DEAR DR. DONOHUE: Some time ago, you wrote about multiple system atrophy. Can you repeat this? — J.S.

ANSWER: Multiple system atrophy is a group of disorders that share a variety of symptoms, including some symptoms of Parkinson’s disease, symptoms of trouble with the cerebellum (such as loss of balance), symptoms denoting damage to other parts of the brain and spinal cord, and symptoms of trouble with the autonomic nervous system. The autonomic nervous system takes part in regulating blood pressure, heart rate, sweating and all the many bodily functions not under voluntary control. Fainting spells, walking difficulty because of imbalance, fluctuations between very high and very low blood pressure, loss of bladder control and trouble emptying the bladder are examples of the things that happen in MSA. No specific medicine works for all MSA symptoms. Medicines that help control individual problems like low blood pressure are useful. Physical therapy helps with balance problems.

DEAR DR. DONOHUE: My legs have sprouted a crop of red bumps. They happened all of a sudden. They hurt if I touch them. I thought it must be an allergy, so I took antihistamines and covered them with a cortisone cream. They’re still there. I can’t see a doctor right now. I’m out of work and don’t have any insurance. I’m counting on you to tell me what they are. — S.T.

ANSWER: I understand your situation, but you really have to see a doctor. Make arrangements for delayed payments, if necessary. I can give you only a guess.

I think you have erythema (AIR-uh-THEME-uh) nodosum, an outbreak of tender, small, red bumps on the lower legs. It is sort of an allergic reaction.

Infections are one cause. A previous bout with strep is high on the list of infections that produce it. Did you have a sore throat before the outbreak? Fungal infections also can trigger it. In the Southwest United States, a fungal infection called Valley Fever is a frequent cause. A large number of other bacteria and fungi can cause it. It’s also seen in illnesses not due to infections. Ulcerative colitis is an example. A somewhat-mysterious illness called sarcoidosis is another cause.

Drugs can bring it on. Sulfa medicines and birth-control pills are two that often are implicated

This is only a partial list of causes. That’s why it’s so important to see a doctor.

Treatment involves treating an underlying cause, if one is found. If a cause cannot be determined, then the anti-inflammatory medicines such as indomethacin and naproxen usually can suppress an outbreak. Liquid potassium iodide is another effective treatment.

TO READERS: Questions on cervical cancer and Pap smears are answered in the booklet on those topics. Readers can obtain a copy by writing: Dr. Donohue — No. 1102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What can you tell me about chronic lymphocytic leukemia? About three years ago, at age 57, a blood test indicated I had a high white blood cell count. I was not feeling sick. My family doctor sent me to a hematologist, who confirmed the diagnosis. At that time, my lymphocyte count was 23,000. Today it is 50,000. My doctor tells me that since the count has not doubled in a year’s time, it indicates that the disease progression is slow. I have no symptoms. My doctor says I need no treatment. I find this confusing. I keep myself in excellent condition. Should I push for treatment against my doctor’s advice? — R.H.

ANSWER: The word “leukemia” conjures up thoughts of imminent death. That’s not true of all leukemias, and chronic lymphocytic leukemia — CLL — is a case in point. It’s the most common kind of adult leukemia in Western countries. It defies another cancer principle: The one that says early treatment is best.

Lymphocytes are one of the five kinds of white blood cells. They produce antibodies and are involved in fighting off infection in other ways. Most often, CLL is discovered quite accidentally, when a person has a blood count for some unrelated reason. And most of these people have no symptoms.

If a person has no signs or symptoms, treatment for CLL can be postponed without any harm. Should a patient develop anemia as a consequence of CLL or should the patient’s platelet count fall, then treatment is instituted. Or if a patient has a persistent fever, weight loss, drenching night sweats or extreme fatigue, treatment is begun. Swollen lymph nodes and enlargement of the liver and spleen are other signs that might prompt treatment. A doubling of the lymphocyte count in six to 12 months is an indication for instituting medicines.

You have none of these factors. The doctor is safely withholding treatment. You always have the option of seeking a second opinion, but the consulting doctor most likely would agree with the first doctor. Your doctor is taking good care of you.

DEAR DR. DONOHUE: I am anxious to hear from you. I have written to you several times, but have not seen a reply.

I am 90 years old and in good health. I am concerned because my urine has an objectionable odor. It used to be very clear and without any odor. Could this be caused by medications? I take blood pressure pills and a couple of heart medicines along with potassium and magnesium. I am restricted in my fluid intake. Please answer. I am anxious to eliminate this odor. — D.T.

