DEAR DR. DONOHUE: I have idiopathic thrombocytopenic purpura. When I was diagnosed with it, I had never heard of it. When I tell people about it, they never know what it is either. This illness can be life-threatening. I would appreciate your devoting a column to it, and please note that there is a support association at www.pdsa.org and 1-877-528-3538 – F.

ANSWER: “Thrombocyte” is another name for platelet, the blood cell that forms clots. “Penia” is a word indicating a deficiency. Thrombocytopenia, therefore, is a deficiency of platelets. Purpura is a bruise, the consequence of too few platelets.

Idiopathic thrombocytopenic purpura is an illness where the number of platelets has fallen so low that its victims can have many bruises and bleed easily. During their menstrual period, women patients bleed quite heavily. If the platelet count has dropped below normal but not to the point where bleeding and bruising arise, the illness is detected when a blood count happens to be ordered for some unrelated condition or reason.

ITP comes on at any age and happens to both men and women, but it mostly happens to young women between the ages of 20 and 40. The immune system makes antibodies that coat platelets, and the spleen sees these antibody-coated platelets as sandwiches and gobbles them.

In children, the onset of ITP is abrupt and usually follows a viral infection. Most children recover in one to six months. In adults, the onset is gradual and the illness is protracted; it can persist for years.

If the platelet count has dropped to a dangerous zone where bleeding is likely, prednisone, a cortisone drug, is given. If the platelet count remains low, the spleen – the site of platelet removal – can be removed. There are other drugs, and one of the newest ones is rituximab, a medicine that reduces the number of cells that produce antibodies.

The Web site of the Platelet Disorder Support Association provides an astonishing amount of information. I’m sure the toll-free number provides the same information. Thanks for informing us.

DEAR DR. DONOHUE: My mother was affected with rheumatoid arthritis at 27. She had me at the age of 32. Could I get it since she had it for almost five years before she had me? Is it hereditary, or does it affect people randomly? – C.F.

ANSWER: Women with rheumatoid arthritis outnumber men with it by a ratio of 3-to-1. Being a woman, therefore, puts one at greater risk for it.

There is a hereditary component to this illness. If one identical twin has it, the chances of the other identical twin having it are 30 percent to 50 percent. Identical twins have the exact same genes. Children of an affected mother or father are twice as likely to have it than those without such a family history.

Genes aren’t its only cause. Environmental factors are involved too. Your mother having been sick with rheumatoid arthritis when she had you is no more of a risk for your getting it than if she had come down with it long after your birth.

The booklet on rheumatoid and osteoarthritis deals with these two common conditions and their treatments. Readers 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.

DEAR DR. DONOHUE: What is bilirubin? My husband has it. What can he take to get rid of it? – B.D.

ANSWER: Everyone has bilirubin. It’s a byproduct from the body’s breaking down old red blood cells to recycle their parts.

High blood levels of bilirubin point to liver troubles. Such high levels turn the skin and the whites of the eyes yellow.

Do you have his bilirubin level on a lab slip? The normal values will be indicated next to his level. If his are normal, then there is nothing to worry about.

DEAR DR. DONOHUE: If a person had his entire prostate gland removed in surgery, can that person ever have a sex life without shots or without an attached penis pump? – E.P.

ANSWER: Today’s surgeons are careful to avoid traumatizing the nerves adjacent to the prostate gland that are responsible for erections. However, even with meticulous care, those nerves are frequently injured during surgery. It can take up to two years after the operation before they start working again, so time might be the answer to postsurgical impotence.

Sometimes, however, even time doesn’t restore potency. Viagra, Cialis and Levitra can produce erections in some of these instances. Penile implants are another choice. By “pump,” do you mean a vacuum pump? Such a pump is not attached to the penis. A vacuum pump creates a vacuum (hence the name) that draws blood into the penis.

The prostate booklet explains the prostate gland’s many troubles and their treatments. Readers can obtain a copy by writing: Dr. Donohue – No. 1001, 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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