DEAR DR. DONOHUE: I was told I have valvular heart disease. Please explain it to me. I am 65. – L.M.

Each of the heart’s four chambers has a valve that directs blood flow to the next chamber and prevents back flow of blood into the chamber it just left. Bad things can happen to any of those four valves. They can narrow – stenosis – and that makes it tough for blood to leave one chamber and move to the next. If the aortic valve – which is located at the junction of the large pumping chamber (the left ventricle) and the body’s main artery (the aorta) – narrows, the left ventricle has to pump with added vigor to get blood into the body. In time, that causes heart enlargement and heart failure.

Valves also can leak – regurgitation. That makes blood back up and can cause flooding of the lungs with blood. It’s another cause of heart failure.

Sound-wave pictures of the heart – echocardiograms – give clear images of the valves and the degree of valve malfunction. Many times, leakage and narrowing are minor. Such defects can be ignored. The doctor watches for any progression. A simple statement by the doctor of valvular heart disease might not imply significant changes.

Heart valve problems create murmurs, and that’s one reason why doctors listen to people’s hearts with a stethoscope.

What causes valve changes? Some people are born with defective valves. Aging takes its toll on them. Infections of heart valves deform them. Rheumatic fever, once a common consequence of strep throat, is another cause of valve problems.

The booklet on valvular heart disease discusses this common heart condition in depth. Readers can order a copy by writing: Dr. Donohue – No. 105, 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. Allow four weeks for delivery.

DEAR DR. DONOHUE: My problem is trigeminal neuralgia – a nerve that goes down the left side of my head and has three branches. I have been many times to the operating room to have a needle shoved into the nerve to kill it. It hasn’t helped me. The pain is terrible, and pain pills don’t help. I can have an attack at any time. My friend says this cannot be cured. Do you have any suggestions? – W.G.

You gave a good description of the trigeminal nerve. There’s one on each side of the face, and they bring sensations on the face to the brain. With trigeminal neuralgia (also called tic douloureux), irritation of that nerve creates incredibly painful spasms that are short-lived but can occur several to dozens of times each day. A light breeze on the cheek, chewing food, shaving or many, other similar harmless, daily events can trigger a tormenting attack. Medicines sometimes work. Neurontin and Tegretol are two often used drugs. Injections are another valuable tool, but they didn’t work for you. Let me suggest a procedure with a high success rate – microvascular decompression. An artery wraps around this nerve, and its pulsations lead to these painful episodes. A surgeon can interpose a spongelike material between the artery and the nerve to end attacks. Talk with a neurologist or neurosurgeon about this.

DEAR DR. DONOHUE: I have diabetes and I am supposed to watch what I eat, but I don’t understand the difference between sugar and carbohydrate. Are they the same? – C.C.

Carbohydrate includes sugars and starches. Most of the foods we eat are carbohydrates. Meats are not carbohydrates. Fats aren’t carbohydrates. Everything else is.

Understanding a diabetic diet is troublesome for everyone. A local hospital might offer classes in diabetic diets. You also can contact the American Diabetes Association. A face-to-face period of instruction with a dietitian will straighten this matter out for you. Your local hospital is bound to have one of these people.

DEAR DR. DONOHUE: I was diagnosed in 1986 with discoid lupus. I didn’t get treatment then. I still have blotches on my face and head. I am currently incarcerated. I am on Valisone and hydrocortisone cream. Is this curable? – A.L.

Discoid lupus affects only the skin and sometimes the lining of the mouth. It starts out as dull red to purple patches with a scale that looks glued onto the patch. In time, the patches become paler and often hairless. They may or may not itch. Patches appear on the scalp, the bridge of the nose, the cheeks, ears and the upper lip. Other locations are possible. It’s usually controllable but not always curable.

An important fact is that discoid lupus progresses to full-blown lupus (systemic lupus) in a few people, around 5 percent to 10 percent.

The medicines you are receiving are the standard medicines for discoid lupus – Valisone and hydrocortisone creams, both members of the cortisone drug family. Sometimes cortisone drugs are injected into the patch when creams or lotions don’t work. Even oral medicines, like hydroxychloroquine, used for systemic lupus might have to be prescribed. Above all, stay out of the sun and protect yourself with sun lotion with an SPF of 30 or higher.

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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