DEAR DR. DONOHUE: Last summer I had a very bad reaction to a hornet sting. I was taken to the emergency room and stayed there for six hours. I was sent home with an EpiPen.

One doctor suggested shots of venom to desensitize me. Another said they don’t work. I do not want to go through this again. I was told that without medical help, I would have died. Do the shots work? I garden and am now afraid to go out in the yard. – Anon.

ANSWER: For most people, the sting of honeybees, yellow jackets, wasps, hornets and imported fire ants causes only pain and swelling for a day. A few people have more pronounced pain and swelling that last five to seven days. A very few have a severe reaction where they break out in hives, swell, become short of breath and develop a cough. Their blood pressure can drop. The voice box might swell and make the passage of air into the lungs difficult or impossible. This kind of reaction is called anaphylaxis (ANN-uh-fill-AXE-us) and can be deadly if not treated quickly.

You should not be so anxious that you’re afraid to go out in your yard. Such worry is unwarranted. However, you should see an allergist about getting desensitized to the venom of these insects. The shots do work. They prevent a recurrence of a serious reaction 98 percent of the time. A better record is hard to come by.

I don’t want you to be a worrywart, but you should also have a plan in mind that you can put into action should you be stung again – a not unlikely event. Carry with you or have near you the EpiPen kit. For readers, this contains a syringe that’s filled with adrenaline (epinephrine). The syringe is self-activated by pressing it against the skin. Put an antihistamine in a place where you can get to it. Don’t use perfume when you’re outside. Don’t wear bright clothing with a floral pattern. Do get a MedicAlert bracelet or necklace that states you have had a previous serious reaction to an insect sting.

DEAR DR. DONOHUE: I am a 56-year-old man who is 5 feet 6 inches tall and weighs 165 pounds. I just had my yearly physical. I thought everything was excellent because my total cholesterol is 119 and my LDL cholesterol is 72, both of which are fine. However, my HDL cholesterol is 35. My doctor says it should be 40 or higher.

Do I have to be concerned with my low HDL? If I do, can you provide me with recommendations for increasing it? – J.B.

ANSWER: Your total cholesterol and LDL cholesterol numbers are awesome. LDL cholesterol, so-called bad cholesterol, clings to artery walls and obstructs blood flow. It should be less than 100 (2.6), and the lower, the better.

HDL cholesterol, good cholesterol, keeps arteries free of buildup and prevents heart attacks and strokes. For men, a good number is above 40 (1.04), and for women, it should be slightly higher.

Exercise raises HDL. If weight loss is indicated, a drop in weight also raises it. Two to 6 ounces of wine at dinner can elevate it. If you don’t drink alcoholic beverages, don’t start just to raise your HDL. If your doctor believes you need medicines, nicotinic acid (niacin) or Lopid can bring it up.

You don’t need to do much more than you are already doing. At present, the cholesterol numbers that trigger action are the LDL cholesterol and total cholesterol. Your values are so good that worrying about your slightly low HDL is gilding the lily.

The cholesterol booklet provides the facts on this frequently discussed topic. To obtain a copy, write: Dr. Donohue – No. 201, Box 536575, 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: My father coughs frequently. Could it be the mineral oil he takes all the time? – M.D.

ANSWER: Mineral oil can dribble into the lungs and airways. It could be the cause. He shouldn’t take it regularly. Have him take more fiber or a stool softener.

DEAR DR. DONOHUE: Our son, age 53, who has never been sick before, has been diagnosed with ankylosing spondylitis. He is being treated with Enbrel, but so far, no success. What is his prognosis in life? – M.G.

ANSWER: Ankylosing (ANN-kuh-LOW-sing) spondylitis (SPAWN-duh-LITE-us) is a kind of arthritis that affects mostly the back. It’s more common in men than in women, often runs in families and usually begins at a relatively young age, with the average age of onset being 23.

It begins without arousing suspicion as nondescript lower back or hip pain, or both. Pain and stiffness inch their way upward in the back. In time, the entire spine can be involved and can immobilize a person. When the process is extensive, people walk locked in a forward stoop, with their knees and hips slightly bent. It can make turning the neck impossible. Not all patients have this extensive involvement.

Other joints can also be involved – hips and shoulders are two examples.

Sometimes the inflammation characteristic of this illness affects the eye, and it can cause the heart’s aortic valve to leak.

As with other varieties of arthritis, anti-inflammatory medicines are the first drugs turned to. Your son’s medicine, Enbrel, has been a recent godsend treatment for many. I don’t know how long he’s been on it, but it might be only a matter of time before things turn around for him. Another new medicine is Remicade. It might benefit him if Enbrel fails.

A physical-therapy program is a must for all A-S patients to preserve as much flexibility in their spines as possible.

Although things are not going your son’s way at present, most A-S patients stay functional, with only some limitations of activity, and live a normal life span.

The arthritis booklet tells the arthritis story for most kinds of this illness, but not for A-S. People can order a copy by writing: Dr. Donohue – No. 301, 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.

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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