DEAR DR. DONOHUE: I need information about aspergillosis. Your help will be greatly appreciated. E.W.

ANSWER: Aspergillus  is a fungus. Aspergillosis is the illness it causes.

The aspergillus fungus is found everywhere in the world — in soil, water, food and decaying vegetation. Every one of us has breathed in aspergillus spores, the embryo state of the fungus. Hardly anyone becomes ill as a result. Our immune systems fight it off promptly. It’s a different story for people with an immune system that has been weakened. For instance, cancer or cancer treatment can so debilitate the immune system that aspergillus becomes a great threat. Even quite healthy people, when exposed to a large number of spores, can come down with a serious illness.

“Invasive aspergillosis” indicates that the spores have developed into adults and have burrowed into the lung. A dry cough, extreme shortness of breath, chest pain and fever are indications that this has taken place. It is a serious infection that can spread to many other body organs, like the brain or bones. Antifungal medicines exist to stop its spread and eliminate it.

Another aspect of aspergillosis is an allergic reaction to spores. Hay barns incubate this fungus. Farmers entering a barn filled with aspergillus spores can have asthma attacks that leave them breathless. This is only one example of asthma-caused aspergillosis. It is treated with a cortisone drug to quell lung inflammation and with antifungals to do in the aspergillus fungus.

DEAR DR. DONOHUE: My son, 52, has Klinefelter’s syndrome. He has done relatively well. He self-administers testosterone. I wonder if it would be possible for him to take testosterone in oral form. It would be so much simpler. I read that men do take testosterone orally. L.T.

ANSWER: Normally, people have two sex chromosomes that determine their gender. A female has a pair of X chromosomes. A male has an X and a Y chromosome. In Klinefelter’s syndrome, a male-appearing baby has three chromosomes: XXY.

With this configuration of genes, the testes don’t mature normally and don’t produce the necessary supply of testosterone to effect changes that should occur during puberty — muscle growth, body hair and other male characteristics. Treatment is to supply testosterone to the affected person. Oral testosterone is rapidly metabolized, so it’s not an effective way to administer the hormone. Derivatives of testosterone, testosterone lookalikes, are marketed for oral use for other purposes. Those are the oral testosterone medicines you read about. One illegitimate purpose of these products is the development of muscle size and strength by some athletes. These derivatives don’t effect the full masculinizing changes that testosterone achieves. However, skin patches of testosterone and testosterone gels applied to the skin do work. If your son would like to try these products, he should discuss it with his doctor. He will need to be checked if he decides to use them to see if his blood levels of testosterone are adequate.

DEAR DR. DONOHUE: I am an older man who needs help with erectile dysfunction. Viagra doesn’t work well for me. Can you provide any information on what I can do? D.C.

ANSWER: You could try the two Viagra-like medicines, Levitra or Cialis. Or you can try a medicine called alprostadil that comes as tiny pellets with an applicator that positions the pellets in the penis (the MUSE system). It also comes as an injection.

Penile prostheses are available. One is a pump-and-fluid system that has to be surgically implanted. Your urologists will know about these and can explain them in detail.

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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