DEAR DR. DONOHUE: When a doctor says, “Take a deep breath” and he’s not listening to your chest, you know something bad is going to happen, especially if he has a long, black, snaky thing in his hands. Our doctor has suggested that my wife and I consider a colonoscopy. We understand that such an exam involves a discomfort level that can’t even be discussed. With modern sedation, why do such procedures have to hurt? I bet that once patients become confident that there will not be pain, thousands will have to courage to do what is best for their health. – B.D.

ANSWER: People are given sedation and pain medicine before a colonoscopy exam. Someone has given you a distorted picture of the procedure. It’s not high on a list of recreational activities, but it’s not one of life’s most unpleasant experiences, either. At most, it is slightly uncomfortable, and usually it does not rise even to that level.

The colon is 4 to 5 feet long. It runs up the right side of the abdomen, crosses over to the left and then runs down the left side to the rectum. Only colonoscopy (KOH-lon-OSS-kuh-pea) provides a clear view of the entire colon.

It also permits the doctor to snip off any polyps. Polyps can be cancer precursors. Snaring a polyp isn’t painful. The colon senses pain only when it is stretched.

Colonoscopy is the best way to detect colon cancer, and it is the best way to prevent it. Beginning at age 50, everyone should have this exam. People with hereditary forms of colon cancer should begin scope exams at younger ages.

The thought of the exam is freaking you out unnecessarily. Even I, who find an excuse to avoid the slightest pain, don’t recoil from the thought of a colonoscopy exam.

The booklet on colon cancer provides the complete story on this common killer. Readers can order a copy by writing to: Dr. Donohue – No. 505, 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 mentioned to my doctor that I was bothered by my hand trembling when I raised it with a cup of coffee. He prescribed Inderal. This seems strange, since you mentioned Inderal for a patient with an irregular heartbeat caused by mitral valve prolapse. Am I taking the wrong medicine? – C.S.

ANSWER: The same medicine can be used for many unrelated conditions. Inderal (propranolol) is given for high blood pressure, irregular heartbeats and some kinds of headaches. It’s also used for essential (familial) tremor, the kind of shaking that occurs when threading a needle or bringing a cup of coffee to the mouth.

Consider the conditions for which aspirin is given. It’s a pain reliever and a blood thinner. It doesn’t actually thin blood, but it stops blood platelets from sticking to each other and forming a clot inside an artery. That’s why it’s used to prevent strokes and heart attacks.

Amitriptyline is an antidepressant. It’s also used for pain control in many conditions.

There are many more examples of medicines that have diverse uses. You’re taking the right one.

DEAR DR. DONOHUE: There are persistent reports that heart attacks are caused by necrosis in the left ventricle due to acidosis. I have learned strophanthine is the only remedy for this. Why can’t I get it? Do I need to fly to Berlin? – R.P.

ANSWER: The buildup of plaque – an amalgam of fat, cholesterol, protein and platelets – causes heart attacks, which are the death (necrosis) of a section of heart muscle due to the obstruction of blood flow. Usually it occurs in the muscle of the left ventricle, the pumping chamber of the heart.

Strophanthine (also spelled strophanthin) goes by the name ouabain (wa-bane) in North America. It belongs to the digitalis family of heart medicines. It is not much used here for heart attacks. It’s not much used here for any heart conditions. Send me the information you have on it. I’d like to read it.

DEAR DR. DONOHUE: I am a 44-year-old black woman. I had eczema on the back of my neck. It itched so bad that I would scratch it during sleep. The eczema has gone, but the skin where I scratched has turned a deep black. My normal skin color is brown. What can I use to get the skin to turn back to its normal color? – K.M.

ANSWER: You describe postinflammatory hyperpigmentation, a skin condition common in blacks. Eczema alone can lead to it. Scratching injures the skin and heightens the probability of developing it. There is an increase in melanocyte activity after such skin injury. Melanocytes are the pigment-containing skin cells.

You can lighten the color by applying sunscreen to the area faithfully. It might take a whole year, but the color should return to normal if you protect it from sunlight.

Bleaching agents can also lighten the patch of skin. Hydroquinone is such a medicine, and it can be obtained without a prescription. Brand names include Eldopaque, Esotérica Regular, Esotérica Sunscreen and Solaquin. The amount of hydroquinone in over-the-counter medicines is less than that in prescription medicines. If these don’t work, you’ll have to obtain a doctor’s prescription for the stronger varieties.

Azelaic acid, an acne medicine, can also slow melanin production and lighten postinflammatory hyperpigmentation.

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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