DEAR DR. DONOHUE: I can’t believe this. My youngest child, age 5, has pinworms. I deserve an Academy Award for playing the role of Mrs. Perfect Housewife. I clean, scrub and vacuum all the time. How did he get this? I have two other children. Will they or my husband or I get it? This is so embarrassing. – W.B.

ANSWER: Keep cleaning, scrubbing and vacuuming. Pinworms aren’t going to make you lose your Academy Award bid. Cleanliness has nothing to do with them. Embarrassment isn’t warranted. You’d be hard-pressed to find a mother who hasn’t had some experience with them.

Your youngster must have been playing with another child who had pinworms. From scratching, the infected child gets pinworm eggs under the fingernails. Then when that child touches an uninfected child or touches toys shared by that child and other children, pinworm eggs are transferred. Eggs remain infective for as long as 20 days. The second child invariably puts his or her fingers in his or her mouth and swallows eggs.

In the intestinal tract, eggs develop into mature adults in two weeks to two months. At night, the female pinworms travel to the anus, where they deposit their eggs. The anus and adjacent skin become quite itchy, and the child scratches and eggs stick to his fingers and under his fingernails. He or she becomes a new courier for delivering pinworms.

You don’t have to increase your cleaning. Washing and drying underwear and sheets sterilizes them. Towels and washcloths for the infected child should be kept separated from those of other family members. Vacuuming around the bedroom and bedroom curtains is all the cleaning needed.

Medicines are quite effective in getting rid of the worms. Albendazole and mebendazole are two such medicines. A second dose of medicine is given three weeks after the first. Family members can be treated at the same time to prevent their coming down with the infection.

DEAR DR. DONOHUE: I have a soft bulge behind my right knee. It hasn’t hurt, but it began to give me some concern, so I saw my doctor. At first, she thought it might be a clot in a leg vein, but it turned out to be a Baker’s cyst. She wants me to see an orthopedic doctor. Why? It doesn’t bother me. – K.U.

ANSWER: A Baker’s cyst is a bursa swollen with fluid. Bursas are flat, circular disks interposed between tendons and bones to stop friction when the tendon rubs across the bone. There are five behind-the-knee bursas.

When filled with fluid, a bursa can be painful, or it can be symptomless. If the bursa enlarges, it can burst, and that’s a memorably painful experience.

Your doctor has good reasons for referring you to an orthopedic doctor. One reason is for a complete examination of the knee. Quite often, knee trouble is the source of fluid that seeps into the bursa. Arthritis, torn knee cartilages or other knee injuries increase the fluid production of the knee joint, and the fluid makes its way into the bursa. Treatment of the knee problem treats the Baker’s cyst.

The orthopedic doctor can drain the fluid out of the bursa and inject a cortisone drug into it to prevent recurrence of fluid. If medicines or injections don’t stop fluid recurrence, then the orthopedic doctor can surgically remove the inflamed bursa.

DEAR DR. DONOHUE: When I turn on my side at night, I hear my heartbeat. Does this signal a heart problem? It drives me nuts. – J.G.

ANSWER: Hardened arteries next to the heart can transmit the sound of the beating heart when a person rolls over onto the side. That’s not usually a sign of dire implications.

High blood pressure can also make the heartbeat audible. So can anemia, blood vessel tumors and Paget’s disease – a bone disease.

At your annual exam, mention this to your doctor, who can look for the rare but significant problems. Most likely, it will turn out to be nothing.

DEAR DR. DONOHUE: One of my daughters, grown and living away from home, is undergoing treatment for depression. What’s the cause? Is it something we did while she was growing up? Her therapist says she has anhedonia. Is that part of depression, or another illness? – M.D.

ANSWER: Depression comes from an imbalance of brain messenger chemicals. Modern medicines are able to restore the chemical balance for most depressed people. Your daughter’s depression has nothing to do with anything you or your husband did or did not do when she was growing up.

Anhedonia is a loss of pleasure in things that used to bring a person happiness. Food becomes unattractive. There’s no joy in socializing with friends. If your daughter was an avid reader, reading becomes a chore. Anhedonia is a part of depression.

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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