DEAR DR. DONOHUE: I am writing in regard to my daughter, 45, who has hepatitis C. Is there any cure for it? What can we expect for her future? She is supposed to start medicine – shots combined with pills. Please give me some information on this illness. – S.E.

ANSWER: In the United States, 4 million people have been infected with the hepatitis C virus, and about 30,000 new cases occur annually. Close to 80 percent of those infected will have a chronic infection. That means the virus continues to live in their livers forever. Of that 80 percent, up to 20 percent will develop liver cirrhosis in 20 to 30 years; 15 percent face the possibility of liver failure in 10 years; and a smaller number will come down with liver cancer. A considerable number don’t ever become seriously ill.

Treatment is given if a person shows ongoing liver destruction with persistently elevated blood levels of liver enzymes. Treatment is also given if the person has evidence of hepatitis C virus in the blood or if the person’s liver biopsy discloses scarring and inflammation.

Two drugs are given. One is peginterferon, which is infused into a vein. The other is ribavirin, an oral medicine. If no virus can be found in the blood six months after completion of treatment, the person is said to have a sustained virologic response – a cautious statement that implies cure but doesn’t come right out and say so.

The number that achieves this state depends on the strain of hepatitis C virus that is responsible for the infection. With strain 1, 60 percent achieve viral clearance. With strains 2 and 3, close to 85 percent do. Second treatments can be administered. Cure is possible.

The booklet on all three hepatitis viruses – A, B and C – explains what they do and how they’re treated. Readers can order a copy by writing: Dr. Donohue – No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./ $6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am between a rock and a hard place. I take verapamil for high blood pressure. I also take timolol eyedrops for glaucoma.

According to the brochure I got, they should not be taken together. Both doctors who prescribed the medicines say it’s all right to continue using them. What are your feelings? – P.L.

ANSWER: The manufacturer says that “caution” should be used when timolol eyedrops are combined with a calcium channel blocker like verapamil. The combination might cause a drop in blood pressure, might disturb the electrical signal generated by the heart’s pacemaker or could lead to heart failure.

All this sounds like you are on the edge of a cliff, ready to step off. But bad reactions from the combination happen infrequently. However, if a person has impaired heart function, that person should not use the combination.

If you want to completely wiggle out of the space between the rock and the hard place, you can do so without a whole lot of fuss. There are an immense number of blood pressure medicines that can be substituted for verapamil.

Trusopt, Azopt, Xalatan, and Lumigan are glaucoma medicines that can be used in place of timolol. They are completely different drugs and can be used with verapamil.

DEAR DR. DONOHUE: My doctor has me on hydrocortisone because of adrenal gland insufficiency. My question to you is, How serious is adrenal gland insufficiency? I gave up my apartment and moved in with my sister and brother-in-law. – R. B.

ANSWER: The adrenal glands, which are located above the kidneys, produce a number of life-sustaining hormones. They make hormones of the cortisone family that help the body cope with stress and suppress overexuberant inflammation. They also make a hormone that figures into blood pressure control and in retaining enough body fluid, sodium and potassium.

Adrenal insufficiency can come about for many reasons. Today, an immune attack on the glands is the chief reason. Previously, infections of the glands caused their failure, and TB was the most common infection to do so. Infections still occur today, but not as many as in the past.

Once the condition is discovered, treatment is easy – supply the missing hormones in pill form. That takes away its seriousness.

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