DEAR DR. DONOHUE: I am 79 and have lived a very active life as a Marine and police officer. My first attack of Ménière’s disease was four years ago. I would get tinnitus and nausea so bad I was unable to walk. It reached a point that I was hospitalized and placed on a low-salt diet of 500 mg a day. The diet has lessened the attacks, but did not stop them. I have taken either Niaspan or Serax for the attacks, but I still have one every two or three days. Any advice you have would be appreciated. – Anon.

ANSWER: Ménière’s (main-YAIRS) disease – due to too much fluid in the inner ear – consists of attacks of dizziness, hearing loss and ear noises. People don’t need to have all three to merit the diagnosis, but many do. As time passes, the attacks become more frequent and the hearing loss and ear noises become more or less permanent.

A low-sodium diet benefits many. You are definitely on a low-sodium diet. I’m sorry it hasn’t done wonders for you.

You should also stay away from alcohol, nicotine and caffeine.

Diuretics like hydrochlorothiazide can remove fluid from the inner ear and are often a part of a treatment program. Antivert is useful for dizziness control. Compazine can take care of nausea, a common consequence of dizziness.

If medicines bring no relief and if Ménière’s disrupts life, then thoughts turn to such things as injecting gentamicin into the ear. Gentamicin is an antibiotic. It is used here because it can stop the generation of signals that bring on dizziness. Surgical drainage of the inner ear fluid works for some people. A surgical procedure called labyrinthectomy removes the inner ear structure responsible for instigating dizziness. The nerve that transmits dizziness signals to the brain can be severed. Another option is the Meniett device. It fits into the ear canal and delivers bursts of low-pressure air into the ear to promote fluid drainage out of the inner ear.

The booklet on vertigo (dizziness) discusses all the causes of this troublesome symptom and their treatments. Readers can order a copy by writing: Dr. Donohue – No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. along with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I was diagnosed with asbestosis about a year and a half ago. What do I have to look forward to? – L.S.

ANSWER: Asbestosis raises the risk for lung cancer and for an unusual cancer, mesothelioma, a cancer arising from the pleura – the lung coverings – or the peritoneum – the coverings of the abdominal organs. Such cancers happen when there has been a lengthy and heavy exposure to asbestos. Smoking raises the risk for asbestos-associated lung cancer.

Asbestos can also lead to scar tissue formation in the lung – asbestosis. It happens long after exposure to asbestos, 20 or 30 years later. Asbestosis produces a dry cough and shortness of breath. Do you have either symptom? If you don’t, then things look bright for you.

X-rays of the lungs and tests of the way they function can provide information that can be used to predict future lung impairment.

DEAR DR. DONOHUE: My son called me last week to say he had an echocardiogram that showed a persistent left superior vena cava. The doctor said no medicine or treatment was needed. We come from a black family with lots of high blood pressure, heart attacks and diabetes. I worry about this. My son is 26. Did I do something wrong during my pregnancy with him? – B.R.

ANSWER: The left superior vena cava is a blood vessel present during fetal life. It usually shrivels after the baby is born. A persistence of this blood vessel isn’t a health threat. Nothing need be done.

You didn’t do a single thing during pregnancy that caused this to happen.

DEAR DR. DONOHUE: The medical community is so fixated on gallstone patients always being very obviously sick that patients with “silent” gallstones receive little attention. Gallstones can completely obstruct the small intestine, a condition known as gallstone ileus. So far, no one realizes that gallstones can partially restrict flow in the small bowel and cause chronic constipation. Shouldn’t patients be evaluated for silent gallstones before signing a living will? – P.E.

ANSWER: I appreciate the novelty of your theory, but you’ll need scientific proof that people are dying from silent gallstones causing partial intestinal obstruction before the world will give the theory its wholehearted support. Autopsies don’t confirm the idea.

Silent gallstones are recognized by medicine. At autopsy, 20 percent of women older than 40 and 8 percent of men of the same age are found to have gallstones that never kicked up any fuss when these people were alive. When people have X-rays, scans or ultrasounds for some unrelated problem and gallstones are discovered, doctors don’t urge them to have the stones removed if they aren’t causing any symptoms. Those “silent” stones can be left in the gallbladder.

Ileus is intestinal obstruction. Gallstone ileus occurs when a large stone blocks the small intestine. It accounts for only 1 percent of ileus cases. The stone enters the small intestine through a tunnel connection – a fistula – between the gallbladder and the intestine.

As for small stones being the cause of chronic constipation, I am a skeptic. I promise to keep an open mind on the matter.

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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