DEAR DR. DONOHUE: I am a 77-year-old male who has been diagnosed with bladder cancer. It was discovered by chance. I have yearly exams, and part of the exam includes blood and urine tests. The test showed my urine had blood in it. My doctor sent me to a urologist, who, in turn, found the bladder cancer on a scope exam of the bladder. He removed the cancer.

He has me scheduled for BCG treatments. I don’t understand. What are they? Why do I need treatment if the cancer has been removed? — B.P.

ANSWER: Around 70,000 new cases of bladder cancer will be diagnosed this year in the United States. It’s more a male cancer than a female one. For every woman who develops it, three men will have it. It’s the fourth most common cancer in men.

The 70s are the years when it is most often discovered. Cigarette smoking, an unappreciated fact, contributes to bladder cancer. It’s an occupational hazard for workers in the production of certain chemicals and dyes. Blood in the urine, most often seen only with a microscope, is a sign, and up to 85 percent of bladder cancer patients have it.

The outlook for bladder cancer, like all cancers, depends on how deeply the cancer has invaded the bladder muscle and whether it has spread to lymph nodes. Even when the cancer has been detected early, as yours has, it tends to recur. For that reason, follow-up scope exams of the bladder are scheduled. And many patients are advised to have treatments that prevent recurrences. Instilling the bladder with a drug called mitomycin C or with BCG discourages the reappearance of cancer for some patients. “BCG” stands for “bacille Calmette-Guerin,” a weakened form of the germ that causes TB in cattle. A strange but true fact is that it also has the property of boosting the bladder’s resistance to a return of cancer.

DEAR DR. DONOHUE: My husband had his right knee replaced. The new knee is working fine, but my husband isn’t. He’s not the same as he was before surgery. Immediately after he came from the recovery room, he made no sense at all. He still isn’t thinking as straight as he did, and his memory isn’t as good. Someone told me anesthesia does this. Does it? — H.K.

ANSWER: General anesthesia — putting a person into deep sleep — can be hard on older people. As many as 60 percent of those older than 65 experience great confusion upon waking from general anesthesia. The confusion can last for one or two days. Older people don’t metabolize drugs as rapidly as younger people do.

Sometimes, older people (and some younger people) have a much longer recovery from anesthesia. Younger and middle-age people, however, almost always return to full mental function within three months. However, around 12 percent of older people show persistent reduction of mental abilities at three months.

To prevent this, a new anesthesia technique is undergoing trials. It’s called light sedation. Only the amount of anesthesia needed to put a person into a drowsy and pain-free state is given. The anesthetized person can respond to questions while the surgery is taking place. Light sedation causes less brain impairment and might become the standard procedure for surgery.

DEAR DR. DONOHUE: What can I do to improve my chipping, splitting fingernails? I was getting a weekly manicure but stopped due to economic reasons. My nails had grown stronger. Now they’ve become a disaster again. Please help. I take vitamins and calcium. — M.H.

ANSWER: Aging makes nails brittle, thin and fragile for quite a few people. Dryness fosters brittleness. After every hand-washing and before going to bed, coat your nails with a moisturizer. Petroleum jelly (the many Vaseline products) works well. When washing dishes or putting your hands in water, wear waterproof gloves. Don’t use nail polish remover often.

The B vitamin biotin toughens nails for some. You’ll need 2.5 mg daily.

Neither calcium nor gelatin strengthens nails.

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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