Husband appears to be sleeping his life away

Q: My 33-year-old husband has a sleep disorder. When he is asleep he hears no sounds – including his three alarm clocks, telephone, or any loud noises. I have to make several attempts to wake him for work which often results in me being late for my work. He is tired all through the day and has very low energy levels. The problem has been going on for several years and seems to be worsening as time goes on.

He has talked to our family doctor about this disorder that runs in his family, along with insomnia and sleep walking. The doctor did a physical exam and ran blood work to test for low iron, thyroid problems, and other abnormalities. Nothing other than what was described as a “old mono virus” was found. A CT was run on his brain and nothing was found there. He was tested for sleep apnea as his brother has that condition, but was not found to have any problems there.

This has presented a problem for him at his job. He’s frequently late for work and loses energy as the day goes on. His boss has been supportive in the past but is beginning to be frustrated since no medical cause can be found.

When my husband is not at work, he is sleeping. If left undisturbed, he will sleep up to 16 hours straight. He used to play golf frequently, doesn’t socialize much, and seldom has enough energy to play with our son. He hasn’t lost interest, just energy. He says he has to force himself to do things physically. He has become depressed and sees no way of getting better.

Do you have any suggestions on what type of doctor we can see, tests we should request, or treatments we should seek. You are our last hope. If my husband loses his job, we could probably lose our home.

A: It appears you have done everything medically possible and have come up empty handed, a situation that must be painful for everyone. The amount of sleep a person requires varies, depending on age, daily activity levels, general health and lifestyle. The average individual sleeps between seven and nine hours a day – not 16. A condition known as hypersomnia is a medical disorder. Many individuals with the condition have low energy, memory problems, periods of anxiety, and most pronounced – a constant need to sleep the day away. You have addressed sleep apnea and depression, so we will bypass those. However, how about diabetes? Is your husband aware (or even care) that excessive sleep patterns may increase his risk for diabetes, trigger headaches, lead to obesity, cause back pain, and invite cardiac issues?

There may be an underlying cause for your husband’s condition (such as narcolepsy) that hasn’t been identified as yet, or a medication he is on that is reacting adversely. There are also a number of sleep disorders other than sleep apnea that may require a consultation with a sleep medicine specialist. You might choose to speak with your family physician about those possibilities. Your next step (and with his permission, of course) might be to make an appointment with the sleep medicine specialist I mentioned, followed by a psychiatrist or psychotherapist who may be able to get to the bottom of the issue with him. Because of having ordered a CT of his head, it appears his physician(s) may have been considering a neurological connection. Something may have been missed along the way that needs to be determined to allow your husband and his family to have a life again.

Reader prefers drugs to natural remedies as a sleep aid

Q: Even as a child, I never slept well. My parents told me I was a poor sleeper and a failure-to-thrive baby. I had horrible nightmares and awoke feeling tired and anxious every morning. My issue is that I just do not understand why some doctors persist in the belief that “natural remedies” work best. I can tell you that I have spent most of my life feeling miserable because of doctors who push natural remedies, claiming they work best. Is there a natural remedy that really works, because if there is, I haven’t found it yet but I finally got up sufficient nerve to go to a psychiatrist who helped me and the one saving grace for me has been a caring doctor and medications. Even as a senior, I still remember some of my worst nightmares.

A: Nightmares for children may begin as early as three years of age. They commonly decrease in frequency and intensity after around the age of 10 yet in some individuals, the nightmares continue into a person’s teens, adulthood, and throughout their lives. The sleep disorder is referred to as parasomnia and involves less than pleasant experiences while falling asleep, during sleep, or on awakening.

