DEAR DR. DONOHUE: I am a 53-year-old woman with spasmodic dysphonia. I have received five Botox shots. They have not helped my speech. I have a very hard time talking to people. It’s very depressing.

The doctors don’t say much about this disease. Will it get worse? No one seems to know much about this. – H.H.

Spasmodic dysphonia produces a hoarse, strained voice that makes it difficult for people to talk fluently. Their speech is broken and difficult to understand.

It’s one of the dystonias. They’re a family of muscle illnesses where the muscles contract violently and involuntarily. One common dystonia is torticollis (wry neck). In torticollis, the neck muscles, in persistent contraction, draw the head down to the shoulder and keep it locked there. In your dystonia, the vocal cord muscles are in a state of constant contraction and produce your hoarse voice and difficulty in speaking.

Botox is often a successful treatment for it. Since it hasn’t been for you, you have to pursue other treatments. A speech therapist will help you use your voice more effectively even though the vocal muscles are in spasm. For resistant cases like yours, an operation might be the solution. The doctor severs a few of the nerves that innervate the vocal muscles so they don’t keep the cords slammed closed. Close to 90 percent of those who have had the operation are pleased with the results.

Before you take another step, contact the National Spasmodic Dysphonia Association, an organization that provides information on the illness and its treatment, and one that can direct you to doctors familiar with it. Its toll-free number is 800-795-6732 and its Web site is

DEAR DR. DONOHUE: I am 78 and recovering from having my left kidney removed. There was a cancerous growth in it, about 7 centimeters (2.8 inches) long. It was found quite by accident on a CT scan that was taken for another reason. It’s the first time I have been in a hospital for anything besides having my six babies. Isn’t there any kind of routine test to detect kidney cancer? I have met a few other people like me whose cancer was found by accident. – J.C.

Many kidney cancers are discovered just as yours was. A scan or an ultrasound is ordered for an unrelated reason, and the cancer is seen.

There is no routine screening test for it. Signs often don’t develop until the cancer has gotten quite large. Blood in the urine is a tip-off for kidney cancer. The blood can be visible or can be detectable only with a microscope. Kidney cancer is not the most common cause for blood in the urine, but it is the most important cause of it. Weight loss, fever, night sweats and pain on the side in the kidney region are other signs of kidney cancer, but they are also late signs.

Your cancer was discovered at a stage where the chance for a cure is great. For that, I’m happy for you.

DEAR DR. DONOHUE: My son, 26, had cancer of a testicle. It was a germ cell cancer. I have some questions for you about it. What is the meaning of “germ cell”? Isn’t my son too young to have cancer? He lives far from me and doesn’t like me to ask him any questions about it. – H.K.

ANSWER: Testicular cancer is a young man’s cancer. It usually appears between the ages of 15 and 40. Most often it begins as a firm, painless lump. A man who feels a testicular lump should have it investigated quickly.

Germ cells are the cells that produce sperm. Most testicular cancers are germ cell cancers. The cure rate for these cancers is quite high when they’re treated early.

DEAR DR. DONOHUE: I have epidemiology etiology. Is it contagious? Is it life-threatening? I am concerned. – M.P.

Very funny, M.P. Epidemiology is the medical specialty that identifies how illnesses begin in a defined population and how they can be controlled. Etiology is the cause of an illness.

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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