DEAR DR. DONOHUE: I am recuperating from a kidney infection (pyelitis). The doctor did a culture of my urine, which showed a gram negative rod. What kind of infection is that? — S.B.

ANSWER: The more common urinary tract infection is infection of the bladder — cystitis. Pyelitis, now usually called pyelonephritis, is an infection of the kidney itself. It is a much more serious infection, and one that usually makes people take to their bed.

Pyelitis causes high fever often alternating with chills. People have intense flank pain, the side area between the lowest rib and the upper part of the pelvis. The infection also might make people urinate more frequently and with pain. These two signs, however, are more apt to indicate bladder infection.

The most frequent cause of pyelitis is the bacterium E. coli. Bacteria are classified into two large groups based on how they react to a stain used to visualize them with a microscope. The stain is the Gram stain, named after the doctor who devised it. Bacteria are either gram positive or gram negative. A gram positive bacterium turns blue with the stain; a gram negative turns red.

Bacteria also are classified by their shape. Some are elongated sticks — rods. Others are oval-shaped. E. coli is a gram negative rod.

Pyelitis is a situation that calls for immediate and usually intravenous antibiotic treatment. It responds promptly to such treatment. The temperature often returns to normal within two days.

The booklet on urinary tract infections describes both upper urinary tract infections (kidney — pyelitis) and lower urinary tract infections (bladder — cystitis). Readers can obtain a copy by writing: Dr. Donohue — No. 1204, 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: My husband has just been told he has spasmodic dystonia. He has had two Botox injections. They made it worse at first but then better. Friends and family have never heard of it. Would you give us an explanation of it in layman’s terms? — T.W.

ANSWER: Spasmodic dysphonia messes up the voice. People often believe they have laryngitis from a virus. They don’t; they have a cramping of the muscles that control their vocal cords. Their voices crack while saying a word, or become weak and breathy, or sound as though they are being choked. Sometimes it seems like the affected person has developed a stutter. The condition usually arises between the ages of 30 and 50. Its cause is unknown.

An ear, nose and throat doctor can make a diagnosis by viewing the affected person’s vocal cords and seeing how they are misbehaving. Botox can put an end to the vocal muscles’ spasms. Treatment lasts for about three months, and then another injection is given.

Contact the National Spasmodic Dystonia Association (www.dysphonia.org or 800-795-6732) for detailed information and for notifications of any new treatments.

DEAR DR. DONOHUE: I have seborrheic keratoses and have had them for many years. Doctors say nothing can be done. I had them cut off and frozen off, but they come right back. Can you help?

ANSWER: Seborrheic keratoses are brown, warty-looking spots on the back, chest, arms, legs and sometimes the face. They are not cancers and don’t become cancers. There may be only a few, but there can be hundreds of them. Their cause is a mystery, but they appear at older ages, so aging is somehow involved. A doctor can scrape them off or freeze them. They might come back, but they can be retreated if they do. The tendency to develop them is inherited.

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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