DEAR DR. DONOHUE: Will you please write about hepatitis A, B and C? When I was young, I had yellow jaundice and was very sick. I don’t understand hepatitis A, B and C. It is related to yellow jaundice, I think. – R.M.

A discussion of hepatitis A, B and C requires 20 pages. The best I can do is a brief summary.

Hepatitis is liver-cell inflammation with death of some of the cells. It can come from poisons like carbon tetrachloride, from alcohol, from fat invasion of the liver, from some bacteria and from viruses, among which are the hepatitis A, B and C viruses. In the acute stages of hepatitis, all these causes produce a similar illness – yellowing of the skin and eyes (jaundice), great fatigue, loss of appetite, fever and profound mental fogginess. Sometimes the initial attack is so mild that the symptoms aren’t appreciated. What happens after the initial illness is quite different for the different causes.

Hepatitis A most often comes from contamination of food, water, milk, shellfish or even vegetables. The illness usually gets better on its own, although in rare cases it can be fatal. It does not cause a chronic infection. This is probably the kind you had.

Hepatitis B is transmitted through the sharing of injection needles, from mother to child during pregnancy or delivery and from sexual relations. In some, the reason for transmission isn’t found. From 1 percent to 5 percent of those infected will have a persisting infection that can lead to cirrhosis, liver cancer or death.

Hepatitis C is spread from unclean needles, from mother to child during pregnancy or delivery, from sex with many partners or from blood transfusions given before 1992. Not all cases have an easily identified infection source. Eighty percent of the infected stay infected for life, but signs of infection don’t become apparent until 20 or more years after being infected. Around 20 percent of the persistently infected develop cirrhosis or liver cancer.

The booklet on hepatitis A, B and C provides more details on these infections. Readers can order a copy by writing: Dr. Donohue – No. 503, 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 have a sister who has narcolepsy. She thinks a head injury as a teen brought it on. It has been a source of embarrassment for her all her life. Is it hereditary? I heard of a family in Italy in which four sisters had it. I have no symptoms, but I do have sleep apnea. Is that considered to have any relation with it? – M.S.

Sleep apnea has nothing in common with narcolepsy except the symptom of daytime sleepiness.

Narcolepsy is the irresistible urge to fall asleep during the day in inappropriate times and places, like while driving a car. It has been reported to result from a head injury, but that’s true only in a minority. It does have a genetic basis too, but that does not mean all family members have it.

Cataplexy is another feature. It’s the loss of muscle tone due to intense emotion, like anger or convulsive laughter. The result can be imperceptible, like the dropping of the jaw, or quite dramatic, as in falling to the ground. Hallucinations at the onset of sleep or upon wakening are another aspect of narcolepsy. So is sleep paralysis, a transient inability to move upon wakening. Not all these symptoms are present in all narcolepsy patients.

Provigil, Ritalin and Concerta are examples of medicines used for narcolepsy control.

DEAR DR. DONOHUE: I am 85 and in good health, I think. Does the male body stop manufacturing semen at an advanced age? – W.S.

The production of sperm and seminal fluid lessens with age, but usually doesn’t come to a complete stop.

DEAR DR. DONOHUE: I am a woman with breast cancer that has spread to bone. Can you direct me to a source of information on this? – C.W.

The Bone and Cancer Foundation is a new source of information about cancer that has spread to bone. Cancers that are prone to do so include breast, prostate and lung cancers. The foundation has six recently published booklets concerning bone spread of cancer, available on the foundation’s Web site,, or by phone at 888-862-0999. There is no charge involved. The Bone and Cancer Foundation is a program of the Paget Foundation, which has been providing excellent information on bone disorders to patients for 30 years.

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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