DEAR DR. DONOHUE: I have waited with bated breath for more than a year, and I haven’t given up but am darn close to it. I would like an answer while I am still breathing.

I am 76 and was diagnosed with endocarditis in November 2004. I spent two weeks in the hospital and five weeks in a nursing home. During that time, I was given two antibiotics, one of which was gentamicin. I have an artificial heart valve. My sense of balance was damaged by the gentamicin, but I am now able to walk with a cane. I know this is a serious and sometimes fatal infection. My doctor says I will get it again and again, and will have to take the same treatment. Isn’t there some other medicine I could take? – J.K.

ANSWER:
Your doctor is far too pessimistic. Having an artificial heart valve and having had one episode of endocarditis puts you at a higher risk of getting it again, but the risk is not all that high, and your chances of another bout of endocarditis are actually quite small.

Endocarditis is an infection of heart valves or the heart lining (the endocardium). It is a serious infection. A heart valve that has been damaged by rheumatic fever or an artificial heart valve is the target of bacteria that get into the blood. They find such valves to be a place of sanctuary, and they multiply and grow on the valves. There, they are less susceptible to the body’s attack on them.

The choice of antibiotics for endocarditis depends on the infecting bacterium. If you are infected again, it probably would not be by the same bacterium, so you might not need the same antibiotic.

Furthermore, you should now be on a schedule of antibiotic protection when you have any procedure where bacteria are released into the blood. That includes some dental procedures. Your doctor and your dentist should give you a list of the dental procedures before which you need antibiotics. The same goes for some procedures done on the urinary and digestive tracts. Such measures lessen the chances of a second endocarditis infection.

DEAR DR. DONOHUE: It has been many years since I had my first basal cell cancer removed, and since then I have had many more removed.

I have friends of the same age and the same complexion who have never been to a dermatologist and are none the worse for it. I can see how removal of basal cell cancer from my face is important, but I wonder why it’s necessary to remove ones from my legs and back. Is it necessary? I am 77 years old. – E.M.

ANSWER:
Basal cell skin cancer is the most common kind of skin cancer, and it usually appears on skin that’s been exposed to the sun – the scalp, ears, face, neck and hands. It can also be found in other places – the chest, back and legs. It’s called “basal” because it comes from the lowermost layer of skin – the basal layer, or base.

The cancer starts as a pearly white or pink small bump that bleeds easily. The bump turns into a crusted sore that does not heal or heals but returns.

Basal cell cancers don’t usually spread to lymph nodes or other body sites, but they can bore deeply into skin and into underlying muscle – and even into bone. They should be removed wherever they are. I mentioned in the past that my grandfather had one on his nose, applied a cream he bought from a door-to-door salesman and lost half of his nose.

You should apply sunscreen to all sun-exposed skin whenever you go outside.

Your friends who have never seen a dermatologist are to be pitied. Dermatologists are really quite nice people.

DEAR DR. DONOHUE: My son cannot visit me in Florida because he has a severe allergic reaction to something in the air. The reaction starts with a swelling of his tongue and closing of his throat. Is there a specialist he can contact for more information? – N.S.

ANSWER:
Your son should contact an allergist. If this happens in a particular month of the year, the allergist might be able to track down what the allergen is and desensitize him to it.

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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