DEAR DR. DONOHUE: Will you please discuss how a trigger finger arises, and the cures, if any, for it? — J.V.

ANSWER: Trigger finger is an inflammation of the covering tissue that wraps around the finger and thumb tendons. When an affected finger bends down toward the palm, it catches and locks in the bent position due to the inflammation. A snapping noise, like the snap of a gun’s trigger, can be heard when the finger finally achieves release. In addition, just below the juncture of the finger with the palm, you can feel a hard, small knot, an additional cause of the catching.

Diabetes, rheumatoid arthritis and gout are illnesses often associated with trigger finger. Whether repetitive motion of the finger leads to this condition is something that hasn’t been established definitively.

Depending on the degree of involvement, treatment is to rest the finger with immobilization. That might be all that’s needed in the early stages. For more advanced conditions, a cortisone injection of the area involved with triggering often solves the problem.

In far-advanced and resistant cases, surgery is the answer.

DEAR DR. DONOHUE: I recently had a CT scan to assess my coronary arteries. Granulomas, both calcified and noncalcified, were found. About 15 years ago, a routine chest X-ray showed a large granuloma, and a needle biopsy was done. It was found to be negative. A comment was added that “many living in this area of the country have this, and it is harmless.” I have lived in northeast Ohio for my 71 years.

I consulted a pulmonary specialist, who said the same thing. The specialist said my lungs are otherwise clear, and my blood gases are normal.

You wrote about a fungal lung infection common in parts of the U.S. Apparently, I do not have an infection, as no comments were made and no medications prescribed. What do I have? — D.H.

ANSWER: Granulomas are the body’s way of walling off infections and foreign materials that make their way into organs like the lungs. The granuloma is like a prison. The body often coats granulomas with calcium to keep the prisoners inside locked up forever in a calcium-reinforced granuloma.

The tuberculosis germ, some fungi and some aerosolized materials stimulate granuloma formation. One of your granulomas was biopsied and showed no danger to your health. You are 71 years old and have lived with these granulomas for much of your life without developing a single sign or symptoms. You’re OK. You need not dwell on them.

Histoplasmosis is a common fungal infection of the Ohio and Mississippi River valleys. The fungus thrives in soil enriched with bird droppings. If the soil is disturbed in any way, incubating fungi are dispersed into the air and are inhaled by those in the area. Your body took care of this fungus for you. Not all are so lucky. Some need treatment. You do not. That’s true of most people who inhale the fungal spores. Your granulomas might be the result of Histoplasma invasion in the distant past.

DEAR DR. DONOHUE: I am a 68-year-old woman who started taking Lexapro in 2003 and stopped taking estrogen at the same time. In the six following years, I gained 25 pounds. I understand Lexapro can cause weight gain. Did stopping estrogen contribute to the gain? I stopped Lexapro a year ago and have lost a few pounds. I do aerobic exercise three to five times a week for 40 minutes, plus work out with weights. Do you have any advice? — M.R.

ANSWER: Weight gain is a listed side effect of Lexapro, an antidepressant, but not a weight gain of 25 pounds. The effect of stopping estrogen may or may not have contributed to the gain. Perhaps the lifting of depression brought back your appetite, and that could explain some of the weight gain.

Regardless of the cause, you are making a laudable effort to exercise. In addition, you have to cut back on calorie intake. Exercise alone, unless it is over-the-top, vigorous exercise, will not lead to large weight losses.

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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