DEAR DR. DONOHUE: We had to take our 18-year-old son to the emergency room because he was having horrible stomach pain. The ER doctor wasn’t sure what the trouble was. He thought it might be appendicitis, but it took three hours before the doctors were certain enough to take him to surgery. I knew it was his appendix.

Why such a long delay over something like appendicitis? My dad died of a ruptured appendix, and I was afraid that was going to happen to my son. – A.G.

Believe it or not, appendicitis is not so easy to diagnose. Many causes of abdominal pain present in a similar way, and they have to be considered before the appendicitis diagnosis is a certainty and operation becomes the proper treatment. The classic symptoms include pain that begins around the navel and then migrates to the lower right side of the abdomen. Body temperature is mildly elevated, around 1.8 degrees F (1 degree C). Patients usually lie with their right leg flexed. Straightening it increases pain. The abdomen becomes rigid to the touch. The white blood count is often elevated. The trouble is the appendix hasn’t read this script, and inflammation of it presents in many different ways. That makes the diagnosis quite difficult.

These days, a CT scan adds valuable information that greatly aids in identifying the appendix as the cause of abdominal pain.

The appendix looks like a worm. It’s about 3.5 inches long (9 cm) and has a hollow core. If the core is blocked, then the number of bacteria in the appendix increases and causes swelling. If the swollen appendix isn’t removed, it bursts and sends millions of bacteria into the abdomen. That creates a severe infection that, at times, proves lethal. In your father’s day, there were no such things as CT scans and there were many more cases of burst appendixes.

I’m sorry your son was in pain for hours, but three hours is a pretty short time to make the diagnosis.

DEAR DR. DONOHUE: My doctor says I have mitral regurgitation. I know it has to do with my heart, but beyond that I don’t know much about it. The doctor didn’t tell me I had to restrict my activities. I play several sports. He didn’t give me any medicine to take. Is there something I can do to correct this? – P.P.

The mitral valve regulates blood flow between the upper left heart chamber – the left atrium – and the lower left heart chamber – the left ventricle. The left atrium is a tank for blood returning from the lungs with oxygen in it. The left ventricle is the muscular pump that ejects blood from the heart into the body. When blood passes from the left atrium into the left ventricle, the mitral valve closes to prevent backflow of blood when the left ventricle contracts and pumps blood out of the heart.

Mitral regurgitation (also called mitral insufficiency) means that some blood leaks back into the atrium when the ventricle contracts. The degree of leakage dictates treatment.

Small leaks can be safely followed to make certain they aren’t increasing. Large leaks – ones that cause symptoms like breathlessness – are surgically corrected.

There isn’t anything you can do on your own to make things better. You probably have a small leak.

DEAR DR. DONOHUE: When I was young (I am 82 now), people poured hot paraffin on their joints if they had arthritis. It worked. I had several relatives and neighbors who did this and said it took away their pain. They could move about much better than they did before the treatment. Why isn’t this done today? – W.F.

Warm paraffin (not hot) brings soothing comfort to an arthritic joint just as do warm soaks or warm compresses. Warmth increases blood flow, and that makes a person feel better.

There’s nothing magical about paraffin.

I don’t know anyone using that treatment today. I guess the enthusiasm for it must have died out. Could it be that it doesn’t work for everyone?

DEAR DR. DONOHUE: When’s the best time to take a vitamin? There are no directions on the bottle, and all the doctors I ask simply shrug their shoulders. – B.W.

It’s the kind of question that prompts a shrug because there’s not a lot of information on the subject. I have been told to take a multivitamin on a full stomach — after eating. Many vitamins are absorbed better then.

I take a multivitamin early in the morning, before eating. It’s an act of defiance on my part.

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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