DEAR DR. DONOHUE: Please explain myasthenia gravis. Is it curable? For me, it started after a kidney was removed for cancer. Two weeks later, the symptoms of myasthenia began. My doctor suggested a second opinion, as he has little experience with it. He has prescribed pyridostigmine. – C.C.

ANSWER: Myasthenia gravis is a disconnect between nerves and muscles. Muscles contract when nerves send them a message to do so. The message consists of a chemical – acetylcholine – that nerves release. Acetylcholine plugs into “receptors” on muscles. It’s like plugging a lamp into an electric outlet. Once it’s plugged in, you can turn the light on. Once muscles are plugged in with acetylcholine, they can move. In myasthenia, the muscle receptors (electric outlets) are filled with antibodies, so the chemical messenger can’t activate the muscles. The primary symptom of myasthenia is, therefore, weak to no muscle action.

Myasthenia isn’t a rare illness. It strikes women usually in their 20s and 30s and men in their 50s and 60s. Signs of muscle weakness include droopy eyelids, double vision (the eye muscles aren’t in line), difficulty chewing and swallowing, trouble speaking and arm and leg weakness, which can be profound.

If your doctor wants you to see a doctor who’s more experienced in the treatment of myasthenia, do so. The expertise of the doctor produces the best results. Pyridostigmine, brand name Mestinon, is the most popular treatment, but it’s not the only treatment. Treatment can also call for removal of the thymus gland, a mysterious gland in the upper chest. It’s often involved in myasthenia.

Most treated myasthenia patients lead an active, fulfilling and long life.

The Myasthenia Gravis Foundation can help you with more information. Contact the foundation at 800-541-5454 or on the Internet at www.myasthenia.org.

DEAR DR. DONOHUE: I have a Baker’s cyst behind my left knee. It is painful when I bend the knee or when the leg has to bear weight, as in walking up stairs. I am 74. I exercise moderately every day, and I am not overweight. What would you suggest I do or refrain from doing in regard to the Baker’s cyst? – E.B.

ANSWER: Want to keep it simple? You can do anything that doesn’t cause the cyst to be painful. A Baker’s cyst is a soft, behind-the-knee bulge. It’s a swollen bursa. More than a hundred bursas are scattered throughout the body between tendons and bones. They prevent tendon irritation when the tendon rubs against the bone.

A tunnel connects this behind-the-knee bursa with the knee joint. Swelling of the bursa indicates trouble in the knee – arthritis, torn cartilage or some other problem. The knee, in response, produces more joint fluid, and that fluid flows into the bursa. That’s how a Baker’s cyst forms.

Your doctor can drain the bursa with a needle and syringe and, at the same time, inject it with cortisone to prevent fluid from coming back. Only when the swollen bursa does not respond to these conservative measures would surgery be necessary.

How do you know this bulge is a Baker’s cyst? If it’s a self-diagnosis, have your doctor examine it. Other things can look very much like a Baker’s cyst but are not. An aneurysm of an artery in the same region is an example. An aneurysm is an artery bulge caused by a weak spot in the artery wall.

DEAR DR. DONOHUE: I need an answer as soon as possible. I have heard about a cream for facial hair. I have had bad facial hair ever since menopause. The name of the cream is Vaniqa. Can you tell me anything about it? Waxing is expensive. – Anon.

ANSWER: Vaniqa cream has been around for quite some time, and many women have found it effective in retarding facial-hair growth. It shouldn’t be used by pregnant or nursing women. Its side effects are few. It might make the skin burn or sting – especially if the skin is broken – and it can turn the skin red. There are many other ways to control facial hair – shaving, bleaching, electrolysis, depilatories and laser treatments.

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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