DEAR DR. DONOHUE: Please explain progressive supranuclear palsy. Is it hereditary? What causes it, and what are its symptoms? Can anything be done to prevent it? – C.
ANSWER: Progressive supranuclear palsy stems from deterioration of brain cells in specific brain areas. Its cause has yet to be discovered. The genetic influence is currently being studied. However, only about one PSP patient in 100 has a known affected relative. Prevention is another area where our knowledge is lacking.
One prominent sign of PSP is a glitch in eye movement. In the early stages, people have difficulty turning their eyes down, and that creates great problems in performing simple tasks like stepping off a curb. After a time, patients have a hard time turning their eyes upward. The eye-movement trouble often creates double vision. In addition to loss of control of eye movement, patients’ muscles become stiff, and their motions are robotlike. This muscle rigidity often leads to a mistaken diagnosis of Parkinson’s disease. Balance becomes a problem, and falls are common. The falls are backward. Speech might be garbled, and swallowing presents a difficulty. Mental functions often deteriorate.
The actor Dudley Moore suffered from PSP.
No medicine prevents this illness, and no medicine has had much effect on easing its symptoms. Parkinson’s disease medicines might be prescribed, but they don’t have the same impact that they have on Parkinson’s disease.
So much of PSP is a question mark that it’s wise for patients and their families to get in touch with the Society for Progressive Supranuclear Palsy. Its number is 800-457-4777, and its Web site is www.psp.org. The society keeps people up to date on new information and provides help in finding doctors skilled in diagnosing this illness.
DEAR DR. DONOHUE: Will you please address the need for people who have gastric bypass surgery to have their mineral and vitamin intake monitored after the surgery? In 2000, I weighed 320 pounds at age 67. I had to use a walker. I was on medicines for diabetes and high blood pressure. My doctor sent me to a surgeon to discuss bypass surgery. I had it. I now keep my weight at 124 pounds. Two years after the surgery, I passed out. It turned out that my iron level was low, and I was anemic. People who have this surgery should be aware of the possible vitamin and mineral problems that can arise from it. – D.C.
ANSWER: You didn’t mention in your letter which kind of bypass operation you had. Three operations are the most popular ones for weight loss: gastric banding, Roux-en-Y gastric bypass and biliary-pancreatic diversion with duodenal switch. In gastric banding, a beltlike device is wrapped around the upper stomach to create a small stomach that holds a limited amount of food. The rest of the digestive tract isn’t rearranged as it is into the other two surgeries. Vitamin and mineral deficiencies aren’t as common in gastric banding as they are in the other two. All patients should be forewarned about the possibility of nutritional complications, and doctors and patients should watch for any deficiencies.
People might wonder which operation is the best. The best operation is the one your surgeon judges benefits your particular needs the most. You made a huge turnaround. Do you still have to take blood pressure and diabetes medicines?
DEAR DR. DONOHUE: I just survived pneumonia. I was told by the lung specialist that I should get the pneumonia vaccine every year. I am 66. My sister-in-law told me that her doctor said pneumonia shots are not needed after age 65. Who is correct? – D.T.
ANSWER: The “pneumonia” shot is for one kind of pneumonia, pneumococcal (NEW-moe-KOK-ul), the most common bacterial pneumonia, one that can be quite life threatening for older people. The current recommendations call for a single shot of the vaccine for those over 65. If the vaccine was given before age 65, a second dose should be administered five years later. If people have any illness that weakens their immune system, they, too, need a booster shot of the vaccine.
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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