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The cause, treatments of cellulitis

Question: I would appreciate your comments on cellulitis, its cause and cure. I have been told that it is an infection. What can I expect in the way of a cure? _ Mrs. E.L.S.

Answer: Cellulitis is infection of skin and tissue immediately beneath the skin with either the staph or strep germ. Those germs can penetrate the skin through a pinprick opening so minor you may not be aware of its presence.

Impaired local drainage of blood or lymph fluid provides a setting for cellulitis. You have to treat it with antibiotics very early, for this is an infection of rapid spread.

You give me no reason to suspect the following from your letter, and I use it here as an example of cause. Leg cellulitis can be a consequence of heart bypass surgery, where the large leg vein is removed for use as a bypass vessel. The decreased (leg) drainage I spoke of earlier can follow.

If this applies in your case, then immobilizing the limb and frequent elevation of it is part of treatment. Application of cool saltwater dressings is helpful, and, as I mentioned, antibiotics help fight off the germs.

If the leg bypass scenario fits, it might be something to look into.

Lacunar infarct

Question: Would you clarify what lacunar infarct is? One day I woke up with loss of use of the left shoulder and arm.

A CAT scan showed a lacunar infarct. It had to do with blockage in the brain. I had a rapid and complete recovery by doing my prescribed exercises, but I am concerned about this lacunar infarct and worry about a recurrence.

I have been taking aspirin regularly and wonder if that had anything to do with it. _ Mrs. A.F.L.

Answer: Lacuna is Latin for a small lake or pit, and an infarct means death of tissue from blood deprivation. In your case it happened in a small section of your brain.

The tissue dies in the small circumscribed area (lacuna) where small local arteries are blocked by the same fats that block heart arteries to cause coronary infarction (heart attack).

What you had was a form of little stroke. The aspirin didn't cause it and in fact would tend to lessen such blockage, but please, don't jump to conclusions regarding your aspirin therapy.

Check with your doctor. I don't want you overdoing what sounds like a good thing.

No one can predict whether you will have another of these episodes, but it's great that you bounced back so handily. You can minimize recurrence by doing things that discourage artery blockage. I mean lowering blood cholesterol, controlling blood pressure, shedding excess weight, exercising and quitting smoking. None of those things sounds dramatic, but they can add up to miracles of prevention.

Urodynamic testing

Question: I have read your comments on urinary incontinence, and you never mention urodynamic testing. Can you explain that? _ Mrs. G.S.

Answer: In urodynamic testing, the urinary bladder is filled with water via a catheter. The test gives the doctor much valuable information with which to evaluate a patient's incontinence.

It indicates bladder size and indicates just when the first sensations leading to voiding occur. It also tells how well the urinary bladder muscles are performing and how long the patient can control the urge to void.

In short, the test helps doctors ferret out the many different causes of incontinence.