DEAR DR. DONOHUE: Will you please explain what the disease lupus is? I was told it’s a disease of the blood. Is the butterfly design on the nose one of its signs? – J.K.

Lupus isn’t a blood disease. It is more like an illness, such as rheumatoid arthritis. It’s one of those many illnesses where the immune system turns against its own body. It produces a slew of antibodies – immune system grenades – and tosses them at many organs.

Skin is one of those organs, and the butterfly rash you ask about is a tip-off that a person has lupus. It consists of red patches on the cheeks joined to each other by a short, horizontal bar that crosses over the bridge of the nose. The pattern does look like a butterfly. It’s not present in every lupus patient.

Joints are frequent victims of lupus. They hurt and swell, but they don’t become deformed, as arthritic joints often do. Wrists, fingers, elbows, knees and ankles are the ones that take the brunt of the immune attack.

Muscles often ache and are stiff. The nervous system can be affected. Frequently, kidneys suffer in the attack, and kidney damage can be one of the most serious complications of this illness. Many other organs, including the heart, are targets of lupus, and symptoms vary depending on which organs are most affected.

During periods when lupus acts up, people often have a fever, lose weight and are completely without energy. Sunlight triggers worsening of symptoms, so lupus patients have to avoid the sun.

Although lupus isn’t a blood disease, the blood in lupus patients can show changes. The red blood cell count often dips (anemia), as does the white blood cell count, which makes people more susceptible to infections.

The outlook for today’s lupus patients is much brighter than it was only 15 years ago.

DEAR DR. DONOHUE: I am in my late 70s. More than 24 years ago, I had a mastectomy for breast cancer. No chemo or radiation. I have been fine until this year. My yearly mammogram showed a large lump in the remaining breast. Two ultrasounds indicated that it was filled with fluid. A surgeon aspirated it. There were no cancer cells in the fluid. Since then (three months ago), I get sharp pains in my breast that last for about three minutes. Can you give me any reason why I should be concerned? – G.E.

I can think of things that are concerning. For one, a woman who has had one breast cancer is at greater risk of developing another cancer, unrelated to the first cancer.

I also can think of things that are reassuring. The lump appears to be a fluid-filled cyst, and fluid from the cyst showed no cancer cells. That’s about as close as is humanly possible to saying this lump isn’t cancer. Furthermore, the lump isn’t hard. Breast cancers usually are, and they are usually irregularly shaped and painless. I don’t know what the breast pain is, but it’s not a common cancer sign.

If all this preys on your mind, you can seek a second opinion for assurance.

The breast cancer booklet deals with all aspects of this common cancer in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Will you please tell me if peanut butter is constipating? – M.S.

There’s no reason why it should be. I have to confess that I turn a deaf ear to any bad news about peanut butter. It’s one food I refuse to give up, no matter what. I love the stuff, and it has kept me alive.

DEAR DR. DONOHUE: I have suffered from anxiety since birth, and it has made life difficult at times. In my retirement, life was good. I was happy writing novels, composing songs and entertaining on the piano. During that time, I drank beer regularly, usually in the evenings. When I cut out the beer, I lost interest in everything and became depressed and anxious.

I have seen doctors, psychiatrists and therapists, and have probably taken every antidepressant made. I feel quite bad in the morning and usually improve by evenings. Can you help? – G.W.

It’s typical of depression to be worse in the morning and less intense in the evening. Depression is an illness with strong proof of having a basis in disturbed brain chemistry. Medicines often can restore the correct chemical balance. Even though you might think you’ve taken every antidepressant made, I know you haven’t. There are too many. Finding the right one often is a matter of repeated trials.

Depression doesn’t clear overnight. It can take months and months for a depressed person to feel alive and well. Medicines play a large role in treatment, but not the entire role. Maintaining a relationship with a mental health professional on a regular basis is important too.

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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