DEAR DR. DONOHUE: My co-worker, 52, has felt bad for about a year. He comes to work but takes off after half a day. Today he fell from his chair with a loud “boom.” He had a seizure and was foaming from the mouth. By the time the ambulance arrived, he was coherent but didn’t remember what happened. The emergency-room doctor had several tests done. Nothing was found. He suggested that my co-worker see his regular doctor. What should he do? Whom should he see? — Anon.

ANSWER: A seizure is a sudden discharge of electrical activity from nerve cells in the brain. Seizures come in many varieties. Your co-worker had a generalized tonic-clonic seizure, a grand mal seizure. Tonic is rigid muscle contraction at the beginning of the seizure followed by contraction and relaxation of the arm and leg muscles, tonic-clonic. The arms and legs jerk repeatedly. The mouth fills with saliva. Usually, the person emits a groan at the onset of the seizure. Seizures last only a few minutes, but it seems like an eternity to the observers. The patient wakens and does not remember what happened. He or she might appear somewhat confused.

This man needs a thorough workup soon. A neurologist is the doctor who specializes in the diagnosis and treatment of seizures. One seizure doesn’t constitute epilepsy, but the possibility of another seizure occurring is high. The neurologist will assess that possibility. Brain scans and a brain-wave test, an EEG (electroencephalogram), are all but standard for someone like this man.

A tip for those who observe a seizure in progress: Put something soft under the patient’s head. Remove eyeglasses. Loosen ties and collars. Don’t try to forcibly stop the jerking movements. Don’t pry open the person’s mouth to prevent swallowing of the tongue. That never happens. Time the seizure. It’s usually over in two minutes. If it lasts longer than five minutes, medical help should be summoned. When the seizure stops, turn the patient on his side in case he should vomit.

DEAR DR. DONOHUE: I had calcium oxalate kidney stones. I am on a new diet that’s low in oxalate and calcium foods. Every six months I have a 24-hour urine collection and a blood check to see what my calcium and oxalate levels are. If I eat a lot of high-content oxalate foods and drinks the day of or the day before I have these tests, will these foods and drinks affect the tests? — K.B.

ANSWER: Don’t change your diet. Stay on the same diet you adopt for yourself on a daily basis. Changing the diet will give you either a falsely low level of calcium and oxalate or a falsely high level. You want to know what the level is with your regular diet.

Low calcium diets are not favored for those who had a calcium stone. A low intake of calcium increases the intestinal absorption of oxalate and the chances to form new stones. Unless your doctor has told you to stay on such a diet, you don’t need to watch your calcium intake.

As for oxalate, it might be good to limit the intake of very high-content oxalate foods, such as spinach, peanuts, chocolate and soy. Most patients with a calcium oxalate stone don’t have to rigidly eliminate all oxalate foods from their diets.

The best prevention is to drink plenty of liquids: around 2 liters (a little more than 2 quarts) of liquids a day. You can judge how well you’re doing on keeping yourself hydrated by noting the color of your urine. It should be pale yellow or colorless.

DEAR DR. DONOHUE: At 22 months, my great-granddaughter’s vocabulary consists of “momma,” ”daddy,” ”mine,” ”no,” ”dog,” ”Bob,” ”up” and “uh-oh.” Every time she cries, a pacifier is put in her mouth. She uses it most of the time. In every other respect, her development is normal. She eats with a spoon and is almost potty-trained. Could the pacifier be responsible for her limited vocabulary? Her pediatrician sees nothing wrong. — D.G.

ANSWER: At 18 months, an infant has a vocabulary of about 15 words. After the 2-year mark, the vocabulary expands to 50 to 100 words. As far as the pacifier being the cause for a small vocabulary, I can’t find any reliable information implicating it. I believe for the present I would let nature take its course. Children don’t always follow the accepted norms in every aspect of their learning and lives.

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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