DEAR DR. DONOHUE: My 15-year-old son went for surgical correction of a torn knee ligament and meniscus. The surgery was canceled due to suspicion of malignant hyperthermia. He was rushed to a children’s hospital for 24-hour monitoring. His symptoms were muscle twitching, a rise in body temperature and something to do with CK levels. All this happened within the first few minutes of administering the anesthesia and the drug succinylcholine. At the children’s hospital, his temp came down within 24 hours, so they say he might not have had malignant hyperthermia. We were told there is a muscle biopsy test for this condition that is very expensive and administered at only a few hospitals. How necessary is this? We have two other teens. Should they be tested? Does insurance cover it? If we don’t do the test, should he wear a medical bracelet stating possible MH? — L.H.

ANSWER: Malignant hyperthermia is a genetic condition that leads to a rise in temperature, muscle rigidity and muscle disintegration when a susceptible person is exposed to anesthetic gases of the halothane family or to muscle relaxants like succinylcholine, given in many operations to facilitate the procedure. CK is creatine kinase, a muscle enzyme. A rise in its blood level indicates muscle damage. All of this happens quickly and can be lethal. Dantrolene is the drug used to counteract the process.

The muscle test is CHCT, caffeine halothane contracture test, and it is the ultimate test for diagnosing the condition. You’re right. It is expensive and is done in only a few places. You have to contact your insurer to see if it’s covered. Since malignant hyperthermia requires only one gene from either parent, all family members have a 50 percent chance of having it. If the test isn’t done, your son and you, your husband and all your children must tell doctors, anesthesiologists and surgeons of the possibility that you all carry the gene. Alternate anesthetics can be given. Wearing an identification bracelet is a safeguard, and carrying this information in a wallet is another way to alert doctors to the possibility of malignant hyperthermia, should a family member be unable to communicate this information.

The Malignant Hyperthermia Association has an excellent and informative website at www.mhaus.org and a toll-free number, 800-986-4287. It will help you make some of these perplexing decisions.

DEAR DR. DONOHUE: For the past year, my blood pressure has fluctuated around 112/58 to 115/60. My doctor says this is around the normal range. It seems low to me. I get lightheaded once in a while, and wonder if this is the cause. — B.W.

ANSWER: A blood pressure of 115/75 is ideal. A first number (systolic pressure) of less than 90 or a second number (diastolic pressure) less than 60 is out of the norms. Your diastolic of 58 is so close to 60 that it should not be considered abnormal. I doubt that your lightheadedness comes from having too low a blood pressure. Do you have your own blood pressure unit? They’re not expensive. Why not get one and find out your pressure at the time you feel lightheaded?

Hypertension is the exact opposite of this woman’s blood pressure. It’s one of our most common maladies. The booklet on blood pressure explains it and its treatment. Readers can obtain a copy by writing to: Dr. Donohue — No. 104, 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 79 and in good health. Our local drugstore advertises that it will administer the shingles vaccine. I’m debating whether to get it, because I’m not certain I ever had chickenpox. If I didn’t, would the vaccine cause bad side effects? — C.C.

ANSWER: The vaccine will not cause any trouble if you’ve never had chickenpox.

The fact is that close to 99 percent of adults were infected with the chickenpox virus, whether they remember it or not. The illness could have been so mild that it was not recognized as chickenpox.

It’s quite safe to have the vaccine.

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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