DEAR DR. DONOHUE: I have the dry type of macular degeneration. I take PreserVision with lutein tablets twice a day. I hear lutein is very good for my eyes, and I would like to take more than the 10 mg a day that I get in my tablets. I don’t know how much is safe. My doctor said he didn’t know. Will macular degeneration leave me completely blind? How long will it be before I cannot see anymore? — C.B.
ANSWER: The macula is a small, round area in the center of the retina, the layer at the back of the eye that transmits incoming images to the brain so we can see. The macula is essential for clear, central vision, the kind needed to read, to drive and to recognize faces. Off-to-the-side vision remains. You won’t go completely blind.
Furthermore, dry macular degeneration most often advances gradually. It’s the more common variety, accounting for 90 percent of cases. It can stay at its present level for years, even for life. Wet macular degeneration comes about from the growth of blood vessels beneath the retina. Those vessels are fragile and leak fluid. It tends to advance more rapidly.
Currently no cure exists for dry macular degeneration. A combination of vitamin C, vitamin E, beta carotene (or vitamin A), zinc and copper appears to slow moderate macular degeneration’s progression to a more advanced stage. Your PreserVision is one such preparation.
Lutein is a plant product that might aid in delaying the advance of dry macular degeneration. At this very moment, a large study is taking place to ascertain the place of lutein in the treatment of this common eye condition. The amount of lutein being tested in the study is 10 mg a day. Lutein appears to be a very safe substance, but I would stick with the 10 mg dose until the present study defines lutein’s place and its optimum dose.
The booklet on macular degeneration explains this prevalent eye problem in great detail. Readers can obtain a copy by writing: Dr. Donohue — No. 701W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Please tell me about post-traumatic stress disorder. I think someone in my family suffers from it. — A.F.
ANSWER: Having faced an event that threatened life or caused serious injury is the basis for post-traumatic stress disorder. The event keeps resurfacing in the mind with a clarity that imparts terror and helplessness, and sometimes guilt. The remembrance can happen during the day or in dreams.
An affected person stays in the alert mode at all times. He or she loses interest in life, neglects those around him or her, suffers from fragmented sleep, often erupts in outbursts of anger and is usually quite depressed. Soldiers, firemen, policemen and those who suffered a sexual or physical attack are people who most often develop PTSD. With the combination of talk treatment and medicines, these people can usually regain their equilibrium and resume a normal life.
DEAR DR. DONOHUE: Our grandson soon will be 15. He still wets the bed. His parents have done everything from pills to alarms, but nothing helps. Sometimes he gets depressed, and that scares us. He says he will never be able to have a relationship with a girl. Sometimes we worry that he will hurt himself. Is there anything that can help this situation? — W.M.
ANSWER: I feel deeply for your grandson. No one can understand the isolation and hopelessness he has to grapple with. He could stand professional counseling. Perhaps a few facts will help him. Between the ages of 5 and 6, 15 percent to 20 percent of children are still wetting the bed. Of that number, every following year, 15 percent will stay dry during the night. By age 18, only 1 percent to 2 percent of these youngsters are still battling the problem. Your grandson has three years in which his chances of gaining control are good.
The problem of bed-wetting appears to stem from a brain that doesn’t respond to a full nighttime bladder by rousing the sleeper. It might be a delay in developing that response. Or it might be a delay in the attainment of a large enough bladder capacity to hold nighttime urine production. Or it might be that these children produce too little of the hormone vasopressin, which suppresses nightly urine formation.
Your grandson can once more try things he probably has already tried. He should measure carefully how much fluid he drinks in one day. Once he learns that number, he should drink 40 percent of the total in the morning, another 40 percent in the afternoon and limit fluid to 20 percent of the daily total from 5 p.m. on. He can increase his bladder’s capacity by holding off on urinating during the day. If he delays each time by five or 10 minutes for one week and then gradually lengthens the delay in following weeks, the bladder will stretch. This takes time. He has to be patient.
Alarms can work. They sound or vibrate when the first few drops of moisture touch them. It can be as long as six months of use before the training takes hold.
For occasions when he is invited to stay at other people’s homes for the night, desmopressin, as a pill or nasal spray, slows nighttime urine production.
DEAR DR. DONOHUE: I am so concerned about our grandson. He is a senior in college. He felt he couldn’t focus well enough on some of his difficult classes. He went to a doctor and was put on Adderall.
I am so worried that he will become addicted. Should I be concerned? — R.G.
ANSWER: Adderall is a drug of the amphetamine family. It does have the potential of leading to dependence. However, it’s been used for so many years for the treatment of attention-deficit hyperactivity disorder that it can be well managed and not present a danger.
The doctor who prescribed the drug is responsible for monitoring how it is used. He or she will continue writing for its use only if it’s safe to do so.
I sincerely believe you do not have to worry yourself about your grandson.
DEAR DR. DONOHUE: My daughter, 37, has rheumatoid arthritis. Is it genetic or a diet/lifestyle illness? What can be done to alleviate her discomfort? I read somewhere that cod liver oil brings relief. — H.B.
ANSWER: Arthritis comes in many guises. Osteoarthritis is the most common kind. Nearly everyone has a touch of it before death. Rheumatoid arthritis affects about 1 percent of adults, with two women afflicted for every man. It makes its appearance most often in the 40s and 50s. The lower two knuckles of the fingers, the wrist, elbows, ankles and foot joints are the ones most often attacked, but any joint can be affected, including the shoulders and hips. It’s a symmetrical arthritis, meaning that the same joint on the right is stricken as the one on the left. It’s also a systemic illness. The body as a whole suffers. Fever, weight loss and fatigue are common in many stages of this illness. The eyes can become inflamed, as can blood vessels. Changes in the lungs are possible.
It’s not a diet/lifestyle illness. Genes play a role, but not the entire role. The immune system is involved. Cod liver oil is no longer used for treatment.
A new dawn has broken for the treatment of this often-disabling affliction. Formerly, anti-inflammatory drugs like Motrin and aspirin were the initial treatment. Now treatment most often begins with drugs called disease-modifying anti-rheumatic drugs, DMARD. These medicines have the potential to stop the progression of the illness. Methotrexate is one example.
A brand-new class of rheumatoid arthritis drugs, the biologicals, neutralizes body chemicals that lead to joint inflammation and deformity. They can halt the arthritis process in its tracks — not always, but enough of the time to call them amazing. Some names are Humira, Kineret, Actemra, Enbrel and Remicade. They also have powerful side effects that have to be quickly attended to. Your daughter lives at a time that is a good one for people with this illness.
The booklet on arthritis describes the various kinds and their treatments. Readers can order a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am a 76-year-old man with COPD (chronic obstructive pulmonary disease — emphysema and chronic bronchitis). I am relatively symptom-free and have reduced the use of my inhaler to one puff in the morning and in the evening. I jog and walk two miles, three times a week, in 25 minutes and have done so for the past four years. Am I putting undue stress on my heart? Am I hurting or helping myself? — R.S.
ANSWER: You’ve stuck with this program for four years and are now using less medicine than you did. It appears to help you. Your regimen isn’t a dangerous one. However, I have to stop short of giving you carte blanche approval. Only your doctor can do so. He or she knows all aspects of your medical history; I don’t. I’m pretty sure you’ll get the doctor’s OK.
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