DEAR DR. DONOHUE: I used to consider hemorrhoids joke material, until I got them. I use a foam spray, but it’s not working too well. What else can I do? I don’t look forward to surgery. – J.B.

ANSWER: You can consider hemorrhoids to be the rectum’s varicose veins. There are two types. Internal hemorrhoids are up high and out of sight; they tend to bleed. External hemorrhoids are lower and can be felt and seen; they tend to hurt.

Simple treatments can sometimes yield great rewards. One is to sit in a tub of warm water with knees bent so the water can bathe the hemorrhoids. Two is to keep stools soft. Passing hard stool further irritates hemorrhoids. You can keep stool soft by increasing fiber in the diet or by taking stool softeners.

Over-the-counter hemorrhoid preparations can often soothe hemorrhoids. Many contain cortisone, like the foam spray you’re using. Even though your spray hasn’t helped you, it has helped many. Products that contain the numbing agent lidocaine are also useful.

Doctors can encircle some hemorrhoids with rubber bands. They eventually shrivel and are sloughed off. Heat probes, lasers, infrared light and electric coagulation are other, nonsurgical procedures that can get rid of hemorrhoids.

If a clot in your hemorrhoid is the cause of pain, you will welcome the relief a doctor can give by incising the hemorrhoid and removing the clot.

Don’t dismiss surgery out of hand. It isn’t as painful as your imagination has led you to believe.

DEAR DR. DONOHUE: I just finished baby-sitting for my daughter when she and her family moved to a new house. One morning, I gave the baby, 10 months old, a spoonful of honey. She enjoyed it. My daughter screamed at me to never do that again because I could poison the child. I raised eight children and gave all of them honey when they were infants. None died. What’s my daughter talking about? – R.C.

ANSWER: She was screaming about botulism, one kind of food poisoning – potentially the most dangerous kind. Most botulism food poisoning happens to adults and comes from improperly home-canned foods. Botulism results from a poison made by the botulinum bacterium. The poison can survive the canning process when it’s not done carefully. When people eat food contaminated with the poison, they often experience nausea, vomiting and stomach pain. Then the most feared complication begins. The poison can paralyze muscles. Double vision is often the first sign of muscle paralysis. The paralysis descends rapidly from the head to the legs. Paralysis of breathing muscles requires artificial ventilation to prevent death.

In infants, the story is a bit different. Botulinum bacteria form spores, embryos encased in a hard covering. When infants eat foods with botulinum spores, the spores germinate into adult germs in the infant’s digestive tract, and the adult germs begin to make their poison. The poison paralyzes, just as it does in poorly canned foods. The baby becomes listless. Its muscles are limp. Breathing muscles can be paralyzed and death can occur. In the digestive tracts of older infants and adults, spores do not develop into mature germs. Honey is one source of botulinum spores, so infants less than 1 year old should not eat it.

This has to be put into perspective. There are very few cases of infant botulism in any given year, and only a few can be traced to honey. Honey is a healthy, tasty, wonderful food that can be eaten by all except young infants.

There is a new treatment for infant botulism, an antidote for the poison made with human gamma globulin

DEAR DR. DONOHUE: I had an ultrasound for ovarian cysts. I don’t have any, but I do have gallstones. My doctor says to leave them alone. Is he right? – J.L.

ANSWER: “Silent” gallstones, ones that haven’t caused any pain, can be ignored. The chances that they will cause pain are small. Your doctor is right. You don’t need to have your gallbladder out or its stones removed.

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.

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