DEAR DR. DONOHUE: My son has been living with a girl who has been diagnosed with hepatitis B. I am devastated. How serious is this? Is it contagious? Is it curable? Is there a vaccine to prevent it? Would this virus be passed on to a child if she were to become pregnant? – A.M.
ANSWER: Hepatitis B is a serious infection. Some infected people harbor the virus for the rest of their lives, and that can result in liver cirrhosis, liver failure or liver cancer. However, those outcomes are not as common as was once believed, and there are medicines to treat the infection, something that was not true just a few years ago.
Your son must get two issues settled immediately. First he must learn the status of his partner. Perhaps she was infected with the virus in the past and is no longer infected. Blood tests can determine if the virus still poses a threat. If it does not, then your son is in no danger.
If she still has the virus, then your son should have himself tested to see if he has caught it. Hepatitis B is contagious. If he has not caught it, then he should make arrangements to get the hepatitis B vaccine, a vaccine that is quite effective in preventing infection. He should not delay in having those tests or getting the vaccine if it is needed.
An infected mother can pass the virus to her newborn. Therefore, all infants born to infected mothers are given antibodies against the virus (hepatitis B immunoglobulin) soon after they are born. The babies are also given the hepatitis B vaccine.
There are now three medicines available for the treatment of chronic hepatitis B infection, and those medicines can usually suppress the infection – another milestone in the hepatitis B story. Some patients must take medicine on a long-term basis.
The hepatitis booklet provides information on the three common hepatitis infections, A, B and C. Readers can obtain a copy by writing: Dr. Donohue – No. 503, 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.
DEAR DR. DONOHUE: Several weeks ago on TV, a doctor compared the symptoms of NPH to those of dementia and Alzheimer’s disease. He stated that there is treatment for it. Unfortunately, due to an electrical storm, my TV went off before I found out what NPH is. Will you please supply the information? – M.R.
ANSWER: NPH, normal pressure hydrocephalus, is a condition in which there is an increased volume of cerebrospinal fluid. That results in enlargement of the brain ventricles, the hollow spaces within the brain. (These ventricles are not related to heart ventricles.)
NPH has three striking signs. An abnormal gait is one. Affected people shuffle or sometimes walk with their feet spaced wide apart. They find it hard to lift the foot when they take a step, so it looks like their feet are glued to the ground. The second NPH sign is loss of urinary bladder control. And the third is dementia, a failure of memory and of other mental functions. Not all three signs need be present.
When the diagnosis is established, cerebrospinal fluid can be routed from the brain into the abdominal cavity by a relatively simple surgical procedure that involves placement of a thin, plastic drainage tube. Many patients, after the fluid has been shunted from the brain, lose some or all of the symptoms of NPH.
NPH is not a common illness, and it would be heartless to leave the impression that a huge number of dementia patients have it and are curable.
DEAR DR. DONOHUE: What does it mean to have ketone bodies in the blood? I have diabetes. – H.M.
ANSWER: Ketone bodies appear when the body turns exclusively to fat as a source of its calorie fuel. Such happens to diabetics whose low insulin levels make carbohydrates (sugar) inaccessible to body cells for fuel. In them, therefore, ketone bodies indicate poor blood sugar control.
DEAR DR. DONOHUE: I took my 9-year-old son to a nurse practitioner and was told he had molluscum contagiosum. She removed the tiny bumps from his arm and leg with liquid nitrogen. I asked if he could have gotten this from a swimming pool. She said she doubted it. I mentioned it again, and she said you could get it from a pool. She has me confused. I also would like to know why the sheet I was given says that risk of infection is higher in people with allergies or who take immunosuppressive drugs. What does this mean? – R.S.
ANSWER: The virus that causes molluscum contagiosum is passed through direct contact with a person who has the infection. It can also be passed by inanimate objects – doorknobs, for example – that have been touched by skin coated with the virus. I spent much time looking for a swimming pool connection. Only one reference in a stack of many others suggested that the virus could be passed by pool water. I think this mode of transfer is infrequent, if it happens at all.
Infected skin can develop firm, raised, flesh-colored, dome-shaped little bumps that range in diameter from 0.08 to 0.2 inches (2 to 5 mm). The center of the bump has a depression that makes it look like a miniature volcano. Squeezing the bump causes cheesy material to exude from the central pit.
Doctors can freeze the bumps with liquid nitrogen or scrape them off with an instrument called a curette. Aldara cream applied to the bumps is another treatment. Covering the bumps with surgical tape continuously for four months can sometimes clear the skin. The tape is applied after showering or bathing. I have no personal experience with this method, so I can’t vouch for its effectiveness.
Children who have eczema often have more extensive infections from the virus. Eczema and allergies go hand in hand. That’s the connection you read about. Immunosuppressive drugs are drugs given to attenuate the immune system’s response. Such drugs are used for transplant patients, for example. They too can have widespread infection.
Some people choose to ignore molluscum contagiosum. It goes away on its own, but that can take six to nine months or even two years to happen.
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.
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