DEAR DR. DONOHUE: One doesn’t hear or read often about my problem, which was diagnosed by a speech therapist. It’s spasmodic dysphonia. It started about a year ago. Sometimes it worsens in the evening hours or when I get upset. It’s quite annoying and at times difficult for me to speak, and is, of course, embarrassing. I visited my family in the Northeast, and didn’t notice a problem there. Would heat or humidity have anything to do with this condition? I have heard that Botox injections are advised but do not solve the problem. They have to be repeated, and they’re expensive. I am well over 65. Thank you for any advice you may give me. — C.H.

ANSWER: These first words aren’t for you, C.H.; they’re for readers with voice changes. Any vocal changes lasting more than two weeks ought to be brought to the attention of a doctor. Such changes aren’t always laryngitis, the common viral infection of the voice box.

Spasmodic dysphonia affects the muscles in the voice box (larynx). Those muscles bring the vocal cords to each other so that sound is made when air passes through the openings they make. In spasmodic dysphonia, the muscles are in spasm. They have a long-lasting cramp. This produces breaks in the voice, a strained voice and often speech difficulties that make the voice unintelligible.

No one has yet found why this happens. I can’t explain why your voice improved in the Northeast.

An ear, nose and throat doctor has instruments that allow the doctor to visualize the spasm of the vocal cords.

Sometimes, voice therapy can relax the vocal muscles so they function normally. The most effective treatment is Botox, an injection made into the muscles that releases them from their sustained cramp. One injection lasts three to four months. Medicare should cover much of the expense.

And get in touch with the National Spasmodic Dysphonia Association online at or by phone at 800-795-6732. The association provides people with the latest information and has a list of doctors skilled in the treatment of this disorder.

DEAR DR. DONOHUE: According to your column, you said the body cannot absorb more than 500 mg of calcium at one time. If my doctor tells me to take 1,500 mg daily, how can I do that? — M.B.

ANSWER: Take 500 mg at breakfast, lunch and dinner. If the tablet is a 1,500 mg tablet, split it into thirds, or look for tablets containing only 500 mg.

I’m sure you’re taking calcium carbonate. It comes in 1,500-mg size. Calcium carbonate is best absorbed when taken with food, because that’s when stomach acid production is at its height. Calcium carbonate needs stomach acid for absorption. The breakfast-lunch-dinner schedule is perfect for you.

DEAR DR. DONOHUE: Out of curiosity, what kind of doctor are you?

After smoking for 35 years, do the lungs and health improve upon stopping? How about if you have asthma or emphysema? Is bike riding bad for emphysema? — C.

ANSWER: What kind of doctor am I? Not a bad one. I’m an internal medicine specialist with a subspecialty in infectious diseases. Internal medicine is the branch of medicine that treats illnesses that are not remedied through surgery.

Stopping cigarettes improves the lungs, even if the person has emphysema and asthma. It doesn’t return the lungs to the state they were before you started smoking, but it stops progression of lung damage, lessens the chances for lung cancer and does improve your ability to breathe. You’ll notice a marked improvement in a month or so. You won’t be coughing like you do now.

Bike riding is good for emphysema. Don’t overdo it at first. Gradually increase your biking distance and speed.

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