DEAR DR. DONOHUE: Is there any point in getting a second opinion after a diagnosis of emphysema? My 47-year-old son was a “chesty” baby, lots of bronchitis. Then we went to Africa for two years, and he didn’t seem to have chest problems while there. An internist diagnosed him as having chronic bronchitis when he was only 18. His father was diagnosed with emphysema at age 68, and died at age 73. He had been a smoker. My son was also a smoker, although he quit some time ago. — C.P.
ANSWER: Forty-seven is young to have emphysema, even for someone who was a cigarette smoker. His young age and childhood history suggest he might have a genetic form of emphysema due to a deficiency of the enzyme alpha1 antitrypsin. It’s somewhat rare, accounting for 1 percent to 2 percent of all emphysema patients.
Emphysema is a destruction of the lung’s air sacs (alveoli), clusters of tiny, soap-bubble-thin structures at the end of the breathing tubes. Oxygen passes through those air sacs to reach the blood.
In normal lungs, a janitorial crew keeps the air sacs clean by using enzymes to digest foreign matter that makes its way into them. Another enzyme, the antitrypsin enzyme, puts an end to the cleanup. If it doesn’t, the cleanup squad goes overboard and damages the air sacs. People with a deficiency of the antitrypsin enzyme come down with emphysema at an age younger than 50. Those people don’t need to have been cigarette smokers to get it.
Treatment for people with antitrypsin deficiency follows treatment for ordinary emphysema, but replacement of the enzyme helps some people who don’t have enough of it. Your son could be one of those people.
DEAR DR. DONOHUE: My friend has been diagnosed with PND. I searched the Internet for a meaning and found only something about it being an infant disease. My friend is 70. Will you explain this ailment and what the outcome is? — J.S.
ANSWER: PND is the abbreviation for paroxysmal nocturnal dyspnea. Paroxysmal is a sudden outburst, and dyspnea is extreme difficulty in breathing. PND happens at night and wakes a person from sleep, panting for air and coughing. It’s a sign of congestive heart failure.
When people with heart failure lie down at night, fluid seeps back into the circulation and overloads it. The fluid then oozes into the lungs and fills them. It’s very similar to drowning. That’s PND.
Treatments for heart failure are many, and most respond to treatment. Your friend should be on medicines.
DEAR DR. DONOHUE: I have a question regarding liver enzymes. I am told there are three liver health indictors on standard blood tests: SGOT, SGPT and bilirubin. What do they indicate? They’re a mystery to most folks. — B.W.
ANSWER: SGOT, now called AST, and SGPT, now called ALT, are liver enzymes. Enzymes are proteins within every body cell. They keep cell chemistry moving at peak performance. When cells die, they release their enzymes into the blood. Enzymes often are specific for cells of a particular organ. SGOT and SGPT are enzymes found mostly in liver cells. When their blood level rises, it indicates liver injury.
Bilirubin is a pigment that comes from old red blood cells. The liver recycles it. If the liver isn’t working, bilrubin pigment blood levels rise, and white skin and the whites of the eyes turn yellow — jaundice. It’s another indication of liver damage.
DEAR DR. DONOHUE: I love garlic and have it every night in a salad. Can this cause an ulcer? — Wondering
ANSWER: No. It might cause problems for those close to you.
DEAR DR. DONOHUE: I love tonic water. I drink about two bottles of it every day. Someone told me it’s not good for you because it contains a malaria medicine. I don’t want to be taking any medicine if I don’t need to. Should I stop the tonic water? — G.L.
ANSWER: Tonic water has quinine in it. Quinine was a standard malaria treatment. The amount of quinine in an 8-ounce glass of tonic water is only 40 mg. That’s nowhere near the dose of quinine used for malaria. You can continue drinking tonic water without any fear of hurting your body.
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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