DEAR DR. DONOHUE: Last summer I was diagnosed with temporal arteritis. I was treated with prednisone, which stopped the temporal arteritis. I had many side effects from prednisone and am being treated for them. I developed diabetes and glaucoma. My dose of prednisone has been cut down. My doctor continues to gradually lower the dose but doesn’t know if I ever will be completely off it. I know this illness has something to do with the immune system. What can you tell me about it? — J.S.

ANSWER: Temporal arteritis got is name because of inflammation of the temporal artery, the artery at the sides of the head, at the temples. However, it’s not the only artery affected. The immune system is involved. The artery inflammation comes from an infiltration of artery walls with cells of the immune system. What triggers this invasion is not known with certitude.

Temporal arteritis has another name: giant cell arteritis.

Temporal arteritis is an illness of older people, hardly ever occurring before 50 and with the average age of onset in the 70s.

One feature of this illness is the headaches it causes. Fever is another sign. The scalp becomes tender to touch. Some patients are afflicted with jaw pain when they chew, and some find it difficult to talk because of jaw pain. By far, the most dangerous complication is inflammation of the artery that supplies the eye. Unless treatment is started promptly, blindness can result.

Temporal arteritis has a twin illness, and frequently, both occur simultaneously. That illness is polymyalgia rheumatica.

Treatment is with the cortisone drug prednisone. Somewhat-high doses have to be used to prevent the catastrophe of vision loss. Symptoms respond quickly, but prednisone must be continued. A gradual reduction of the dose is possible. Complete cessation of prednisone can take two or more years.

DEAR DR. DONOHUE: Four years ago, I contracted polymyalgia rheumatica. I took prednisone and got rid of the pain. Recently I have been feeling some of the old PMR pain. How do you suggest I deal with it? — R.T.

ANSWER: Deal with it by checking with your doctor. If it has come back, you need to go on prednisone again. But don’t do that on your own. Polymyalgia, like temporal arteritis, is an illness of older people. Its salient signs and symptoms are stiffness and aching pain of the shoulders, neck, hips, thighs and lower back. People also may lose their appetite, experience weight loss, become easily fatigued and have a low-grade fever.

One simple lab test, the sedimentation rate (sed rate), has a high reading in both illnesses. It furnishes a big tip-off to what’s going on. A specially calibrated tube is filled with blood, and the distance that the red blood cells descend from the top of the tube toward the bottom (sediment) in one hour is the sed rate.

A high sed rate with a return of PMR symptoms will have to be retreated with prednisone.

DEAR DR. DONOHUE: I am an 80-year-old female on medications for high blood pressure, cholesterol and type 2 diabetes. I have a quite-large hernia to the right of my navel. It does not hurt. Four years ago, I had emergency surgery for a ruptured gallbladder. The surgeon attempted to repair an umbilical hernia at the same time. Months later, this hernia appeared. My doctor sent me to a surgeon who specializes in hernia repair. I have two brothers-in-law with similar hernias whose doctor told them to forget about it. My surgeon plans to use a local anesthetic and do the repair as an outpatient. Should I have this done? — A.M.

ANSWER: I bet your brothers-in-law have a groin hernia, not the kind of hernia you have. The decision for surgery is yours. If you leave things alone, the hernia can get larger. The surgery is to be done by a specialist and as an outpatient. You won’t be laid up for any length of time.

I’d go for the operation. No one, however, will fault you if you decide to wait things out. The call is yours.

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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