For decades, home pregnancy tests have allowed the worried and the hopeful to find out – in private – whether a baby is on the way.

For years, people with diabetes have been able to monitor blood sugar levels, with increasingly sophisticated test kits, and adjust their insulin accordingly.

You can test yourself at home to see if you’ve ovulated, to learn if there’s hidden blood in your stool or urine, or to see if you have a urinary tract infection, high cholesterol or soaring blood pressure.

You can even, thanks to a recent decision by the US Food and Drug Administration, monitor how fast your blood clots – a potentially huge boon to the 1.5 million people who take blood-thinning drugs for heart rhythm disturbances and other problems.

Because of ever-improving technology and consumer demand, the home test industry is now a $ 1 billion a year business that’s growing at 12 to 13 percent a year, according to two market research firms, the Freedonia Group, Inc. in Cleveland and Frost & Sullivan in Mountain View, Calif.

The question is, is all this self-monitoring a good idea?

The answer, perhaps surprisingly, is a cautious yes – with some important caveats.

Used correctly, home testing can save endless trips to the doctor to monitor an ongoing problem. It can also save money – most kits range from a few dollars to $ 150 – and help you feel in better control of your own health. And you can often catch little problems, like a worrisome trend in clotting time or blood sugar levels, before they become big ones.

“If you are in a relationship with a health care provider and have a clear indication for how to use a test, this stuff can be superb,” says Dr. Gary Horowitz, director of clinical chemistry at Beth Israel Deaconess Medical Center.

On the other hand, virtually all tests have pitfalls, especially the kind that you interpret yourself. You may get “false negatives” that show you’re fine when you’re not, and “false positives,” showing the opposite.

And if you’re an amateur at the art of test interpretation, you may needlessly worried about a seemingly “bad” result – like low blood sugar upon awakening, which is normal – or falsely reassured when you should seek professional help.

That said, many home tests do vastly more good than harm.

Home monitoring “has revolutionized the care of people with diabetes, making it possible for people to be much more pro-active in taking care of themselves minute to minute,” says Dr. Edward Horton, vice president and director of clincal research at the Joslin Diabetes Center in Boston.

Taking frequent finger-stick tests to measure blood sugar levels and then eating or taking insulin to keep those levels within a safe range has enabled many diabetics to avoid complications such as damage to the retina, kidneys and nerves, according to a 10-year, multi-center study completed in 1993.

And noninvasive glucose tests are in the pipeline, including a yet-to-be-approved infrared device that eliminates the need to draw blood from a finger, according to the Health Industry Manufacturers Association.

Better technology has also made home blood pressure kits more reliable, says Dr. Michael Weber chairman of the department of medicine at Brookdale University Hospital in Brooklyn, N.Y.

Until a couple of years ago, he says, home blood pressure kits were often inaccurate. In fact, the American Heart Association still does not take a position on the kits for either blood pressure or cholesterol.

But some doctors feel the kits are helpful. “You can depend on those numbers,” says Weber, though he warns that those who monitor their own blood pressure should never alter their medication dosage without checking with a doctor.

Dr. Irene Gavras, a hypertension specialist at the Boston University School of Medicine, emphatically agrees, adding that you should not use the kits to diagnose yourself but only to monitor a problem already diagnosed by a doctor. And you should have a health care professional check your home blood pressure kit for accuracy before you use it.

Home cholesterol testing, on the other hand, may be not wise.

“I’m against checking it at home for many reasons,” says Gavras, noting that the kits use a tiny drop of blood from the finger and provide only one number: total cholesterol.

“This is essentially useless,” she says, because you need to know your levels of “good” and “bad” cholesterol and triglycerides, or fat molecules, as well.

If you find your cholesterol is higher than the desirable 200 milligrams per deciliter or less, you may panic, even if you have lots of good cholesterol. Or your home test may show your overall cholesterol is fine, even though you have too much bad cholesterol.

Being your own doctor can be risky also because you may miss a problem you’re not worried about.

“You may think your major risk is heart disease. So you measure your cholesterol and find it’s normal. But what you’ve got on your back is a melanoma that no one sees,” says Horowitz. “Or if you’re having trouble getting pregnant, you may spend months using an ovulation detection kit when the problem lies elsewhere.”

And testing for some diseases, like HIV, can be upsetting.  In part because of this, the FDA has not allowed HIV home test kits on the market, although it has approved two kits that allow patients to draw blood, which they then send to established labs for testing.

(About 10 days ago, however, one of those kits, Confide HIV, made by Johnson & Johnson, was taken off the market because of the lack of demand.)

Even the straightforward pregnancy test is not always as simple as it seems, says Dr. Joseph Pinzone, a research fellow in medicine at Massachusetts General Hospital.

If it’s positive, you need to see a health care provider to get pre-natal care. But if it’s negative and you’ve missed some menstrual periods, you need to see a doctor anyway to find out why. On the other hand, many people like the convenience of finding out on their own and then making a doctor’s appointment.

