DEAR DR. DONOHUE: For the past year, my wife has had to deal with autoimmune hepatitis. It’s something that hardly anyone knows about or understands, and that makes it even more difficult to cope with. Everyone thinks she has an infection. I can only haltingly explain what she has. Will you tell your readers about this illness? — D.R.

ANSWER: Say “hepatitis,” and people automatically think of a viral infection. Say “cirrhosis,” which is sometimes the last stage of hepatitis, and people think of alcohol as the cause. Not all hepatitis is virus-caused, and not all cirrhosis is alcohol-caused. Your wife’s illness is an example. Her liver is inflamed (hepatitis), not from an infection but from an attack on her liver by her immune system.

The reason why a person’s immune system, a system designed to keep us healthy, turns on the liver is obscure. Signs that the immune system is the cause are demonstrable by finding antibodies in the blood. Antibodies are the ammunition the immune system makes to fend off dangerous invaders. One special antibody, the anti-nuclear antibody, is a big indication that the liver has come under an immune attack.

The course of autoimmune hepatitis is unpredictable. It might be mild with few symptoms, or it may take a more aggressive course in which the skin and eye whites turn yellow, where fatigue is immobilizing, where abdominal pain is common and where the skin develops an itch.

Quite often, a liver biopsy is the procedure that provides evidence of autoimmune hepatitis.

Prednisone, one of the cortisone drugs, often is the treatment of choice. It reins in an out-of-control immune system. Another immune-modifying drug, azathioprine, can be added to the regimen. It sounds like your wife is responding well to treatment (from parts of your letter that I had to delete).

DEAR DR. DONOHUE: My husband tells me he has sickle cell trait. He never mentioned it before we were married. What implications does this have for his and our children’s health?

We’re planning to start a family, but I would like to know if that’s a good idea for us. — J.P.

ANSWER: Sickle cell anemia results when both the mother and the father have the sickle cell gene. Sickle cell trait occurs when either the mother or the father has the gene. The sickle cell gene is widespread in Africa, among American blacks (8 percent to 10 percent), in many Mediterranean peoples, in those from the Middle East and in some parts of India.

Sickle cell trait is, for the most part, a benign condition having little to no influence on a person’s life or health. You can start your family immediately without any fears.

Sickle cell anemia is a serious condition.

Prolonged, exhausting exercise in heat has been linked to the sudden death of a few individuals with sickle cell trait. Division I college athletic programs require testing for sickle cell trait in all their athletes so that precautions can be taken not to overtax those carrying the gene, especially in hot weather.

DEAR DR. DONOHUE: I am in the fourth month of pregnancy.

I suddenly am unable to wear my contact lenses for more than an hour or so. My eyes burn. Is this part of pregnancy? — B.C.

ANSWER: The most likely explanation is that your eyes have become dry. That often happens during pregnancy. It’s due to the hormones produced during pregnancy. Artificial tears can help you get over such changes.

Mention this change to your doctor. The doctor might advise you to stop wearing your lenses until you deliver.

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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