ANSWER: Urea and ammonia — two byproducts of normal body chemistry — impart a slight odor to urine. Usually, it’s all but undetectable. If urine is more concentrated, the odor is more prominent. I believe that’s what’s happening to you. You are on fluid restriction, so your urine is concentrated. You can tell by the urine’s color. Well-hydrated people have pale-yellow to colorless urine. Is yours dark yellow? If so, it’s so undiluted that the odor is noticeable.

Rarely is urine odor a sign of anything significant. Infected urine sometimes has an offensive odor. Asparagus imparts a bad smell to it. Fruity, sweet-smelling urine occurs with uncontrolled diabetes. Your medicines are not at fault.

DEAR DR. DONOHUE: Having started on a fiber laxative (Metamucil), I find it gives me a better bathroom schedule. It also has enabled me to lose weight without semi-starving myself. Is it absorbing food before the food is digested, and is this an acceptable method of weight control? — L.F.

ANSWER: Metamucil (psyllium) relieves constipation by keeping undigested food moist and soft during its passage through the colon. That keeps people regular. It also fills the stomach and decreases appetite, thus promoting weight loss. It slightly decreases fat absorption, and it might interfere with absorption of some minerals, but not to an extent that it causes trouble.

It’s giving you two benefits. Stick with it, and count yourself lucky.

DEAR DR. DONOHUE: What are the results so far with PinPointe laser treatment for toenail fungus? I want to have it done, but insurance won’t cover it. Is it worth the gamble for me? — D.F.

ANSWER: With PinPointe FootLaser treatment, a laser beam is directed in such a way that it is supposed to eliminate the toenail fungus without hurting surrounding tissue.

This a fairly new procedure. The number of expert-reviewed reports is few. The Food and Drug Administration has not given a seal of approval to it yet. Personally, since it is expensive and is new, I would wait until more information is available to support its effectiveness and safety.

DEAR DR. DONOHUE: My husband and I each are 27. Last year we took a skiing vacation. He’s good; I’m a novice. He’d ski on the highest slopes while I confined myself to the beginner’s area, although he did teach me, and I got fairly good. On our last day, my husband had a pneumothorax and had to be rushed to a hospital. He wants us to go skiing again this year. Should we? Will this happen to him again? I don’t understand clearly what a pneumothorax is. Please explain. — D.D.

ANSWER: Air in the chest should be in only one place — the lungs. Both lungs are covered by a double-ply tissue called the pleura. It holds the lungs in place and permits them to expand and contract easily. A pneumothorax (NEW-moe-THOR-ax) is an air leak. The air comes out of the lung and into the space between the pleura and lung.

A large leak of air collapses a part of or the entire lung. This provokes sudden and severe chest pain, and leaves the person gasping for breath.

Doctors can evacuate the air in different ways depending on the amount of leaked air. Sometimes, simply inserting a needle into the air pocket takes the pressure off the lungs. When the volume of air is greater, a tube has to be inserted.

The air leak most often comes from a bleb on the surface of the lung, and that bleb has been there for many years, even from birth. It’s a delicate structure. When it breaks, air pours out of it. The thinking used to be that vigorous activity was responsible for the bleb’s bursting. The scene you painted supports activity-related exertion as being a cause. Actually, that’s not the case. Most of the time, the bleb bursts when the person is at rest.

Recurrences happen to as many as 25 percent to 50 percent. Tall, thin males who smoke are the ones most likely to have a recurrence, and it usually happens during the first year following the initial incident. Is it safe for your husband to ski again? Unless his doctor has forbidden it, I don’t see why not. His chances for a second episode are as great sitting in a chair as they are on a ski slope.

DEAR DR. DONOHUE: I would like to know if the shingles vaccine poses a problem for someone who is infected with genital herpes. I have had the latter for 35 years with outbreaks every few months. — D.C.

ANSWER: The vaccine shouldn’t have any bearing on a herpes infection or on the number of outbreaks a person has.

Herpes is thoroughly discussed in the booklet of that name. Readers can order a copy by writing: Dr. Donohue, No. 1202, 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: Can you help me explain to my friends why I don’t have a terrible disease? I am 48 years old and take no medications. I am healthy.

I have never worried about sitting on a toilet seat in public restrooms. I don’t cover the seat with toilet paper or use seat covers.

Can you tell me how I have avoided getting anything and what I could have gotten but haven’t? — C.T.

ANSWER: If you’re talking about illnesses in general, you can thank your genes. They’ve given you a body strong enough to overcome the many ills others are sickened by. Don’t push it, though. You do have to pay attention to reducing risks that we bring on ourselves by smoking, drinking excessive amounts of alcohol, not exercising, overeating and ignoring other health risks.

If you’re talking only about sexually transmitted illnesses, I can’t think of a single such illness transmitted from toilet seats. Sexually transmitted illnesses are contracted through sex, with a few exceptions. That’s why they’re called “sexually transmitted.”

