DEAR DR. DONOHUE: A 25-year-old nephew had an eye injury. When an ophthalmologist examined him, he stated he had "bear tracks" in his eye. He said it would require no treatment. The doctor seemed quite excited and called in his associate to look at his eyes. He took pictures. The family is concerned and would appreciate any information you can give us to explain this rare phenomenon. - Mrs. M.D.
ANSWER: Bear tracks are small gray to black dots scattered on the retina at the back of the eye. Seen with an ophthalmoscope, they do resemble animal tracks. They are nothing but pigment deposits and don't interfere with vision. They are rare, and the person is born with them. Yours is the first reference to the phenomenon I have seen in the millions of reader letters over the years.DEAR DR. DONOHUE: I would like to ask you about a disease by the name of amyloidosis. - M.S.
ANSWER: Amyloidosis (AM-ill-oyd-OH-sis) is a group of diseases whose common feature is the deposition of an abnormal material (amyloid) in body tissue. Seen under a microscope, this tissue resembles volcanic lava flow. Where it occurs, normal function is disturbed, determining the resulting severity and kinds of symptoms.
The amyloid tissue can occur in a number of organs, including the liver, spleen, heart, kidneys and GI tract. It can occur in the skin and nerves. If it occurs in tongue tissue, swelling occurs. In the heart there may be enlargement; in the kidneys, degrees of failure.
Treatment depends on the extent of the amyloid process. Drugs like colchicine help control things. Perhaps if you were more specific about the kind of amyloidosis you have, I could be a bit more specific about the future.
DEAR DR. DONOHUE: I am always interested in your gallbladder items. I have developed a condition called acalculous gallbladder. I don't have stones, though. I understand that only 5 percent of gallbladder trouble is this kind. Can you explain this condition. - J.A.C.
ANSWER: You have a gallbladder problem minus the stones. That's what acalculous means. Your 5 percent incidence figure is correct.
Let me review the gallbladder function. The gallbladder stores bile, a potent digestive aid. When you eat, the bladder gets the signal to contract, sending a spurt of this bile down a duct leading to the digestive tract. There it does its digestive work. When a stone blocks the duct, the bile is retained in the bladder, causing pain.
Although you have no stones, your bladder is in some kind of trouble. An inflamed and swollen bladder can bring about the same duct blockage and the same pain that stones create. But your problem is a notch or two above normal gallbladder trouble. In most cases, the bladder has to be removed on an urgent basis.
Why is this happening? It is hard to say. Many times, the condition defies explanation. Sometimes it happens to people on near starvation diets. In others, it might be the effects of extensive stomach surgery. And it can come from simple bladder infection. You should have learned the cause of your acalculous bladder by the time your read this. Please let me know.
For more information about the gallbladder and its problems, send for pamphlet No. 40. Write Dr. Donohue/No. 40, P.O. Box 830, Gibbstown, NJ 08027-9909. Enclose a long, stamped (52 cents), self-addressed envelope and $2.
DEAR DR. DONOHUE: I wonder if you might list the symptoms of gallstones. I save your columns (I have for years) and cannot find this, although you do answer readers' questions on stones from time to time. - Mrs. G.G.
ANSWER: Abdomen-centered pain is difficult to trace. Such symptoms can emanate in places other than the gallbladder, as in the stomach or intestines.
Most often, the pain from a gallbladder disease appears in the upper-right abdomen, with frequency ranging from weekly to almost daily. Such pain may spread to the upper back. Some patients describe a gnawing ache lasting from an hour to an entire day as opposed to a sharp, jabbing sensation.
We used to believe that the gallbladder will act up after a greasy meal. Recent evidence tells us this is not so, although sometimes the pain can occur an hour or so after any meal. NOTE: This does not mean gallbladder patients can ignore the advice to avoid excessively fatty meals in general.
All such discussion would be moot in the case of an acute gallstone attack. There the pain is so severe that the patient seeks emergency help no matter the source. And, of course, any abdominal or back pain in a person with a gallbladder illness history always takes on special significance.
DEAR DR. DONOHUE: My internist ordered a number of liver blood tests. One of them, for gamma GT, was high. Are there other tests for liver function? - C.M.O.
ANSWER: Gamma GT (glutamyl transpeptidase) is one of several enzymes that appear in the blood when there is any injury of liver, bile duct, pancreas, kidney or lung tissue. It is unusual to have one of these enzymes elevated by itself without others. It can be a transient quirk or indicate recent intake of alcohol or certain medicines.
If you have no symptoms or signs of liver disease, for example, then your doctor may ignore this single test finding and opt for continued observation and liver checks from time to time. There are other tests to measure liver function. Some are more standard liver enzyme blood assays and some involve sophisticated imaging, as with ultrasound or by CAT scan. The ultimate test is the biopsy, where a bit of liver tissue is retrieved via an aspiration needle.
I don't think, based on what you tell me, that your doctor is going to have you running into yourself in medical corridors for tests that might be futile. However, be sure you avoid alcohol for at least two weeks before your next scheduled liver test. And give your doctor a list of all the drugs you are taking - even over-the-counter kinds.- Dr. Donohue welcomes reader mail but regrets that, due to the tremendous volume received daily, he is unable to answer individual letters. Readers' questions are incorporated in his column whenever possible.
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