Dr. Steven Gutman, director of the division of clinical laboratory devices at the FDA, says that all the kits now on the market had to pass two hurdles prior to approval: They were shown to work in the hands of the average consumer and the benefits of home testing outweigh the risks.

Sometimes, as with two new prothrombin tests that measure how fast blood clots in people on anti-clotting medication, the FDA approves a home test with a condition: Patients need a doctor’s prescription to get it.

This ensures that patients learn to use the test properly and that a doctor helps interpret the results, and it lessens the chances that a patient will change the dosage of medication, says Gutman. Taking too much of a blood-thinner like Coumadin can lead to serious bleeding; taking too little can lead to dangerous blood clots.

“No test is perfect,” says Gutman. “If you have a health problem that you’re worried about, it doesn’t matter if you test positive. If it’s bothering you, go see a doctor.”

Tips for using home test kits

1. Read the label carefully. The FDA requires the makers of home test kits to write labels that anyone with an 8th grade education can understand. But well-written labels do no good if you don’t read them.
2. Be precise. If the test involves careful timing, use a stopwatch or clock with a second hand.
3. Keep accurate records of your results.
4. If you have questions, don’t hesitate to call the “800” number listed on many home kits.
5. Don’t use a home test result to change a medication or dosage unless your doctor has said it’s okay. (Many diabetics have been taught how to adjust their doses of insulin.)
6. Don’t try to diagnose yourself with a home kit. The kits are useful for monitoring a condition you and your doctor know you have. But diagnosis is often trickier than monitoring, so call your doctor if you are worried about your health.
7. If you buy a home blood pressure kit, take it to your doctor for an accuracy check. And before you buy a kit, make sure the store will give you a refund if it is not working properly. Make sure it’s calibrated right, something medical supply stores often do. And to avoid getting anxious about each tiny fluctuation, don’t use a kit more often than your doctor suggests. Inexpensive kits – about $ 30 – with which you listen through a stethoscope to the sound of your blood flowing, can often be just as good as more expensive electronic kits.
8. Don’t use home cholesterol kits unless your doctor suggests it. It’s better to get a full “blood lipid profile” that includes measures of good and bad cholesterol and triglycerides from a health care provider. Once you have this, your doctor may want you to monitor total cholesterol at home.
9. Remember that home test kits are a complement to an ongoing relationship with a doctor, not a substitute for it.
10. And if a home test comes out negative but you still have symptoms? You guessed it – call the doctor.

They were captured, marched to the coast, kept in pens, then chained in the holds of slave ships, often deprived of life’s basics: salt and water.

Many of them died.

Those who survived – the genetic ancestors of today’s African Americans – may have been the ones most able to conserve salt in their bodies, speculates Dr. Clarence Grim, a high blood pressure specialist at the Medical College of Wisconsin.

Today, in salt-rich America, the one-time advantage of what Grim calls this “unnatural selection” process has become a major disadvantage: a salt sensitivity that may partly account for American blacks’ dramatic tendency to develop high blood pressure.

Diet, as well as the stress of racism and poverty, may contribute as much, or more, than any controversial genetic factor. But the unarguable fact is that black men in America today are five times more likely to die from high blood pressure, or hypertension, than white men.

Among other things, this means they have more heart failure, more strokes and more severe kidney disease, says Dr. Rodman Starke, senior vice president for science and medicine at the American Heart Association.

But cardiovascular troubles are just one card in a deck that seems stubbornly stacked against black men’s survival. There is a lot that an individual can do to beat these unhealthy odds – but without that extra effort, they can be formidable indeed.

Black men, for instance, have more than their share of diabetes. They have a higher incidence of cancer than any other racial or ethnic group in America. Their risk of prostate cancer is particularly sobering: White men have a 1-in-11 lifetime risk; for black men, it’s 1-in-7, according to the American Cancer Society. That is the highest rate in the world, and nobody can explain why.

Violence and HIV infection, too, rob many black men of their shot at long life. Homicide is the leading cause of death for black men between 15 and 24 years old and the fourth leading cause for black men of all ages, according to the National Center for Health Statistics.

Murder isn’t even among the top 10 causes of death for white men, though suicide is. For black men of all ages, HIV infection is the third leading killer; for white men, it’s seventh.

But perhaps most telling is this: A male black born in 1995 had a life expectancy of only 65.2 years. A white male born that same year could expect to live 73.4 years.

“Black men have the lowest life expectancy,” laments Dr. Kenneth Edelin, who runs the Roxbury Comprehensive Community Health Center in Boston and is associate dean for student and minority affairs at the Boston University School of Medicine.

“Staying healthy is a lifelong endeavor,” he adds, and a lot of it “has to do with diet and exercise.”

But many of the better health habits that have benefitted other Americans have not yet caught on among black men, says Dr. Louis Sullivan, former US secretary of health and human services and now head of Morehouse School of Medicine in Atlanta.

