DEAR DR. DONOHUE: I recently tested positive for lupus, about which I know nothing. Please furnish me with some information. — E.L.

ANSWER: Men, children and the elderly can come down with lupus, but the main target group is young women between the ages of 15 and 45. Lupus causes a staggering number of signs and symptoms. No one person develops all, but some have many. Joint swelling and pain; a drop in the number of white and red blood cells; a tendency to form clots in veins; skin rashes; malfunctioning of nerves, the brain and the spinal cord; inflammation of the coverings of the heart and lungs; kidney damage; and an injuring sensitivity to sunlight are the major troubles facing lupus patients.

All of this comes about because the immune system declares war on body organs and tissues for reasons not fully understood. Antibodies — products of the immune system — are signs of the immune attack. They are useful for diagnosing the illness. When you say you tested positive for lupus, do you mean you had a positive blood test? One frequently used is the ANA (anti-nuclear antibody) test. A positive ANA suggests lupus but is not diagnostic of it. Two other antibody tests, anti-dsDNA and anti-SM, are stronger evidence of lupus.

Lupus is a formidable illness, but modern treatment has taken away much of its dread. In the past, it shortened life. Now 80 percent to 90 percent of lupus patients live 10 or more years. Lupus is subject to flare-ups and periods when it greatly quiets down. For flares, the cortisone drugs are put into play. For quiet periods, medicines with fewer side effects are prescribed. The list of medicines available for lupus is large. A new one has just come on the market.

The booklet on rheumatoid arthritis and lupus, two similar illnesses, gives a comprehensive view of lupus and its treatment. To order a copy, write: Dr. Donohue — No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order 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 a 90-year-old senior in good health. I belong to an HMO. During my annual physical, I told the doctor I had some hemorrhoids. He insisted I get a colonoscopy. My family is ready to kill him for recommending this for someone 90 years old. I have refused the colonoscopy and received a letter stating that I would be responsible for any bills if I ever have a problem. Should I have this procedure? — H.L.

ANSWER: The U.S. Preventive Services Task Force, a committee of recognized authorities, says people can stop having colonoscopies at age 75 if previous colonoscopies have been normal. It also says that people older than 85 should not be routinely advised to have a colonoscopy, because the danger of colon perforation during the exam is greater than their risk of dying from cancer. However, if older people have a life expectancy of 10 years and want to be screened, their wishes should be honored. Ask your doctor about other ways of detecting colon cancer. The fecal immunochemical test for blood is an example. Your stance is not unreasonable.

DEAR DR. DONOHUE: I’d been on Ambien for three years. I’m off it now. I take melatonin. It works better. What are the good things and bad things about it? — R.M.

ANSWER: The pineal gland in the brain makes melatonin, a hormone-like substance that contributes in regulating our internal clock. Melatonin is secreted at night and signals the body to go to sleep.

The benefits ascribed to melatonin are amazing: quelling inflammation, acting as an antioxidant, bolstering the immune system, preventing cancer. The evidence for these benefits is not overwhelming. It does, however, prevent jet lag and foster sleep. Long-term side effects and safety are not known.

Chronic insomnia is best treated by consulting a sleep specialist.

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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