DEAR DR. DONOHUE: My mother, 68, could pass for a woman in her 50s. She’s always been a go-getter. Lately she’s slowed. She walks only for a short distance before she’s out of breath. I insisted she see a doctor, and she finally did. She has congestive heart failure. How treatable is it? Will she need assisted living? — J.D.

ANSWER: Congestive heart failure can be shortened to “heart failure.” The “congestion” refers to fluid retention, especially in the lungs. Ankle swelling is another sign of fluid overload.

Heart failure means that the heart is beating feebly. It doesn’t pump as much blood as it should with each heartbeat.

Struggling for breath when doing anything physical is a prominent sign. People with heart failure find it difficult to lie flat in bed. In that position, fluid accumulates to an even greater extent in the lungs. Sudden wakening during the night gasping for air is an indication that the lungs are flooded.

With a stethoscope, doctors can hear fluid crackling in the lungs. Swollen ankles is an obvious sign. One of the best tests for quantifying the degree of heart failure is an echocardiogram, a soundwave picture of the heart. It yields a quantitative measure of the heart’s pumping strength.

Heart failure causes are many. Heart arteries plugged with cholesterol are one cause. Sometimes it comes about after a heart attack. Untreated high blood pressure is another frequent cause. So is problems with the heart’s valves. Disturbances of the heartbeat, atrial fibrillation being an example, also can lead to heart failure.

Medicine that corrects the problem causing a particular case of heart failure can restore vigor to the heart. Today’s list of remedies is long. Medicines called ACE inhibitors — Vasotec is one example — are standard treatment for heart failure. So are water pills, diuretics that rid the body of accumulated fluid. Digoxin is often employed. In the past it was about the only medicine available. A diet that restricts the use of salt is also important. Your mother should be able to do well on her own after treatment.

The booklet describing heart failure explains this common malady. Readers can obtain a copy by writing: Dr. Donohue — No. 103, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My primary care doctor ordered a CEA test for me as part of my annual exam. I took it, and am sorry I did. It came back positive. The doctor said it was a test to detect colon cancer. I have had untold numbers of blood tests, a colonoscopy and have seen both a gastroenterologist and an oncologist. Both told me I do not have cancer, but said I should follow up with my primary-care doctor. What’s the next step? — G.G.

ANSWER: CEA is carcinoembryonic antigen, a protein that’s made during fetal life. After birth, its production stops. Many cancers behave in the way that tissues behaved in the fetus. At one time, CEA and other such cancer markers were believed to be the way to detect cancer early on.

CEA is not a reliable test for colon cancer detection. Smokers have high levels of it. Diverticulitis raises CEA levels. So does cirrhosis. Furthermore, with many colon cancers, CEA doesn’t rise. It is, however, a useful test to detect a return of treated colon cancer.

The next step for you is doing nothing. Your consultants have said you don’t have cancer.

DEAR DR. DONOHUE: Please give me your opinion on colonics. My friend takes them regularly and says she feels much better since she started. She says they rid the body of toxins. Is this true? — R.S.

ANSWER: Colonics, or colonic irrigation, entail “cleaning” the colon by infusing into it large volumes of water mixed with many other materials like herbs or soaps.

The colon cleanses itself. It doesn’t generate toxins.

The short answer to your question is that I am not a fan of colonics.

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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