DEAR DR. DONOHUE: My grandson is 5. He was supposed to start kindergarten this year, but after the first few days, the school recommended that he see a doctor because of his disruptive behavior.

He has tics, and has had them since he was 3. He contorts his mouth and lips into peculiar shapes briefly but repeatedly, and he often makes a barking noise. At other times, he behaves well and plays with other children.

The doctor who first saw him recommended that he see a pediatric neurologist. He did, and the diagnosis is Tourette’s syndrome. Is this a mental disorder? Does it get better? — R.S.

ANSWER: Tics, which is what your grandson has, are brief muscle contractions. Shoulder-shrugging, blinking, head-jerking and things like jumping are motor tics. Vocal tics are throat-clearing, barking noises, repetition of words or coughing. The child can suppress the tics for a short time, but feels greatly relieved when he expresses them.

Children with Tourette’s have both motor and vocal tics. Their onset most often is between the ages of 2 and 15. Rarely does the syndrome appear after age 18. Tourette’s is not a mental disorder. Something is askew with the brain’s wiring and its production of messenger chemicals.

Therapy to teach the child to realize when a tic is about to occur and to initiate another action that cancels it out is one form of treatment. A long list of medicines exists to help a child suppress expressing the tic.

By age 18, about half the children with Tourette’s see a diminution of tics or a remission of them. In early adulthood, about two-thirds of Tourette patients are able to lead a life that isn’t hampered by tics. Many famous people, including professional athletes, have suffered from Tourette’s syndrome.

The Tourette Syndrome Association (U.S.) and the Tourette Syndrome Foundation of Canada are eager to help these children and their families. You can reach the American association at www.tsa-usa.org or at 888-4-TOURET and the Canadian foundation at www.tourette.ca or at 800-361-3120.

DEAR DR. DONOHUE: I am a widow living alone. I have had strokes. I watch what I eat and always buy items with zero trans fat. My daughter says that items marked “zero trans fat” can have some trans fat in them. Do they? Enclosed is the label from a box that says “no trans fat.” I eat quite a bit of it. The label also says 11 percent total fat with 8 percent saturated fat. What is the other 3 percent? I don’t want to have another stroke. I am 83. — E.W.

ANSWER: Trans fats are truly bad fats. They lower HDL cholesterol — good cholesterol, the kind that doesn’t cling to artery walls and leads to strokes and heart attacks. In addition, trans fats raise LDL cholesterol — bad cholesterol, the kind that clogs arteries and brings about strokes and heart attacks.

A manufacturer is allowed to print “zero grams trans fat” if its product has less than 0.5 grams of trans fat in one serving. That’s a very small amount of trans fat, not an amount that will do you harm.

The label also says the product has a total fat content of 11 percent, with 8 percent being saturated fat. Saturated fat also raises cholesterol, but not to the degree that trans fat does. An amount of 8 percent is not a health threat. The other 3 percent of fat must be monounsaturated or polyunsaturated fat, fats that don’t create trouble.

DEAR DR. DONOHUE: I am a 75-year-old man. When I urinate, bubbles appear in the toilet water. What causes that, and how do I cure it? My doctor doesn’t seem to know what it is. — D.G.

ANSWER: Every liquid poured from a height onto another liquid creates bubbles. There’s nothing you can or should do about that.

If the urinary stream produces a layer of bubbles that looks like a head of beer, that can be a sign of too much protein in the urine. This isn’t a reliable test. A urinalysis gives better information.

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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