Nightmares may be vivid, real, and extremely intense. The individual may awaken, feel anxious, afraid, sad, threatened, and falling back asleep may be difficult to impossible. And, the younger a person is when having bad dreams or nightmares, the more frightened he or she may be. The subject matter may have a bearing on the person’s age. A young child may dream of monsters, a scary TV show, or being in the dark, while someone slightly older may dream of not turning in school papers or being unable to find the right school bus to get on to return home. Someone older may have bad dreams or nightmares because of the death of a loved one, stress at work, or may reconstruct a traumatic event that occurred recently. So what causes nightmares or bad dreams to occur? For children, it may be irregular sleep patterns brought on by travel or visiting relatives rather than being at home, sleeping in a strange bed, or moving away from a “safe” house and to another town and attending another school.

Treatment may, in part, depend on the age of the individual having nightmares. With children, talking about the dream and making it clear that it is just that – a dream – must be stressed. The child may need to be comforted, need a favorite stuffed animal to hug, or have a night light left on to be sure the goblins don’t return in the night. You may be able to hang a note on a child’s door telling monsters or bad animals they aren’t allowed in. Or, you can make a lighthearted effort to do a nightly check under the bed and in the closet with a flash light to assure the room is a safe one and no monsters are hiding. And, I can appreciate that older individuals may require the help of a therapist or psychiatrist. As we age, stress, medications including beta blockers, anti-depressants or blood pressure drugs may be to blame. Substance abuse cannot be overlooked, nor can stress or mental health issues that require professional intervention.

No one wants to give a child medication and many older individuals prefer to be treated, whenever possible, with effective natural remedies rather than medication. A warm glass of milk before bedtime may help a child, and a cup of herbal tea or melatonin may help a teen or someone older. The key here is to speak with the pediatrician or primary care physician early on, not after years of agony, in the pattern and determine what intervention is appropriate. When natural remedies fail to provide relief and when a health care provider determines prescription medication is appropriate, that avenue should be considered. Drugs aren’t always the answer. They can have other side effects and we certainly don’t want to substitute one issue with another. So, you may be unhappy with beginning slowly but it may be best in the long run. I’m glad you have someone able to help you.

Neurological disorder plagues patient

Q: I’m a female, age 50. After three plus years of symptoms, I have been diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) this year by my neurologist. I have just completed my second month of intravenous immunoglobulin treatments. My PCP told me if I didn’t have these treatments, I would end up in a nursing home. The only other treatment available is to suppress my immune system but that is not an option since the risks of liver and/or brain cancer are too high.

Do you think I have any other options available and what can you tell me about CIDP? I could not come up with a cause, nor could my neurologist so any information you can provide would be appreciated.

A: CIDP is a neurological disorder that presents with progressive weakness and impaired sensory function of the extremities. Symptoms may include numbness and tingling that begins in the fingers and toes, areflexia (loss of deep tendon reflexes), fatigue, and weakness of the arms and legs. The disorder is caused by damage to the myelin sheath of the peripheral nerves. Myelin is the fatty covering that surrounds and protects nerve fibers. It has been noted that patients frequently report a viral infection several weeks prior to the onset of the disease. While both genders can be affected, CIDP is more common in men than in women and is seen in young adults more frequently than in older ones.

Diagnosis of CIDP is generally accomplished by an EMG so the neurologist can study the patient’s nerve function. In some instances, a spinal tap may be performed, while in other cases, a muscle and nerve biopsy may be done. CIDP is more common in those individuals with a diagnosis of diabetes.

The mainstay of therapy is steroids, plasma exchange and intravenous immunoglobulin therapy. Some physicians may choose an addition of imunosuppressant drugs. While steroids are known to have serious side effects, patients may find improvement in a matter of weeks once the therapy is begun. When patients fail to respond completely to steroids, there are also steroid sparing drugs that can be attempted. Plasma exchange and IV immunoglobulin therapy have also been found effective and physiotherapy may help improve muscle strength and mobility, while minimizing muscle and tendon shrinkage. Plasma exchange involves removing blood from the body, clearing away the antibodies, and returning the blood back to the individual in a process that resembles dialysis.

