DEAR DR. DONOHUE: I am writing to ask you to fill in for my doctor, who is quite tight-lipped. He told me I have protein in the urine. I am 43 and have three children. I asked him the significance of this, and he just shrugged his shoulders. He wants me to give another specimen in a week. I’m quite concerned about this, and, when I have asked people, I always get bad predictions. Will you shed some light on this? — A.H.

ANSWER: The kidneys’ main function is to filter the blood. They remove useless and potentially harmful material. Proteins are useful material. They are large, and they don’t pass through the kidney’s filters into the urine. When protein appears in the urine, it indicates that the kidney’s filters have gaps, allowing these large structures to exit the body.

To determine the significance of urine protein, two specimens should be collected on different days. If both specimens contain protein, then the next step is determining how much protein is lost in 24 hours.

Normally, less than 150 mg of protein is found in one full day of urine production. If the daily output of protein is less than 2,000 mg, the cause is often a benign condition. Heavy exercise or fever can produce such protein loss. A condition called orthostatic proteinuria is another unthreatening cause of urine protein. Affected people lose protein during the day when they are standing (orthostasis). They lose no protein when they’re asleep and horizontal. An early-morning urine specimen, therefore, is free of protein. A specimen taken before retiring, however, has protein in it. This condition is not an indication of illness.

Illnesses that cause loss of greater amounts of protein are things like kidney inflammation for a number of reasons, kidney infections and inherited kidney disease. Frequently, the cause requires a needle biopsy of the kidney. That can be done as an outpatient.

If your doctor is so tight-lipped that he doesn’t give you an answer in a short time, consider seeing another doctor.

DEAR DR. DONOHUE: All of a sudden I heard a swooshing sound in my left ear. It turns out I have a hole in the eardrum. The doctor said I need not do anything about this. The noise has lessened, but I wonder if this wait-and-see policy is the correct one. Is it? — T.P.

ANSWER: The eardrum has an important job. It transfers sound to a linkage of three bones in the middle ear and they pass on the sound waves to the inner ear, where the hearing nerve is.

A hole in the eardrum is a perforation. A perforation has to have a cause. Getting hit in the head or on the ear, an infection of the ear, cleaning the canal with something like a paper clip or diving to great water depths can lead to eardrum perforations. Are you sure you can’t think of something that could have caused the hole?

Small holes heal on their own in a matter of weeks. Large holes generally call for a patch.

While the hole is healing, you have to exercise caution not to get water in the ear. Take baths, not showers. Wash your hair in a sink.

If the sound persists for longer than two more weeks, go back to the doctor.

DEAR DR. DONOHUE: Does rapid weight loss cause gallstones? I went on a very strict diet and lost more than 50 pounds in one month. Shortly thereafter, I had a gallbladder attack and had to have it removed. I’ve been wondering ever since if the diet contributed to the attack. — R.S.

ANSWER: Rapid weight loss can lead to gallstone formation. During a very calorie-restricted diet, more cholesterol than normal is secreted in the bile. The cholesterol molecules stick to each other to form cholesterol crystals. The crystals, in turn, aggregate to make a stone. Cholesterol stones are the most common kind of gallstones.

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

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