described in your letter, is often the cause.

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.