DEAR DR. DONOHUE: Will you please explain the relationship between sarcoidosis and uveitis?

My mother developed uveitis in her early 50s and was diagnosed with sarcoidosis 10 years later. I was diagnosed with uveitis at age 51, but don’t have a diagnosis of sarcoidosis — yet. My lungs are clear. My doctors suspect underlying sarcoidosis.

Is it hereditary? My mother is now 75 and legally blind. — Anon.

ANSWER: The cause of sarcoidosis isn’t known. It produces inflammation in many body organs, including the lungs, liver, skin, heart and nervous system. Sometimes the eye is involved. One of the distinctive features of sarcoidosis is granulomas, heaps of dead cells that form small mounds in the inflamed organs, including the eye.

In the eyes, inflammation takes place in the eyes’ middle layer, the uvea. That why the condition is called uveitis. The eyes redden, may burn, become dry and have blurry vision. Eye symptoms may precede symptoms due to other organ involvement by many years.

A familial form of sarcoidosis does exist. About 5 percent of patients have a family member who also has it. This isn’t the case for the majority of patients.

You have been diagnosed with uveitis and not sarcoidosis. You might never come down with sarcoidosis, but the story you tell of your mother is unsettling. You are being treated for eye inflammation. That is a huge preventive step in preserving your vision, whether you come down with other organ involvement or not.

DEAR DR. DONOHUE: What do I do if I can’t take any of the medications for osteoporosis? — M.P.

ANSWER: The most prescribed osteoporosis medicines are the bisphosphonates. If swallowing medicine is the reason you can’t take these drugs, two bisphosphonates can be injected. Boniva (ibandronate) is both an oral medicine and an intravenous drug given every three months. Reclast (zoledronic acid) is infused intravenously once a year. Atelvia (risedronate) is a new, delayed-release form of Actonel that doesn’t have to be taken on an empty stomach. It can be swallowed after eating breakfast.

Forteo, a carbon copy of parathyroid hormone, is a self-administered injection, given like insulin is given. It is not related to the bisphosphonates. It has none of their side effects.

Raloxifene (Evista) is an oral medicine that has bone-enhancing properties of estrogen without estrogen’s risk for breast cancer.

The newest osteoporosis medicine Prolia (denosumab) is administered by the doctor or nurse in the doctor’s office every six months. It’s an antibody, completely different from all the other osteoporosis medicines. It slows bone absorption and thereby increases bone density. Like all new medicines, it’s expensive.

If you’re unable to take any of these, vitamin D, calcium and exercise are dependable standbys.

DEAR DR. DONOHUE: As I moved into my mid-50s, I began to experience insomnia (not drastic). I have been using sleeping aids (Tylenol PM, Advil PM), and they work well for me. I am concerned that they might have harmful side effects. My doctor said I could use them. I would greatly appreciate a second opinion. — C.G.

ANSWER: It’s best to keep all medicines to a minimum. Every now and then, see if you can get by without taking these drugs. Tylenol PM is a combination of diphenhydramine and acetaminophen. Diphenhydramine is the antihistamine Benadryl. Advil PM is a combination of diphenhydramine and ibuprofen. The likely ingredient that keeps you sleeping is the antihistamine. You can buy that medicine without any additions. That eliminates the other drug and might work just as well for you. The dose is 25 mg, a small dose. You can find it on the counters of all drugstores.

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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