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Dear Dr. Roach: About two months ago, we decided to keep an 8-week-old kitten born from a stray in our garage. Shortly after this, my husband and I started suffering muscle aches and pains at the same time, with sensitive skin and sharp pain. I fear that we have been invaded by toxoplasmosis from the litter box. I clean it daily and change the litter once a week, and wash the box with bleach.

Do only pregnant women have to be concerned about getting this, and is there a cure? My doctor says there is no treatment.

H.S.

Dear H.S.: Toxoplasmosis gondii is a parasitic infection spread by cats (usually kittens, who may be infectious for about three weeks in their lifetimes). The infection is spread by oocysts in cat feces, which, if ingested, lead to infection. Meticulous hand-washing after changing the cat litter dramatically reduces risk. Cleaning your cat’s litter box daily also reduces risk, since the oocysts need one to five days after excretion to become infectious. Keeping the cat indoors reduces risk of acquiring disease. Pregnant women probably should not change cat litter, although it certainly is possible to get toxoplasmosis other ways, such as gardening (from contaminated soil) and consuming raw or undercooked meat (from infected animals). Toxoplasmosis can spread from a pregnant woman to her developing baby.

In people with normal immune systems, the infection is usually mild: 80 to 90 percent of people have no symptoms, and in 10 to 20 percent, symptoms usually are enlarged lymph nodes, especially in the neck. Some have other symptoms, including fever, rash, headache and muscle aches. In people with immune system disease, especially those with advanced HIV infection, the oocysts can infect and invade the brain. This is extremely rare in people with normal immune systems, though eye disease happens occasionally.

Toxoplasmosis can be diagnosed by blood test, which though imperfect, is good at ruling out toxoplasmosis. In other words, if the blood test is negative, it’s really negative. But false positives can occur.

I’d recommend that you discuss blood testing with your physician. Although I don’t think it’s likely you acquired toxoplasmosis, it’s possible you have something else that needs evaluation. However, I frequently find that when someone is really worried about having symptoms of a particular disease, the symptoms can last and be very bothersome until the person is reassured that he or she doesn’t have the disease, at which point the symptoms often disappear.

Dear Dr. Roach: Among people who die from heart attacks in their sleep, is there any statistical evidence that more of them were sleeping on their left or right side?

R.A.J.

Dear R.A.J.: Surprisingly (to me, at least), there is: Sleeping on the left side is more associated with risk of heart attack. Another study showed that sleeping on the right side showed more vagal stimulation, which is associated with healthy hearts. Thus, it seems to be the nerve supply to the heart that is more favorable when sleeping on the right side. Sleeping position also has an effect on breathing, with people sleeping on either side being less likely to stop breathing from obstructive sleep apnea than people who sleep on their backs. This is a mechanical issue.

Several authors recommend that people with severe heart disease, from congestive heart failure and from coronary artery disease, sleep on the right side.

The type of study done doesn’t let me to give an estimate of how important sleep position may be; but I doubt it has a major effect.

Email questions to ToYourGoodHealth@med.cornell.edu.

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