DEAR DR. DONOHUE: Back in 1945, I was a baby and supposedly had scarlet fever, which damaged my heart. I had an aortic valve replaced and a bypass in 2006. In 1964, I was diagnosed with type 1 diabetes. Then I read an article stating that rheumatic fever causes heart-valve damage. Was I misdiagnosed? Was it scarlet fever, rheumatic fever or diabetes that caused my heart disease? — L.B.

ANSWER: You can think of scarlet fever as a strep throat plus a skin rash. That particular strain of strep produces a material that generates a diffuse red blush. The rash starts on the face and neck, and then spreads to the chest, the rest of the trunk, the arms and the legs. The skin with the red rash has tiny bumps that make it feel like sandpaper. The tongue turns beefy red.

Certain strains of strep, including the strains that cause scarlet fever, lead to rheumatic fever. It’s due to the production of antibodies, stimulated by the strep germ. Those antibodies attack the heart and heart valves. This is rheumatic fever, the aftermath of strep sore throat. It occurs two weeks after the sore throat. In addition to the heart, the antibodies of rheumatic fever also might lead to joint swelling and pain, involuntary movements of the legs, the sprouting of painless nodules under the skin and a rash that’s different from the rash of scarlet fever.

Of all these complications, only the heart and heart-valve damage are permanent. Heart valves on the left side of the heart are the ones most often involved — the aortic and mitral valves. Either they narrow (stenosis) or become leaky (regurgitant).

Your heart-valve problem came about from rheumatic fever, which, in turn, was the result of your strep throat. Your strep throat happened to be the scarlet fever variety. Diabetes had nothing to do with your valve problem. It could have contributed to your needing bypass surgery, a quite different problem.

TO READERS: The booklet on breast cancer explains this devastating illness in depth. Readers can obtain a copy by writing: Dr. Donohue — No. 1101, 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 83-year-old male. My red blood cell count has been falling for six years. I had front and rear scopes. Everything was normal. I used to take aspirin but have not taken it for two months. I feel good. Can you help me? — J.H.

ANSWER: Your scope exams, one for the stomach and the upper small intestine, and the second, a colonoscopy, for the colon, found no source of bleeding. That’s a big worry removed. Apparently the aspirin didn’t cause bleeding.

Still, the answer to your blood loss isn’t explained. It might be that your bone marrow isn’t producing red blood cells. That would call for a marrow biopsy. Or it might be that your red blood cells are prematurely dying. They usually last 120 days. Lab tests will bring an answer. At this point, a hematologist would be the doctor who can shed some light on what’s going on.

DEAR DR. DONOHUE: I am a healthy, 43-year-old woman who has been told I have a schwannoma, a nerve sheath tumor, found on an MRI done for back pain. My doctor says it isn’t cancerous. Currently he’s monitoring it every six months. What is the possibility of it being cancerous, and what are the chances of me not being able to drive or walk after surgery? — P.G.

ANSWER: Most schwannomas are slow-growing. Malignant schwannomas, on the other hand, grow rapidly and are extremely rare. The slow growth of yours is a sign of a benign tumor. If surgical removal becomes necessary, your prognosis is good. The doctor uses a microscope during removal to preserve the nerve and the spinal cord. The chances of serious complications are slim.

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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