DEAR DR. DONOHUE: This past April, our family made a 300-mile trip to visit my husband’s mother. We have three children, ages 9, 7 and 5. About an hour into the trip, the 7-year-old complained that his stomach hurt. A little later we stopped for lunch, but he wouldn’t eat. An hour later, he was doubled up in pain. We stopped at the next town to locate a hospital. The doctors weren’t able to make up their minds about what was going on. They finally took a scan, and said he had appendicitis. Why all this time? I suspected it from the beginning. — R.W.

ANSWER: Appendicitis is one of the most common causes of abdominal pain and one of the most common surgical procedures. It’s not always an easy call. Many other conditions mimic appendicitis pain. When I started out, I once asked an older doctor to examine one of my patients who I believed had appendicitis. After he did, he shook his head and said, “I’ve been at this for 35 years, and it doesn’t get any easier.”

The appendix is a wormlike structure dangling from the first part of the colon in the lower-right corner of the abdomen. It has a hollow core. If the core is blocked, the appendix swells. Swelling cuts off its blood supply. If the swollen appendix isn’t removed within 48 hours, it bursts, and that creates big trouble. Bacteria from the burst appendix spread throughout the abdomen and cause a nasty infection.

When things go according to the book, appendix pain starts out around the navel, and then moves to the lower-right side. However, the position of the appendix varies considerably, so the pain that it causes also varies in location. If a diagonal line is drawn from the navel to the right pelvic bone, pressure on an area slightly removed from the pelvic bone is a big tip that the pain comes from a swollen appendix. This rule doesn’t hold all the time either.

An elevated white blood count and a fever point to appendicitis. Neither might be present.

These days of CT scans and ultrasound take much of the guesswork out of arriving at a correct diagnosis. All the same, things aren’t as easy as they might seem. I hope your son recovered quickly.

DEAR DR. DONOHUE: My daughter is on Effexor for depression. She’s been on it for six months, and actually is doing quite well. She’s able to handle her job and take care of her family.

Does she take this medicine for life? I worry about addiction and what it might be doing to her brain. — N.M.

ANSWER: Antidepressants are not addicting. They don’t damage the brain.

What they do is restore normal brain chemistry. An imbalance in brain messenger chemicals is believed to lead to depression.

Your daughter’s doctor will tell her when she can stop taking the medicine. If a person relapses into another depression after stopping medicine, then she should take antidepressants for a more prolonged period, possibly for life.

DEAR DR. DONOHUE: I think my husband is an alcoholic. He drinks far too much. He’s not abusive, but his consumption of alcohol is more than a six-pack of beer a day, and sometimes whiskey. He usually falls asleep in a chair. My sister tells me the cage test can diagnose alcoholism. What is it, and where can he get it done? He won’t talk about these things to me. — C.L.

ANSWER: It’s not a lab test. It’s four questions. They are: 1. Have you ever felt the need to Cut down on your drinking? 2. Are you Annoyed when people criticize your drinking? 3. Do you ever feel Guilty about your drinking? 4. Have you ever taken a drink first thing in the morning as an Eye-opener?

Two “yes” answers indicate alcoholism. It’s a simple but reliable test.

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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