As I have said many times, disorders present differently and the response is different from patient to patient. Some individuals may experience spontaneous recovery, while others may only experience partial recovery between relapses. In some instances, an overall weakness may occur and be so severe as to require actual hospitalization. Generally speaking, symptoms may begin with muscle weakness, numbness, extremity pain, and a gait abnormality. Progression of symptoms may vary from days to weeks to months. One study from 2006 indicated complete remission (defined as lasting more than two years with normal nerve conduction studies), was noted in 26% of the patients observed. Partial remission (defined as being able to walk) was noted in 61% in the group and a severe disability (indicating an inability to walk) or relapses related to tapering of medication were present in 13%. Because of the periods of remission and relapses that occur, most patients will likely require some form of therapy for life.

Cost of medication is downright frightening

Q: Why won’t doctors listen to their patients any more? I’m old school and accustomed to a doctor listening to a patient’s concerns when prescribing medicines. Today it seems doctors just prescribe the newest and most expensive medicines on the market without actually knowing much about them. I’m referring to some of the cholesterol medicines out now. Well, I just don’t seem to be a candidate for any of the cholesterol lowering medicines. They seem to cause me more problems than they’re designed to cure.

For example, after only a few days on one drug, I was in so much pain I could barely walk or lift my leg. Can you imagine what it would be like driving and getting pulled over by a cop when all of a sudden sweat just pours off you and runs down your face like a faucet being turned on? Well, that’s what it was like. At first I didn’t connect all the side effects to the cholesterol med. When I did, I stopped taking the drug and the severe muscle pain in my thigh and legs went away within days. I’ve tried to explain this to my doctor, only to be met with a blank stare – and advice to try another medicine which wasn’t any better and even more expensive than the one before. I almost passed out when I took the prescription to my pharmacy and was told what it would cost to be filled.

I’m frustrated and tempted just to stop going to the doctor altogether. It’s as if they want you not to have a say in your own treatment. I tend to suspect doctors may not be reading lab results correctly – as has happened numerous times before – and which led to what could have been some serious complications.

I don’t fit the stereotype of the individual who doesn’t eat right. I don’t eat fattening or junk foods so it’s not a challenge for me to stay away from them. I usually eat lots of fish and vegetables and I love eating fruit. I only cook in olive oil. I exercise. Despite this, my doctor often tells me I’m eating ice cream and chocolates and that’s why my numbers are high. Sign me frustrated.

A: And I don’t blame you for being frustrated. Without knowing what medication you were on, I can only assume you were placed on a statin drug which is designed to block a substance in the body that produces cholesterol. Statins also reduce a patient’s risk for developing cardiovascular disease and countless other disorders, yet they aren’t right for everyone. Common and well-known side effects may include joint and muscle pain, constipation/diarrhea, nausea, type 2 diabetes, and liver damage (which is why physicians order lab work on a periodic basis). Statins can cause an increase in liver enzymes.

There are options to drugs in this category, yet that’s not at the top of your to-do list. First and foremost, you need a new physician. If your doctor is not willing to work with and believe you, find someone else who will. Speak with other family members or neighbors, or telephone your local hospital for a referral. Make an appointment for a get-acquainted visit. Explain your situation. If you don’t like what you see and hear, simply say thank you and walk away. There is help for you. Your problem may have a genetic overtone and have nothing to do with the secret indulgence in ice cream and chocolates your present doctor perceives you have. He’s wrong in not listening and you have every right to find someone in whom you can trust.

Is medication to blame for gynecomastia?

Is medication to blame for gynecomastia?Is medication to blame for gynecomastia?Q: I am a male in my mid 40s. About three or four months ago my breasts began to actually hurt and enlarge. I didn’t want to see a doctor but finally made an appointment because of the pain. He ordered a mammogram which was really embarrassing for me. I’ve always thought that test was just for women and not for men. Anyway, the X-ray was normal and I was told I had gynecomastia. Well, my breasts still hurt.

