DEAR DR. DONOHUE: I have had two incidents of atrial flutter in the past four months. They were frightening experiences. I now take medicine to prevent a recurrence. I was checked thoroughly by a cardiologist with an echocardiogram, a nuclear stress test and an EKG. All tests were negative. I have exercised daily. I take high blood pressure medicine, but my pressure is controlled. I am not overweight, I eat a low-fat diet and I drink only half a cup of coffee a day. My cholesterol has never been elevated. How could a health-conscious adult get this kind of problem? – P.M.

Your chagrin is understandable and justified. You have played by all the rules, but still you came down with a heart problem. The unfair truth is that not all illness is preventable. Atrial flutter is sometimes a case in point.

Atrial flutter is a heartbeat disturbance where the atria – the two upper-heart chambers – beat 300 times a minute. The lower heart chambers – the blood-pumping ventricles – also speed up, but at a slower rate, usually about 150 times a minute. People know something is wrong because they become short of breath and their heart feels like it’s flapping in time with a hummingbird’s wings. It’s “fluttering.”

The cause can’t always be identified. Sometimes it’s triggered by a developmental anomaly in the upper heart chambers that occurred during fetal life but never caused trouble until the current episode. Or scar tissue in the heart muscle might set off atrial flutter. The scar tissue is a consequence of aging. Or one of the heart valves might be slightly misshapen and generate the fast heartbeat. Or it might just happen.

Now that you are on preventive medicine, you shouldn’t experience another attack. To look on the bright side, a thorough examination of your heart didn’t disclose any abnormality that could bring on a heart attack or untimely death. Readers, atrial flutter is not the same as the more common atrial fibrillation.

The booklet on heartbeat abnormalities discusses various heartbeat troubles and their treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 107, 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.

DEAR DR. DONOHUE: I have had several sebaceous cysts removed from my head. What causes them? Can I prevent new ones from forming? Are they always located within the hairline? – S.H.

Cysts are soft sacs containing liquid or semisolid matter. They vary in size from a grape to a crabapple.

Sebaceous cysts form in skin pores that are the drainage outlet for oil glands. The cyst is filled with a protein material called keratin. In the cyst, it’s soft and mushy. A doctor can remove most cysts in the office. If the cyst is infected, it becomes red, hot and painful. It has to be drained, and the person most often must take antibiotics. There isn’t a lot you can do for prevention.

Sebaceous cysts form wherever there are oil glands.

Cysts on the scalp within the hairline are often pilar cysts. They tend to appear in multiples. Keratin fills these cysts too, but it’s a slightly different variety of keratin than the kind in a sebaceous cyst. Pilar cysts are often a family affair. Does any relative have them? They are treated much the same as sebaceous cysts are. Prevention isn’t that effective.

DEAR DR. DONOHUE: Would you say this is a true statement: “The root of all addiction is depression”? – O.R.

Depressed people often self-medicate with alcohol, drugs or dangerous behavior. I don’t think anyone will take issue with that. However, depression isn’t the root of all addictions.

Addiction is a very complex subject that has many causes. Experts in the subject are welcome to chime in with their knowledge. I’ll print whatever is printable.

DEAR DR. DONOHUE: I am a man, 54, who has been in good health. However, about three months ago, my arms began to tire quickly, and shortly after, I was seeing double. My doctor suspected myasthenia gravis, and a neurologist confirmed the diagnosis. I am now on medicine and doing better. I would appreciate a better understanding of this illness. There was talk of surgery. What surgery is that? – T.R.

Myasthenia isn’t an unusual illness. There are approximately 50,000 myasthenia patients in the United States and Canada. In women, it usually makes its appearance in the late teens and 20s. In men, its onset is most often in the 40s and 50s. Its distinctive feature is muscle weakness that occurs because of a disconnect between nerves and muscles. Muscles contract when they are energized by the chemical acetylcholine, produced by nerves. That chemical must land on a muscle receptor, a docking station. In myasthenia, the immune system has made antibodies that plug up those receptors, so muscle contraction becomes feeble or impossible.

Muscle weakness is most prominent after repeated movements. Double vision is the result of eye-muscle fatigue. The eyelids often droop. Arms and legs tire quickly. Speech and swallowing can be affected. Not all muscles are affected to the same degree, so symptoms vary from patient to patient.

Mestinon is a widely used medicine that increases the effectiveness of acetylcholine.

Surgery involves the thymus gland, a mysterious gland that usually shrivels early on in life. It’s located in the upper chest. Removing the gland can help the patient gain control over myasthenia, particularly in those for whom medicine is not giving sufficient relief. Often, it is suggested for myasthenics who are younger than 55. If there is a tumor of the gland, a thymoma, then surgery is almost always strongly suggested.

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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