DEAR DR. DONOHUE: My question concerns PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection. Nineteen years ago, when my son was 12, he had a mild case of scarlet fever. Shortly after, he exhibited signs of obsessive-compulsive disorder. I read about the relationship of OCD with strep infection. I took him to doctors, neurologists and psychiatrists. They gave me a blank look when I brought this up. My now 31-year-old son is still on OCD medicines, but they do not help. Is it possible that the strep still lurks in him? — R.H.

ANSWER: The existence and diagnosis of PANDAS is fraught with controversy. The theory is that in a few susceptible individuals, a strep infection gives rise to or worsens obsessive-compulsive disorder or tics. With obsessive-compulsive disorder, people block the conscious intrusion of a disturbing thought by performing repetitive rituals like constant hand-washing, repeatedly checking the stove to be sure it’s turned off or forever straightening the fringes of a carpet. Tics are involuntary movements, such as facial grimacing or windmill-like twirling of the arms or other such purposeless actions. The basis of the theory is that antibodies induced by the strep germ affect parts of the brain that trigger OCD or tics. The theory hasn’t been accepted by all authorities.

PANDAS happens between the ages of 3 and puberty. How long it lasts isn’t known. The condition has been mostly studied in children. Whether it persists into adulthood is questionable.

As for treatment, current recommendations are to treat the strep infection, when present, as strep infections would be treated (with penicillin) and to treat the OCD or tics with medicines specifically designed for them. Your son wouldn’t benefit from strep treatment at his age unless, of course, he has a current infection. The strep germ doesn’t lurk in the body after the acute infection. Antibodies to the strep germ, however, can be present for long periods. The PANDAS story is still unfolding.

TO READERS: Vaginal infections plague many women. Answers to questions about these infections can be found in the booklet on this topic. To order a copy, write: Dr. Donohue — No. 1203, 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: I am an 85-year-old man who was recently put on Coumadin by my cardiologist. I am an avid vegetable eater. I have been told I cannot eat greens, such as spinach, broccoli and Brussels sprouts, and must stay away from cranberries. Will you clarify this situation for me? — G.G.

ANSWER: Coumadin prevents unwanted clots from forming in blood vessels. Popularly it’s called a blood thinner, even though the blood doesn’t become thin. It’s an anticoagulant. It achieves this goal by limiting the action of vitamin K in producing effective blood-clotting proteins by the liver. If a person on Coumadin eats large quantities of vitamin K-containing foods, that person could block Coumadin’s blood thinning. Collard greens, spinach, salad greens, broccoli, Brussels sprouts, cabbage and Bibb lettuce are rich sources of vitamin K. So long as you are consistent in the amounts eaten of these vegetables and so long as your blood tests show that you are getting enough Coumadin, you can continue as you have done throughout your life. I don’t understand the cranberry ban.

DEAR DR. DONOHUE: Will you please address Grover’s disease? Mine started two years ago. My doctor said it comes and goes, there is no cure and the cause is unknown. The itch from it is bad. I am a widow and live alone and cannot apply ointment to my back. — P.M.

ANSWER: Dr. Ralph Grover, a Texas physician, was the first to describe this skin problem in the 1970s. It’s an eruption of small, red bumps, mostly on the abdomen, chest and back. The itch can be fierce. Grover’s might last for only a few weeks or months, or it can be a chronic condition that recurs or persists.

Avoid sun exposure, and do not get overheated; both worsen Grover’s. Bathe with bath oils or with colloidal oatmeal. Zinc oxide, calamine lotion and cortisone ointments alleviate the itch. Perhaps ask a neighbor to help get ointments on your back? Antihistamines suppress itching. UV light with oral psoralens is another way to treat Grover’s.

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.