Chronic disorder leads to brittle bones

Dear Dr. Gott: I’ve recently been diagnosed with Paget’s disease, following a bone scan and other X-rays. I’m bothered by nausea, unsteady walking and vision problems. I’m on one 400 mg Didronel tablet each day. What’s your opinion regarding my symptoms, prognosis, and whatever else there is pertaining to this disease? Is it hereditary?

Dear Reader: Paget’s disease of bone is a chronic disorder of the adult skeleton, primarily in the elderly, leading to patchy areas of rapid bone metabolism. The cause is unknown.

Because of hyper-metabolism of the bone cells, some portions do not calcify completely; hence, they are more prone to fracture. When the skull is affected, patients often experience headache, decreased visual acuity and increased size of the skull. Other symptoms include bone pain, fatigue, stiffness and deformity of the legs. The diagnosis is made by X-rays and bone scans.

Didronel is a prescription drug that stabilizes bone formation. The medicine is usually administered for up to six months, followed by a rest period of three months; after this, depending on the patient’s response, additional “pulsed” therapy may be given. Didronel is largely free of complications. However, it can cause nausea, diarrhea and kidney damage.

Although there is a family incidence of Paget’s disease, no clear-cut genetic pattern has been identified.

Ordinarily, the prognosis is quite favorable. With treatment, patients can live long and reasonably comfortable lives.

In my opinion, such patients should be under the care of metabolic specialists or endocrinologists.

Dear Dr. Gott: I’m an 18-year-old white male. Occasionally when I defecate, blood is passed along with my stool. This only seems to happen when my stool is enlarged and defecation hurts. Could this be an early sign of hemorrhoids? Should I see my doctor?

Dear Reader: Rectal bleeding is always a medical concern, regardless of a person’s age. In a healthy adolescent, with the circumstances you describe, the bleeding almost surely has a benign cause, such as slight tissue-tearing or hemorrhoids.

However, you really should check this out with your doctor, who after examining you, will diagnose the problem and offer a solution. For example, your situation might be cured by consuming more fluids (to soften your stools), using more brain and fiber (to aid evacuation) and attempting to defecate on a regular schedule (so that your lower rectum is not as stressed by bulky, hard, infrequent stools).

To give you related information, I am sending you a copy of my Health Report “Constipation and Diarrhea.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.