“The fitness movement is really middle class,” says Sullivan. “It has not been as successful in reaching low-income people.” Nor has the message to eat a lower fat diet, quit smoking and drink less alcohol.

“Black men smoke more than white men,” says Sullivan, and they get “more lung cancer, more emphysema, more bronchitis.”

And men of all colors still shy away from doctors more than they probably should – and more than women do.

“Women are in general much more tuned in to their bodies and more willing to admit vulnerabilities,” says Dr. Harvey B. Simon, editor of Harvard Men’s Health Watch, a consumer newsletter.

“In my practice, men come in with lists made out by their wives,” says Simon, adding that in health matters, the similarities between black and white men are greater than the differences.

That was partially borne out in a survey released last week by Men’s Health magazine and CNN. About a third of all men, black and white, had not seen a doctor in the preceding 12 months.

But by oversampling black men, the pollsters from Opinion Research Group in Princeton, N.J. did discover differences between black and white men’s attitudes toward health.

Blacks, for instance, were far more likely than whites to cite cost and lack of trust as reasons for not seeing doctors.

“There’s a hesitancy on the part of African American males to establish an ongoing relationship with a health care provider,” notes Dr. Warren Jones, an active duty military physician who is also an official of the American Academy of Family Physicians who deals with issues affecting minorities.

Beyond that, he says, many black men have jobs that make it hard to take time off from work to get to a doctor’s office.

Granted, many doctors no longer think an annual physical exam is a must. But certain things – like checking your blood pressure and discussing with a doctor whether to be screened for prostate cancer – are important, says Dr. Harold Sox, chairman of the department of medicine at Dartmouth Medical School and president-elect of the American College of Physicians.

Prostate screening is dicey for all men, because screening can lead to more testing, which is often followed by surgery and radiation that can lead to impotence and incontinence.

But doctors who treat black men, like Dr. Mark Drews, medical director of the Whittier Street Neighborhood Health Center in Roxbury, often recommend screening because prostate cancer is such a huge risk. Drews takes “the view that if we’re saving some people’s lives, it’s worth it.”

So is trying to get young black men into the habit of taking care of their health – and seeing health care providers regularly, says Dr. John Rich, an internist at Boston Medical Center who started a clinic there for young men.

Many young men “don’t recognize to what extent stress can make their lives unpleasant,” he says. “The reasons for stress are legitimate and real – safety and economic issues. But one of the benefits of connecting with a primary care doctor is that there are ways of dealing with stress that can improve your life.”

Unlike much of the rest of the population, Rich says, young men often want to gain weight “to get bigger.” So he uses that urge to teach them about good diet, safe ways to lift weights and how to take care of their bodies.

One who has taken Rich’s philosophy to heart is Christopher Pierce, 26, who works with a group called Boston Health Crew at Boston Medical Center to teach young men about health.

“With young black men, there’s a tough guy attitude,” says Pierce, who hopes to go to medical school and follow Rich’s example. “We try to help before they . . .get shot.” Young black men, he adds, “don’t realize health is everything.”

For all black men, health advocates say, there is an important message that doesn’t always get through: Health counts, and there are clear ways to enhance it.

For older black men, this may mean getting regular blood pressure checks, and taking medications to keep high blood pressure under control. For younger men, it may be learning about safe sex and conflict resolution skills to avoid violence.

Whatever your age, says military physician Jones, the key is “to get together with people that love you – your spouse, your kids, your significant other – to put together a list of health care concerns and take that list to a doctor.”

How you can help yourself

Health advocates offer the following health tips for black men who want to take charge of their own health:

• For young men, consider a visit to the Young Men’s Health Clinic at Boston Medical Center, or call 617-534-5951. You can get free medical care if you need it, as well as advice on safe sex and substance abuse. Clinic workers also offer help on how to deal with violence, and tips on weight lifting, body building and healthy diets.
• For older men, get your blood pressure checked regularly. Many neighborhood health centers offer free or low-cost testing. You can also be checked at some workplaces or your doctor’s office.
• If you have high blood pressure, get it treated. There are lots of medications available; if one does not work for you or causes side effects, there are often other choices.
• If you’re over 40, talk with your doctor about prostate cancer screening.
• Limit salt intake to less than 2,000 milligrams a day, about three quarters of a teaspoon, especially if you have high blood pressure. Because 80 percent of salt intake is from prepared foods, read food labels carefully. A “Lunchables” snack, marketed for kids, is one of the most salt-rich products on the market, with almost 2,000 milligrams of salt.
• Exercise regularly – at least 30 minutes per session, three to five times a week.
• Limit intake of fats to less than 30 percent of calories.
• Eat five servings a day of fruits and vegetables. (Orange juice counts.)
• Find a doctor you like – whether you have insurance or are getting free care – and use that relationship to help deal with stresses in your life. Doctors can help you find ways – like meditation and counseling – to reduce stress.

Don’t let your dog lick the baby’s mouth. Don’t splash around in a pool of water where some critter may have just peed. And whatever you do, don’t pick an aggressive dog as a pal for your kids.

