Ask the Doctors: Rabies comes from contact with saliva

Hello again, dear readers, and welcome back to the monthly letters column. You've filled our mailboxes to the brim, so we'll dive right in. — We recently discussed the series of shots required when someone is exposed to rabies. This prompted a letter from a reader in Virginia whose husband found a baby bat. "He touched the bat with his foot (while wearing socks and shoes), and it flew off," she wrote. "Then he got worried about rabies. Is there a test that can reassure someone they don't have rabies?"

There is no single test for rabies in humans. Instead, several tests on samples of saliva, blood serum and spinal fluid are performed. The results show if infection has occurred. Rabies is nearly always transmitted through a bite. It is possible to get infected through surface contact with infected saliva, but it's rare. In the scenario you describe, your husband did not come into direct contact with the bat.

— In response to a column about gastroesophageal reflux disease, or GERD, a reader from Louisiana shared their approach to managing the condition. "A behavioral change that works for me to prevent GERD is the elimination of sugar from one's diet," they wrote. "Give it a try, and if it works, you have a solution. If not, no harm done." The reader's experience is backed by recent research. A study published last year in the American Journal of Gastroenterology found that people with GERD who reduced sugar improved the pH level in their esophagus and experienced fewer reflux episodes.

— We've had several letters in reference to a column that included a discussion about hydration. One reader asked about distilled water. "I prefer the non-taste of distilled water, so that is what I normally drink," she wrote. "But someone told me it's bad for my body. Is that true?" It is safe to drink distilled water when accompanied by a balanced diet. That's important because distilled water has been stripped of electrolytes and minerals, including calcium and magnesium. Although the primary source of minerals essential to human health is the foods we eat, water also plays a role. Some studies have found that relying solely on distilled water may contribute to lower levels of these important minerals.

This brings us to a letter from a reader from Nebraska who regularly drinks spring water and wonders if it contains minerals. The answer is yes. For people who dislike the taste of tap water, spring water can be a good alternative.

— A column about balance that suggested standing on one foot as a useful strengthening exercise prompted a question from a reader. "Should I balance on one foot with bare feet or with shoes on?" they wrote. "I think there will be a significantly different result." You're correct that each scenario elicits a slightly different kinetic response. But since both involve the mechanics of balance, we think both would be useful.

Thank you, as always, for taking the time to write. We love hearing from you. We have had an unusual amount of mail recently and will add several bonus letter columns in the coming weeks. Dear Doctors: I was surprised to find out that a co-worker gave his nephew a kidney several years ago. He never mentions it and I don't want to invade his privacy, but I would like to know more about the process. What does it take for someone to donate a kidney? Is it safe for them to do it?

Dear Reader: Your co-worker is what is known as a living donor. It's just as it sounds — the donation of an organ by someone who is still alive.

The kidney is the most frequently transplanted organ from a living donor. While less common, it is also possible to donate a lobe of the liver, all or part of a lung, a portion of the pancreas or part of the intestines. The majority of the 6,000 organs provided by living donors each year come from relatives, loved ones or close friends. A small number come from a donor who has chosen to help someone they don't know but who is in great need. Whatever the circumstances, becoming a living donor is a weighty decision that requires serious thought.

Depending on the transplant center, the prospective donor must be at least 18 or 21 years old. They must also be mentally competent to make the decision to donate and be in good health. Conditions that can interfere with becoming a living organ donor include diabetes, cancer, uncontrolled high blood pressure, hepatitis, HIV or an active infection. All of this is ascertained during the evaluation that is required of all potential donors. This begins with blood tests and tissue typing to see if a potential donor is a good match. If so, the person undergoes additional testing, including heart and lung exams, a colonoscopy, and liver and kidney function tests.

Not surprisingly, given the enormity of such a decision, a mental health assessment is an important part of the screening process. The transplant center also makes sure the donor has the financial, medical and personal support required when someone undergoes major surgery.

The transplant itself is done under general anesthesia and takes three to four hours. Most kidney transplants are now done laparoscopically, which means small incisions and a faster recovery time. The timing of a return to work and a regular routine varies, but typically takes three to six weeks.

Short-term risks to the donor include those involved in any surgery. These include infection, pain, blood clots and an adverse reaction to anesthesia. Long-term risks include the natural decline in kidney function that accompanies aging and developing a disease that itself impedes kidney function. This includes Type 2 diabetes, high blood pressure and obesity. A donor loses 25 to 35 percent of their kidney function. To compensate, the remaining kidney increases in size.

The data show that donating a kidney does not affect the donor's life expectancy. People on the kidney transplant list wait an average of three to five years for an organ. Tragically, some don't survive the wait. In donating a kidney to his nephew, your co-worker has made a courageous and generous choice.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.