DEAR DR. DONOHUE: This is probably the sixth letter I’ve sent to you. None was answered.

I had phlebitis in my left leg for about three years. This past month the pain has gone, and I am able to walk with a cane. I had gotten very used to a walker. Can I expect to stay pain-free forever? I am 68. – M.G.

ANSWER: The sixth letter does it every time.

Phlebitis (flea-BITE-us) is vein inflammation, and it quite often happens in a leg vein. The process is actually thrombophlebitis, indicating that there is both vein inflammation and a clot (thrombus) in the vein.

Thrombophlebitis in a leg vein that is just beneath the surface of the skin carries little risk to health other than the pain it causes. When it happens to a deep leg vein – one buried in the leg muscles – the consequences can be lethal. Bits of the clot can break loose, and the blood can carry those bits to the lungs, where they lodge in blood vessels and cut off blood supply to a portion of the lung. The broken-off piece is called an embolus. If the embolus is large or if there are many of them, pulmonary embolism can cause death.

Most of the time, thrombophlebitis is treated with blood thinners in order to prevent growth of the clot and to prevent embolus formation. The vein inflammation usually subsides.

It’s most unusual to have thrombophlebitis or just phlebitis for three years. I’m glad you finally have gotten over it.

If phlebitis or thrombophlebitis is not adequately treated, there’s a 40 percent chance of its coming back. If it has been treated, the chance for a recurrence drops to 3 percent or less within three months of resolution of symptoms. If you have passed the three-month mark, you are more or less home free.

DEAR DR. DONOHUE: We live in an area where there is a very high incidence of Lyme disease. Three weeks ago, my 28-year-old son lay on the ground to cut a tree. The next morning he came to me complaining of a bug bite on his right side near the beltline. I saw a tick attached to his skin. I removed it and cleaned the area with alcohol. It is normal-looking now.

How long should we continue to watch for the bull’s-eye rash to develop? How long should he wait to be tested for the illness? What are symptoms that indicate infection? How long does it take for them to appear? What is the best treatment for it?

ANSWER: Your son’s chance of not having been infected is good. The tick usually has to stay attached to the body for 36 hours or more before the Lyme germ is transferred to the human host. You got the tick off quickly.

The bull’s-eye rash of Lyme disease, generally occurring at the site of the tick bite, appears anywhere from three to 30 days after the germ has been transmitted. Early on, it might be a solid red circle. Then the circle expands and its center pales, but the border has a bright-red color, making it look like a bull’s-eye.

Other signs and symptoms of illness include headache, fever, chills, and muscle and joint pain. They appear around the time the rash appears.

The blood tests for detecting antibodies to the rash become positive four to six weeks after the bite.

Lyme disease is treated with antibiotics. Vibramycin is commonly used – it’s a tetracycline antibiotic. Amoxil and Ceftin can also be successfully used.

Not every tick bite spreads Lyme disease.

DEAR DR. DONOHUE: Four years before my marriage, I was vaccinated for hepatitis B. I am a nurse. My husband has just been diagnosed with hepatitis B. I was checked, and I have no antibodies from the vaccine. What should I do? – K.L.

ANSWER: You should get the vaccine again.

The booklet on hepatitis A, B and C explains these illnesses. To obtain a copy, write: Dr. Donohue – No. 503, 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. Allow four weeks for delivery.

DEAR DR. DONOHUE: I realize that muscle-building steroids give unfair advantage to young athletes and probably have damaging side effects. But how about aging athletes? I still ski at age 83, but my muscles are aging. Last winter I fell on the slopes, and I couldn’t get up. My legs didn’t have the strength. Is there any good reason why I shouldn’t take steroids? – B.E.

ANSWER: An older man with a deficiency of male hormone and under the supervision of a doctor might have a reasonable case for taking male hormones – muscle-building steroids.

However, I am not convinced that they would build leg-muscle strength any more than leg exercises would. It’s been shown that people in their 90s can significantly strengthen their muscles with weightlifting exercises.

I can think of a very good reason not to take male hormones, if they are not needed. Male hormones promote the growth of the prostate gland. An enlarged gland gives rise to all sorts of troubles, one of which is having to get out of bed many times to empty a bladder that can’t be completely emptied because of the obstructing prostate gland.

Male hormones also foster the growth of prostate cancer, and you want that side effect even less.

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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