DEAR DR. DONOHUE: I have a friend who’s been hospitalized with something called VRE. One of the nurses told me that this disease is often fatal. What the devil is VRE, and how is it treated? Is it contagious? How common is it? His friends and family are worried sick. – B.S.

ANSWER: The E of VRE is enterococcus, a bacterium found in soil, water and the large intestine of animals and humans. Most of the time it remains in those places without creating trouble. However, in hospitalized patients, who are poked, prodded and invaded with all sorts of devices, the enterococcus can escape from its natural niche and find its way to places it should not be – the bladder, the kidney, the blood, heart valves and many other sites. In those places it does cause trouble. It has always been a pesky germ and difficult to treat, often requiring two antibiotics, but now it has assumed even greater notoriety.

In 1988, in France, an enterococcus appeared that did not respond to the usual antibiotics and was resistant to vancomycin, the antibiotic held in reserve for the most stubborn enterococcus infections. That is VRE, vancomycin-resistant enterococcus. It’s a supergerm. In the 16 years since its discovery, it has spread worldwide, and treating it has become a major headache. Newer antibiotics, such as linezolid, and novel combinations of older antibiotics can usually gain the upper hand over VRE infections.

When visiting a VRE-infected patient, people might have to wear a gown and gloves so they don’t pick up the germ and spread it to vulnerable people – the elderly and those whose immune systems are impaired. The visitors, however, are not in great danger of coming down with a VRE infection.

Such infections are not common outside the hospital. They are relatively common within hospitals. Depending on where the infection has settled, VRE can be fatal. A heart valve infection, for example, could lead to death. Most infections are treatable and curable, difficult as that might be.

DEAR DR. DONOHUE: I am 88 years old, and my PSA test in December 2002 was high. I went to a doctor and had biopsies of my prostate gland. They showed cancer. Since then I have been given Lupron shots. My last PSA was very low, and I am happy about that.

I understand that the testicles are involved with prostate cancer. The shots are very expensive, so if I could have the testicles removed and keep the cancer under control, I would. I will appreciate your opinion. – Anon.

ANSWER: Testosterone, the male hormone, fosters the growth of prostate cancer. Therefore, for some prostate cancers, suppression of testosterone is an important aspect of treatment.

Lupron is one medicine that can achieve that goal. It stops testicular production of the hormone.

Removal of the testicles is often an equally effective alternative treatment to medicinal suppression of testosterone production. The thought of such an operation unhinges many men, and they choose the medicine route.

Tell your doctor your desire. Unless there are circumstances unknown to you and me, the doctor most likely will acquiesce to your wishes.

DEAR DR. DONOHUE: I am a 69-year-old female and have osteoporosis. I have taken Fosamax for several years, but it recently began causing me stomach problems. After a couple of years, Evista has not helped.

My doctor has started me on the new injection drug Forteo. I am somewhat concerned by the safety information of this medication. Studies in rats have shown that some rats who took the medicine developed bone cancer. I wonder if there has been more research on this drug, and just how safe you think it is. – B.L.

ANSWER: Forteo (teriparatide) is a laboratory-produced parathyroid hormone. Parathyroid hormone regulates the level of blood calcium and stimulates the formation of new bone.

It is true that some lab rats given high doses of Forteo – much higher than those used in humans for osteoporosis treatment – developed bone cancer. There has been no evidence of that in humans. Testing went on for a long time prior to Forteo’s marketing, and observation continues.

Honestly, I would have no qualms about using this drug myself.

DEAR DR. DONOHUE: I am a 53-year-old female who is very athletic and eats well. I have been getting my blood work done for the past 20 years. I have always heard that you should try to keep your cholesterol under 200. Is that total cholesterol or LDL cholesterol, the bad stuff? My HDL is high, but my LDL is low. Do I have a problem? – P.S.

ANSWER: Would that everyone had your problem. Your numbers are excellent. The total cholesterol should be under 200 mg/dL (5.18 mmol/L). Yours ranges between 170 and 209. The higher the HDL cholesterol, the better off you are. Any number above 40 (1.04) for men and 50 (1.3) for women is desirable. The higher the better. Yours varies between 88 and 121. This is the kind of cholesterol that prevents heart attacks. The level of LDL cholesterol ought to be low – the lower, the better. If a person has three risk factors for heart disease, the LDL reading ought to be lower than 100 (2.59). Two risk factors call for a reading lower than 130 (3.36). With one or no risk factors, the limit can be 160 (4.1). Risk factors include a previous heart attack, angina, peripheral vascular disease, diabetes, high blood pressure, smoking and a family history of heart attacks at a young age. Your LDL ranges from 52 to 79.

All is well. Be thankful.

The cholesterol story is told in the pamphlet with that name. People can order a copy by writing: Dr. Donohue – No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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.