DEAR DR. DONOHUE: Will you please write an article on bladder cancer? How is it treated? How do you tell if you have it? What is the life expectancy with bladder cancer? — M.A.

ANSWER: Bladder cancer is the fourth most common male cancer and the 13th most common female cancer. Around 69,000 new cases occur annually in the United States, and it causes close to 14,000 deaths every year. The number of cases of bladder cancer is on the increase, but the number of deaths from it is decreasing. That’s a testimonial to the treatment for this cancer.

Smoking is a huge cause of bladder cancer. Most people are unaware of that. It’s another reason to motivate people to give up the cigarette habit. Bladder cancer has a unique property: It tends to recur, and that’s why follow-up surveillance is so important after the initial treatment is given. Blood in the urine is a sign of this cancer. Although bladder cancer isn’t the most common cause for urine blood, it is the most important cause, and should spark attention for other signs and symptoms of cancer. An increase in urine frequency and pain on urination are other signs, but they are not always present.

Once bladder cancer is suspected, a scope look into the bladder is often the next step. Not only can doctors see the cancer, but they can remove it. The life expectancy for bladder cancer hinges on the depth to which the cancer has invaded the bladder, its spread to other body sites and how aggressive is the appearance of the cancer cells when viewed with a microscope. Superficial cancer, naturally, has the best prognosis, and 75 percent of newly discovered bladder cancers are superficial. They carry as high as a 90 percent survival rate. Since bladder cancer so often recurs, doctors frequently have to instill in the bladder BCG (bacillus Calmette-Guerin, a cousin of the TB germ). It stimulates the bladder’s resistance to forming new cancers.

DEAR DR. DONOHUE: My husband is 90 years old and has ITP, idiopathic thrombocytopenic purpura. His doctor says nothing can be done for it. He seems to be in good condition for a 90-year-old. My medical book says steroid therapy is effective. I’d appreciate your input. — E.W.

ANSWER: Are you sure the doctor said nothing can be done for it? Or did he say nothing needs to be done for it? Idiopathic thrombocytopenic purpura is now more commonly called immune thrombocytopenic purpura to emphasize the immune system’s role in its genesis. The immune system makes antibodies that attack and destroy platelets, also called thrombocytes. Platelets are the body’s clot-forming cells. A drop in platelets causes bruising (purpura) and can lead to serious bleeding. A normal platelet count is 165,000 to 415,000 per cubic mm of blood. Counts of 50,000 and above don’t usually call for treatment. Treatment is considered when the count drops below 20,000 or when a person is actively bleeding. Prednisone, one of the cortisone drugs (steroids), or intravenous gamma globulin is given when the count drops to dangerous levels.

DEAR DR. DONOHUE: Please clear something up for me. Should I take Lipitor in the morning with my vitamins, or at bedtime? Or should I take it in the morning and then take my vitamins at bedtime? — S.H.

ANSWER: You can take Lipitor (atorvastatin) at any time. You can take it with or without food. You can take it with your vitamin pill. Be consistent when you take it. If you want to absorb every last milligram, microgram or IU (international unit) of your multivitamin, take the pill on a full stomach, shortly after eating. Vitamins A, D, E and K require some fat for optimum absorption. Most of us get more than enough vitamins, so the timing for taking a vitamin pill is not so crucial. I take a multivitamin before breakfast as an act of rebelliousness. I am tired of following so many rules and regulations.

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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