Enzyme deficiency gives rise to emphysema
DEAR DR. DONOHUE: I would like to call your attention to a question you answered about emphysema. I think you should have mentioned alpha-1 antitrypsin deficiency. It would have been a good opportunity to bring this condition to the public’s attention. I have it and was diagnosed at age 53, after having been misdiagnosed for eight years. I have been on Prolastin, which has stabilized my lung capacity. While more doctors are aware of this condition, there are some who are not. — D.C.
ANSWER: Lungs come equipped with their own janitorial crew. They inhale lots of foreign debris, and they create trash in their work of transferring oxygen into the blood and carbon dioxide out of it. The cleanup crew is trypsin, an enzyme. Trypsin, however, can go overboard, so another enzyme, called alpha-1 antitrypsin stops it from overdoing the trash collection and destroying air sacs in the process. Emphysema is destruction of those delicate structures. Cigarette smoking is the No. 1 cause of emphysema, also known as one of the chronic obstructive pulmonary diseases, COPD.
Symptoms of emphysema, regardless of cause, include shortness of breath with little physical exertion, cough and increased sputum production.
The delay in your diagnosis of alpha-1 antitrypsin deficiency is par for the course. On average, the diagnosis takes eight years from the time a person first visits a doctor for emphysema symptoms. This illness should come to mind when a relatively young person or a person who has never smoked develops emphysema. A simple blood test for the level of the antitrypsin enzyme can secure the diagnosis.
Treatment is the same as treatment for smoking-caused emphysema. However, there is an additional treatment for alpha-1 antitrypsin deficiency emphysema. Intravenous infusions of the missing enzymes can benefit those with the deficiency. Your Prolastin is one such product.
The booklet on emphysema and chronic bronchitis, the two chronic obstructive pulmonary diseases, discusses the more-common variety in detail. To obtain a copy, write: Dr. Donohue — No. 601, 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. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Twice in the past eight months, I have been hospitalized for internal bleeding from an AVM. What is an AVM? — D.W.
ANSWER: An AVM is an arteriovenous malformation, a ball of arteries and veins. Arteries and veins are connected by capillaries — small, delicate vessels. In an AVM, no capillary connections exist, and the arteries and veins tend to break and bleed. They can be found in many places, like the brain and the lung, and usually they’re there from birth.
AVMs also can be found in the digestive tract. Most often, these AVMs form at older ages. The process is called angiodysplasia. They, too, bleed easily. Since most of these AVMs occur in the colon, they can be obliterated with a scope and an instrument that dries them up with an electric current or with an injection of a chemical solution. There are other ways of handling them, too.
DEAR DR. DONOHUE: I am a 68-year-old female, and I take the following: a multivitamin, omega-3 fish oil, Citracal calcium with vitamin D, glucosamine/chondroitin and vitamin C.
Am I taking too many supplements? I eat well, lots of veggies and fruits. My blood pressure and cholesterol are good. — Anon.
ANSWER: You take a lot of supplements, but you’re not in a danger zone. As far as vitamin overdoses, watch your vitamin A intake. The recommended daily allotment is 700 micrograms (2,300 IU) for women, and 900 (3,000) for men. The upper limit is 3,000 micrograms (10,000 IU). The vitamin C recommendation is 75 mg for women and 90 for men. Its upper limit is 2,000 mg. You’re not near those limits.
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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