DEAR DR. DONOHUE: My wife had a bout of pneumonia and came close to dying. The doctor said both she and I should have gotten the pneumonia shot. We are going to get it. I don’t understand pneumonia. I know the lungs are involved, but I didn’t believe it was such a serious thing. Please give us a better understanding of what happens in pneumonia. — R.C.

ANSWER: Pneumonias are viral or bacterial infections of the lungs. As with any infection, the lungs become inflamed, and air sacs fill with dense fluids, which interfere with the transfer of oxygen into the blood and carbon dioxide out of it.

I’m going to limit the discussion of pneumonia to the kind caused by the pneumococcus (NEW-moe-KOK-us) bacterium, the one for whom the pneumonia vaccine was devised.

Half a million cases of pneumococcal pneumonia occur annually in the United States and are responsible for 50,000 deaths. This kind of pneumonia starts with shaking chills and a steep rise in temperature. Coughing is part of the picture. Infected people bring up thick, yellowish sputum. Often, they complain of chest pain and take shallow breaths because of the pain.

Prior infection with the flu virus makes people more susceptible to this pneumonia. Advanced age also makes people more susceptible to it. A history of smoking and of chronic obstructive pulmonary disease puts people at greater risk for contracting it.

How a person comes in contact with the pneumococcal germ isn’t easy to determine. Somewhere between 40 percent and 50 percent of healthy adults carry this bacterium in their noses and throats for four or more weeks without becoming sick. If they cough or sneeze, they produce an aerosol of pneumococcal germs that spread to those nearby. This is one way it spreads.

The “pneumonia” shot isn’t a shot for all pneumonias. It a vaccine designed to offer protection against pneumococcal pneumonia. Adults 50 years old and older should get the newest pneumonia vaccine.

DEAR DR. DONOHUE: My 33-year-old son passed a kidney stone two weeks ago. He says it was a painful experience.

I am writing to ask you what his diet should be. I asked him if the doctor put him on a special diet, and he claims he did not. I thought a calcium-restricted diet was given to everyone who had a kidney stone. Am I wrong? — K.T.

ANSWER: A calcium-restricted diet was imposed on people who had a calcium kidney stone. It no longer is. It turns out that such a diet doesn’t prevent new stones from forming. It actually increases the risk of new stone formation.

The most important dietary intervention for prevention of a recurrent stone is to drink lots of water. Diluting the urine is the best way to stop minerals like calcium from aggregating into a stone.

DEAR DR. DONOHUE: My doctor insisted I have an EKG even though I have no heart symptoms. I am a 51-year-old woman. His nurse took the EKG, and when she was finished, she told me I could get dressed and leave. The doctor would call me with the results. He didn’t, so I called him. His receptionist called me back to say my EKG was normal, but it showed first-degree AV block. Is that something I need to worry about? — A.S.

ANSWER: It’s not. It means the electrical impulse that generates every heartbeat travels a little slower than normal. That slowness has no health consequences.

It’s not a problem. Forget it.

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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