DEAR DRS. DONOHUE AND ROACH: About four months ago, my 39-year-old, retired Marine son was diagnosed with dermatomyositis. He had always been very healthy, and he used to run six or seven miles a day to stay in shape. Now he can barely get up from a sitting position. He has a rash that covers his body. Can this disease be controlled by medicines that don’t have severe side effects? Any information you can give will be helpful. — J.R.

ANSWER: The “derm” of dermatomyositis (DUR-muh-toe-MY-oh-SITE-iss) refers to skin; the “myo,” to muscles; and the “itis” to inflammation. Skin changes include a purple-red discoloration of the eyelids and the skin around the eyes. The skin can have a flat, red rash on the face and upper trunk. The knuckles may be covered with scaly, red patches.

Muscle involvement leads to profound weakness. It’s difficult for a patient to get out of bed or rise from a chair. Swallowing and breathing might be affected.

Laboratory tests help confirm the diagnosis. One test is the CPK test, a test that indicates muscle involvement. A muscle biopsy provides information that establishes the diagnosis without doubt.

Initial treatment consists of high doses of cortisone drugs. Cortisone drugs in high doses have a long list of possible unpleasant side effects. One effect, however, is germane to this illness. They usually control all the terrible symptoms of this malady. Azathioprine and methotrexate may be added to the program so the dose of cortisone can be reduced.

Once the initial and formidable symptoms come under control, a program of physical rehabilitation restores muscle strength, and the patient is able to return to a normal life. How long this takes is unpredictable. Your son’s excellent health before this struck is greatly in his favor.

DEAR DRS. DONOHUE AND ROACH: I am an 85-year-old man who has, all of a sudden in the five or six months before June, had peculiar changes in my hands and fingers. They turned white and would tingle.

I am a professional clarinet player, and this causes me problems. A doctor told me I would have worse problems if I took drugs. Please help. — G.B.

ANSWER: What was the diagnosis the doctor gave you?

Some of what you said makes me think of Raynaud’s syndrome. In this, the fingers blanch on exposure to cold. The arteries have clamped down so hard that no blood circulates to the fingers. They turn white and can hurt. Most people with Raynaud’s will have a second color change after the white appears. The fingers then turn blue as all oxygen leaves the blood. Then when the arteries open up again, the inrushing blood causes them to turn red. Some people, however, have only the white change of artery clamping.

Anything that keeps the fingers warm stops this from happening. Gloves, for instance, are a worthwhile investment. Making windmills with the arms forces blood to the fingers. My diagnosis is nothing more than a far-out guess. The fact that warm weather led to a disappearance of symptoms made me think of Raynaud’s.

DEAR DRS. DONOHUE AND ROACH: How could I come down with pernicious anemia? I know it has to do with a deficiency of vitamin B-12. I have taken a multivitamin with B-12 for many years. — G.D.

ANSWER: Vitamin B-12 needs intrinsic factor, a material produced in the stomach, to get into a person’s blood. Without intrinsic factor, the vitamin can’t reach the circulation and bone marrow. The B-12 you took didn’t get into your blood. It will get to the circulation and bone marrow with B-12 shots.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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