DEAR DR. DONOHUE: I think I am a bit of a medical miracle for having recently survived necrotizing fasciitis, the flesh-eating disease, at the age of 77. I attribute my good fortune not just to my underlying good health but to the expertise of my physician and his nurse. This illness is often misdiagnosed, and since it is a fast-moving disease, the result is often fatal. You would do a service to readers in describing the symptoms of this dreadful illness. – A.U.

ANSWER: Only a short time ago, the media were obsessed with stories about flesh-eating bacteria, the lurid name for necrotizing fasciitis. It hasn’t gotten much attention lately. I don’t know why. It’s still with us and still is, as you said, a dreadful illness.

Fascia is a sheet of tough tissue that wraps around and supports muscles and unites skin with underlying tissues. It’s a little like the covering of a sausage or hot dog.

The fascia sometimes becomes a freeway for bacteria when they penetrate the skin through even a minor injury such as a small cut, a burn or an insect bite. The germs speed down the fascia and create great destruction as they move. A medley of germs is often involved, but the strep germ is prominent in one variety of this infection.

The infection starts out with red, swollen, hot, shiny and tender skin. The skin breaks down to an open sore surrounded by blisters. Nearby blood vessels plug up with clots, and that adds to the destruction of skin and muscle. The swelling and redness travel quite rapidly, as does the destruction of all tissues unless steps are quickly taken to stop it.

Antibiotics must be given immediately. Surgeons have to remove all dead tissue to deprive bacteria of their sanctuary from antibiotics. You were lucky that your doctor and nurse took quick action. They saved your leg or arm, and your life. (I say leg or arm because the infection usually starts in an extremity.)

DEAR DR. DONOHUE: Thirty years ago, I had a malignant bladder tumor. Then I had cystoscopies every three months for two years, then every six months for two years and then once a year. After 30 years, another tumor came back, and it was removed. Now I go again for a cystoscopy every three months. I am also receiving BCG treatments.

What is the percentage of recovery with BCG? Why do I have to have the scope exam every three months again? Will I have to have these exams for the rest of my life? I am 78. – A.L.


ANSWER: Bladder cancer is notorious for recurrences. Of the 63,000 Americans who come down with it this year, 70 percent will have a recurrence after initial treatment.

Since bladder cancer is known for doing this, a surveillance program to catch recurrences early is instituted for all bladder-cancer patients. The surveillance is done with a cystoscope – a viewing device that allows the doctor to see the bladder clearly. A schedule similar to the one you describe is standard.

When there is a recurrence, the patient starts the procedures from scratch with a scope exam every three months for two years. The frequency tapers off after that. You will most likely have to continue the scope exams for life.

BCG is bacillus Calmette-Guerin, a bacterium used to immunize against tuberculosis. Here it’s used to stimulate the immune system to attack bladder cancer. That’s accomplished by instilling it into the bladder. This treatment reduces the number of recurrences by 60 percent or more.

The electrical stimulation treatment (a deleted part of the letter) you had did not cause your cancer recurrence.

DEAR DR. DONOHUE: I have a twitch in my eyelid. Is this a sign of anything bad? – K.D.

ANSWER: Not usually. People often get such a twitch when they are tired or under stress. Massaging the closed lid or putting a warm compress on it often ends the twitching.

If the twitching gets worse or stays on and on and on, then you should see your doctor.

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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