DEAR DR. DONOHUE: Please print something about urinary tract infections. What causes them? How do you prevent them? I’m 86. — M.W.

ANSWER: Women get more urinary tract infections than men. One reason is that the female urethra, the tube that drains the urinary bladder, is smaller in women than in men. Furthermore, the female urethra’s opening to the exterior is in a place where bacteria thrive. I’m limiting my comments to the common kind of urinary infection, bladder infection, called cystitis. A more-serious urinary tract infection is infection of the kidney; that’s pyelonephritis (PIE-uh-low-nuh-FRIGHT-iss).

The typical bladder infection gives rise to pain when passing urine. The bladder calls for frequent emptying, and there’s an urgency to empty it when the call of nature sounds. In younger years, intercourse often is a prelude to a bladder infection. At older ages, a laxity in bladder support and a change in the bacteria that surround the urethral opening are the more common causes for infection. The bacterial change occurs when estrogen production falls off.

For infections that are related to intercourse, a woman ought to empty her bladder soon after relations. Or, if that doesn’t stop recurring infections, then she can take a dose of antibiotic after sex. Another way to nip a full-scale infection in the bud is to have on hand an antibiotic prescription that can be taken at the first inkling that the bladder is coming down with another infection.

For recurrent infections not related to sexual activity, a nightly dose of an antibiotic is one way to stop infections from repeatedly returning.

Always, people want to know about the effectiveness of cranberry juice as prevention for these infections. Some endorse taking 8 ounces of pure cranberry juice daily to end cycles of infection. Cranberry juice contains a material that stops bacteria from clinging to the bladder wall. Don’t use cranberry cocktail. You can use cranberry tablets and pills. Others feel cranberries have no beneficial effect.

Recurrent infections also call for some lab work to see if the urine has a new germ or if the old germ is what keeps reappearing.

DEAR DR. DONOHUE: I am an 83-year-old male who has been diagnosed with myelofibrosis. I am not on any treatment. My blood is checked periodically. I would appreciate any information about this disease. — J.C.

ANSWER: The “myelo” of “myelofibrosis” refers to the bone marrow, the place where blood cells are produced. “Fibrosis” indicates that strands of scar tissue are filling up the marrow. Myelofibrosis has a tendency to develop into leukemia. In this illness, the spleen and liver enlarge because they take over some of the tasks of manufacturing blood cells. Symptoms, when they appear, are fatigue, weight loss and often night sweats. Itching is a common sign. So is bone pain. A deficit of red blood cells often occurs and constitutes an anemia, and a deficit of white blood cells makes a person more likely to develop infection. The cause of this illness has yet to be found.

So long as the process stays at a low level of myelofibrosis activity, treatment consists of observation. When and if the cancer change takes place, medicines are prescribed. Prednisone, one of the cortisone drugs, is one of those medicines. One new medicine that has shown promising results is ruxolitinib. It is in the testing phase. It doesn’t cure, but it adds years to a patient’s life.

DEAR DR. DONOHUE: I had benign cysts removed from both breasts 20 years ago. I have been using a popular diet program for a few months. Much of the food on the diet is whey protein and soy protein. I am concerned about getting too much soy. Should I be? — M.S.

ANSWER: Are you worried that soy protein might lead to a return of breast cysts? Don’t worry about that. It won’t. I don’t believe you will have any ill effects from the soy or whey protein, so long as you are not protein-restricted, as people who have kidney disease often are.

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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