Adrenal gland failure requires treatment
DEAR DR. DONOHUE: I am 54. Last year, after two months in two different hospitals, I was diagnosed with Addison’s disease. I have to take prednisone daily. I have gained 84 pounds, and now I have type 2 diabetes. I know Addison’s has to do with the adrenal glands shutting down. To what extent do they shut down? I’ve been told this is fatal. Do I take medicine for the rest of my life? Please explain Addison’s disease to me. — V.B.
ANSWER: Weighing in at only 1/10 ounce, each adrenal gland — one sitting above the right kidney, and one above the left kidney — performs complicated and life-maintaining jobs for the body. They produce cortisone, which guides the metabolism of sugars, proteins and fats, and limits body inflammation. They make other hormones that regulate body sodium and potassium levels and keep blood pressure from plummeting. And they make hormones like adrenalin, which keeps us on our toes when danger threatens. Adrenal-gland shutdown does kill if left untreated. Ninety percent of the glands have to be destroyed before the body begins to fall apart.
Fatigue and muscle weakness are two prominent symptoms of Addison’s disease. Appetite disappears. Nausea, vomiting and weight loss are common. Blood pressure falls. Body stores of sodium become depleted, but body potassium rises.
In the old days, tuberculosis was the cause for most Addison’s cases. Today, the cause is believed to be an immune attack on the glands.
Treatment for Addison’s is straightforward: Replace the missing hormones. Prednisone is one often chosen. Treatment is for life. Your weight gain is not entirely due to prednisone. You are getting a dose that replaces the missing hormone, the same dose your glands would provide for you. If weight gain is a big problem, you have to increase your physical activity and decrease your calories. Weight loss will help with diabetes control.
DEAR DR. DONOHUE: A close friend used to be an airline stewardess. Maybe because of the tight, high-heel shoes she wore and because of being on her feet so much, she developed bunions. Now she can hardly walk because of the pain. Her doctor hasn’t suggested surgery. What can help her? — D.S.
ANSWER: A bunion is a painful bump at the side of the base of the big toe. Along with that bump, the big toe turns inward toward the other toes. High heels — pointy, narrow shoes — are always cited as a cause, but they are not the sole cause. Men get bunions, too. Heredity, arthritis and bone misalignment are other causes.
Your friend has to wear low-heel shoes that have plenty of space for her bunions and her toes. Running shoes are a good buy. She can cushion the bunion with protective pads, found in all drugstores. A podiatrist can fashion for her a shoe insert that takes pressure off the bunion.
From your description, your friend appears to be at a stage when surgical correction would do her the most good.
DEAR DR. DONOHUE: I was recently hospitalized for ischemic colitis. I can’t find any information on it. Why does it occur? How can I prevent it from happening again? Is constipation a factor? — L.W.
ANSWER: Doctors couldn’t function without the word “ischemic” (is-KEY-mick). It means “deficient blood supply.” Something blocked blood flow to a part of your colon, and the result was crampy abdominal pain. Constipation had nothing to do with it. Resting the colon by feeding the affected person intravenously allows blood flow to resume. Most often, it isn’t a permanent problem.
Prevention is the same kind of prevention used for heart artery obstruction — a low-cholesterol, low-fat diet, one with lots of vegetables and fruits and whole grains.
There are some ischemic conditions affecting the digestive tract that are very serious and even life-threatening. These ischemic events do not get better on their own and can lead to death of the involved part of the tract. Treatment involves immediate surgery.
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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