Special kind of back arthritis strikes young men
DEAR DR. DONOHUE: My son has ankylosing spondylitis. He has been told it is arthritis of the vertebrae and should plateau around 50 years of age. Your comments, please. My son must take painkillers every day of his life. — S.P.
ANSWER: “Ankylosing” (ANN-kuh-LOW-sing) indicates that joints have become immobile because bone has fused them into a solid mass. “Spondylitis” (SPAWN-duh-LITE-iss) signifies that the backbones are involved — the vertebrae of the spine. This is a special kind of back arthritis, one that appears most often in late adolescence to early adulthood.
In extreme cases, the process ascends to the top of the spine in the neck, and the person can hardly bend his back or his neck. In truth, the extent of AS cannot be predicted with accuracy.
The hips and the shoulders also can partake of this arthritic process. For a small number of patients, it causes eye inflammation, and sometimes, the heart’s aortic valve develops a leak. All of this sounds terrible, but the picture is not so bleak.
Cure can’t be spoken of, but control can. The first medicines used are the nonsteroidal anti-inflammatory drugs — Motrin, Aleve, Advil and many more. Physical therapy treatments and a supervised exercise program keep the spine flexible.
Other medicines are available. The greatest breakthrough in treatment is the advent of new drugs with a novel mode of action. These medicines block the body chemicals that cause the joint inflammation and destruction. They are infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira). Not everyone with AS requires these newer medicines. Those who don’t respond to standard treatment or who are severely afflicted are candidates for them. They have to be used with caution, as they can have serious side effects.
DEAR DR. DONOHUE: My husband is 28, and as far as we know, he is healthy. His father had a heart attack at age 27. His paternal grandfather passed away at 37 from a heart attack. When we told the doctor about his family history, he did nothing and told us not to worry. Well, I am worried. Why would a doctor not be concerned? — P.C.
ANSWER: In your husband’s case, worry is justified. Family history repeats itself. His father and grandfather had heart attacks at young ages. Your husband has to pull out all stops so that he doesn’t suffer a similar fate. He has to stay on the slim side; watch his cholesterol, blood pressure and blood sugar; eat a low-fat, low-cholesterol diet (one consisting mainly of fruits, vegetables and grains); and not even think about smoking. He has to stay active. I can’t answer why your doctor isn’t concerned. Your husband would benefit from a second opinion, and might even consider having a stress test to check on his heart’s status now.
Coronary artery disease is often a family affair. The booklet on this topic explains it and its treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 101, 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: Will you say something about male breast cancer? My right breast is painful, and when I push on the nipple, it hurts more. — R.C.
ANSWER: Men can get breast cancer, but not as frequently as women do. For every man who comes down with it, 150 women do. Close to 80 percent of male breast cancer starts as a painless lump beneath the nipple. The nipple might be sore, and it may sink into the breast tissue.
Mammograms and ultrasounds are as useful in detecting male breast cancer as they are in detecting female breast cancer. You don’t mention a lump, which makes breast cancer unlikely. All the same, see the family doctor to find out why your nipple and breast are painful.
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.