Most recover from frightening attack of unknown cause
DEAR DR. DONOHUE: I have not seen you write anything on sarcoidosis. My 42-year-old son was recently diagnosed with it. — J.G.
ANSWER: Few readers are familiar with sarcoidosis, an inflammatory illness that attacks many tissues and organs. Granulomas are one of its hallmarks. They are heaps of dead and dying cells that have been engaged in hand-to-hand combat with the as-yet-undiscovered cause of this illness. It often strikes healthy people around age 40. Many organs are involved, but the lungs top the list. Liver, skin, eyes and heart are other targets. Some sarcoidosis patients have no symptoms, and the illness is discovered on a routine chest X-ray. Others are desperately ill. Since the lung is the organ involved, in most cases, respiratory symptoms are its chief signs. Cough and breathlessness on slight exertion indicate lung involvement. Loss of energy, fever and weight loss are other nonspecific signs.
Rashes can occur. One of them is erythema nodosum, an outbreak of painful red bumps, most often seen on the leg.
With eye involvement, people become sensitive to light and must keep the eyes shaded. Dry eyes are another sign.
Cortisone drugs are the mainstays of treatment. The decision to treat has to be carefully weighed, since the illness often resolves on its own. When symptoms make it difficult to carry on the tasks of daily life, treatment is started.
I have an acquaintance who has had sarcoidosis for more than 20 years and has not had to take any medicine and has worked quite hard since the day he was diagnosed. I hope your son has as benign a course as my acquaintance has had. Many do.
DEAR DR. DONOHUE: For the past two years, my sed rate has been high. I have taken all kinds of tests to find out why, but nothing has turned up. Can this be normal? I am 82 and in good health. — E.S.
ANSWER: The sedimentation rate (sed rate) is a simple office test where blood is put in a calibrated tube and remains there for one hour. The distance the red blood cells fall (sediment) from the top of the tube in that time is the sed rate. This test doesn’t point to one particular illness. It indicates that there is body inflammation. The doctor’s job is to find out where the inflammation is and whether it is significant.
Obesity, aging, kidney disease, anemia and high cholesterol elevate the sed rate. If the tube is not perfectly vertical during the test hour, the sed rate is abnormally high.
For two years, you have had a high sed rate. Many tests have not discovered a cause. You feel fine. It might be wise at this point, to put a halt to further testing, because an isolated, high sed rate without any other signs or symptoms has little meaning. Your doctor can follow you with routine office visits.
DEAR DR. DONOHUE: I eat a high-fiber breakfast. I also eat one banana, a large orange and some walnuts. I do not take calcium at this time, as I have read that bran keeps the body from absorbing it. Does it do so, and does it keep nutrients from the orange, banana and nuts from being absorbed? How long after I eat can I take calcium? — T.Y.
ANSWER: Fiber can grab onto calcium and limit its absorption. To avoid that, take the calcium two to three hours after eating breakfast. If your calcium is calcium carbonate, take it with a snack, like crackers. Food promotes stomach-acid secretion, and you need some stomach acid to absorb calcium carbonate. If you take calcium citrate, you can take it anytime, with or without food.
Fiber doesn’t interfere with nutrients from oranges, bananas and nuts. They have their own fiber.
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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