DEAR DR. DONOHUE: My father suddenly died when I was 17 and he was 45. There was an autopsy, and we were told he had a “cardiac” death. They did not say he had a heart attack. To this day, my mother and I wonder what this actually means. I am now 37, married and have two children. I wonder if the same thing could happen to me. – W.S.

ANSWER:
Sudden death from a cause traceable to the heart happens to 450,000 Americans every year. Most people would think that a heart attack is the cause. Actually, the cause comes from ventricular tachycardia or ventricular fibrillation about 80 percent of the time. They are two very dangerous heart rhythms. They’re associated with a heart attack in only 20 percent of cases.

Quite often, people who die from these rhythms had no previous warning of heart disease. Your dad might have been one of those people. Silent changes can occur in a heart, and those changes predispose people to developing one of these two heart rhythms. To save a life, the rhythm must be stopped quickly.

Ventricular tachycardia and ventricular fibrillation are not the same as atrial tachycardia and atrial fibrillation. The “ventricular” indicates the heartbeats arise in the lower, pumping heart chambers, the ventricles. In both rhythms, the heart’s pumping is impaired, especially in the ventricular fibrillation variety. Death occurs rapidly if ventricular fibrillation is not ended quickly.

You’re probably aware that defibrillators are now available in many public places. A defibrillator delivers an electric shock to the heart that can pull it out of these lethal rhythms.

Are you at risk? It’s hard to say. It would be most helpful if you had a copy of your father’s autopsy report so that you could provide your physician with it. If that’s impossible, you should establish yourself with a doctor so that any hidden or genetic heart disease can be detected early.

The booklet on heart attacks explains what happens during such an event and what can be done to prevent it. Readers can obtain a copy by writing: Dr. Donohue – No. 102, 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 a 47-year-old male. I am 6 feet, 2 inches tall and weigh 195 pounds. I ran three miles a day and lifted weights for 45 minutes, five days a week. I ate and eat a good diet and limit my alcohol. I was stricken with a gallstone attack and pancreatitis. It came on suddenly at work. I had surgery to remove my gallbladder. Why did this happen? What causes gallstones? Why did pancreatitis occur? Will it recur? – L.K.

ANSWER:
Genes, obesity, rapid weight loss, estrogen, increasing age, pregnancy and a high-calorie, high-fat diet are some of the factors that cause gallstones. You had none. That shows you that medicine cannot provide all the answers. Your gallstone traveled from the gallbladder through the bile duct and into a duct that the gallbladder shares with the pancreas. It blocked the pancreas’s secretion of digestive enzymes into the intestine. Those enzymes started to digest your pancreas – pancreatitis. It shouldn’t happen again. You have no gallbladder.

DEAR DR. DONOHUE: A neurologist diagnosed my niece (bumping 60) with progressive supranuclear palsy, PSP. She has double vision, often falls and cannot feed herself. What can you tell me about it? – D.K

ANSWER: Early on, PSP is often mistaken for Parkinson’s disease. People walk stiffly, lose their balance and fall repeatedly. They cannot aim their eyes. They cannot look down. Often they have double vision. In time they become forgetful and irritable. They speak softly and in a monotone. Swallowing is a challenge. The cause is unknown. Medicines for Parkinson’s disease are often prescribed, but they don’t work as well as they do for Parkinson’s. Contact the Society for Progressive Supranuclear Palsy at 800-457-4777 (in Canada, 866-457-4777) for in-depth information on this illness and its treatment.

DEAR DR. DONOHUE: For about a year, I had nagging pain in my right hip. Then the pain spread to my pelvic area. I had to beg my doctor for an X-ray. I have a plan where cost savings has the final word. The doctor relented, and it turns out I have Paget’s disease. I am scheduled to see a specialist in a month – if all goes well. Will you give me some information now? – L.C.

ANSWER:
Paget’s is an illness in which the daily, well-synchronized process of bone demolition and bone rebuilding is thrown into anarchy. Our bones renew themselves daily, at least partly. A section of bone breaks down, and then that section is rebuilt. In the first phases of Paget’s disease, the destruction process outpaces the rebuilding phase. Then rebuilding shifts into overdrive and lays down new but misshapen and fragile bone. This can happen in only an isolated area of bone, or it can happen in many places. The result is a deformed section of bone that is easily broken. If the newly formed and overgrown bone presses on adjacent nerves, trouble arises. Or if it encroaches on a joint, arthritis develops.

Some patients have no symptoms at all. Others, like you, have pain, and some sustain a fracture with very little trauma.

Alkaline phosphatase, something that is often included in a panel of routine blood tests, is high in Paget’s disease. It comes from bone. An X-ray or bone scan shows the Paget bone clearly.

The bones most likely to develop Paget’s disease are the pelvic bones, the spine, the skull, the arm bones and the leg bones.

The bisphosphonate drugs, the ones used for osteoporosis, also are used effectively for this condition. Fosamax (alendronate) is an example. There are others.

The best way for you to help yourself and gain knowledge about Paget’s is to contact The Paget Foundation. The foundation’s phone number is 800-237-2438, and you can visit its Web site at www.paget.org.


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