I’ve since heard through a television ad that if men suffer from painful breasts and have ever taken Risperidone, there may be a connection. I was prescribed Risperidone for a short time several years ago but discontinued the medicine because I didn’t like the way I felt when I was on it. I’m not interested in calling any 1-800 number so I can sue but I’d sure like to know why I’m in such pain all the time. Could this be my problem and where do I go from here?

A: Risperdal/Risperidone is an antipsychotic medication approved for the treatment of bipolar disorder and schizophrenia in adolescents and adults and autism spectrum disorders in children and adolescents. The medication is not approved for use in psychotic conditions with a relation to dementia. The product was initially approved by the FDA to treat schizophrenia in 1993 and later uses for the drug were expanded. Physicians often prescribe drugs for conditions other than which they were intended. Referred to as ‘off label’, this practice has been used to treat ADHD and other disorders. Government regulators and attorneys general in 36 of the United States and the District of Columbia settled a suit in which they determined the manufacturer of Resperdal (Rispirdal) illegally promoted off-label use in children prior to FDA approval for younger patients. Beyond that, hundreds of lawsuits have been filed against the manufacturer by users who claim psychological trauma from breast growth. In 2011, two lots of Resperdal (Rispirdal) were recalled when they were found to be contaminated with chemicals used to treatment pallets manufactured for shipment and in 2013 another injectable Resperidal (Rispirdal) recall occurred because of concerns with mold.

Unfortunately, what makes Risperdal work is exactly what can cause side effects which may include tremors, agitation, weight gain, extremity pain, headache dizziness, depression, and more. The drug works by altering the levels of serotonin and dopamine in the brain. Unfortunately, a number of complications may be triggered by the abnormal levels of hormones in the body, thus the prescribing physician should be notified if any of the following conditions develop – a high fever, cardiac arrhythmias, breast swelling or tenderness (in men or women) impotence, easy bruising, cough, or shortness of breath. Patients could also experience a reaction if they take specific prescription medications, some over-the-counter substances, vitamins, or herbal products.

So, can I indicate the medication is the result of your breast enlargement? Perhaps so, but the answer is best left to your prescribing physician who can review your medical history and make or rule out the connection. Other possible reasons may include the use of ulcer medication, the excessive use of alcohol/amphetamines/heroin/methadone, hyperthyroidism, kidney or liver failure, tumors, the aging process, the buildup of fatty breast tissue, and many other conditions. Gynecomastia in men generally occurs between the ages of 50 and 80 and at least one in four men in this age group are affected. If you haven’t already, ask your physician to order lab work.

Young doctor’s age off putting for woman

Q: My husband’s feet and lower legs started swelling a few months ago. He went to an internist who is in his second year of practice. He had blood work and several tests to rule out heart trouble and blockages. The doctor said everything came back normal, including the kidneys and thyroid. He prescribed a water pill and it didn’t help. The swelling is still there and my husband is now feeling worse. He has shortness-of-breath.

Do you have any advice as to what we should to next?

A: The causes for foot and ankle edema are many. The most common systemic diseases involve the kidneys, liver and heart – essentially because of the body’s retention of too much sodium. Excess salt can cause the body to retain water which then leaks into interstitial tissue space and results in edema. If the flow of blood to the kidneys is decreased by heart failure, the kidneys react by retaining salt. An inefficient heart cannot pump blood adequately through the lungs, causing a person to become short of breath as fluid accumulates in the lungs.

Other than a water pill, you don’t indicate if your husband is on any other medication such as a calcium channel blocker or NSAIDs (non-steroidal anti-inflammatory drugs) that could have edema as an unwanted side effect. Up to half of all patients on calcium channel blockers develop edema. My guess is that the medication aspect should have been covered when he saw his physician but if not, you should make a list to present to him or her for review.

Then there are bad dietary choices including eating foods such as potato chips or salting foods heavily (sometimes even prior to tasting them), indulging in anchovies, eating canned soups, many of which are high in sodium, consuming cold cuts from the deli on an all too regular basis, and much, much more.

