Heatstroke, abdomen pain, gynecomastia, and diet

DEAR DR. DONOHUE: My husband is growing increasingly angry with me because I can't take the heat anymore. I have had three heatstrokes -- bad enough that I had to go to the hospital, but not bad enough to be put in ice water. The first time was when I was a teenager. The second time was at my daughter's graduation. The third time was in 2005, when I had to ride buses to visit my husband, who was recovering in the hospital from heart surgery. That was in the hot Las Vegas sun. I am 60 now. It's hard for me to walk any distance without overheating. He says I'm crazy. Please help. -- J.T.

ANSWER: Heatstroke calls for immediate attention in order to prevent death. Body temperature rises to 104 F or higher (40 C). The heart beats fast and respiration is rapid. The skin can be either wet or dry. Affected people are confused and often delirious. Without treatment, they die. The brain goes into overdrive to stop bodyheat production by putting muscles in a resting state. Heat exhaustion is a step below heatstroke, and you probably had that. Body temperature doesn't reach 104 F. People feel dizzy, faint and often have stomach cramps. This, too, is a serious condition, but things usually turn around promptly if people are put in a cool environment and given fluids. Having had one episode of heat exhaustion doesn't make you more susceptible to another. However, you are quite sensitive to heat, and your husband should back off. You have to stay hydrated, and it would be wise to carry water with you when you are out and about. You might be able to acclimatize yourself to activity in the heat by gradually increasing the amount of exercise you do. Start with a very short walk and, day by day, increase the distance slightly. In a matter of three or four weeks, you should be able to tolerate heat better. I envy people who bask in the Las Vegas sun.

DEAR DR. DONOHUE: I would like to start out by saying my anatomy and physiology class reads your column every day. My friend S. says hello. We're big fans. I have a bit of a medical problem. About every two to three months, I wake in the middle of the night with intense pain in my upper abdomen. I am only 16. Sometimes the pain is so bad that I have to get up. I am nauseated and feel like vomiting, but I never do. The pain subsides a little when I lie in the fetal position. Eventually I fall back to sleep and wake up in the morning feeling normal. My diagnosis is gallstones. What can you tell me about gallstones? -- E.V.

ANSWER: How can I not answer a letter with such an introduction? Hello to S. and to you. The first thing I can tell you is that gallstones in a girl your age (E.V. is a girl) are extremely rare. They almost never appear in young people unless there's another condition, like sickle cell anemia or spherocytosis (another blood problem), that contributes to their formation. The typical pain of a gallbladder attack most often is felt in the upper-right side of the abdomen, and usually starts soon after a meal. The pain is constant and lasts for several hours. It might spread to the right shoulder, right shoulder blade or back. Fever, nausea and vomiting can also be present.I'm sorry to say I don't know what's causing your pain. There are more than 23 causes of abdominal pain. You really need a doctor's examination to determine which of those causes applies to you. Pain that's so severe it wakens a person from sleep is something that shouldn't be ignored. Ask your parents to take you to the family doctor.

DEARDR. DONOHUE: I have an embarrassing problem that keeps me out of the pool and off the beach. I am ashamed to bare my chest. I have gynecomastia. How do I correct the problem? I am 88. -- S.S.

ANSWER: Gynecomastia -- the growth of the male breast -- happens in older ages when there's a drop in male hormone production with undiminished production of female hormone. Men do make female hormones. The only way to correct gynecomastia is removal of the breast tissue, an operation that is not as daunting as it might sound.

DEAR DR. DONOHUE: My 37-year-old daughter had a massive coronary. She has quit smoking and is trying to lose 100 pounds through diet and exercise. She is a diabetic and has high blood pressure and high cholesterol. Please tell us how much sugar, sodium, cholesterol and carbs she can have a day. -- C.C.

ANSWER: Your daughter has serious illnesses at a young age. The diets for her conditions are confusing. She needs the guidance of a dietitian, who can instruct her on the ins and outs of a low-salt, low-cholesterol, diabetic diet. It will take her more than a few sessions to master this. You can go with her. A rough estimate of daily calories for one wanting to lose weight is 10 calories for each pound of desired weight. If your daughter should weigh 130, then she should be on a 1,300-calories-a-day diet. Of those calories, 50 percent to 55 percent is carbohydrates -- sugars, starches, things like pasta, bread, fruits, vegetables, grains and low-fat milk. Ten percent to 20 percent is protein -- meat, poultry, dairy products and eggs. Thirty percent or less comes from fats -- oils, shortenings and dairy products, like butter. You see dairy products under all three groups. Most foods are a mixture of all three. Salt presents a problem because it's spoken of as "sodium" or "sodium chloride." We're told to keep our total daily intake of sodium to 2,300 mg (5,700 mg of sodium chloride -- salt). Some set the limit at 1,500 (3,750). Your daughter should not add salt to her food at the table or during cooking.