Dear Dr. Donohue: Although I read you every day, I have never seen anything about optic neuritis. Please explain what causes it and how long it takes to clear up.
- Mrs. S.F.
Answer: Optic neuritis is inflammation of the optic nerve. A viral or bacterial infection can produce it, or it can fall into the "uncertain cause" category.
One troubling aspect deserves mention up front in any discussion of optic neuritis: a possible association with multiple sclerosis, a larger neural problem. Not everyone with optic neuritis gets MS - not by any stretch of the imagination. It's just a flickering alert.
Most of the time, the nerve inflammation symptoms are limited to disturbed vision in the affected eye. Vision might be lost temporarily, and the affected eye will produce pain when the patient moves it in shifting focus.
Vision return can take from a couple of weeks to six months. Most patients recover fully. For some, a slight vision disturbance lingers, but not to the point of interfering with living.
I want to stress the importance of continued post-recovery monitoring. That can ease minds all around in light of the MS potential, which should be neither of obsessive concern nor lightly dismissed. Continued surveillance is the key.
Dear Dr. Donohue: I used to swear by Tylenol for relief of my back pain. I recently read of side effects that can come from it. If what I read is true, why have they not removed it from the market? My doctor says they're talking about high doses. What is high? I and some friends are a bit confused.
- Mrs. W.J.
Answer: Tylenol - acetaminophen - has been around for almost a half-century. First marketed as a prescription drug in 1950, it was approved in 1960 for over-the-counter sale and has earned excellent marks for safety and effectiveness.
What understandably concerns you are reports of a few dire reactions in patients who took high dosages. Some patients who took 15-gram dosages experienced liver damage. You'd have to ingest 45 regular-strength Tylenol pills to get a 15-gram dose.
The recommended Tylenol dosage is four grams a day, 12 of the regular-strength tablets. Those who exceed that level of use or who have existing liver or kidney insufficiency would fall into the potential risk category. Such people need to discuss things with a doctor.
Alcoholics should realize that they might get into trouble with Tylenol. And people should not take Tylenol on an empty stomach - after an overnight fast, for example.
Only in the few rare instances noted above or in others stipulated by the individual physician need anyone discontinue or adjust Tylenol use.
Labels carry definitive use and dosage data and should be consulted in cases of doubt.
Dear Dr. Donohue: Herpes 1 is the virus of cold sores, herpes 2 of the genital eruption. Please go into how different body areas might be affected. I have pain that comes before the rash shows. In some places, the herpes keeps recurring. I am confused. Cut my long letter as you wish. Thanks.
- Mrs. V.B.
Answer: I accepted your invitation to edit your long letter. Most letters are edited for space considerations.
Yes, herpes 1 causes cold sores, herpes 2 the genital outbreak. But that oversimplifies matters, for you can spread the virus from one area to another. It's called "autoinoculation."
If a person scratches a cold sore, the finger can carry the virus to a second body site. Transmission among wrestlers is legend. If one athlete has herpes, the intimate contact of competition easily leads to its transfer.
Nerve pain can occur before actual outbreak of a rash, and it can be severe enough to be mistaken for muscle soreness.
You mention recurrence of the pain and rash. You can settle a lot by having tests done on cultures from the rash site. Microscopic viewing of cells obtained from the site can show telltale signs of herpes infection.
I know of no illness that both looks quite like herpes and shares its tendency to recur at the same sites. Yet only the testing I mention will answer your nagging unanswered questions.
For more on herpes, see my report on the subject. Others can order a copy by writing: Dr. Donohue - No. 17, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (55 cents) No. 10 envelope.
Dear Dr. Donohue: Please zero in on fatty tumors. My son, 33, had one removed from his back. He was told not to worry. There are more, but this one was in an inconvenient back location. What causes them? Can they get cancerous?
- Mrs. E.M.
Answer: I cannot answer the question about the cause of fatty tumors. I can tell you that they are common and almost never are or ever become cancerous.
Mostly, surgical removal is done either for cosmetic reasons or - as in the case of your son - because of the tumors' inconvenient location, where they are leading to irritation. They can be irritable in the belt-line area.