DEAR DR. DONOHUE: My husband, 91, has just been diagnosed with emphysema. He never smoked. No one in the family smokes, and he has not been exposed to smoke-filled areas. What is his prognosis? – R.M.

ANSWER:
The lungs have something on the order of 300 million air sacs (alveoli). Emphysema means that some of those air sacs have been destroyed and that others have been enlarged and rendered functionless. It’s through these air sacs that oxygen passes into the blood and the waste gas carbon dioxide leaves the blood.

The principal symptom of emphysema is breathlessness upon even slight exertion. The principal sign of emphysema is a barrel chest due to overinflated lungs. The lungs have too much air filling the destroyed and overly stretched air sacs. Oxygen, however, cannot get into the blood in these blighted areas.

Emphysema has a twin illness, and the two are usually seen together. That twin is chronic bronchitis, a condition in which the breathing tubes (bronchi) are narrowed and filled with thick, pus-saturated sputum. Cough is its principal sign. These illnesses constitute COPD, chronic obstructive pulmonary disease.

Smoking is the predominant cause of emphysema. However, around 20 percent of emphysema patients never smoked. Some of them worked in environments where inhaled irritants affected their lungs – coal miners and workers in textile mills are examples. Hereditary conditions also cause emphysema. And aging makes the lungs more likely to have destroyed air sacs.

The severity of emphysema is determined by breathing tests and the person’s symptoms. I have to imagine that your husband’s symptoms are mild or the condition would have been discovered many years ago. If he ever needs it, supplemental oxygen can help him get around with greater ease. I don’t believe that this diagnosis is going to appreciably shorten an already long life.

Your husband needs a yearly flu shot, and he needs the pneumonia shot to protect his lungs from further damage.

The booklet on chronic obstructive pulmonary disease explains this common illness in depth. Readers can order a copy by writing: Dr. Donohue – No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Can you tell me why the recommended age for a first colonoscopic exam is 50? Why is this the magic number? By the time my husband of 23 years was age 50, he had a perforated colon due to colon cancer, with no prior symptoms. – N.G.

ANSWER:
I understand your anguish and your position for an earlier age for colonoscopies. The reason age 50 was chosen as the age for a first colonoscopy is that most colon cancers appear in people 50 and older. Colon cancer can begin at younger ages. Perhaps giving some public recognition to your story will motivate others to ask for a younger screening age. You have my deepest sympathy.

DEAR DR. DONOHUE: I am afflicted with type 2 diabetes and am under the care of a physician. I take oral medicine for it. With even a slight variance from a reasonable diet, my sugar reading, two hours after any meal, is elevated. I have frequent urination, but generally feel good. I exercise regularly, and my wife tries very hard to prepare correct foods. Would increasing my water input help wash out the excess sugar? – J.B.

ANSWER: It’s a nice thought, J.B., but it won’t work. Water doesn’t wash out sugar. High blood sugar, on the other hand, does make a person urinate frequently. Does your doctor know about your sugar readings? Perhaps a change in medicine or the addition of another medicine will bring your sugar down.

The doctor might even ask you to take insulin for better sugar control. It’s not as daunting a task as you might think.

DEAR DR. DONOHUE: For two years or more, my son (44) has had this redness of his nose and on his cheeks. What can he do to get rid of it? An M.D. did no good at all. I say a dermatologist is the doctor to see. – Anon.

ANSWER:
Going on your description, I’d say your son has rosacea (rose-AY-she-uh). It starts with redness of the nose, most often its tip, and the cheeks. In time, small pimples break out on the involved skin. Spiderlike tangles of blood vessels also can appear on the red skin patches.

Without treatment, the condition gets worse, and the nose can become quite deformed, the kind of nose W.C. Fields had.

One popular treatment is metronidazole cream or gel. It and the other rosacea treatments are prescription items. Your advice to see a dermatologist is good advice.

Your son can help himself until he sees the doctor by staying out of sunlight and forgoing alcohol and spicy foods.

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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