DEAR DR. DONOHUE: It’s very important that you reply to this letter, because it involves a number of women who are 75 and older. I am 81. Two years ago, my doctor suggested that I get a Pap smear. It turned out negative. I moved and changed doctors. When I asked for a Pap smear with my new doctor, he said that women my age do not need one. I called a close friend who happens to be a physician. He said that my doctor’s statement was not true, and that I should demand a Pap smear.

Who’s right? I am very concerned about this. – R.J.

ANSWER: Prestigious medical organizations that set the standards for medical testing have endorsed a policy that allows women at certain ages to stop having Pap smears. They can stop if they have had three normal smears and have had no abnormal smears in the past 10 years.

The organizations and their suggestion for the age of stopping are: the American Cancer Society says to stop at age 70; the American College of Obstetricians and Gynecologists states that the age of stopping is a matter to be decided on an individual basis; the US Preventive Services Task Force picks 65 as the age when Pap testing can be terminated.

The booklet on cervical cancer and Pap smears goes into these topics more thoroughly. Readers can obtain a copy by writing: Dr. Donohue – No. 1102, P.O. 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 a 2½-year-old niece who sometimes suffers from constipation. Her mother gives her Children’s Tylenol or Motrin to calm her. She is not hyperactive. I feel the use of these drugs has caused the constipation and that she will be immune to them when she does need them. The pediatrician put the little girl on a stool softener. Please shed some light on this. – M.M.

ANSWER: Since she has seen a pediatrician and since the doctor found nothing wrong with the child, then I have to assume that her constipation is an intermittent thing and not due to any serious problem. A stool softener is a reasonable approach in such cases.

I cannot find constipation as a side effect of either Tylenol or Motrin. However, it is not great idea to pop pills into a young child’s mouth for no good reason. Neither Tylenol nor Motrin calms anyone. Both, as can any medicine, have side effects. The child won’t develop immunity to them, but she could develop an allergy to them or she could suffer side effects from them. The mother ought to stop this practice.

DEAR DR. DONOHUE: Three months ago, my mother was diagnosed with a collagen disease. Her doctor put her on prednisone. Her symptoms include muscle fatigue and feelings of no strength. Her doctor has not defined what kind of collagen disease she has. Would you please give our family some insight and describe to us in simple terms what all this means and what her options are? – P.F.

ANSWER: Collagen is a protein found throughout the body. It is a main component of tissues that support organs and the skin. It’s found in ligaments, tendons, joints, cartilage and blood vessels.

Collagen diseases, or more commonly collagen vascular diseases (vascular because blood vessels are involved), include rheumatoid arthritis, lupus, scleroderma, dermatomyositis and polyarteritis nodosa. Each of these illnesses has some common elements shared by the others, but each is a distinctive illness with its own set of signs and symptoms, its own prognosis and often its own treatment.

The doctor has an obligation to tell your mother which of these illnesses she has. He has put her on a strong medicine – prednisone, one of the cortisone drugs. It shouldn’t be prescribed unless there is a compelling reason to use it.

If the doctor won’t give her a specific diagnosis, your mother would be well served by contacting a rheumatologist, a specialist in these illnesses.

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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