DEAR DR. DONOHUE: The only way I can describe what happens to me is that I feel shaky. I’m not shaking visibly, but I feel like I am inside. If I grab something to eat or drink, the feeling goes. My sister-in-law had similar problems, and she was told it was hypoglycemia. I haven’t seen her recently, but I understand she’s doing well. Do you think I have the same thing? — W.W.

ANSWER: About 35 years ago, hypoglycemia (low blood sugar) was a popular diagnosis and was promoted by many prominent people. The symptoms included what you describe, as well as anxiousness, trembling and sweating. Those sorts of things are found in many conditions, including panic attacks. Hypoglycemia isn’t as popular a diagnosis as it was when hypoglycemia was the rage.

The way to make the diagnosis is to have blood sugar checked at the time when symptoms strike and then rechecked after taking food that raises blood sugar to see if the symptoms go away. The hitch is that it is hard for a person to get to a place where blood sugar can be checked; symptoms come on at inconvenient times.

When the diagnosis can be made and proven, then modifications in the diet generally can stop these dips in blood sugar.

An insulinoma, a tumor of the insulin-making pancreatic cells, is a most important, but exceedingly rare, cause of low blood sugar. It is a treatable cause. The tumor can be removed. Another pancreatic condition that leads to drops in blood sugar also comes from insulin-making pancreatic cells. No tumor is involved. Removal of the parts of the pancreas where these cells are located cures this condition. Both of these illnesses are most uncommon.

What you ought to do is see the family doctor. You and the doctor can devise a plan where you hightail it to the doctor’s office or to a lab the doctor designates when you have symptoms. Someone else should do the driving for you.

DEAR DR. DONOHUE: For more than five years, I have taken atenolol to prevent migraine headaches. It works for me. I have had only three migraines in all those years.

I am uneasy about making a lifelong commitment to a drug unless the condition being treated is a life or death illness. Migraines are disruptive, but they don’t kill you. Do you think I should stop the medicine? What sort of deadline would you set?

ANSWER: Atenolol (Tenormin is one brand name) belongs to the large family of medicines called beta blockers. Those drugs are used for a wide variety of unrelated medical conditions — angina (chest pain coming from partially clogged heart arteries), high blood pressure and some heartbeat abnormalities. Most of these conditions are lifelong, and the people who take them don’t run into many serious problems. I don’t anticipate you would run into any problems if you choose to continue with atenolol.

If I were you, I wouldn’t stop, or I would stop only for a time to see if the headaches reappear. If they did, I would move quickly to get back on the drug.

People who have taken atenolol for a long time ought not to stop taking it suddenly if they have clogged heart arteries. You don’t know the state of your heart arteries, so talk this over with your doctor.

DEAR DR. DONOHUE: My doctor’s nurse studied my ears with great interest the last time I was there. I asked what she was looking at. She said I had a crease in my earlobes, and it’s a sign of heart disease. I looked in a mirror. I do have a crease. Does it mean I have heart disease? — J.K.

ANSWER: Right in the area where an earring is worn, some people have a transverse crease. At one time a fuss was made about it being a sign of heart disease. If it is, it’s not a reliable sign. I have those creases too.

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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