Beyond that – and a few other common sense things like washing your hands a lot – it’s fairly easy to live in domestic bliss, and health, with most pets, despite the more than 200 so-called zoonotic diseases, illnesses that animals can pass on to humans.

(It’s only fair to note that some diseases go the other way, from us to them. If you get the flu, for instance, your ferret – the yuppie pet of the 1990s – may, too.)

But for many people, especially parents of young kids, the big worry about sharing a home with animals is the risk of injury or disease that pets pose to people, not vice versa.

With nearly 60 percent of Americans households now owning pets – 60 million cats, 55 million dogs – the risk is real, though largely offset by the companionship that animals offer and the fact that many zoonotic diseases are treatable.

By far the biggest health problem with pets, says Dr. Ellie Goldstein, an infectious disease specialist at St. John’s Hospital and Medical Center in Santa Monica, Calif., is dog bites. They occur at the astounding rate of one every 40 seconds.

In 1994, that translated into roughly 4.7 million bites, says Dr. Jeffrey Sacks, an epidemiologist at the federal Centers for Disease Control and Prevention. That’s the most recent year for which the statistics have been compiled.

Most bites, of course, are minor, but 800,000 that year were serious enough to prompt people to seek medical care, Sacks says. In 1995 and 1996 alone, at least 25 people – 20 of them children – died from dog bite wounds. Half of the fatal attacks involved rottweilers.

Most people who suffer animal bites either know or own the animal, notes Goldstein, adding that many people are bitten on the hands while trying to separate two fighting dogs.

If a dog is rabid, of course, its bite can also transmit rabies – a viral infection that is fatal unless you are promptly vaccinated. You can also catch rabies from cats, raccoons, foxes, skunks, woodchucks and bats. And bats are the biggest culprits – though not too many people have them as pets.

Since 1980, 34 people in the United States have died from rabies, most of them from the types of rabies virus found in bats, says CDC epidemiologist James Childs. But most of these people did not remember being bitten by a bat or any other animal, so the exact chain of transmission is unknown.

Even when a dog bite isn’t fatal, serious infection can result because staphylococcus or streptococcus bacteria that normally live harmlessly on human skin get pushed deep into tissues, says Dr. Arnold Weinberg, head of the MIT Medical Department and a specialist in infections from animals.

But dog saliva contains more exotic bacteria, too, including Pasteurella multocida and Capnocytophaga, which, though treatable with antibiotics, can cause serious infections, especially in people whose immune systems are weakened.

Cat bites – which total 500,000 a year – can be even worse because cat saliva contains more Pasteurella. And because cats’ teeth are so sharp, a cat bite is essentially an injection of bacteria deep into tissues, even into bones and joints.

You can get Pasteurella from lions, too, though if you tangle with a lion, that’s likely to be the least of your problems.

Even cat scratches can be a problem. Cat scratch disease, caused by a bacterium called Bartonella hensalae, hits 22,000 people a year, says James Fox, director of comparative medicine at the Massachusetts Institute of Technology.

The Bartonella bacteria, which live in the cat’s bloodstream, get picked up by blood-sucking fleas on the cat’s skin. The cat then scratches the fleas, which leaves “flea debris” (a euphemism for flea feces) on the cat’s claws. If the cat scratches you, you get an injection of this bacterium into your skin.

Fleas also spread the bacteria from cat to cat, a major problem since American’s 60 million pet cats often come in contact with the 60 million wild cats in cities and towns.

Fleas from cats and dogs can also jump off their four-footed hosts onto you, causing a characteristic pattern of bumps in a row that some doctors dub “breakfast, lunch and dinner.”

Usually, a flea bite, at least with New England fleas, results in little more than an itchy spot. But swallowing a flea – this gets a little gross – can be more serious.

If your dog licks its fleas then sticks its tongue near enough to your mouth, you can get the flea. And if the flea is harboring tapeworm larva, you get the tapeworm, too.

Even cuddling has its risks – you can get a treatable skin fungus called ringworm if your cat or dog is infected.

Don’t panic, though. Despite all this, keeping a pet has been shown many times to provide important psychological and social benefits to children and adults alike. There’s just a tiny bit more unpleasant reality to confront – the miseries you can acquire from animal droppings.

Salmonella and camplyobacter – bacteria that cause diarrheal diseases in people – are easily spread via cat and dog feces, especially from puppies and kittens that have been in pounds or pet stores.

Iguanas, another trendy pet, also contribute their fair share to the salmonella problem, as do snakes and, historically, small box turtles. In fact, the risk to kids of playing with box turtles and plunging their hands in their soiled water was serious enough to prompt federal officials more than a decade ago to ban interstate commerce in the turtles.

Even good, old dirt in your gorgeous garden can spread infections, if neighborhood critters use it as a bathroom.

A major problem here is the droppings of cats and dogs, especially young animals, which may contain roundworm eggs called toxocara.

