DEAR DR. DONOHUE: In my extended family, I am told, are people with sickle cell disease. I am a newly married, 28-year-old black woman and am now pregnant. In the past, no doctor has told me I have sickle cell. Could I be carrying the gene for it? I need education on sickle cell and its treatment. – M.M.

Sickle cell disease is inherited. Both mother and father have to give an affected gene for a baby to have sickle cell disease. Are you sure your relatives didn’t have sickle cell trait? About 10 percent of black Americans have the trait. Only one gene is necessary for sickle cell trait. Most people with the trait live normal, healthy, long lives. They might develop symptoms at high altitudes, where oxygen pressure is low, or after prolonged, intensive exercise, but those are unusual circumstances.

Sickle cell disease, on the other hand, is a serious condition. The defect lies in hemoglobin, a gigantic protein inside red blood cells. Hemoglobin grabs onto oxygen like a magnet when red blood cells pass through the lungs. It releases oxygen when red blood cells reach parts of the body in need of it. Sickle cell hemoglobin makes red blood cells sticky. They can adhere to each other and block blood circulation through small vessels. When that happens, sickle cell patients are in great pain, and the part of the body where the blockage takes place dies. This episode is a sickle cell crisis.

A second problem with sickle cell hemoglobin is the premature death of red blood cells. Death of red blood cells leads to red blood cell deficiency – anemia.

The list of treatments for sickle cell disease is long. I’ll mention only one drug: hydroxyurea, a medicine that promotes the production of a different hemoglobin that doesn’t have the unhealthy properties of sickle cell hemoglobin. It has made treatment of sickle cell disease much more manageable.

DEAR DR. DONOHUE: I have had migraine headaches, off and on, for more than 10 years. I will turn 32 in two months. My last migraine began quite differently from all the headaches I had in the past. Before my head hurt, I saw a shower of flashing lights. The show lasted only a few minutes, but it scared me. I called my doctor, who said it was an aura. Have my headaches taken a turn for the worse? Do I need different medicine? – N.L.

Auras precede the migraine headache in about 20 percent of migraineurs. Most often, they are some kind of visual spectacle — flashing lights, wavy zigzag lines. Temporary weakness of an arm or a leg is another example of a migraine aura.

Having an aura doesn’t make the headache any different, doesn’t carry any bad connotations and doesn’t require a change in medicine.

I don’t know why an aura has developed after 10 years of never having one.

The headache booklet explains common headaches and their treatment. Migraine is included. Readers can order a copy by writing: Dr. Donohue – No. 901, 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: I am in the habit of drinking a glass of wine with dinner and another glass after dinner. It never affects me. It doesn’t make me dizzy or the least bit tipsy. My friend tells me this is too much wine and that I could develop cirrhosis. Is this so? I’ve been drinking like this for 20 years without any illness in all that time. I am 64 and a female. – P.M.

ANSWER: The rule for alcohol consumption is one drink a day for women and two for men. A drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.

Rules are generalizations. Everyone has a different tolerance of alcohol. I don’t believe your alcoholic consumption is leading to cirrhosis of the liver or any significant disturbance of your health.

DEAR DR. DONOHUE: I am a 73-year-old man whose recent blood test came back with a PSA of .55. Please explain what this reading means as to the state of my prostate gland and what the future may hold regarding enlargement or cancer. – R.E.

ANSWER: PSA, prostate specific antigen, is a protein made by prostate cells and is made in excess by cancerous prostate cells. It’s used as a test for detecting prostate cancer. For a man of your age, a reading of 0 to 4 is considered normal. Your reading of .55 is low – not suggestive of prostate cancer.

The PSA test can be slightly elevated by prostate enlargement too. However, a finger examination of the gland is a more reliable indicator of prostate enlargement than is the PSA test.

No one can tell what the future holds, but your prostate gland future looks good.

DEAR DR. DONOHUE: What can you tell me about coconut oil? I have started cooking with it. Does its saturated fat clog arteries? I heard it’s a different kind of saturated fat. – K.P.

Let me paraphrase Dr. Walter C. Willett, one of the world’s most respected nutrition authorities. He says that 1 ounce of coconut oil has more saturated fat than 1 ounce of butter, lard or margarine. The one benefit of coconut oil is that it raises HDL cholesterol, good cholesterol, but that’s not enough of a plus to make it a choice for cooking. It can clog arteries.

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 at P.O. Box 536475, Orlando, FL 32853-6475.

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