DEAR DR. DONOHUE: I wrote to you three or four months ago about a nodule in my lung. What would cause it? — B.B.

ANSWER: “Nodule” is a word that’s a stumbling block for many people. The direct translation of that word from Latin is “little knot.” The knot you use to tie your shoe is a nodule. Lung nodules always arouse a suspicion of lung cancer, but most lung nodules arise for other reasons. It could be an old, healed infection or a harmless cyst; rheumatoid lung nodules can be seen with rheumatoid arthritis. A nodule can be a tangle of blood vessels, or it can be an old fungal infection that has become covered with calcium. The task of the doctor is to make sure that a nodule isn’t cancer.

How does the doctor make that call? The patient’s history helps. A nodule in the lung of a nonsmoker is less likely to be cancer than is a nodule in a smoker’s lung. Very small nodules — those less the 4 mm, or about 1/4 of a dime, are not usually cancerous. Nodules one and a half to two times that size raise a greater suspicion of cancer and must be watched closely with repeat X-ray or scan.

A nodule’s growth aids in determining its cancer potential. A nodule that hasn’t changed size in two years can be safely assumed not to be cancer.

If your nodule is small and hasn’t changed in size, the cancer possibility isn’t great. If the doctor finds it impossible to judge the nature of a lung nodule, then he or she will ask for a biopsy. That’s the ultimate test for assessing what the nodule is.

TO READERS: Chronic fatigue syndrome is a mystery illness suffered by many. A thorough discussion of that condition is found in the booklet with that name. To order a copy, write: Dr. Donohue — No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Please write about neuropathy. What causes it? Is there treatment? Can chemo medicines for cancer cause it? — L.V.

ANSWER: Nerves are the body’s electrical grid. Information shoots over them from the brain to muscles and bones and tells them to contract so we can move and grab hold of things. These are motor nerves. Information also travels from nerves to the brain to give it information about the world around us and how we react to it. These are sensory nerves, which tell the brain if we are hot or cold or are hurting. Neuropathy — nerve damage — happens to motor nerves or sensory nerves or both. An affected motor nerve leads to muscle weakness. A common example is a foot drop. If the nerves to muscles that move the foot are damaged, raising the leg to take a step leaves the foot dangling. It causes a person to trip. That’s a foot drop. A sensory nerve in the leg with neuropathy causes numbness or pain.

Causes are numerous. Some cancer drugs are responsible. Vincristine, cisplatin and paclitaxel are three cancer drugs that cause neuropathy in a few patients. Other causes of neuropathy are vitamin deficiencies, infections, diabetes, inherited illnesses and many, many more. Treatment rests on finding the cause. Not all neuropathies are treatable, but the pain and weakness of neuropathy can be cared for with braces or other appliances, and with pain medicines.

The Neuropathy Association will help you with information that delves into this topic more deeply. The association’s website is www.neuropathy.org, and its phone number is 800-247-6968.

DEAR DR. DONOHUE: I am 90. I have read about gastric reflux (heartburn) many times in your column. Forty years ago I began suffering from it, and I was put on a bland diet, along with antacids. One night, at a friend’s house, I was served a rich meal. I said to myself I am going to eat it and enjoy it. I did. I had the first good night of sleep in years. In the morning, I awoke and thought about what I ate. I had yogurt, which I never had eaten before. I continue with plain yogurt and am able to eat anything. — H.T.

ANSWER: I like your testimonial. We’ll see if yogurt works for others.

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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