After two weeks in the soil, these become infective, says Dr. Leonard Marcus, a veterinarian and physician who is the liaison between the state medical and veterinary societies.

The roundworm parasite then migrates to different parts of the human body, causing disease which is hard to treat, though rarely fatal. In southern parts of the country, hookworm, also spread in contamined soil, is also a considerable problem.

Even pretty birds like parrots and parakeets cause their share of misery, notably a disease called psittacosis, caused by a chlamydia-like bacterium that lives in bird droppings. When the droppings dry out, the bacteria can become aerosolized, and you can inhale them while you’re cleaning the cage.

On the bright side, feline leukemia, a major problem for unvaccinated cats, does not spread to humans, nor does any other cancer seem to leap in either direction across the species barrier.

And you probably can’t catch ulcers from your cat, either.

Ulcers are usually caused by a bacterium called Helicobacter pylori. The bacterium has been found in one closed colony of cats and under experimental conditions has been shown to infect other cats. But so far, there is no evidence pet cats carry it, nor any evidence they transmit it to people, says Fox of MIT.

You might, however, be able to catch it from flies.

Dr. Peter Grubel, a medical resident at St. Elizabeth’s Medical Center in Boston, has shown that flies can pick up H. pylori from lab dishes and pass it in their feces. Whether people actually catch it from flies that have walked on infected human feces and then on food is not known but is certainly plausible, at least in the Third World, Grubel says.

But the bottom line, says Marcus, who has a private practice for two-footed, featherless creatures in West Newton, is that if you exercise common sense – and do a lot of handwashing – “the fun and benefits outweigh the risks of having pets.

“I strongly encourage people to own pets,” he says. “It’s an important part of regular living and a good experience.”

Previous “Health Sense” column are available through the Globe Online searchable archives at http://www.boston.com. Use the keyword columnists and then click on Judy Foreman’s name.

Some dos and don’ts

Doctors, veterinarians and federal disease control specialists offer the following tips for pet owners. For dog owners

• Pick an appropriate dog. Dogs with histories of aggression are inappropriate in households with children.
• If a child seems fearful about getting a dog, wait until the child is older.
• Spay virtually all dogs to reduce aggressive tendencies. If your dog does get in a fight with another dog, use your feet or a stick – never your hands – to break up the fight.
• Never leave a young child alone with any dog.
• Don’t play aggressive games with the dog.
• Teach children never to approach an unfamiliar dog and never to run away from a dog and scream. Rather, teach them to remain motionless if approached by an unfamiliar dog – the “be still like a tree” approach.
• Teach children that if they are knocked over by a dog, to roll into a ball and lie still – “Be still like a log.”
• Avoid direct eye contact with a dog; the dog may see this as a sign of your aggression.
• Let a dog see and sniff you before you pet it.
• Wash a dog bite wound immediately. Other tips
• Wash your hands and your child’s after handling any animal feces, including after your daily pooper-scooper/dog walk routine.
• Clean out the cat box at least every couple of days, preferably daily; try not to inhale the dust. Get someone else to clean the box if you have a weakened immune system or are pregnant. Cat droppings can contain toxoplasmosis, a protozoa that can lead to congenital defects in children and cause disease in immunosuppressed people.
• Wash vegetables grown in soil that might be contaminated by animal feces.
• Keep pets healthy – for their own sake and yours – by keeping regular veterinary appointments.
• Call your veterinarian if your pet seems sick.
• Be sensitive to a cat’s mood. When a cat says “no,” it really means it. Most cat bites occur if you try to snuggle with a reluctant cat.
• If you or your child comes down with a disease that stumps your physician, mention any potentially infectious animal contact.
• Respect your pet and interact appropriately.

Louise Pace was a happy, 42-year-old commercial real estate boker in Florida when her body began going bananas.

Bruises popped up on her legs, so she went to her doctor, who suspected leukemia. It wasn’t, so the doctor suspected abuse.

When her monthly periods stopped and she developed hot flashes, mood swings and insomnia, her gynecologist said it was early menopause, gave her estrogen and told her to calm down.

A dermatologist said the purple marks on her chest were from sunbathing for too many years. Nobody seemed to know why she suddenly gained 40 pounds and became moon-faced. Or why her hair fell out everywhere, except on her face, where it sprouted.

“I cried every day when I looked in the mirror at my fat, ugly, balding self,” she recalls.

Desperate, she went to a psychiatrist who, she recalls, said she was obsessed with her body and gave her Prozac. She wrote suicide notes and called a college roommate to say goodbye.

That call saved her life, says Pace, now 51 and living in Boston. After four years and 15 doctors, it was the roommate, a medical editor, who got the diagnosis right: Cushing’s syndrome.

Spontaneous cases of Cushing’s, usually caused by tumors in the pituitary or adrenal glands, are rare – about 1,500 cases a year in adults and kids.

But thousands of others develop Cushing’s or some of its symptoms, not because of tumors like Pace’s but because they are taking prescribed steroid drugs such as prednisone.

