DEAR DR. DONOHUE: An EKG, taken during a routine physical exam, showed that I had a left bundle branch block. At the same time, I was diagnosed with breast cancer. The surgery was a success, but more cancer was found in my lymph nodes. What impact would chemo or radiation have on my heart problem? — P.M.

ANSWER: Let’s take the left bundle branch block first. Two bundles, like electric cables, bring the electrical signal generated by the heart’s natural pacemaker in the top part of the heart down to the bottom part of the heart to the ventricles, the pumping chambers. When the signal arrives there, the heart muscle contracts and pumps blood out of the heart.

With a left bundle branch block, something causes the signal to slow down or makes it impossible for it to travel the whole length of the bundle. The left side of the heart, the side that pumps blood out to the body, has a delay in pumping. A signal eventually reaches the left ventricle. It might cross over from the right side.

Radiation can do many things to the heart. If your right breast is where the cancer started, radiation of the right side of the chest arouses little worry about striking the heart. If the left breast was involved, radiation can interfere with the working of the heart. It could, for example, make it impossible for the electric signal to get down the bundles to the ventricles. In that case, a pacemaker would take care of the problem. Be assured that the doctor administering radiation realizes possible complications to the heart from radiation and is well prepared to cope with it.

As for chemotherapy drugs, each drug has to be evaluated by itself. The list is long. But I can reassure you here, too. The oncologist, the cancer specialist, knows every possible complication of the drug or drugs being used. That doctor, too, is prepared for any side effect that might develop.

The booklet on breast cancer deals with this common cancer and its treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: In your recent article on histoplasmosis, I was surprised that you did not discuss an important complication. I had histo when I was 5, in 1942. In my 20s, I was hired as a pilot. When the doctor examined my eyes, he brought in two other doctors to examine them. They said I had spots in my eyes, but they weren’t affecting my vision. During the FAA physical, the doctor, after examining my eyes, guessed that I grew up in the Midwest, because the eye changes suggested infection with histoplasmosis. In 1971, because my vision changed, I saw a retina specialist. He saw that I had leaking blood vessels in the eye and sealed them with a laser. People infected with histoplasmosis should know about this possibility. — D.L.

ANSWER: Histoplasmosis is a fungal infection found in people who are exposed to soil contaminated with bird and bat droppings and people who live in the Mississippi valley and Ohio River valley. Most infected people never develop a single symptom. Some come down with lung disease. A very few have disseminated infection, one that spreads to many organs.

Eye infection with histo is most frequently discovered at a later date in life. It’s called POHS, presumed ocular histoplasmosis syndrome. Scars are seen in the retina and central hemorrhages might occur in the macula, the part of the retina needed for fine vision like reading. Laser treatment is the treatment of choice for it.

Considering all patients infected with the fungus, eye infection is quite rare. I’m happy yours was discovered and successfully treated.

DEAR DR. DONOHUE: Did you know that nuts are constipating? I found out for myself. Alert your readers. — C.J.

ANSWER: I didn’t know that. I do know they have the opposite effect for me.

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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