DEAR DR. DONOHUE: In the past year I have gone from being an active man to one who has trouble taking a few steps without panting. I also have an annoying cough. I tried every cough remedy I could find. None worked. My family doctor thought I had bronchitis and put me on antibiotics. They didn’t work. Finally he sent me to a lung specialist, who thinks I have idiopathic primary pulmonary fibrosis. What is this? – R.R.

ANSWER: Fibrosis is scar tissue. Something, as yet unknown, has roused certain white blood cells and special lung cells to a frenzy of activity. (Incidentally, “idiopathic” means “cause unknown,” and “primary” implies that no other organ is the principal mischief-maker.) As a result of all this cellular activity, strands of scar tissue stretch across the air sacs just as they do in a skin injury. The tissue blocks the passage of oxygen from the lungs into the blood. People with this condition are in a state of oxygen deprivation, and only slight exertion leaves them breathless.

A second sign of the illness is a dry cough that refuses to respond to medicines.

The diagnosis of this illness is made by putting together several pieces of information: patients’ signs and symptoms; results of breathing tests; pictures taken with high-resolution CT scans; and often a biopsy of lung tissue. The biopsy shows the scar tissue in the air sacs.

Prednisone, azathioprine and many new medicines are given to try to stop the progression of the illness. None is a sure cure. However, lung transplantation remains an option if medicines fail.

DEAR DR. DONOHUE: I have been to my eye doctor for a checkup. She tells me I have “old eyes.” My age is 61. She says it’s no big deal.

My son went to the same doctor, and she told him the same thing. He has “old eyes.” She took pictures of the inside of his eyes and wants him to come back next year to see if anything has changed. Again she said to him, “No big deal.” His age is 30. He is all upset. What is this all about? – G.S.

ANSWER: I don’t know. It appears this woman has two favorite expressions – “old eyes” and “no big deal.” I’d be in the market for a different eye doctor unless this one is able to explain in a clearer fashion what is the exact condition of your and your son’s eyes.

DEAR DR. DONOHUE: I live in a Southern climate and spend a considerable amount of time outdoors when the temperature often exceeds 100 F. I take all the usual precautions such as wearing a long-sleeved shirt, long slacks and a broad-brimmed hat and using a sunblock of SPF 45, and I drink plenty of water.

I have been wearing a bandanna around my neck with crystals sewn inside, which hold water. The water evaporates slowly and creates a cooling effect.

Is there any danger of developing arthritis or anything else from wearing this wet cloth around my neck? – J.R.

ANSWER: No.

Where did you get this thing? I’d like one.

DEAR DR. DONOHUE: Since I have gotten older, I can’t wear pumps or high-heeled shoes without the balls of my feet hurting. Any idea of what I can do? – G.M.

ANSWER: Sure. Don’t wear pumps or high heels.

Now that I got that smart-aleck answer off, I’ll try to give you a more serious answer. These shoes put your feet in such a position that all the weight of your body rests on the metatarsal bones, the bones that abut on the base toe bones. You can buy metatarsal pads that relieve the pressure. Specially constructed shoe inserts – orthotics – also take the pressure off those bones. Tight Achilles tendons also stress the metatarsals. The Achilles tendons are the tendons that insert on the back of the heels. You can stretch them by standing on the lowest step in a stairway with your heels projecting off the step. Rise up on your toes as high as you can and then lower yourself so your heels are as far below the stair as possible. Repeat as many times as you can.

DEAR DR. DONOHUE: For the past four to five months I have had blood in my semen. My PSA is 0.7, and two physical prostate checks were good. Six months ago I went on Coumadin for atrial fibrillation. Doctors attribute the blood in the seminal fluid to bleeding caused by Coumadin. I have no other abnormal bleeding.

I am concerned that the seminal fluid blood is from something else, like cancer. I would appreciate your thoughts. – B.W.

ANSWER: Blood in the seminal-fluid always terrifies people. They think it must be a sign of cancer. Rarely is it a sign of any serious problem. It arises from the breaking of a few small blood vessels in the ducts through which sperm passes. Taking the blood thinner Coumadin or using aspirin daily for prevention of heart attack makes a man more prone to have this happen. Your doctors have cleared you. You don’t need any fancy tests. All is well.

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 wwwrbmamall.com

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