Over the last five years, steroid prescriptions have grown steadily – to more than 30 million in 1996 alone, according to IMS America, a pharmaceutical market research firm.

And that “is a major problem,” says Dr. George Chrousos, chief of pediatric endocrinology at the National Institute of Child Health and Human Development, even though many doctors have learned to use steroid drugs better than in the past.

Steroid drugs – not to be confused with the anabolic steroids that some athletes use illegally – can be “lifesaving and hugely important in controlling many important diseases,” says Dr. Jerry Avorn, an internist at Brigham and Women’s Hospital who studies drugs and their side effects.

Because of their powerful anti-inflammatory action, they can help combat asthma, chronic lung disease, allergies, rheumatoid arthritis and other auto-immune diseases, certain cancers and rejection of transplanted organs.

But the cost of that benefit can be high.

Dr. David Orth, of Vanderbilt University in Nashville, estimates that 250,000 people a year develop Cushing’s from taking high doses of steroids for long periods. In fact, a person can develop Cushing’s symptoms from taking 20 milligrams of steroids a day for as little as three to six weeks, says Orth, one of a number of endocrinologists, or hormone specialists, who worry that steroids are being overprescribed.

Cushing’s syndrome, or hypercortisolism, occurs when the body’s tissues are exposed to too much of the hormone cortisol.

In a healthy person, cortisol is pumped out every day by the adrenal glands, which sit atop the kidneys. The pituitary gland, which lies just beneath the brain, sends the signal that triggers cortisol production, with the peak output occurring around 8 a.m. – as if nature were providing a jolt to get moving.

And at normal levels, 25 micrograms per deciliter of blood in the morning and about 5 micrograms at night, cortisol is essential to life. It helps regulate blood pressure, energy production, the ability to fight infections and respond to stress. It also seems to keep the immune system in check so that it doesn’t make antibodies that might attack the body’s own tissues. And it seems to balance the effects of insulin in breaking down sugar for energy and to regulate the metabolism of proteins, carbohydrates and fats.

In fact, if you have too little cortisol, you can wind up with Addison’s disease, which President John F. Kennedy had, a condition that can be fatal without hormone replacement.

But too much cortisol – whether produced naturally in the body or taken as steroids – is disastrous, too. It can cause sudden weight gain, especially in the trunk, a florid moon-like face, thin skin, mood changes, muscle weakness, purple stretch marks on the torso, high blood pressure, diabetes, a fatty “buffalo” hump on the neck, depression, and severe osteoporosis.

Left untreated, Cushing’s can be fatal.

In spontaneous Cushing’s, the usual culprit is a tumor in the pituitary gland that sends too many signals to the adrenals to make more cortisol. But tumors in the adrenal glands can also cause excess cortisol production, as can more rare tumors that occur in the lungs and elsewhere.

Whether Cushing’s is caused by tumors or steroids, one result is “severe osteoporosis with devastating consequences,” says Dr. Michael Holick, chief of endocrinology, nutrition and diabetes at Boston Medical Center. “Steroids have a direct effect on bones, causing severe bone wasting. The bones get so thin that a heavy cough can cause fracture of the ribcage.”

No one knows that better than Kathy Carbone, now 48 and a business manager in Richmond, Va., who had a pituitary tumor. Like Pace, Carbone was in her early 40s when the perplexing symptoms began. She spent four years and went to 12 physicians before her disease was diagnosed – also by a friend.

Though Carbone was a very fit aerobics instructor at the time, her bones became so weak she would wake up with spontaneous rib fractures. Her muscles, too, became weak: “If I squatted I would fall over.”

For people like Pace and Carbone whose Cushing’s is caused by tumors, the first step is getting a diagnosis, which includes a series of urine samples collected over 24 hours, then surgery to remove the tumor. But many pituitary tumors – which are usually benign – are so small they can be hard to find amid normal tissue.

For that reason, says Dr. Beverly M.K. Biller, an endocrinologist at Massachusetts General Hospital, it is crucial to find a neurosurgeon who has done “hundreds and hundreds” of the surgeries, usually a procedure called a transsphenoidal adenomectomy, in which the tumor is removed through the nose or an opening below the upper lip.

If you’re in a managed care health plan that requires you to go a specific neurosurgeon, she adds, you “are better off going outside the provider circle if that surgeon is not an expert.”

Like pituitary tumors, about half of adrenal tumors are also benign and can be removed surgically. In almost all cases, this cures the Cushing’s. A malignant adrenal tumor can also be removed surgically, but it must be followed by drugs to suppress cortisol produced by any pieces of the tumor that may have spread, and to curb the cancer.

As both Pace and Carbone can attest, removal of even a benign tumor is just the first step in a long recovery. If surgery cuts cortisol production to zero, the patient is left with a temporary form of Addison’s disease, which must be treated, paradoxically, with hormones, usually prednisone or hydrocortisone.

When Cushing’s is caused by steroids, not a tumor, there are also things you can do.

