DEAR DR. DONOHUE: My wife, 73 years old, had to be hospitalized for a high fever and a nonstop cough. Her first few days in the hospital were touch-and-go. I thought I was going to lose her. It turns out she had Legionnaire’s disease. I remember reading about it years and years ago, but I haven’t heard a word about it lately. I thought it had gone. Why is so little said about it? – M.D.

ANSWER:
Legionnaire’s disease is very much with us, and the annual number of cases is actually rising. The headline news it got in 1976 came about because of an American Legion convention held in Philadelphia. An alarming number of conventioneers became gravely ill with an unidentified illness. Finally, infectious-disease specialists uncovered a bacterium responsible for the illness. In honor of the American Legion, the bacterium was named Legionella, and the disease, Legionnaire’s disease.

This illness accounts for at least 4 percent of all pneumonia cases every year. The germ is found in water, lakes, pools, manmade reservoirs, fountains, cooling towers, whirlpool baths and similar water-filled storage depots.

Like all bacterial pneumonias, Legionnaire’s presents with a high fever alternating with chills, a troublesome cough and difficulty breathing. Headaches, muscle pains, joint pains and diarrhea occur in up to 50 percent of patients and give this pneumonia distinctive features.

A novel test that detects parts of the Legionella bacterium in the urine provides a fast way to diagnose the disease.

Rapid identification of Legionella is important, because this pneumonia responds to antibiotics that are not the ones usually called on for pneumonia treatment.

You were justified in worrying about your wife’s prognosis. Untreated, this infection carries a mortality rate of 16 percent to 30 percent.

DEAR DR. DONOHUE: I have had a pain in my chest that gets worse if I sneeze, cough or twist my chest. The pain in on the left side, next to the breastbone. I don’t remember having any injury there.

The pain is tolerable most of the time, but it can get quite annoying. What do you think this might be? Could it be my heart? – R.E.

ANSWER:
Most of the time, heart pain comes with activity and doesn’t worsen with coughing, sneezing, twisting or deep breathing. However, all chest pain must be viewed with caution, so I want you to check this with your doctor.

My guess is costochondritis. It’s an inflammation of the cartilage (chondritis) that connects a rib (costo) to the breastbone. Often, it’s one or more of the upper ribs. Its cause is unknown. It’s a very common condition.

Heat applied to the painful area in the form of a towel or washcloth moistened with hot water might help. Anti-inflammatory drugs like Aleve, Motrin or Advil frequently control the pain and calm the inflammation.

If these measures are futile, a doctor can inject the painful area with cortisone, which almost always provides rapid relief.

DEAR DR. DONOHUE: Please don’t give me a sermon. I have smoked marijuana since I was 18 and continue to do so. I am 22. I have noticed that my breasts are getting bigger. It’s got me worried. Could it be due to marijuana? – S.J.

ANSWER:
Marijuana is implicated as a cause of gynecomastia, growth of the male breast. It’s not the only cause but, in your case, it’s a likely one.

Not only can marijuana enlarge the breasts, it also can lower blood testosterone levels, depress the sperm count and decrease sperm motility.

DEAR DR. DONOHUE: With so many people battling high blood pressure, please address the subject, and please answer why it is impossible for so many to get their pressure controlled. My father, 83, was put on Altace, and his blood pressure was fine for a full month. A few days ago, his doctor took his pressure, and it was very high. The doctor checked it with my dad’s monitor and got the same reading. Why would his pressure go out of control all of a sudden? Our neighbor was told to rest in bed to get her pressure down. Is this the right way to go? – P.M.

ANSWER:
More than 65 million Canadians and Americans suffer from high blood pressure – hypertension. Only about one-third of them are adequately controlled all the time – not a testimonial to doctors. Your dad’s sudden rise in blood pressure might never be explained. It might be that it is just that his body is not reacting to his medicine as it used to. Or it might be that he is doing something that upsets blood pressure control, like using too much salt.

There are six classes of blood pressure medicine. Each class has a number of slightly different drugs, so the total number of blood pressure medicines is huge. Your dad’s medicine belongs to the group called ACE-inhibitors – very fine blood pressure-lowering drugs. However, he might need a dose adjustment or a combination with one of the other classes of medicines or an entirely new drug. It’s not unusual to have to adjust a patient’s medicines when blood pressure no longer responds to the one he or she’s been taking.

What’s he doing for his pressure in addition to taking medicine? If overweight people lose weight, their pressure drops 5 to 20 points. Thirty minutes of daily exercise can lower pressure 2 to 9 points, and the exercise need not be exhausting or need not be done for 30 consecutive minutes. Limiting salt to 1,500 mg of sodium (3,700 mg of salt or sodium chloride) a day brings down pressure 2 to 8 points. Increasing potassium in the diet takes down blood pressure. Potassium foods include baked potatoes with skin, peas, cantaloupe, orange juice, dates, watermelon and bananas. A diet emphasizing fruits, vegetables, whole grains and low-fat dairy products also decreases blood pressure. I am sure your dad can get his blood pressure back to the desired range with a medicine adjustment or change and an adoption of new lifestyle habits. Bed rest is not usually required to lower pressure.

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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