DEAR DR. DONOHUE: I’ve been after my husband to stop smoking since we were married. That’s 15 years ago. He has stopped cigarettes, but has taken up cigars. Is this any better? It’s not better for me. Everything now reeks of cigar smoke. — A.D.

ANSWER: If a cigar smoker doesn’t inhale, he’s sparing his lungs. However, former cigarette smokers are used to inhaling, so, when they make the switch to cigars, they often continue to inhale cigar smoke.

Even if he doesn’t inhale, cigar smoke can lead to cancers of the mouth and throat. He also absorbs nicotine from the linings of the mouth. He needs to abandon all nicotine products.

DEAR DR. DONOHUE: My doctor says I’m anemic but don’t need iron. Isn’t iron the usual treatment? — R.J.

ANSWER: The definition of “anemia” is a lower-than-normal number of red blood cells. It doesn’t indicate the cause of anemia. There are many causes, and iron deficiency is only one. A lack of vitamin B-12, an immune attack on red blood cells and a decreased production of red blood cells by the bone marrow are some of the other reasons why a person becomes anemic. Iron doesn’t do a thing for these people.

DEAR DR. DONOHUE: How many calories are in beer?

I am trying to lose weight, and my wife insists I could lose a lot by not drinking beer. I’m not an excessive beer drinker, maybe two cans a day. — S.A.

ANSWER: A 12-ounce can of beer has around 150 calories. Light beer has 100. If you’re drinking regular beer, you’re taking in 300 calories a day, 2,100 a week. That’s not an amount to be ignored. You definitely would lose some weight by eliminating beer calories.

DEAR DR. DONOHUE: Three times I have suddenly become sweaty and completely flustered. The first time it happened was in a convenience store. The other two times, I was shopping for food in a grocery store, and these attacks were much worse and lasted longer. I became sweaty, my hands shook and I felt like I was about to die. I had to sit down for 15 minutes or so before I got control of myself.

Has this got something to do with food? The three times it happened, I was in places where food is sold. Could it be an allergy? — S.M.

ANSWER: It’s more likely panic attacks. As many as 10 percent of the population suffer from them. They’re exactly as you describe. The heart races, sweat pours off the face and body, and the hands tremble. People believe they are about to die.

Panic attacks often are a family affair. The genetic influence is strong. An imbalance of brain-messenger chemicals is another element in their occurrence. And it might be that some buried memory in your subconscious is leading to an outpouring of hormones, like adrenaline, that puts you and your body on alert that a catastrophe is about to befall you when the reality is that no such thing is going to happen.

See the family doctor. A few physical conditions produce similar symptoms. One is a rare tumor called pheochromocytoma. Another is an overactive thyroid gland. However, your description is classic for panic attacks. You’re in a nonthreatening place and doing a nonthreatening act.

Your doctor or a mental health professional can get you over this. Talk therapy can unearth any subconscious fears triggering the attacks. Calming medicines are another part of therapy. Alprazolam is such a drug. A therapist can go with you to the places where the attacks happened to convince your brain that no calamity is about to strike.

DEAR DR. DONOHUE: Please comment on prednisone. I know a family member and several friends who take it. One friend has been taking it for two years. What does it treat, and what are its side effects? I heard it adversely affects our immune system. — N.C.

ANSWER: Prednisone is the most-often prescribed member of the cortisone drug family. These drugs are used for a large number of illnesses: asthma, COPD, allergies, lupus, inflammatory bowel disease and many, many more. When used in high doses for prolonged periods, they have a number of unwanted side effects. They can weaken the immune system and lead to infections. They often cause a rise in blood sugar and blood pressure. They cause weight gain. They can induce osteoporosis and cataracts. They shrink the adrenal glands. In order to control life-threatening illness, these side effects have to be dealt with.

The possibility of developing an adverse effect depends not only on the length of time and dose of the particular cortisone medicine, but also on which one is used and how it is taken. When administered by shot or by mouth, side effects are more likely to occur than when cortisone medicines are applied to the skin or when taken though an inhaler.

DEAR DR. DONOHUE: My wife of 41 years has tremors. She is 62. The tremors started in her mid-50s. Her mother is 85 and shakes so bad she can’t write or hardly help herself. They told her it is hereditary. Is there any medication or treatment available? My wife is getting very frustrated. She’s not able to carry out simple tasks. — P.E.

ANSWER: Your wife and mother-in-law most likely have familial tremor, also called essential tremor. It does run in families. There is treatment. Propranolol (Inderal) and primidone (Mysoline) work very well for most. Both your wife and her mother should be getting treatment. A neurologist is the doctor who specializes in tremors and their treatment.