DEAR DR. DONOHUE: I am a single woman, 64 years old. I still work full time, and I very much enjoy heavy gardening. I have a hard time doing it because of shortness of breath.

I have been to the doctor. She thought it might be asthma, and she put me on asthma medicines, but they didn’t change the symptoms. Then the diagnosis was congestive heart failure, and I took medicine for that. (I never had swollen ankles, so I sort of doubted that diagnosis.) It didn’t work. What specialist should I see? A lung doctor or a heart doctor? – D.S.

ANSWER:
Shortness of breath is one of the most common complaints heard by doctors, and its causes are almost uncountable. The lungs and heart are the usual sources of trouble, but many other conditions unrelated to the lungs or heart can also bring it about.

Asthma is not the only lung illness where shortness of breath is the primary feature. Pulmonary fibrosis, pulmonary hypertension (high blood pressure in the lungs but not in the body), and conditions such as sarcoidosis are examples of lung troubles that need special tests to detect. The most common lung condition that spawns a hunger for air is chronic obstructive pulmonary disease – emphysema and chronic bronchitis. The severity of those two conditions is measured through lung tests. Since the lung is the No. 1 suspect and since pulmonary tests are so important, a lung doctor is a good choice for you to make now.

Congestive heart failure is another common condition that leaves people breathless. Swollen ankles are not always part of the picture. Since your primary-care doctor hasn’t pursued heart failure and since heart-failure medicines were not a smashing success, we’re on firm ground in eliminating it as a cause.

Anemias – low red blood cell counts – make people oxygen-deficient, so anemias create breathlessness. So do some endocrine problems, such as a misfiring thyroid gland. Poor conditioning, a state into which many people fall after a winter of no exercise, is a remedial cause of a hunger for air. If this is what’s affecting you, the lung tests will show that, and the lung doctor will put you on a program that gets your body in shape and eliminates your shortness of breath.

The booklet on chronic obstructive pulmonary diseases – emphysema and chronic bronchitis – provides essential information on these two causes of breathlessness. To obtain a copy, write: Dr. Donohue – No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order 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 granddaughter, age 14, started to have menstrual periods a year ago. She wants to use tampons but cannot insert them. Her mother tried to show her how, but she couldn’t. Her mother told me that the pediatrician said the girl, as an infant, had a small opening and gave her cream to apply. It apparently didn’t work.

I never heard of this condition. What is the solution? My granddaughter is the world to me. – M.C.

ANSWER:
If the opening through the hymen is too small for a tampon, the family doctor or a gynecologist can correct that situation with little to no fuss. If she has some other vaginal anomaly, it needs a diagnosis now so it can be corrected early in her life. Her mother ought to take her to a doctor soon.

DEAR DR. DONOHUE: I need some information on crack cocaine.

I caught my new, 64-year-old friend smoking it. Can it really kill him? If so, how? What can I expect to happen? – M.T.

ANSWER:
I don’t want to be the first to break the news to your friend, but you and he can expect that he will be arrested if he is caught using or buying cocaine. It’s against the law.

Cocaine can cause very abnormal heartbeats that interfere with blood pumping. It can also cause heart attacks. It might precipitate a seizure. Smoking it irritates airways and sets them up for infection – bronchitis. Snorting cocaine (sniffing it through the nose) gives rise to septal perforations – holes in the portioning wall between the two nostrils – not lethal, but not pleasant.

DEAR DR. DONOHUE: What’s “sundowning”? My dad is in a nursing home because of his total confusion. When he was in his house, he didn’t know where he was, and he frequently got lost. He doesn’t recognize my brother or me. A nurse at the home told me that he’s sundowning. I haven’t a clue what that means. – T.T.

ANSWER:
It means that the person’s inner clock has been reset to a different time zone. These people become active in the late evening, when the sun goes down. They believe that night is day. They usually are quite agitated then.

Sundowning is common in many dementias. It frequently occurs in Alzheimer’s disease. Did the doctor say your father has that illness?

Alzheimer’s disease is a heartbreaking illness that disrupts patients’ lives and the lives of their families. The booklet on this common condition presents the facts about this illness and its treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 903, 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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