While you indicate his heart was checked, heart failure a/k/a CHF is a condition in which the heart fails to pump blood sufficiently throughout the body. This situation may cause a buildup of fluid in the feet, ankles and legs. CHF is more common in seniors than in younger individuals, in those who have had a heart attack, and in people who are obese. While obesity itself does not cause leg edema, the excess weight can lead to lymphedema, idiopathic edema, chronic venous insufficiency, and more. Men are more likely to develop CHF than are women.

Venous insufficiency presents with pitting edema. The individual with a venous insufficiency may have varicose veins. While most patients remain asymptomatic, a sensation of heaviness can occur. A clinical diagnosis may be made; however, confirmation with imaging testing known as a Doppler ultrasound may be used for confirmation.

I can appreciate that your husband’s doctor indicated his heart and thyroid are working well but patients over the age of 45 who suffer from extremity edema of uncertain etiology might consider having an echocardiogram to rule out pulmonary hypertension, heart failure, or other cardiac abnormalities. Your husband should ask about wearing compression stockings which might help the edema but are contraindicated for arterial insufficiency.

Edema can be temporary or it may be permanent depending on its cause. Treatment will depend on the underlying cause which must be determined. If your husband smokes, he should discontinue the practice. If he is on medication for high blood pressure, he should speak with his physician regarding the possible side effects. While he may not be able to discontinue the medication, he might be able to substitute it for another drug. He should put a pillow under his legs and feet when lying down so his legs are higher than his heart. In fact if he can do this three or four times each day, it might help.

Ask for a referral to a cardiologist since the odds are that this problem is cardiac related. If it isn’t, then the cardiologist can recommend a pulmonologist, but don’t be put off by the doctor’s age. An older physician may be able to pull a few tricks out of his hat but a younger one has the benefit of newer technology and cutting edge training.

When is the right time for pneumonia shot?

Q: I had my second pneumonia vaccine seven years ago at the age of 64. My family doctor says I don’t need another since I am over the age of 65. My hospital says people over 65 should get a follow-up shot every five years. So who is correct?

A: According to the Centers for Disease Control and Prevention (CDC), there are presently two types of pneumococcal vaccines available – PCV13 (pneumococcal conjugate vaccine) and PPSV23 (pneumococcal polysaccharide vaccine) that protects against, you guessed it, 23 strains. PCV is most commonly given to infants and young children who may have missed their immunization earlier. Those healthy children between the ages of two and four who have not been vaccinated or who have failed to receive the full series of four doses should receive one dose. Children between the ages of two and five with medical conditions that might include chronic heart or lung disease, sickle cell disease, a damaged spleen, HIV/AIDs or who have a compromised immune system and have not completed the full series should get one or two doses. Children 6 through 18 need direction from their pediatrician since specific medical conditions will call for one dose of PCV13 or a dose of PPSV23.

So, what is recommended for adults? According to the CDC, we never outgrow a need for vaccines. Those required by an adult are determined by such things as age, lifestyle, high-risk conditions such as working in a nursing home/hospital/adult day care center, the amount of travel done, and what immunization has been administered to date. All adults 65 and older who have not previously received PCV 13 should be vaccinated. Then between six to 12 months later, a dose of PPSV23 should be administered. You don’t indicate which vaccine you received, nor do you indicate if you have any medical issues that might come into play. If you have already received a dose of PPSV23, a dose of PCV13 should follow at least one year after you received the PPSV23. While you may be scratching your head at this one, essentially the CDC recommends one dose of PCV13 and one dose of PPSV23 for adults 65 or older – unless those adults have certain health conditions. Those are their guidelines and they are sticking to them.

The vaccines we received as children may protect us for a lifetime – providing we know which vaccines we received and immunity can fade as years pass by. We often become more susceptible to serious diseases such as pneumococcus. In fact, there were about 32,000 cases of invasive pneumococcal disease reported in 2012. This disease is serious and many of its strains are antibiotic resistant. Vaccination is available and is the best way to prevent the disease.

