DEAR DR. DONOHUE: Recently you wrote about third-degree heart block. How does this differ from neurocardiogenic syncope, a condition that my son, 50, has? He was tested on a tilt table. My son had a few dizzy spells, which he ignored. Then, after getting up to go to the bathroom one night, he passed out and landed on his face, smashing his nose and breaking his lower jaw. – M.B.

ANSWER: A third-degree heart block is a permanent and complete blockage of the heartbeat signals that originate in the heart’s natural pacemaker; it keeps the signals from reaching the lower heart pumping chambers. The heartbeat slows to such an extent that circulation to the brain is impaired and people pass out. A pacemaker restores normal heart activity.

Neurocardiogenic syncope is the most common kind of faint. “Syncope” (SING-cuh-pea) means “fainting.” With syncope, the brain is again shortchanged of its blood supply, but the period of passing out is brief. What happens is that blood pools in the legs. That can occur when a person stands in one place, is in a heated room, is under great stress or is in a number of other situations, like passing urine. The heart should speed up. It doesn’t. It slows down. Decreased blood in circulation together with a slow heartbeat lowers blood pressure and diminishes brain circulation. The person slumps to the ground. In the horizontal position, blood gets back into circulation, and the person wakes up quite rapidly. Ordinarily, one or two episodes of syncope are not an indication of serious health conditions. Your son’s case is exceptional. His tilt-table testing shows he has a propensity to have these blood pressure drops. He must have hit the floor with great force.

People who suffer from less-frequent and less-dramatic faints can often terminate a faint when they feel one coming on by tensing their muscles or by immediately assuming a seated or lying position. Your son most likely will have to take medicines that keep blood in circulation. The doctor must carefully examine him to be sure he doesn’t have some underlying condition that’s causing him to faint.

DEAR DR. DONOHUE: Can you give me some information on what causes the inside of my ear canal to stay dry and scaly like dandruff? It constantly itches, and it’s enough to drive me crazy. – A.M.

ANSWER: It most likely is a form of dandruff, seborrheic dermatitis. No matter how itchy the canal is and no matter how rewarding scratching it must be, don’t scratch. Scratching irritates the canal, inflames it and sets it up for infection. Cortisone ear drops can usually control the itch, dryness and scaling. They require a prescription, so you’ll have to see your doctor – a good idea. The doctor can determine if this really is seborrheic dermatitis. It could be something else, like an infection.

DEAR DR. DONOHUE: I have had to have a number of lipomas removed. I am getting more of them and don’t like the thought of having surgery again. I read that there is something a doctor can inject to dissolve them. Do you know what that is? – Anon.

ANSWER: Lipomas are fatty tumors that almost never are cancerous tumors. They grow under the skin to create a soft, rubbery mass that varies in size from a fingertip to a tennis ball or larger. If they are few in number and if they don’t hurt or press on adjacent structures, they can be ignored. (Some lipomas form in or on body organs.)

Surgery is the standard method of removal. Since they’re right beneath the skin, the surgery doesn’t involve deep cuts.

The bile salt deoxycholate has been injected into lipomas and can be used for small ones. Cortisone injections have also been used. Neither procedure is done universally.

Liposuction has also been used to remove them.

You live in a large city with a very good medical school. Why not contact the dermatological or surgical department of that school to see if any doctor there uses the injection technique?

Does anyone in your family have lipomas? There are a couple of genetic conditions that lead to multiple lipomas in family members.

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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