DEAR DR. DONOHUE: I recently had two nodules removed from my right lung. They were “necrotizing granulomas containing yeast consistent with histoplasmosis.” Now I am taking itraconazole. Will you tell me something about this? How serious is it? — R.D.

ANSWER: Histoplasmosis is a fungus (yeast) found in many places, but mostly in the Midwest and Southeast United States, principally in the Ohio and Mississippi valleys. You live in a state where it flourishes. Soil enriched with bird droppings is especially suited for supporting the growth of histoplasmosis.

Digging or tramping through the soil disperses the fungus into the air. People in the vicinity breathe it into their lungs. For most, no symptoms result. Apparently, you had no symptoms but had a chest X-ray that showed nodules (small growths). A few infected people come down with flulike symptoms that resolve. Some develop pneumonia. And in a very, very few, the fungus spreads to other body organs, like the brain, heart and bones. You should not have any serious complications from the infection.

A granuloma is a mound of cells that have been called into action to fight an infection. “Necrotizing” indicates that some of the cells have died. Histoplasmosis is an infection that produces granulomas.

The guidelines on treatment for histoplasmosis are clear. Your doctors have put you on medicine — itraconazole (Sporanox) — that is standard treatment for active histo. Fungal therapy often has to be taken for a long time. It’s not unusual to have to take it for a year or two.

DEAR DR. DONOHUE: My husband has developed plantar fasciitis in his left foot. He is 71. He is on blood-thinning medicine, so he cannot take anti-inflammatory medicines like Aleve and Advil.

He has tried shoe inserts, foot wrapping and foot soaks, with little relief. Do you have any suggestions? He has been told it could take a year to see any results. — J.Z.

ANSWER: The plantar fascia is a band of tough tissue that stretches from the bottom of the heel to the base of the toes. It supports the foot bones. Plantar fasciitis, inflammation of this tissue, is a common cause of heel pain. The pain is worst on taking the first steps out of bed and then gets somewhat better during the day. The most common cause of this inflammation is overuse. Athletes are prone to getting it. So are those who walk, jog or run long distances. Obesity and flat feet also contribute to this condition.

Things your husband can try that he hasn’t already done include stretching the fascia in a particular way. Have him rest his left foot on his right knee. Then he hooks his left hand over the toes and draws the foot toward the shin. He holds the stretched position for 10 seconds and repeats the stretch 10 times. He should do this several times a day.

He might not be able to take anti-inflammatory medicine, but he can take Tylenol for pain.

If he makes no progress, then he should ask his doctor about the advisability of a cortisone injection into the painful area. This usually brings quick relief.

DEAR DR. DONOHUE: I am a 13-year-old girl who has bad eyesight. I just had my eyeglass prescription increased by the eye doctor. I also have bad allergies in the spring. Do allergies cause eyesight problems? — P.H.

ANSWER: Allergies don’t usually cause eyesight problems. You have myopia, nearsightedness. You can see up close, but things at a distance are blurry. It comes about because your eyes have lengthened. Light cannot focus on your eyes’ retinas. Your glasses correct the focus problem. You are in a growth phase, and myopia often worsens during those years.

Nearsightedness is partly a genetic trait. Does your mom, dad or both have the same kind of vision?

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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