DEAR DR. DONOHUE: I have terrible constipation. I eat eight to 10 prunes daily, and they help. But if I miss a day, I am constipated again. I don’t eat breakfast. For lunch, it’s toast with jam. Dinner is soup with crackers or meat with potatoes and a vegetable, and then a dish of yogurt. I snack on crackers. Any help you can give will be appreciated. – J.M.

ANSWER: Your diet has very little fiber, and fiber is often the answer to constipation. Fiber is the indigestible part of food. It holds water in undigested food as it passes through the intestines. That keeps the food residue bulky and moist and easy to evacuate.

People should get around 25 grams of fiber a day. I’ll give you the fiber content of some foods, and you can start including them in your diet as you slowly make your way to the 25-gram goal. An apple, a pear, a baked potato with skin, half a cup of cooked green peas, half a cup of cooked baked beans and a cup of cooked brown rice have 4 grams of fiber each. Half a cup of cooked brussels sprouts has 2; a cup of strawberries has 3; half a cup of cooked pinto beans has 7.

Don’t skip breakfast. Eat a high-fiber cereal. Some have as much as 14 grams of fiber in half a cup. You can get half your daily requirement right there.

You can always add bran to any food. You can buy bran in health-food stores. One tablespoon has 1.6 grams of fiber. It’s tasteless, so it won’t affect the taste of any food you sprinkle it on. And stick with your prunes. Three prunes have about 2 grams of fiber, and, in addition, they contain a substance that has a laxative effect. You can eat them every day.

Increase your fluid intake when you increase fiber intake.

Not everyone agrees about fiber’s value.

The booklet on constipation and laxatives provides more information on this subject. Readers can obtain a copy by writing: Dr. Donohue – No. 504, 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: In 1973, I had a back injury that left me in constant pain. After surgery, injections, spinal taps and myelograms I developed arachnoiditis, which most people have never heard of. What can be done? – H.F.

ANSWER: The arachnoid is one of the three coverings of the spinal cord and brain. Arachnoiditis is an inflammation of that covering, often resulting from a previous injury. Inflammation causes scar formation, and the scar tissue can wrap around the spinal cord or nerves coming from the cord. That creates all sorts of trouble, like pain, weakness or impairment of bowel and bladder control.

One medicine often prescribed for the pain of arachnoiditis is gabapentin. Have you tried it? A clinic devoted exclusively to the treatment of pain would be worth a visit. Your doctor or your local hospital can put you in touch with one. The clinic might suggest something like a spinal-cord stimulator, which delivers a tiny flow of electric current to the spine to block pain signals.

DEAR DR. DONOHUE: On my right calf I have developed what’s called granuloma annulare. What is it, and how is it treated? – H.F. II

ANSWER: Granuloma annulare is firm, slightly elevated, red, tiny skin bumps grouped in a ring (“annulare”) pattern. Outbreaks occur on the neck, the upper trunk, the legs or the upper arms. Sometimes the outbreak itches; sometimes it produces no symptoms. It usually happens to women in late middle age or older. The cause isn’t known.

For most, it clears up, but that can take anywhere from four months to four or more years.

Clobetasol ointment under a DuoDerm patch has been used when the process is limited to a small area of skin.

DEAR DR. DONOHUE: Since I was 40, I have had a physical exam every two years. I am now 63. At my last exam, my doctor said he heard a heart murmur. He dropped it at that. I also had an ECG and a chest X-ray, and both were normal. Do they mean my heart is healthy? Does a murmur always indicate trouble? – W.W.

ANSWER: When doctors put their stethoscope on the chest to listen to the heart, they hear it make a repetitive “lub-dub” sound. The “lub” and “dub” represent the sequential closing of heart valves. Murmurs are sounds interspersed between the lub and the dub.

The significance of a murmur depends on when it occurs with respect to the lub and dub, its quality and loudness, and the transmission of the murmur to other locations in the chest.

Anything that creates eddy currents in the blood as it passes between heart chambers and eventually out of the heart creates a murmur. Roughened heart valves cause whirlpools in the blood that produce a murmur, and they rarely affect heart function. Murmurs are often heard in slender people whose hearts are close to the surface of the chest. They aren’t problems, either.

The fact that your ECG – electrocardiogram – and chest X-ray are normal is another point in favor of dismissing the murmur as not being significant.

I can’t speak for your doctor. But everything that you have said points to the innocence of your murmur. If doctors are in the dark about a murmur’s importance, an echocardiogram – a sound wave picture of the heart – gives a clear image of the heart and its valves and can settle the question of any murmur that leaves a doubt of its seriousness.

Why not put this issue to rest by giving your doctor a call and voicing your concern?

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.