DEAR DR. DONOHUE: I am a 28-year-old mother of two children, ages 2 and 4. This past year, my menstrual periods have been so painful that I dread that time of the month. When I first got this pain, my doctor thought I had appendicitis, but that wasn’t true. Now he thinks I have endometriosis. How is this proved and treated? – B.D.

ANSWER: Endometriosis affects up to 10 percent of women of childbearing age. That makes it a common condition. It causes pain during menstruation, often intense enough to incapacitate a woman. Between periods, some have constant lower abdominal or back pain of less severity. Periods can be quite heavy. Intercourse can be painful. Endometriosis often affects a woman’s fertility.

With endometriosis, what has happened is that pieces of the uterine lining have migrated through the fallopian tubes and landed in the pelvis, on the ovary, or in or on the fallopian tubes, the tunnel through which eggs pass into the uterus. Endometrium is the uterine lining. In the pelvis, it responds to the monthly ebb and flow of female hormones just like the endometrium in the uterus does. However, because it is located in these unnatural sites, it is painful when it comes time for the endometrium to be shed at menses.

The surest way to diagnose it is to see endometrial tissue in the pelvis with a laparoscope, a viewing scope that is passed into the pelvis through a small incision.

Treatment can be as simple as taking a drug like Advil or Indocin, or it can be as complicated as surgical removal. Medicines that modify estrogen production are frequent treatments. They include the birth-control pill and drugs such as Lupron, Synarel and Zoladex. The latest is medroxyprogesterone, which is injected four times a year. Doctors can also root out endometrial deposits with a laser when they use the laparoscope. The laser is inserted through a second small incision.

The booklet on endometriosis tells its story in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 1105, 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: My husband, 33, weighs more than 300 pounds. He has high blood pressure and diabetes. He ignores his weight and the diet his doctor gave him. What can I do? – C.A.

ANSWER: Your husband is a disaster waiting to happen. He has two serious illnesses, both of which can lead to an early death if not controlled. They also can lead to major complications – kidney failure, loss of vision, heart attacks and strokes. Weight control is as essential to diabetes and high blood pressure as medicine is.

Both you and he should schedule an appointment with a dietitian or a certified diabetes instructor. Your husband’s doctor or the local hospital can provide names and phone numbers for you.

He needs to be on an exercise program. First have him check with his doctor to see if he’s fit enough to exercise. I wouldn’t normally ask that of a 33-year-old, but your husband, physiologically, is much older.

If a calorie-restricted, low-salt, diabetic diet and exercise don’t get the weight off, you husband should consider obesity surgery. This surgery carries a small risk of death. Uncontrolled diabetes and high blood pressure, coupled with obesity, carry a high risk of death. If he gets the weight off, his blood pressure is bound to come down, and he might be able to stop treatment for diabetes.

DEAR DR. DONOHUE: I have a 16-year-old grandson who has a terrible case of acne. Shouldn’t he avoid chocolates and greasy foods? In my day, it was the rule avoid do both for acne. I have seen him eating chocolate bars and french fries. I don’t butt in, but I feel I should. Should I? – G.D.

ANSWER: At one time, a great fuss was made about dietary restrictions for acne. Now it’s believed that foods have little to do with acne’s genesis or its aggravation. If pimples break out after eating a particular food, then that food should be avoided. Blanket restrictions on chocolate and fried foods are no longer made.

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.

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