DEAR DR. DONOHUE: About four months ago, I started coughing up flecks of blood. My doctor put me on antibiotics for bronchitis. They didn’t do any good. I went to a lung doctor, who made the diagnosis of aspergillosis. By this time the blood had disappeared, and the doctor said not to do anything at the present. Is that the usual treatment of this infection? – A.K.

ANSWER: Aspergillus is a fungus. If ever there is a fungus that fit the ditty “there’s a fungus among us,” it has to be Aspergillus. It’s everywhere – in decaying vegetation, in soil, in food, in water and in the air. No one on planet Earth escapes contact with it. However, it causes trouble only in a very few.

One Aspergillus-caused problem (not yours) is an allergic reaction in those who have either asthma or cystic fibrosis. A typical story is that of an asthmatic farmer who experiences a severe asthma attack upon entering a barn containing moldy hay. The mold is Aspergillus. Cortisone drugs control this kind of aspergillosis.

Invasive aspergillosis is a very serious infection in which the fungus infiltrates lung tissue and causes a pneumonialike illness. It happens to people whose immune systems are not up to par. Antifungal medicines are urgently needed for these people. This isn’t your variety of aspergillosis either.

Most likely you have a fungal ball, a skein of fungi, in a lung cavity. The cavity could be from an old, healed TB infection, emphysema or a similar lung problem. The fungal ball can erode blood vessels and cause bleeding, which shows up as blood-tinged sputum. Your bleeding has stopped. There’s no consensus about what to do with someone like you. Observation is often the wisest choice. If the bleeding resumes, then surgical removal – a quite delicate operation – is one possibility. Some suggest instilling antifungal medicines into the lung cavity. For the present, your doctor has chosen the safest approach.

DEAR DR. DONOHUE: I overdid my New Year’s celebration and wound up with a killer hangover the next morning. I decided to write you and ask how one should be handled. – K.O.

ANSWER: The best way to handle a hangover is not to get one. Everyone who drinks to excess can just about be assured that the following morning will be most unpleasant.

What actually transpires to cause a hangover has many explanations. One is the production of acetaldehyde from the metabolism of alcohol. Acetaldehyde is a nuisance chemical.

Dehydration is also partially responsible for hangover symptoms.

The best treatment for a hangover is to rehydrate with juices, which provide both fluid and sugar. Blood sugar usually drops after bingeing with alcohol, and the drop also has a hand in producing hangover symptoms

Caffeine does not hasten recovery, but it does make a person more alert, and there is something to be said for that.

DEAR DR. DONOHUE: Please give me information on drinking distilled water. Is there any harm for seniors who drink it all the time? – D.H.

ANSWER: During distillation, the vapors that come off boiling water are cooled and returned to the liquid state. Solids are removed from the original water. Of course, boiling kills all germs.

You can drink distilled water at any age, and you can drink it all the time if you so wish. It won’t hurt you. There is no good reason to do so, however.

DEAR DR. DONOHUE: Some weeks ago, you wrote that Lamisil cream or ointment is a treatment for toenail fungus. Information on the package says you shouldn’t use it for this. Whom are we to believe? – Anon.

ANSWER: The Lamisil item was a long-winded bit about toenail fungus. I wrote that oral – emphasis on oral – Lamisil works, but it can cause liver troubles and is expensive. I ended the piece by saying that Lamisil creams and ointments don’t cause liver damage. The creams and ointments are for skin fungus, not toenail fungus.

I can see how people might have been confused about this – if they really tried to be.

DEAR DR. DONOHUE: More than a year ago I became anemic. My doctor has me on three iron tablets a day. They give me diarrhea, and it has been difficult to live with. Please help. – H.D.

ANSWER: Anemia is a drop in the red blood cell count, and its causes are many. The appropriate treatment, therefore, demands finding a cause. Blind treatment almost never works.

Iron deficiency is a common cause of anemia. Iron deficiency frequently arises from a loss of red blood cells through bleeding. The bleeding can be silent and invisible. Sometimes the only evidence of intestinal tract bleeding, for example, is black stools. Once the site of bleeding is identified and attended to, the iron loss stops. However, to replenish iron supplies, iron tablets are needed. Iron frequently upsets people’s stomachs, and it can cause diarrhea or constipation. It is best-absorbed when taken on an empty stomach, but if it causes stomach distress, then it’s acceptable to take it with meals. That makes it less irritating to the stomach and less likely to bring on diarrhea. You might not have diarrhea if the dose can be safely lowered to one or two tablets a day. It will take longer to replenish iron stores, but it’s better to do so more slowly if symptoms like yours are making life unbearable.

Ask your doctor why iron is necessary. If the doctor says you have an iron deficiency, ask why. That’s the central question. If it’s from blood loss, ask what’s being done to find where the blood loss is occurring. If there’s no answer to that question, consider consulting another doctor.

Focusing on iron as the sole treatment of anemia risks ignoring other major anemia causes. Some anemias develop from premature death of red blood cells. They have a normal life expectancy of 120 days. Certain illnesses shorten that life expectancy and bring on anemia. Other anemias result from deficiencies of things like vitamin B-12. I am beating this issue into the ground. The point is, a cause of anemia must be found.

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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