DEAR DR. DONOHUE: When you read this, you’re bound to think it’s a doting mother who’s writing. I have a 22-year-old son who is remarkable and has never gotten into any trouble in his life. He and his friends were at a bar celebrating one of the boys’ birthday. A fight broke out. My son was punched, and he punched back, hitting the other man in the mouth and breaking two teeth. My son’s knuckles were bleeding. The police arrived, arrested the instigators and let my son’s friends go. They insisted on taking my son to the emergency room because of his knuckles. My son isn’t sure why. No one explained it to him. Why was this necessary for a minor injury? — T.B.

ANSWER: A knuckle injury from a clenched fist hitting the mouth of another isn’t a minor injury. It should be thought of as a major catastrophe. There is no padding over the knuckles. If the skin of that area is broken on the mouth of another, the chance for infection of the bones, joints, tendons and deep tissues of the hands is extremely high. Mouth bacteria from the person hit gain access into the hand. Huge trouble can result.

Emergency treatment of such an injury requires copious irrigation. The hand should be splinted and elevated. A hand surgeon (an orthopedic specialist) ought to take care of this kind of injury. Antibiotic treatment is needed.

DEAR DR. DONOHUE: I’m 63 years old, 140-pound female who walks five times a week, two to six miles, and lifts weights twice a week. I also follow a diet primarily of vegetables with protein, either plant or animal protein. My blood pressure averages 116/70.

In the second mile of walking, I often feel a bit dizzy. This also happens during my workout with weights. I put my head down until it goes away and go on with my exercise.

The other day I walked up a lighthouse tower and got dizzy, felt faint and was nauseated. I couldn’t finish the climb. My husband said I was white; he actually said “green.” He was so worried that I went to my doctor, who sent me to a cardiologist. I had an echocardiogram and a stress test. They showed no problems. It hasn’t happened since, although I still get dizzy when I walk or lift weights. Any idea what it could be? — V.M.

ANSWER: It’s good you saw a cardiologist. High on the list of possibilities is a heart rhythm disturbance or partially clogged heart arteries.

I take it that blood was drawn for other tests. Anemia is another possible cause.

Perhaps your dizzy spells come from a drop in blood sugar. Eat a snack before exercise and carry another snack to eat during the exercise.

If the attacks persist, you have no option but to go back to the doctor for more testing.

DEAR DR. DONOHUE: I have been taking atenolol to control slightly elevated blood pressure for five years. I notice that when I work out on the Lifecycle and it has been less than 12 hours from taking the medication, I can only get to a level of 6 and only get my heart rate up to 120 beats per minute. However, if I work out with at least 26 hours without medication, I can reach level 8 and my heart rate will be 150 beats per minute. Is the lower-level workout giving me any benefit? — M.P.

ANSWER: This is a constantly recurring question. Your medicine, atenolol, is a beta blocker. One of its effects is to slow the heart. You cannot, therefore, rely on heart rate as an indication of exercise intensity. It will give you a false impression of your exercise level.

You have to use different criteria. Perceived exertion is a valid indicator of exercise intensity. You judge for yourself, without referring to your heart rate, if the exercise is light, medium or hard. This method has been proven to be reliable. The lower level of heart rate is giving you more than adequate benefits.

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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