DEAR DR. DONOHUE: My teenage niece has ITP, idiopathic thrombocytopenic purpura. Any treatment? – W.A.

DEAR DR. DONOHUE: I’ve never seen you write about ITP. A dear friend has a 16-year-old grandson with it, and he has had it for six years. His platelets are down to 39,000. Medicines raise his platelets for a while, but they always drop back down. Doctors want to remove his spleen. Surgery is in two weeks. His parents wonder if they should cancel surgery. They’re not comfortable about it. Your opinion would help. – D.C.

ANSWER: Platelets – also called thrombocytes – are the blood cells that form clots when a blood vessel breaks. They keep us from bleeding to death. The normal platelet count is 150,000 to 400,000. A count of less than 30,000 indicates a danger of unstoppable bleeding. A count less than 10,000 is a grave danger.

“Idiopathic” indicates ignorance of the cause. Thrombocytopenia is a low platelet count. Purpura are large bruises, a results of having too few platelets. Although the cause isn’t known, platelets in ITP become coated with antibodies. The spleen devours those antibody-coated platelets, and platelet numbers plunge. In children, the antibody production usually follows a viral infection, and the infection can be something as mild as a cold.

In young children, ITP, as serious as it is, usually comes to a halt on its own. In adults, it follows a more chronic course. The young man described above has an illness that puts him in the adult category. He’s had this for six years. The young lady might have a spontaneous recovery.

Prednisone is standard therapy for ITP. It’s one of the cortisone drugs. Intravenous gamma globulin is another treatment. A newer treatment is Rituxan (rituximab), a drug that targets antibody-making cells.

When medicines aren’t restoring a normal or near-normal platelet count and when there is a persistent threat of severe bleeding, then spleen removal is a reasonable option. If this young man were my son and if his doctors felt spleen removal was in his best interest, I would go along with it.

DEAR DR. DONOHUE: I am 82. I have a lump on my left testicle. It doesn’t hurt, but it worried me so I saw my doctor. He says it’s a cyst and that nothing more need be done. I am worried about cancer. Can I trust my doctor, or should I have further tests done? – W.H.

ANSWER: Testicular cancer most often strikes between the ages of 20 and 35. It’s very unlikely to appear at age 82.

If you want more security, a few blood tests can bring you greater peace of mind. They are alpha fetoprotein and human chorionic gonadotropin. They results are both high in people with testicular cancer.

Was your doctor able to shine a light through the lump? If he was and if the light passed through it, that’s a good sign that it’s not cancer.

If all this truly upsets you, an ultrasound can lay the issue to rest. Or you can always get the opinion of another doctor. If the second doctor agrees with the first, stop worrying.

DEAR DR. DONOHUE: My mom, 86, is fine in most respects, but she makes too much saliva. It drips out of her mouth when she eats. She’s a very fastidious woman, and this bothers her to no end. She has to use a napkin after every bite. Is there a medicine that can turn off the flow? – C.N.

ANSWER: First, find out if your mother is making too much saliva or if she’s having a swallowing problem. Swallowing problems require a different solution.

Medicines can dry the mouth. They often have such unpleasant side effects that people don’t like to use them. The scopolamine skin patch can dry the mouth. It’s a prescription medicine, and the doctor has to judge whether it’s safe for her.

In extreme cases of too much saliva, an ear, nose and throat doctor can tie off some or many of the ducts that lead from the salivary glands to the mouth.

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