DEAR DR. DONOHUE: I read about how people want to lose weight. OK. Now how about my problem? I am too thin and have been all my life. I am 45, weigh 95 pounds and am 5 feet 2 inches tall. I am married with three children. I have great energy and good health. I eat three meals a day, and I eat well-balanced meals. I have no problem with appetite. Skinniness runs in my family. Have you any suggestions? I have had my thyroid checked. It’s normal. – M.H.

ANSWER:
By height-weight charts and by body mass index criteria, you are underweight. But let’s put the brakes on. You have been this way all your life. You have raised three children. You have great energy and a good appetite. You eat healthful meals. Does being thin classify you as sick or unhealthy? I don’t think so. It sounds more like a genetic trait. It will probably add years to your life.

If you want to gain more weight to have a cushion in case you get sick, you can do so by increasing your daily calorie count by 500 calories. You have to buy a calorie-counter book that gives you the calorie content of foods. Such books are cheap, and you can find them in all bookstores. An additional 500 calories a day will add one more pound to your weight in a week.

If you don’t want to be bothered by calorie counting, then take these steps: Increase the food portions eaten at every meal. Have a between-meal snack, but don’t snack so much that it kills your appetite for meals. Yogurt, dried fruits, fresh fruits and nuts are good sources of calories. They won’t kill your meal appetite. A large banana has 130 calories. A banana at midmorning and midafternoon gives you more than half of the 500 extra calories goal.

Another snack before bed can provide the remaining calories needed to reach 500. A peanut-butter sandwich, made with two tablespoons of peanut butter, comes close to 300 calories.

If the snack approach doesn’t appeal to you, try a liquid supplement like Ensure. (There are many other brands.)

DEAR DR. DONOHUE: Please discuss the side effects of Flomax, especially its effect on vision. A brother-in-law and a friend have experienced vision difficulties from it and have been forced to eliminate its use. Please name some substitutes. – A.A.

ANSWER:
Flomax (tamsulosin) relaxes muscles in the prostate gland and muscles that surround the outlet of the urinary bladder. That allows urine to leave the bladder and pass out of the body more easily. Many men with large prostate glands are indebted to it.

IFIS – intraoperative floppy iris syndrome – is one visual complication of Flomax use. The iris is the colored, ring part of the eye. Some men, while on Flomax or who have taken it in the past, experience a peculiar reaction during cataract surgery. Their iris starts to billow outward, and it often constricts. It makes the operation most difficult. Men must tell their eye doctors they are using or have used this drug before such surgery.

Blurred vision is listed as a possible side effect, but it happens to very few users.

Men who have had vision problems can go on a different class of drugs, like Proscar or Avodart.

DEAR DR. DONOHUE: Our son is 39. From infancy, he has had allergies. A few days ago, at a party, he took a few bites of crab cake and a sip of wine. Within minutes he ran for the exit. He spent an hour outside trying to breathe. He considers this too trivial to see an allergist. We think these incidents could be life-threatening. – T.E.

ANSWER:
The incident you described sounds like an allergy to wine or to seafood. Such incidents are emergencies, and they do threaten life. They are not trivial occurrences. He needs the help of an allergist.

The episode you mention (in a deleted part of the letter) when he choked on a sour-ball candy as a child wasn’t an allergy; it was a mechanical blockage of his airway. The Heimlich maneuver you performed saved his life. It’s in no way related to his present problem.

DEAR DR. DONOHUE: I was diagnosed in 1985 with transverse myelitis. Can you explain what this is? I stagger when I walk, so I must use crutches. I must have a catheter because I cannot control my urination. My entire left side is partially paralyzed. Any information you can give me about this will be greatly appreciated. – L.M.

ANSWER:
“Myel” here refers to the spinal cord, and “itis” indicates inflammation. “Transverse” signifies that the spinal cord inflammation runs from the right side of the cord to the left side.

The spinal cord is only about the width of the little finger. It contains both nerve cables and nerve cells. The cables bring information to the brain and take directions from the brain to all body organs and muscles. Spinal cord nerve cells serve to direct muscle action in addition to the input that muscles get from the brain.

Transverse myelitis interrupts the transmission of all these messages. Depending on what area of the spine the inflammation has settled – high in the neck or low in the back – signs and symptoms vary in their extent and severity. Common signs are back pain, leg weakness, loss of sensations and loss of urine control.

Causes include viral infections, blood vessel blockages and illness such as lupus. There are many times when doctors cannot identify a cause, and the illness is then called idiopathic.

About one-third of transverse myelitis patients have a good recovery. Another third make a fair recovery. That leaves a third that don’t regain use of involved organs and muscles. In most instances, there is no medicine that promotes healing.

However, things can be done for those who are left with incapacities. There’s a field of medicine that gets far too little recognition. It is occupational medicine. Occupational therapists are highly trained individuals who can provide people with a variety of devices that make life more livable and easier. You can find these people in almost all hospitals. Contact one.

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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