In myasthenia, nerve-muscle connection is lost
DEAR DR. DONOHUE: I would be most grateful if you would explain myasthenia gravis. My cousin has it. I grew up with her. She lived next door to us, and we were and still are like sisters. Her husband called to tell me about her and this illness. He didn’t give many details, but he left me with the impression that she would end up crippled. Is that the case? Is there no treatment? — L.C.
ANSWER: That’s not the case. It’s highly unlikely that your cousin will be crippled at all. Many treatments exist for this illness.
“Myasthenia” (MY-uh-STHEE-knee-uh) literally means “muscle weakness.” Muscles move only when they get a signal from nerves. The signal is a chemical messenger with the name acetylcholine. The chemical has to swim across a small gap between nerve and muscle, and then land on what’s called a receptor, a landing dock. In myasthenia, the landing dock is cluttered with antibodies, and the acetylcholine cannot land. The muscle doesn’t contract. Antibodies come from the immune system, so myasthenia is an autoimmune disease, one in which a person’s immune system turns against its own body. In this case, it turns against muscle receptors, with muscle weakness as the result.
Symptoms depend on which muscles are affected. When it’s eye muscles, double vision results, because the eyes cannot stay in alignment. Eyelids often droop. Speech can become unintelligible, and swallowing difficult. Arms can’t do what they used to do. These weakness spells fluctuate, and the symptoms disappear for a time, only to come back.
With the passage of time and without treatment, symptoms worsen and become more persistent.
Myasthenia doesn’t have a cure medicine. But it has several effective control medicines. I’ll mention only one, Mestinon. Many others exist. Mestinon provides more acetylcholine. Quite often, the thymus gland — a mystery gland in the upper chest — is removed, and symptoms usually improve. Your cousin and her husband ought to contact the Myasthenia Gravis Foundation of America at 800-541-5454 for current information, treatment and direction to local chapters of the foundation.
DEAR DR. DONOHUE: Since my gallbladder was removed, I have been troubled with diarrhea. My surgeon told me it would get better. It isn’t; it’s getting worse. What can be done? — R.C.
ANSWER: Somewhere between 5 percent and 10 percent of patients develop diarrhea after gallbladder surgery. The cause is believed to be an outpouring of bile acids into the intestine. They speed up the passage of undigested food through the tract.
Treatment with medicines that tie up bile acids often puts an end to this problem. Questran (cholestyramine) is one example; Colestid (colestipol) is another.
You should let your surgeon know that your diarrhea hasn’t gone away.
DEAR DR. DONOHUE: Every morning upon wakening, I take my temperature. It’s always on the low side, around 97 (36.1 C). Is this an indication of illness? — N.N.
ANSWER: Why are you doing this? It’s an unhealthy compulsion. You’re going to drive yourself crazy with this morning ritual.
Normal body temperature of 98.6 (37 C) really isn’t normal. There’s a wide range of temperatures among humans. Furthermore, temperature changes throughout the day and night. It’s higher when we are active, and drops when we rest. In the early-morning hours, it hits a low — around 97. In the late afternoon, it’s at its highest, 99.3 (37.4). And even those values should not be taken as immutable.
Your temperature reading by itself is not an indication of any illness. That you have no other symptoms should put your mind at ease.

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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