DEAR DR. DONOHUE: My mother is 89. She lives alone and drives her car. She had good health until two years ago, when she was put on Altace and Coreg for a fast heartbeat. In the past year, she had only one time when her pulse was 94. Her doctor wants to increase her medicine dose again. He did it once before. My concern is that she’s very petite, weighing only 108 pounds. I have noticed since the last increase that she’s wobbly when walking. She also has wakened in the morning and thought relatives were with her overnight. She functions very well at other times. Could the medicines be too strong for her? – E.J.

You make a good point. Medicine doses should be modified for elderly people, especially for thin elderly people. They don’t metabolize medicines as younger people do. Coreg is a beta blocker used to regulate the heartbeat and lower blood pressure. In older people, its blood level can be 50 percent higher than it is in younger people.

Altace is an ACE inhibitor, one of whose uses is to lower blood pressure too.

The combination of Altace and Coreg is often given for congestive heart failure, and that’s likely the reason why your mother takes the two – not for a fast heartbeat. Perhaps the doctor sees signs of poor control of congestive heart failure, and that’s what prompts his desire to increase the dose.

The next time your mother sees the doctor, go with her. Ask if she’s taking the medicines for congestive heart failure, and ask if they could be causing her early-morning confusion. I don’t see where that’s a common side effect of either drug.

DEAR DR. DONOHUE: How about some information on parotitis? I had it. The family doctor referred me to an ear, nose and throat doctor, who is taking a wait-and-see approach. I would appreciate any information you can give me. – E.D.

Parotitis is an inflammation of the parotid gland, the large salivary gland in the cheek below the ear and stretching toward the mouth. Bacteria can infect the gland and cause it to swell. With such an infection, it becomes hot and tender to the touch, and the skin over it turns red. Antibiotics are the treatment. Sometimes the gland has to be incised to drain pus.

Stones that block the salivary gland’s duct are another cause of swelling. If they don’t dislodge on their own, doctors have to remove them.

Viruses can also cause gland enlargement. There are no good medicines for them, so a wait-and-see attitude is often the one taken.

Until 1967, when a mumps vaccine was developed, the mumps virus was the most common cause of parotitis. Since then, the incidence of mumps has dropped by 99 percent. Many doctors have never seen a case of it.

In December 2005, an outbreak of mumps occurred in Iowa and spread to several states. It was transmitted by infected people who traveled by airplane.

DEAR DR. DONOHUE: My wife turned 70 this past February. Her health has been declining ever since.

She had an MRI, and the doctors think she has multiple systems atrophy. She has poor balance and falls easily.

The doctors don’t recommend any cure for this rare disease. Your suggestions are appreciated. – J.M.

Multiple systems atrophy is a fairly newly described condition. It might not be as rare as you think. Doctors are only slowly becoming attuned to it. Affected people have symptoms similar to Parkinson’s disease. In addition, they often lose bladder control. They have trouble speaking and swallowing. Frequent falls are common. Blood pressure often drops when patients rise from sitting or lying, and that causes dizziness. Thinking, however, usually remains clear.

There is no medicine to combat it. However, there are things that can be done. Occupational therapists can design aids that make it possible for her to do things she no longer can do. A physical therapist can devise a program to keep muscles strong and prevent falls.

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

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