DEAR DR. DONOHUE: A close friend is hospitalized with cirrhosis. I am shocked. I have known her for many years, and I have never seen her drink alcohol, other than a rare glass of wine. Exactly what is cirrhosis? What are her chances for survival? — S.P.
ANSWER: Everyone makes the unwarranted presumption that cirrhosis only is a complication of excessive alcohol. Alcohol is responsible for a large number of cirrhosis cases, but it’s far from being the sole cause. Hepatitis — which can be silent for many years — leads to cirrhosis. Primary biliary cirrhosis, a disruption of the bile ducts in the liver, is another cause with no relationship to alcohol. Hemochromatosis, an inherited condition, also produces cirrhosis. Even fat invading the liver can be a cause.
Cirrhosis consists of bands of scar tissue crisscrossing the liver and disrupting its anatomy and function. The liver stops making protein. It no longer stores glycogen, sugar that comes to the rescue when blood sugar dips. It’s unable to detoxify the many harmful byproducts of body chemistry. It fails to produce clotting factors — substances that aid in clot formation and prevent hemorrhaging.
Signs of cirrhosis are many. The palms often are bright red. The lower two-thirds of the fingernails might turn white, while the end third is rose red. The abdomen frequently fills with fluid and makes people look like they are in the ninth month of pregnancy. Male breasts enlarge. The skin can turn yellow, as can the whites of the eyes.
A most important part of treatment is protecting the liver from any further assault. Alcohol is banned, even for those who are not alcoholics. Immunization against hepatitis is a wise step. Cirrhosis disturbs the absorption of vitamins and minerals, so supplements are therapeutic.
Chances of survival depend on the stage of cirrhosis. Early cirrhosis can be reversed. Late cirrhosis is permanent, but liver transplantation is always possible.
DEAR DR. DONOHUE: In the drugstore where I get my prescriptions filled, there’s a blood pressure machine. I take my pressure every time I’m there. I get a reading of 150 over 90. In my doctor’s office, the nurse takes my blood pressure, and she gets readings of 115 over 72. Which reading do I trust? — C.K.
ANSWER: I’d trust the nurse’s reading. Many of the patients she sees have high blood pressure, and they would know if the office readings were off. A lot of them take their pressure at home.
For an accurate reading, the following steps should be followed. People should be sitting quietly for five minutes before the pressure is recorded. They should not have smoked or drunk caffeine for at least half an hour. The arm around which the cuff is wrapped ought to be supported and at heart level. It’s best if the blood pressure cuff is placed on skin rather than on a shirt or blouse sleeve. I don’t think these rules are followed in the drugstore.
For an exposition on high blood pressure, readers can order the booklet on that topic by writing: Dr. Donohue — No. 104, 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: When I walk upstairs, my knees make noises. They sound like bowls of Rice Krispies, snapping, crackling and popping. My wife thinks this has to be a sign of serious trouble. I have no pain. My knees are not stiff. I play 18 holes of golf three times a week. Should I make a big deal of this? — R.K.
ANSWER: If your knees are not bothering you, then knee noises usually do not indicate any serious problems. Tendons gliding over bones make snapping noises. So do bursting air bubbles in joint fluid.
No, you don’t need to make a big deal of this.
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.

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