DEAR DR. DONOHUE: I have what may be a lifesaving request. My great-grandson, 4 1/2 months old, became extremely dehydrated, constipated, limp and lethargic. He hadn’t nursed for a full day. My granddaughter’s doctor told her to take him to the emergency room. From there he was taken to a children’s hospital, where he was intubated. All sorts of tests were done. Finally a doctor with a computer diagnosed him as having infant botulism. An antidote was requested from a facility in California. It was very expensive. Now, three days after the antidote was given, he is moving his arms and legs. Please write about this, so parents and doctors will be aware of it. — J.D.

ANSWER: Botulism is muscle paralysis caused by a bacterium found in soil and marine environments. It is the most dangerous kind of food poisoning. Adults usually get it from foods improperly canned in the home, although outbreaks have occurred in restaurants and schools. The botulism bacterium produces a toxin (poison) that damages nerve endings and blocks the transmission of nerve signals. Paralysis begins with signs of trouble in the head — blurred vision, weak tongue, difficulty swallowing. The paralysis descends to the arms, chest and finally the lower body.

Infant botulism develops in a different manner. This bacterium produces spores. Spores are like seeds. When spores enter the infant’s digestive tract, they germinate into adult bacteria that release their toxin. Honey was once the major source of infant botulism. Now that parents know not to give honey to children younger than 12 months, this route of transmission is of lesser importance. Most infants who come down with it now are presumed to have ingested dust particles containing the spores of the botulism bacterium.

You have listed the first signs of trouble in a baby: constipation, refusal to take food and floppiness of the body. The baby is no longer able to suck. Eyelids sag. The cry is weak. Muscles are limp.

The doctor who made the diagnosis ought to be congratulated. He saved the baby’s life. Intravenous human-derived immune globulin is the antidote for the toxin. It’s also called BIG-IV or BabyBIG.

Your great-grandson should make a full recovery.

DEAR DR. DONOHUE: Will you clarify something? Through the years we have heard that swordfish is loaded with mercury. I wonder if salmon also has mercury. Is it safe for a pregnant woman to eat salmon? — D.B.

ANSWER: Mackerel (king) shark, swordfish and tilefish are the ones with the highest mercury content. Fish with intermediate mercury content are grouper, halibut, lobster (Northern/Am.) Chilean bass, mackerel (Spanish), orange roughy and tuna.

Salmon has a low mercury content. Pregnant women can safely eat two 6-ounce meals of salmon a week.

DEAR DR. DONOHUE: I am a 15-year-old girl. For a long time, my pinky finger has been bent because the tendon is so tight. A nurse advised us to go for a cortisone shot. What do you advise? — K.M.

ANSWER: I believe you’re talking about Dupuytren’s  contracture, a pulling down of a finger toward the palm. Most often the finger is the little or ring finger. The process starts with a hard lump in the palm on the tendon of that finger. The tendon gradually thickens and contracts to bend the finger to the palm.

Early on, a cortisone injection might stop the process. For marked bends, surgery is necessary.

The Food and Drug Administration has approved a new treatment that involves injections of collagenase, an enzyme that dissolves collagen (the material that’s infiltrating the tendon). The product is Xiaflex.

You are not the typical Dupuytren’s patient. Older men are. You should see a doctor. If my guess is wrong, please let me know.

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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