DEAR DR. DONOHUE: On the printed report of my chest X-ray it says “suggestive of COPD.” Do I have it, and exactly what is it? I feel good. I’m 36 and haven’t had a sick day in the past 15 years. – L.R.

ANSWER:
COPD is chronic obstructive pulmonary disease. The two big COPD illnesses are emphysema and chronic bronchitis, both most often caused by cigarette smoking. There are exceptions to that rule. COPD is one of the leading causes of disability and death in North America. More than 16 million North Americans suffer from it, and more than 80,000 die of it yearly.

With emphysema, the lungs’ air sacs are destroyed. It is through those delicate structures that oxygen passes into the blood and carbon dioxide passes out of it. The principal sign of emphysema is breathlessness when taking even a few steps.

Chronic bronchitis is airway (bronchus) inflammation with an exuberant production of mucus. A constant cough with expectoration of thick mucus is its predominant sign.

Most often, both conditions exist simultaneously.

You’re 36. You didn’t say if you are or have been a smoker, but I’m assuming you never smoked. You have no symptoms. The likelihood that you have COPD isn’t great. It’s close to nil. The X-ray diagnosis says “suggestive,” and that is something that can be said of just about everyone. Furthermore, X-rays don’t make the diagnosis. They can confirm the suspicion of COPD, but more than that they cannot do, except in patients who have far-advanced illness. A physical exam coupled with breathing tests is the way to detect COPD. Breathing tests demonstrate the “obstruction” to airflow and quantitate how bad the obstruction is.

How did you get a chest X-ray without having a doctor? If you do have one, that is the person who should interpret the X-ray for you. If you don’t have a doctor, get one.

DEAR DR. DONOHUE: I would appreciate it if you would listen to my wife’s story. She complained of back pain for more than six months. She saw four different doctors during this time, and none could find a cause of the pain.

The fifth doctor had her take a CT scan, which revealed her problem: retroperitoneal fibrosis. We know nothing about this. Why did the first four doctors miss it? – J.M.

ANSWER:
Back pain is common. Retroperitoneal fibrosis is uncommon. Only about two people in 1 million come down with it. It’s not one of the first things that come to mind when a person complains of back pain. That’s one big reason why the first four doctors missed the diagnosis.

The peritoneum is a large “cellophane” sac that contains most the abdominal organs. “Retro” means “behind.” It’s behind the peritoneum where this illness takes place. That space fills with scarlike tissue. The tissue can wrap around the ureters, the two tubes that drain the kidneys and bring urine to the bladder. Urine obstruction is the major complication of this condition.

Its cause has not been discovered. It’s thought to be an autoimmune disease, one of the many illnesses where the immune system turns on the body.

Prednisone and azathioprine are examples of medicines used in the treatment of this disorder. Both diminish the inflammation that prompts formation of scar tissue, and both regulate an immune system that has gone wild. If the ureters are obstructed, a urologist has to free them from the entrapping tissue.

DEAR DR. DONOHUE: I have been on thyroid medicine for years. It was suggested that I take iodine to get my thyroid gland functioning on its own. Why don’t doctors suggest iodine rather than prescription medicine for the thyroid? – V.W.

ANSWER:
Unless the circumstances are quite unusual and unless a person is truly iodine deficient, taking iodine doesn’t cure thyroid problems. You shouldn’t stop your thyroid medicine unless your doctor says to do so.

DEAR DR. DONOHUE: For the second time in two years, I had what I at first thought was a urinary tract infection. It turns out that it isn’t an infection. It’s epididymitis. It is terribly painful. Both times, antibiotics cured it, but I wonder why I got it twice. Is it common to have a recurrence of this? – G.M.

ANSWER:
Epididymitis (EPP-uh-DID-uh-MITE-us) is an inflammation of the epididymis, a bundle of tubules through which sperm travel in their journey out of the testicles. The inflammation is usually due to an infection. In older men, the infection often is a spillover of germs from the urinary tract. In younger men, the infecting germ is often sexually acquired.

The epididymis is situated on the back and upper end of the testicle. Testicular pain is the hallmark symptom, and the pain can be extreme. The scrotal skin turns red.

Scrotal elevation eases pain, and ice packs also help in the first days of infection. Pain medicine is essential. Antibiotics are the curative treatment. Usually it takes only a week or so before a man is again quite active.

It’s not terribly common to have two episodes of epididymitis. If you have a third, then you should see a urologist. It could be that you have some anatomical abnormality in your genitourinary tract that makes you susceptible to recurrences of this infection.

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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