DEAR DR. DONOHUE: I hope you can shed some light on rosacea for me. Once in a while I feel my cheeks turn hot, and they look like someone punched me. It was finally diagnosed as rosacea. I put metronidazole on the affected areas. What do I have to look forward to? – M.C.

ANSWER: Fair-skinned, easy blushers are the ones most likely to come down with rosacea, but anyone can get it. In its mildest form, rosacea is a blush, like yours, that can be found on the cheeks, chin, nose or forehead. It comes and goes, but for most it becomes permanent. Small patches of tiny blood vessels pop out on the skin too. They look like miniature spider webs and are called telangiectasias.

The third component of rosacea is a breakout of pimples on the involved skin.No one can predict how many of rosacea’s calling cards will affect a particular individual, but without treatment, a person usually comes down with all three of its signs. Things to do on your own to slow the process include staying out of the sun and using sunblock anytime you do go outdoors. Avoid hot foods and drinks – hot temperature-wise and hot spicy-wise.

Your metronidazole cream or gel is standard treatment, and you should apply it to all affected areas. If things don’t come under control, oral medicines can often keep the process in check. Metronidazole comes as a pill, as does doxycycline. They’re antibiotics, but they aren’t used to kill germs. They nullify the blood-vessel dilation and skin irritation caused by the release of chemicals in people with this illness. There are more medicines should rosacea get out of hand, and there are other treatments for the visible blood vessels, such as laser therapy. Dry, gritty eyes are another rosacea sign, one often untreated. Eye involvement calls for special treatment, and sometimes only the eye involvement constitutes rosacea. Patients can benefit by contacting the National Rosacea Society at 888-NO-BLUSH or on the Web at www.rosacea.org.

DEAR DR. DONOHUE: I would like to share my unfortunate experience with your readers. I began to have violent abdominal cramps that brought me to the emergency room. My temperature had spiked to 103. The ER staff missed the diagnosis of appendicitis and allowed my appendix to rupture.

Rather than a relatively simple operation, I have endured two horrible weeks in the hospital and now face six months of rehab. Maybe my story will help other people avoid the same fate. – S.A.

ANSWER: Appendicitis sounds like a banal condition that’s a snap to diagnose; it’s not. Its signs and symptoms can be so confusing that the diagnosis is missed even by the most experienced doctor.

Usually, appendicitis pain begins in the center of the stomach. In four to six hours, it migrates to the lower-right side of the abdomen and people feel better lying on their back with their right knee flexed upward.

People over 65 often suffer the complication of a ruptured appendix. Almost 50 percent of those who develop appendicitis will also suffer from perforation of the appendix. I’m sorry you had such a bad experience and wish you the speediest of recoveries. Thanks for your story.

DEAR DR. DONOHUE: Some time ago, you responded to a question about hereditary nosebleeds. My father, my teenage son and I have frequent nosebleeds. Will you mention this once more?

Few people believe me when I say our nosebleeds are hereditary. – J.

ANSWER: There are a number of inherited conditions that interfere with blood clotting, and people with those conditions often have repeated nosebleeds. The one I mentioned in the past is Osler-Weber-Rendu disease. It’s something that is present from birth, and the nosebleeds happen before visible signs of the illness appear.

Those signs are slightly raised bumps that consist of delicate, easily broken blood vessels. They pop up on the lips, inside the mouth, on the nasal lining, in the digestive tract and elsewhere. Your family should be checked not just for Osler-Weber-Rendu but for other, more-common clotting disorders.

DEAR DR. DONOHUE: I would like to call attention to a problem I don’t recall seeing in your column. Several years ago my doctor prescribed a medicine that came as a 200 mg pill. He then decreased the prescription to 100 mg, and he said I could split my old pills in half. There was no problem until I ordered a large quantity from an out-of-country pharmacy.

After some time taking the newly prescribed pills, I started having muscle spasms and then weakness upon walking. On checking the bottle, it said that the medicine was to be taken whole. I called the company. It was a slow-release tablet. After changing prescriptions, all my symptoms disappeared after three to four weeks. – S.K.

ANSWER: Pill-splitting is acceptable for most medicines. I do it. I take a drug that comes in many strengths. One strength is exactly twice my dose. The double-strength pill costs the same as my dose. I split it and get twice as many pills for the same price.

Enteric-coated pills should not be split. Unscored, extended-release (slow-release) pills also should not be split. Medication isn’t evenly distributed in the two halves of that kind of pill. (A scored pill is one that has an indentation in it from the manufacturer.) Gelatin capsules aren’t suitable for splitting. I never heard of the kind of reaction you had.

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