DEAR DR. DONOHUE: In 2000, I found out I have hepatitis C. I was a drug user in the past and could have gotten it from sharing needles. Since my diagnosis, I notice that my skin is darker, and I have lost most of my hair. I sometimes feel tired for no reason. The doctor at this institution started me on treatment, but I had to stop since my body rejected the treatment. What are my options? – J.W.

ANSWER: Hepatitis C is a widespread infection. In the United States, at least 4 million are infected, and in the entire world, 170 million have it. Nearly 85 percent stay infected with the virus for the rest of their life. Of that number, some 20 percent will come down with liver cirrhosis. That doesn’t happen right away; it takes about 20 years. A smaller percentage – 1 percent to 4 percent – develop liver cancer.

I don’t know if your symptoms stem from hepatitis C. Fatigue is a hepatitis symptom, but hepatitis fatigue is usually persistent, not like yours. Darker skin and hair loss are not terribly common hepatitis symptoms; yellow skin can be.

The standard treatment for hepatitis C is the combination of interferon, given by shot, and ribavirin, given as a tablet or capsule. Headache, nausea and muscle pain sometimes follow interferon treatment. Hair loss, weight loss and depression are also possible. There are medicines to counter some of these side effects, and sometimes the side effects diminish with continued use. Ribavirin can produce cough, shortness of breath, anemia and weight loss, but fewer react to it the way they do to interferon. There is no good substitute for either.

Maybe you don’t need treatment. The indications for it are elevated blood levels of liver enzymes, along with scarring and inflammation seen on a liver biopsy.

Without treatment, the odds of decent health are still in your favor unless your liver biopsy shows severe changes. Even then, abstinence from alcohol spares the liver from increased destruction, and the possibility of a liver transplant can be entertained if such becomes necessary.

The hepatitis booklet provides information on the three common hepatitis varieties – A, B and C. To obtain a copy, write to: 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. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My sister and I both had smallpox when we were young. I am 83. We were told that you never get it again. Doctors now tell me that’s wrong. Is it? – B.F.

ANSWER: You won’t ever get smallpox again. It’s been wiped off the face of the earth – although the virus still exists, locked up in a few laboratories.

When it was given, the smallpox vaccine did a good job of preventing smallpox altogether and making it a much less formidable illness if it was caught. I believe you can safely say the same for a smallpox infection. (This is theoretical now. It’s not going to happen.)

DEAR DR. DONOHUE: I am a 70-year-old man who had a hip replaced one year ago. The doctor prescribed Keflex to be taken before dental procedures. I took the medicine as prescribed and headed to the dentist’s office. While driving, I experienced dizziness, and my vehicle hit a tree beside the road.

I was taken by rescue squad to the emergency room, where numerous tests were done. I was later released. They told me I had an allergic reaction to the Keflex, a penicillin-type drug. I did have itchy, red fingers during the ambulance trip.

What can I do to be safe in the future? My doctor has changed the medicine to clindamycin. – B.M.

ANSWER: People who have leaky or narrowed heart valves, artificial heart valves or artificial joints take antibiotics before dental procedures that cause bleeding. Mouth bacteria can get into the blood and find a safe haven on such valves or joints.

Keflex has a chemical structure similar to that of penicillin, so allergy to one often means allergy to the other. Clindamycin is a perfectly acceptable substitute. You should not suffer a reaction to it.

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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