DEAR DR. DONOHUE: When I was 5 years old, I had rheumatic fever. We didn’t have any medicines for it then. I was put on bed rest. I have a heart murmur as a result.

I am writing to you because I wonder what’s happened to this illness. I never hear about it. Has it gone? — H.T.

ANSWER: Rheumatic fever hasn’t gone, but the number of cases has declined from the bad old days. A few serious and fairly large outbreaks have occurred in the U.S. in the recent past. Worldwide, the number of cases is still large. The reasons for its decline in the U.S. aren’t fully known.

Rheumatic fever follows a strep throat — “strep,” as in the bacterium Streptococcus. Prompt treatment of strep throat prevents rheumatic fever. You must have been raised in the days before there was wide use of penicillin. It’s not the strep germ itself that causes the illness; it’s the antibodies that are made in response to the strep infection that do the damage.

Those antibodies can deform heart valves. Heart involvement is the most serious aspect of rheumatic fever. Other signs are painful joints, purposeless flailing of the arms and legs, a body rash and small bumps under the skin. All these leave the patient without causing permanent problems.

Your heart murmur could be the aftermath of rheumatic fever. You’re lucky you never have needed any treatment for it. Many times, the deformed valve of rheumatic fever has to be replaced.

People who had one attack of rheumatic fever are at risk of having a second attack. For that reason, these people are put on a schedule of penicillin to prevent another strep throat. The treatment goes on for years, but is stopped later in life. You would not benefit from it at this late date.

The booklet on heart-valve diseases explains what happens to heart valves that are deformed not only by rheumatic fever but by many other causes. Readers can obtain a copy by writing: Dr. Donohue — No. 105, 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: Can a doctor diagnose alcoholism from a regular exam? I hope so. My husband has a drinking problem and refuses to admit it. If the doctor can’t pick it up on an exam, how is it diagnosed? — S.P.

ANSWER: Unless long and heavy use of alcohol has led to the kind of changes that happen to those with cirrhosis, the diagnosis of alcoholism cannot be made on an ordinary examination. The diagnosis depends on a patient’s disclosure of how much he has drunk and for how long.

Some lab tests suggest alcohol abuse. An example is a rise in liver enzymes. CDT, carbohydrate-deficient transferrin, is another test that suggests alcoholism.

Asking the four questions of the CAGE questionnaire is most helpful in determining an alcohol problem if the patient is truthful. Those questions are: 1. Do you feel you should CUT DOWN on your drinking? 2. Are you ANNOYED by people criticizing your drinking? 3. Do you feel GUILTY about your drinking? 4. Do you require an EYE-OPENER in the morning to steady yourself?

Two or more “yes” answers to these questions are presumptive evidence of alcoholism.

DEAR DR. DONOHUE: Do oats really lower cholesterol? I read that oat fiber grabs onto foods that increase the liver’s production of it. That seems to indicate that oats increase cholesterol. If that’s so, all my years of gobbling oats have been in vain. — T.M.

ANSWER: What the writer meant by saying oats grabs onto cholesterol is that oats prevent foods that stimulate liver production of it from reaching that organ. The blood level of cholesterol goes down.

Oats work. What is your cholesterol reading? That should prove it to you.

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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