DEAR DR. DONOHUE: Would you address scleroderma, Raynaud’s phenomenon and CREST syndrome? It seems no one knows of these conditions, and not many doctors are familiar with them, either. I had to have two fingers amputated, as they were so badly ulcerated because the diagnosis was missed. There is no local support group, so my information is from the Internet. — D.S.

ANSWER: “Scleroderma” (SKLAIR-oh-DUR-muh), also known as systemic sclerosis, translates into English as “hard skin.” The skin becomes thick and taut, so much so that it is difficult for patients to bend their fingers or draw their lips into a smile. Body organs and tissues undergo the same changes, which often make them function poorly. The lungs, digestive tract, heart and kidneys all can be affected.

In the United States, about 100,000 people have scleroderma. Females get it more often than males, and it usually appears between the ages of 30 and 50. Raynaud’s phenomenon is common in scleroderma patients. It’s an intense constriction of arteries serving the hands and feet when exposed to cold. CREST is an acronym for Calcinosis cutis (deposition of calcium in the skin); Raynaud’s phenomenon; Esophageal problems that make swallowing difficult; Sclerodactyly, hardened and bent fingers; and Telangiectasias, dilated blood vessels seen as tiny circles on the skin. Many scleroderma patients suffer from both Raynaud’s and CREST.

The immune system is somehow implicated in this illness. Specific antibodies pretty much unique to scleroderma are found in scleroderma patients. Antibodies are the immune system’s ammunition.

Cyclophosphamide is a scleroderma medicine used to control the misfiring immune system. Other medicines come into play, too. One great advance for scleroderma patients is ACE inhibitors, a blood-pressure-lowering medicine. High blood pressure is common in scleroderma patients who develop kidney involvement.

You do have access to a huge amount of information. Contact the Scleroderma Foundation at 800-722-HOPE or online at www.scleroderma.org. You’ll find a friend you didn’t know you had.

DEAR DR. DONOHUE: My husband and I had a healthy sex life until his doctor recommended removal of his prostate after discovering cancer. My main reason in writing is to warn men to avoid prostate surgery until they ask and have answered questions about how it affects their sex life and continence. My husband, 69, regrets having surgery and blames his doctor for not presenting other options to him. Perhaps he could have avoided wearing Depends at night, and our sex life would have continued. — L.G.

ANSWER: Doctors have an obligation to inform patients of potential complications of surgery and of the medicines they prescribe. Impotence and loss of urine control are possible outcomes of prostate surgery. Everything, however, isn’t as bleak as your husband might imagine. Six to 24 months after surgery, many men who had lost bladder control regain it. And up to 60 percent of men who are impotent regain potency in two years. This doesn’t excuse your husband’s doctor for not mentioning these possibilities to him.

DEAR DR. DONOHUE: I am a 56-year-old man who was once active and a college athlete. I have had four heart surgeries. In April of 2005, I had mitral valve repair, and then mitral valve replacement with a porcine valve. Last winter, after a 45-minute workout blowing snow, I went into ventricular tachycardia and had to have a defibrillator implanted. I believe I have another leak in the valve. I’m set to have an echocardiogram. What are my options? — S.K.

ANSWER: You have had more than your share of heart troubles and heart procedures, but you have weathered them with admirable equanimity. If you do have a leaky valve, you need to discuss with your heart doctor the full range of possible treatments. Perhaps a mechanical valve, one made from more durable material than the tissue-derived valve like the porcine valve, would stand you in better stead. The disadvantage of such a valve is the need to take a blood thinner like Coumadin. Such valves encourage clot formation.

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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