DEAR DR. DONOHUE: I would like to read about parathyroid conditions. – Anon.

ANSWER:
You don’t waste words, Anon. I’ll try to do the same. The four parathyroid glands lie on the back of the thyroid in the lower neck. They’re small – less than two-fifths of an inch in largest dimension. Their hormone, parathyroid hormone, regulates the blood level of calcium and phosphate.

Hyperparathyroidism is excessive production of the hormone. Blood calcium levels rise and produce a myriad of symptoms. People lose their appetite, have to urinate frequently, are constantly thirsty, often have muscle weakness and joint pain and may become lethargic. Sometimes, the only sign of too much hormone is a slightly higher-than-normal blood calcium without any symptoms. When symptoms are present, removal of the gland that’s gone ballistic is the treatment.

Hypoparathyroidism is the opposite – too small a production of parathyroid hormone. Blood calcium drops. Muscles might twitch or cramp, numbness around the lips can occur, the heart might fail, confused thinking develops and seizures are possible. Treatment is supplemental calcium and vitamin D.

That’s the parathyroid gland story in capsule form. What prompted the question?

DEAR DR. DONOHUE: I am inquiring about my grandson’s white blood cell count. He is 22, and for the past five years his white blood cell count has been in the 1,800 to 2,200 range. He has no symptoms and is attending college.

His low white count was detected on a college physical exam and blood work. He was referred to a hematologist, and a bone marrow sample was taken. No conclusive findings were noted.

Five years ago he was given intravenous cephalosporin. Could this have caused his low white count? – A.S.

ANSWER:
White blood cells are also called leukocytes, and their normal numbers range between 4,000 and 10,000. These cells are the prime defense against infections. They come in five varieties, and the granulocyte white blood cell is the most important infection-fighter. Its normal count lies between 2,400 and 8,000. Perhaps your grandson’s count is his granulocyte count, which is not too off the mark.

Susceptibility to infection is the most serious consequence of too few white blood cells. Your grandson has had this low count for five years and hasn’t had a major infection in all that time. That’s good evidence that he has all the cells he needs. Furthermore, the ultimate blood test, a bone marrow biopsy, was done, and nothing disturbing was found. That’s another bit of evidence that attests to his health. Cephalosporin, an antibiotic, doesn’t usually cause a long-lived depression of the white blood cell count.

Not having any signs or symptoms of illness implies that nothing further need be done. When he’s through college, which will be soon, it would be a good idea for him to have his blood count checked.

DEAR DR. DONOHUE: I am a healthy 67-year-old man who has rather suddenly and inexplicably developed Peyronie’s disease. I consulted a urologist, who said not to be concerned, since it is not severe enough to cause problems with sexual relations. I researched on the Internet and found an article stating that it is important to treat Peyronie’s disease as early as possible because the condition can worsen to the point where sexual relations are impossible. The article described a treatment involving injections into the internal plaque that causes the problem. Your advice would be appreciated. – A.G.

ANSWER:
Peyronie’s (pay-row-KNEES) disease results from scar formation within the penis. The scar can be felt as a hard lump. It bends the penis and leads to painful erections. The cause isn’t known for sure. In the extreme, it can prevent sexual relations. A multitude of medicines have been used, including vitamin E and Potaba. Cortisone and Verapamil have been injected into lumps in hopes of shrinking them. To date, no treatment has met with astounding success. Quite often, Peyronie’s stabilizes, and sometimes it even goes away. Surgical removal of the scars is undertaken when intercourse is impossible. There’s no reason to rush to treatment.

DEAR DR. DONOHUE: My granddaughter is 20. We have just been informed that she suffers from Marfan’s syndrome – something we know nothing about. The only thing that’s different about her is that she is taller than her brothers and sisters. Otherwise, she has been in fine health.

We were told that this is inherited. No one in our family has or had it, and no one in my daughter-in-law’s family has it. How can it be inherited? What is it? – C.N.

ANSWER:
Marfan’s is one of the most common inherited illnesses. When there is no family history of it, then a gene mutation occurred during the child’s early development in the uterus. Your granddaughter has a genetic disease, but, in her case, not an inherited one. About 25 percent of those with Marfan’s have it for the same reason your granddaughter has it.

Marfan’s signs and symptoms vary widely. Most of what I am going to describe might not apply to her.

Marfan’s patients tend to be tall, with the lower part of the body being much longer than the upper part. They have an enormous arm span. Their fingers are slender and tapering.

Inner changes are the ones that cause problems. A wide aorta is an expected finding. The aorta is the large artery that sprouts directly from the heart. A Marfan’s aorta can develop a bulge (an aneurysm), and it can split apart – the most dangerous consequence of this syndrome. The eye’s lens often slips out of place.

All this is intimidating, but the outlook for Marfan’s has changed immeasurably for the better, even for those who are most affected by it. Beta blocker medicines protect the aorta by decreasing the force with which blood is ejected into it from the heart. A close watch is kept on the aorta to see if it’s dangerously expanding. If it is, surgery can correct the defect.

None of this might apply to your granddaughter. She can expect a long and healthy life.

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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