Dear Dr. Donohue: What on earth makes bone start growing in muscle? Our son, age 15, injured his leg when he fell down stairs at home. He had a bad limp and pain, also a strange-looking knot that remained. So we took him in to have it looked at. That is the diagnosis - bone in muscle. What does all this bode for this very active young man?
- Mr. and Mrs. L.J.U.
Answer: Your doctor apparently is speaking of a condition called myositis ossificans.
The problem begins when trauma from an injury such as your son's causes a hematoma, a collection of blood at the site. It is common among athletes.
The myositis emerges in stages, as the hematoma cells become "resorbed," meaning they are taken up by surrounding tissue. In that setting, the cells become confused. They "think" they have entered a new bone-building mode. And, in fact, actual bone does form as a result - but in muscle tissue.
A persistent mass or swelling in the area is the telltale sign of myositis ossificans.
It is hard to predict the immediate future. Your son should show signs of improvement soon. Sometimes, a particularly large mass leaves some remnant, but that rarely causes great problems. The entire recovery process can take weeks or months.
Please be guided by your doctor. Once tenderness has gone and leg strength gets back to 85 percent or more of normal, your son should be ready for full, pain-free range-of-motion exercises. He should be 100 percent shortly thereafter.
It would be wise for your son to wear a protective pad over the hematoma area to avoid further trauma.
Dear Dr. Donohue: What causes a fatty liver? Mom has it. Will I inherit it?
Answer: Diabetes, alcohol abuse and medicines such as cortisone can cause a fatty liver. Also, you sometimes will find a fatty liver in people who have intestinal absorption difficulty. Obesity can cause it, and so can inordinate malnutrition.
A fatty liver rarely causes pain - at most a little tenderness over the liver area. Also, if liver tests are all right, as they generally are, then the fat is not causing any serious effects.
In an edited part of your letter, you mention that your mother is obese. That, as I said, can be a cause of the problem, and weight loss would be one route for her to try.
You won't inherit the problem.
Dear Dr. Donohue: Is there a connection between a heart murmur and an overactive thyroid gland? I received radioactive iodine for the thyroid and wonder if that might have caused the other problem.
Answer: Most of the time, a doctor can tell by listening to a murmur whether it is a sign of trouble. Sometimes, you need an echocard- iogram to sort things out.
Some murmurs indicate a problem, such as a narrow or leaky valve.
Hyperthyroidism can enter the picture, making the heart race -which can cause the eddying blood currents that you pick up as a murmur. When you treat the gland problem, the murmur disappears. The heart has no lasting effect from the episode.
The radioactive iodine treatment for the thyroid does not cause murmurs.
FOR A.T.: Thalassemia minor is a common condition among those who have some Mediterranean sea lineage, "thalassa" meaning "sea" in Greek. The condition leads to an anemia so slight that symptoms are absent and treatment not required.
You ask about a tremor and a tendency to doze off. I cannot relate either to thalassemia minor. The tremor might be a family trait. I cannot suggest a cause of the dozing off. Those are things to take up with your doctor.
Some forms of thalassemia become major medical problems but, from your letter, I cannot say that they pertain to you, A.T.