DEAR DR. ROACH: Could you please explain why alcoholics get distended abdomens, and would the disorder reverse itself if someone quit drinking? — J.P.

ANSWER: Alcohol causes injury to liver cells. The liver has the ability to regenerate. In some people, those with a very long history of alcohol abuse, the liver loses its ability to regenerate itself, and develops fibrosis.

If drinking persists, the person develops cirrhosis. Cirrhosis prevents the blood from flowing normally through the liver and causes elevated pressure in the portal vein, the major blood vessel leading to the liver. The elevated portal vein pressure predisposes the fluid to go into the abdomen.

The fluid is called ascites (a-SITE-eez), and its presence causes the kidneys to try to hold on to more salt and water, which makes things worse.

Quitting drinking helps prevent further damage to the liver and tends to stabilize the liver. Unfortunately, once cirrhosis is established, it is permanent, and the high pressure in the portal vein persists. Treatment usually includes diuretics to reduce excess water and salt. In more-severe cases, a procedure called TIPS can reduce the pressure in the portal vein and reduce swelling.

Many other health problems come with liver cirrhosis, so in addition to quitting drinking, someone with ascites needs to see his or her doctor for a comprehensive evaluation.

DEAR DR. ROACH: I am an 87-year-old man, healthy except for a diagnosis of prostate cancer. I was treated with Lupron in 2010 and again in 2012, and my PSA level is almost zero.

My problem is hot flashes. I get them every hour, 24 hours a day. The sensation travels up my feet to my whole body, which gets soaking wet. I carry a hand towel with me constantly. The sensation lasts about 10 minutes. I asked my doctor about it, and his reply was, “Would you rather have cancer or hot flashes?” Is there anything I can do to stop these? They are wearing me down. — M.J.

ANSWER: Hot flashes occur when sex hormones are suddenly stopped. In your case, the cancer drug Lupron prevents your body from making testosterone. For women with hot flashes around the time of menopause, it’s the ovaries’ inability to make estrogen that leads to the impaired regulation of the blood vessels in the skin, which is felt as a hot flash.

In both cases, there are treatments with hormones and with non-hormone drugs. The hormone most commonly used for men treated for prostate cancer is progesterone. Non-hormone treatments include the antidepressant venlafaxine and the neurology drug gabapentin. These relieve symptoms for many men without interfering with the cancer treatment.

There is non-drug treatment. One small study found acupuncture to be effective.

DEAR DR. ROACH: Could you help me with geographic tongue? A dermatologist has been trying steroid ointment. It helps but has not cleared up the problem. I have had this more than a year. The tongue gets very sore, and the patches come and go. — N.

ANSWER: Geographic tongue — also called benign migratory glossitis — is a very common condition, with as much as 2 percent of the world being affected. The patches come and go in most people, but pain isn’t common with this condition.

Geographic tongue occasionally can be misdiagnosed as an oral fungal infection, but treatment for fungus is ineffective. In addition to steroid gel, one treatment that works for some people is topical antihistamine used as an oral rinse. Your dermatologist can prescribe this.

Fortunately, most cases go away as mysteriously as they come.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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