The most important is to talk to your doctor about reducing the dose. But never suddenly stop steroids on your own – you can go into adrenal failure and die. The goal is to taper off the steroids very slowly.

If you have asthma, chronic lung disease, or rheumatoid arthritis, you may need the steroids just to breathe or walk. Even so, Cushing’s specialists say, you may be able to reduce the dose. And some asthma patients can switch from oral steroids to the inhaled form, which is not absorbed as readily throughout the body.

If you have rheumatoid arthritis, you may be able to taper off some steroids by taking other medications, such as colloidal gold, Plaquenil, Feldene and methotrexate.

For osteoporosis, it may help to take 1,500 to 2,000 milligrams a day of calcium, and 400 International Units of vitamin D. You might also consider taking prescription drugs such as estrogen and Fosamax.

Another strategy is to take steroids only every other day, so you don’t suppress all your own cortisol production. And if you take steroids just once a day, take them at 8 a.m., when your body would normally be making cortisol.

Some day, there may be better drugs that damp down the inflammatory response without so many side effects.

Until then, if you have symptoms that stump your regular doctors, consider seeing a hormone specialist, says Michael Conn, president of the Bethesda, Md.-based Endocrine Society.

And if necesssary, figure things out yourself, says Carbone.

“Anyone who is hurting or seeking answers should take it upon themselves to read, to sit down with medical journals and look up your symptoms,” she says. “I would have been diagnosed far earlier if I had been creative enough to read up on my symptoms.”

To learn more

For more information, call:

• Cushing’s Support and Research Foundation, Inc. 617-723-3674.
• 1-800-HORMONE (1-800-467-6663), The Endocrine society.

Lyme disease is one of the most insidious illnesses around.  It gets you while you’re doing something pleasant – like walking in the woods on a summer day.

The tick that carries it is so tiny – the size of the period at the end of this sentence – that you can barely see it. And seeing it is important, because if you pick it off with tweezers within 24 to 48 hours, chances are you won’t get sick.

Finally, the circular red rash that develops around the tick bite is easy to miss. Yet if you ignore it, or the fever, chills, headache and fatigue that will follow in the next few weeks, you may miss your best chance to stop the disease before it turns chronic – and causes trouble for years.

Like chronic fatigue syndrome or fibromyalgia, Lyme disease, especially the chronic form, has been so misunderstood that frustrated patients and mystified doctors have long been at odds. But following a conference of doctors and activists last month at the National Institutes of Health, the hostilities seem to be simmering down and the scientific controversies coming into sharper focus.

Both activists and researchers agree that preventing Lyme disease is both possible and critical. They also agree that no one really knows how many people have it – it’s both vastly underdiagnosed and, in some cases, wrongly diagnosed in people who don’t really have it.

The federal Centers for Disease Control and Prevention in Atlanta counted 16,197 new cases nationwide last year, up from roughly 12,000 the year before. In Massachusetts, there were 361 new cases last year, up from the roughly 150 to 250 a year in recent years. No particular “hot spots” are expected this year, but the disease is spreading slowly throughout the state. “Only a fraction of the true cases are identified and reported,” says Dr. Bela Matyas, medical director of the epidemiology or disease tracking program at the state Department of Public Health.

And reporting may actually be better in the Northeast than elsewhere. Lyme disease was discovered in Connecticut in the 1970s, and conditions in the New England region are ideal for the Lyme disease spirochete, the bacterium that lives in ticks.

The tick that spreads Lyme disease – and two other diseases called babesiosis and ehrlichiosis – has a complex life cycle. In the larval, stage, the tick lives on white-footed mice. The tick then molts, becomes a nymph, drops off the mouse and sits in low brush waiting for another animal to feed on.

It is at this stage that a tick bite is most infectious to humans. In its adult stage, the ticks live on deer. This means that large deer populations – like those on Nantucket, where residents and state officials last week held a hearing to consider culling herds – help keep the ticks’ life cycle humming. Adult ticks can also infect humans, but less readily.

It’s the diagnosis and treatment of Lyme disease that really gets complicated – and controversial.

Once the tell-tale rash is gone, for instance, it is difficult even to diagnose Lyme disease. CDC’s guidelines suggest using a lab test, called ELISA, to check for antibodies against the spirochete. But this test can be inconclusive, so a second more specific antibody test called a Western blot is often done.

But even this may not be decisive. It can take weeks for the body to make antibodies, so a newly infected person may test negative but still have the disease. And some people seem to have Lyme disease without any detectable antibody response.

Some doctors also use another test, called PCR, or polymerase chain reaction, to look for pieces of DNA from the spirochete itself. But if, as some suspect, the spirochete can hide inside nerve and immune cells, this could make it harder to detect by PCR.

For some people who never noticed a bite or rash, the first sign of acute infection is meningitis, an inflammation of the lining of the brain, or a type of facial paralysis called Bell’s palsy, or fainting due to heart block – an electrical malfunction caused when the spirochete infects the the heart.

