DEAR DR. DONOHUE: This winter my dad complained that his hat was too tight for him. My dad wears hats year-round. He happened to mention this to the doctor when he had his annual physical. The doctor did a special blood test and told my dad he might have Paget’s disease of bone. He sent him to a specialist, who confirmed the diagnosis. Is this treatable? Is it crippling? Anything you can add will be appreciated. — H.D.

ANSWER: Dr. Paget was an English doctor who died in 1899. He was quite a busy fellow. Three illnesses bear his name, a feat that would land him in the Medical Hall of Fame, if there was one. Paget’s disease of bone, although many are not familiar with it, affects almost 4 percent of adults older than 40.

Bones are in constant flux. They undergo daily remodeling — breaking down and being rebuilt with fresh materials. In Paget’s disease, the demolition process suddenly accelerates. That’s countered by accelerated rebuilding. However, the rebuilding is done with such haste that it produces overgrown and malformed sections of bone. These bone areas are fragile. Most people with Paget’s don’t know they have it, because they have no symptoms. Symptoms, when they appear, are bone pain, bone deformities and bone fractures. Or the overgrown bone can press on adjacent structures like nerves and interfere with their function.

The cause isn’t known. Genes are involved, since close relatives have a tenfold increase in the chances of coming down with it. Evidence suggests that viruses also could be involved.

The blood test the doctor ordered for your dad was an alkaline phosphatase test. Alkaline phosphatase is an enzyme found in bones. Elevations of it indicate that frantic activity is taking place in bones.

Your dad lives in a time in which medicines are available to contain the Paget’s progress. Their names are familiar. They’re the same drugs used for osteoporosis: Reclast, Actonel, Fosamax and Aredia.

Your father and you will be richly rewarded by contacting the Paget Foundation at 800-23-PAGET or on the Internet at www.paget.org. The foundation provides an impressive amount of up-to-date information and will become your dad’s best friend.

DEAR DR. DONOHUE: I’d like to fly something by you. For no good reason, I feel my heart suddenly beating hard and fast. I try to take my pulse, but can’t feel most of the beats. The whole thing lasts a brief time, and I feel fine while it’s happening.

My doctor says it’s just some irregular heartbeats. What do you say? — K.O.

ANSWER: It might be nothing more than a few premature heartbeats, but I would like to see proof of that.

People with your problem have another problem: They can’t predict when the heart will speed up next. Furthermore, since the episodes are short, they have no opportunity of getting to a doctor or hospital in time for an examination. That makes a valid assessment mostly guesswork.

There is a way around this obstacle. You can wear a Holter monitor. It’s a small device, about the size of a deck of cards, worn on a cord around the neck or sometimes fitted into a pocket in the pants or vest. It records all heartbeats during the time it’s worn. It provides accurate proof of what the heart speed-up is.

DEAR DR. DONOHUE: Weekly, I get an ad in the mail that sings the praises of a product for ridding the colon of parasites and worms. According to the ad, we all have them. I throw it away, but I have begun to wonder if there is some truth to this. Is there? — L.B.

ANSWER: Our colons are not crawling with parasites and worms.

The colon has an enormous population of bacteria that, for the most part, provide valuable services.

Keep throwing those ads out.

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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