DEAR DR. DONOHUE: What makes a strep throat so different from other sore throats? Our doctor almost never treats our sore throats with antibiotics because he says most sore throats are not strep throats, and antibiotics don’t help. Why not? I feel cheated. – J.K.

ANSWER: Your doctor is doing an admirable job of treating you correctly and preventing the emergence of bacteria resistant to antibiotics. He’s also protecting you from developing an allergy to antibiotics. If you did become allergic to one, you wouldn’t be able to take when it was indicated.

Only about 10 percent of all adult sore throats are strep throats. A strep throat is one caused by the bacterium with the name streptococcus (STREP-toe-KOK-us). With children, the incidence of strep throat is higher, between 15 percent and 30 percent of all sore throats. The overwhelming numbers of sore throats are viral, and antibiotics do not touch viruses.

Even a strep throat gets better with no treatment. Treatment, however, prevents rheumatic fever, a consequence of strep throat infection in a small number of people (less than 3 percent). Rheumatic fever can damage heart valves, and for that reason, doctors are on their toes to distinguish between a viral and a strep sore throat.

They can do so by looking for a number of giveaways. Strep throats almost always cause a fever higher than 100.4 F, and they usually produce pus on the tonsils or back of the throat. They almost never cause a cough. They enlarge neck nodes and make them tender. They are most frequently seen between the ages of 3 and 14.

If the doctor suspects a strep throat, then the next step is to provide proof either by sending a culture of a throat swab to the lab to grow the strep germ or by doing an in-office, rapid test for the detection of the strep germ. If either is positive, penicillin is the drug of choice.

DEAR DR. DONOHUE: I read so much about taking an aspirin if you think you are having a heart attack. No one says what strength of aspirin. What is the proper dose? Will gel caps work? – I.S.

ANSWER: The aspirin to take for a heart attack is regular aspirin – not special aspirin that is enteric-coated or comes in gel caps or gel tabs. It should be chewed. The dose is 325 mg.

The heart attack booklet provides information about this most common and often deadly event. Readers can obtain a copy by writing to: Dr. Donohue – No. 102, 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: Would you tell us something about coccidioidomycosis (valley fever)? My sister is 71, and for the past 10 years has spent the winter in Arizona. Apparently she has this disease. Our doctor doesn’t know much about it. Is there a cure for it? – G.I.

ANSWER: Let’s use the name “valley fever,” since “coccidioidomycosis” is unpronounceable. How you spelled it correctly is a source of wonder to me.

It got the name “valley fever” because of the high incidence of it in California’s San Joaquin Valley. However, it is found in many places in the southwestern United States – Arizona, New Mexico and Texas. It is also found in Central and South America.

It’s a fungal disease. The embryo form of the fungus, the spore, lives in the soil where winters are mild and the annual rainfall is sparse. When soil containing the spores is disturbed through plowing, construction, digging or anything, the spores are released into the air. People breathe in the spores, which land in their lungs.

Most people suffer no consequences from inhaling the spores. A few have a flulike illness and get better in a short time without any treatment. A very few come down with pneumonia and need treatment, as do those who develop widespread infection.

There are antifungal medicines, usually given by vein, which can often cure the infection.

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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