Septic shock often fatal

Dear Dr. Donohue: Can you write something about septic shock? It caused my husband's death. He had macroglobulinemia, and periodically he took plasmapheresis treatments. The last time the catheter was inserted into a vein for a treatment, he was sick at the end of treatment. He was taken to the hospital and admitted with septic shock. We believe the catheter was not sterile. Is that possible? -- J.S.

Septic shock is a precipitous drop in blood pressure. It results from bacterial invasion of the blood. The bacteria release toxic substances that cause the blood pressure to plunge. In addition, the heart beats feebly, the kidneys often fail, and the lungs no longer provide adequate oxygen to the body.

Your husband's illness, macroglobulinemia, made him vulnerable to infection. Macroglobulins are large antibodies. Antibodies protect people from invading germs. Not macroglobulins. They offer no protection against germs.

Furthermore, macroglobulins can so thicken the blood that inadequate amounts nourish the heart and brain. Plasmapheresis cleans the blood of those large, ineffective, sludge-producing antibodies.

In no institution on these shores would an unsterilized catheter be placed into a vein for plasmapheresis. Once used, catheters are discarded.

Bacteria might have gained access to the blood through the small hole the catheter made in the skin. That is something difficult to prove.

Dear Dr. Donohue: I went to donate blood. I received a certified letter stating I tested false positive for AIDS. I was very upset, so I called and asked questions but never got a straight answer. What would cause this? They told me I do not have AIDS, so what does that mean? Please shed some light on the subject so I can have some peace of mind. -- Anon.

To avoid the emotionally charged, anxiety-ridden topic of AIDS, let's set a different scene. Suppose you had chest pain. Suppose the doctor had you take a stress test to detect heart trouble as the cause of the chest pain. Suppose the stress test was positive. The doctor then had you undergo an angiogram, the X-ray procedure where dye is injected into the heart arteries. The angiogram was clean. No artery clogging. The stress test, therefore, was falsely positive.

The analogy to AIDS testing is apropos. The initial screening test for AIDS was positive, just as the stress test was positive. The back-up confirmatory test was negative, just as the angiogram was negative. You do not have AIDS. You had a false positive screening test.

How does that happen? It can happen from human error in the lab. An underlying illness can produce a false positive AIDS test. Even a recent vaccination can turn an AIDS test positive. In most instances, however, no explanation is found. It just happens. Erase this test from your memory.

Dear Dr. Donohue: My grandfather suffers from bullous pemphigoid. Blisters appear on his skin. They break and leave raw patches. What causes this? What, if anything, can be done to alleviate it? -- C.W.

Bullous pemphigoid is an example of an illness where the body's immune system turns on itself -- in this instance, on its skin. The skin breaks out in recurring crops of large, tense blisters. Target areas are the lower abdomen, the arms, the legs and the groin. Sometimes the mouth is involved.

Members of the cortisone family of drugs can be applied directly to the skin for mild cases. That can keep matters under control. For more serious outbreaks, oral cortisone medicines are quite reliable. If nothing makes a dent in taming pemphigoid, drugs that harness the immune system can be added to the program. Azathioprine is an example.

You or your grandfather can obtain up-to-date information on pemphigoid by writing: The National Pemphigus Foundation, Box 9606, Berkeley, CA 94709-0606. Pemphigoid is a close relative of pemphigus. The foundation provides materials for both illnesses.

Dear Dr. Donohue: I am a 59-year-old male and have come down with Peyronie's disease. I have seen three urologists. Each has suggested a different treatment. Which do you recommend? -- Nameless

There are a number of completely different explanations for Peyronie's (pay-row-KNEES) disease and an equally large number of suggested treatments. No explanation or treatment has universal agreement and approval.

Peyronie's is a process in which scar tissue forms within the penis. The scar tissue causes the penis to curve. The curve can be so pronounced that intercourse becomes painful and even impossible.

Some men, anywhere from one-fifth to one-half of those affected, experience a spontaneous cure within a couple of years.

Readers may write Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475.

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