Once acute Lyme disease is diagnosed, the usual remedy is 10 to 30 days of oral antibiotics – usually doxycycline or amoxicillin, says Dr. Allen Steere, chief of rheumatology and immunology at the New England Medical Center, although a newer drug called Ceftin can also work. (Doxycycline and other drugs in the tetracycline family also fight ehrlichiosis, but it takes a more complex antibiotic regimen to treat babesiosis.)

Even though antibiotics work most of the time, Karen Vanderhoof-Forschner, founder of the Connecticut-based Lyme Disease Foundation, worries because data from animal studies suggest that treatment does not always make infection go away.

And if the initial infection is not adequately treated, the bacteria can lurk in the joints and the nervous system, producing chronic Lyme disease – even years later.

In some people, the result is arthritis in the knee, in others, it’s a brain problem called encephalopathy which leads to memory impairment and irritability. Still others develop pain, numbness, and tingling in the hands and feet.

It’s still unclear whether these problems result chiefly from a flareup of a latent infection or, as may happen with arthritis, from an auto-immune attack in which the body attacks tissues harboring the spirochete.

“I think chronic Lyme disease is a persistent infection and that we haven’t figured out how to get rid of enough bacteria to cure people,” says Dr. Sam Donta, an infectious disease specialist at Boston Medical Center and the Boston Veterans Affairs Medical Center.

For chronic Lyme, Donta advocates longterm treatment – 6 months or more – with oral antibiotics such as tetracycline or an erythromycin-like drug that can kill bacteria inside cells.

“My advice is that if a patient starts to improve after two weeks, don’t stop. Keep going until he’s all better,” he says. Other specialists advocate longterm treatment with intravenous antibiotics, which may penetrate the nervous system better.

But all this is hotly debated. Steere, for instance, says, “Nowhere in the medical literature is there information to support the value of giving antibiotics for 10 months, and there is potential danger – such as allergic reactions, colitis or gall bladder problems.”

Rosalie Trevejo, a CDC veterinarian, agrees: “Treatment for over a year would be dangerous.”

Some answers may come from a $ 4.2 million study now getting under way at NEMC by Dr. Mark Klempner, who plans to follow 260 chronic Lyme disease patients, giving half of them 90 days of antibiotics and the other half a placebo.

Ideally, a vaccine could head off much of this misery, but that vaccine “fix” may not come as easily as once thought.

Two similar vaccines – one by Connaught Laboratories, Inc. and the other by SmithKline Beecham – have been tested in thousands of people and the results are now being analyzed, says Steere, the principal investigator of the SmithKline study.

But, he says, “There’s no vaccine ready for this season and I don’t yet know about next year.”

Others say the antigen, or marker, used in both these vaccines may not be the most effective one. A third company, MedImmune, Inc. is betting that a vaccine based on a different protein on the spirochete may work better, but it won’t even begin to be tested in people until next summer.

And some researchers worry that vaccines might reactivate infection in people who have had Lyme disease in the past. Donta has several recovered patients who were vaccinated and then “started to have symptoms after getting the vaccine, usually the booster. It makes you wonder whether the vaccine didn’t set something off.”

Other issues still simmer, too. Karen Vanderhoof-Forschner, who has had Lyme disease, believes her son caught it from her while she was pregnant. He died six years later.

But researchers are still unsure whether the Lyme spirochete can cross the placenta. So far, there’s some evidence in mice that it can, and three unconfirmed cases in people.

All of which means, says Vanderhoof-Forschner, that the best way to deal with Lyme disease is to prevent it.

Prevention is the key

Learn to look for the deer tick, Ixodes dammini, on your skin or clothing after walking in fields or woods. It looks like a dark speck about the size of the period at the end of this sentence.

• If you can’t avoid areas where ticks thrive – woods, marshy areas, high grass and bush – wear long pants tucked into high socks and long-sleeved shirts. Wearing light colors make it easier to spot ticks that get on your clothes.
• Insect repellants may also help. One called permethrin works, but you must apply this only to your clothing, not your skin. Standard repellants containing DEET (diethyltoluamide) are also effective and can be applied to the skin.
• Because too much DEET can cause nerve damage, adults should not use it at concentrations higher than 30 to 35 percent; children should not use concentrations higher than 10 to 15 percent. Never put DEET on infants under age 1.
• When you get home from a tick-infested area, shower or bathe and check yourself and your children carefully for ticks.
• Remove ticks with a pair of tweezers within 24 to 48 hours.
• If pets have been in tick-infested areas, check them, too, as well as areas where they sit or lie. Ticks can drop off from pets onto couches and rugs.

For more information:

If you are interested in enrolling in the New England Medical Center study of the treatment of chronic Lyme disease, call: 1-888-LYME-CTR. (1-888-5963-287)

• Lyme Disease Foundation hotline 1-800-886-LYME (1-800-886-5963)
• American Lyme Disease Foundation, Inc., 914-277-6970.