Adults over the age of 65 who receive the PPSV23 vaccine prior to the age of 65 should receive a booster shot if it has been more than five years since being vaccinated. Since you have had a 7-year interval and in accordance with the recommendation of the CDC, you are ready for a booster. You could not have been vaccinated against pneumococcal bacteria as a child because the vaccine wasn’t available until 2000; however, you should be guided by what your primary care physician who has access to your complete medical history has to say. The vaccine can be given at any time of year, is approved by Medicare and most insurances, and it is essentially painless.

Alcoholic seeks help through drugs

Q: I’m having a really hard time fighting with alcoholism. I suffer from anxiety and a nip or two, maybe more, calm my nerves some during the day when I have to work. Some of my friends have told me that Campral might be my answer. Can you provide me with any information so I can make a decision if it will be right for me?

A: Acamprosate (campral) works by helping restore the brain’s chemical balance of an alcoholic who has recently stopped drinking. The medication is also combined with counseling and behavioral modifications. To begin with, if you continue to drink or if you may have issues with other addictive substances, it is not likely to be effective. If, on the other hand, you have undergone detoxification or have attended AA meetings successfully, it may be helpful in balancing things and keeping you from drinking. Other than Campral, there are other medications such as naltrexone that may be used to help achieve alcohol abstinence. You might choose to speak with your physician regarding this alternative.

Campral will not prevent alcohol withdrawal and it should not be taken if you have severe kidney disease. Your prescribing physician should be informed if you relapse and have a drink or several drinks once you are on the medication. Campral should be taken exactly as prescribed – no more and no less — and for the time period indicated. The pills should not be crushed or chewed but should be swallowed whole, since they have a special coating that reduces side effects when it hits the stomach. Side effects may include depression, pain or weakness, anxiety, sweating, insomnia, paresthesias (numbness or a tingling sensation), and more.

While you don’t indicate your age, Campral’s normal dose for adults and geriatric patients is 666 mg three times a day. Geriatric patients are more likely to suffer from a decrease in renal function than are younger individuals. And, if refills have been ordered, there should not be a lapse in time between prescriptions. On another note, my guess is that your primary care physician is aware of your anxiety issues. If not, he or she should be advised prior to you beginning the medication so a determination can be made if Campral is right for you.

Because we all respond differently to almost any drug, you should be well-informed on the symptoms of overdose and potential side effects which may include nausea, a metallic taste in the mouth, incoherent speech, diarrhea/constipation, excessive fatigue, abdominal pain, weight loss, and more. Some of the side effects may dissipate once your body adjusts to the dose you are placed on but a continuation of the drinking habit will not improve with time. You might want to play it safe and keep your doctor informed.

Change isn’t easy and alcoholism is a disease that is extremely difficult to deal with. I commend you on taking an upper hand to get your habit under control. I might also suggest AA if you haven’t attended meetings yet. There are many, many individuals in the same boat as you and a support group may be extremely effective. Find alternatives to drinking by occupying the time spent with other healthier habits. Avoid triggers. If the people you work with stop after work for a drink or two, excuse yourself and head for home, being sure to stay active. Walk the dog, read the newspaper, or catch up on the news on your television instead. If you have a supportive family, tell them of your new goals and plans and ask for their support at what may be difficult times. You’ll be glad you did.

Young man fights intestinal issues that control his life

Q: Hopefully you can give me some direction or advice to help my son out. He was diagnosed with H-pylori bacteria based on his symptoms of severe stomach pain, weight loss and a blood test. Then he was also diagnosed with IBS. After completing a course of antibiotics, his stomach and bowel issues continued to plague him, causing pain in his lower left abdomen. He continues to take Miralax to keep his stools soft and Prilosec to help with acid reflux. His diet is limited and issues seem to flare up a few times a week, either due to the food he’s eaten or possibly because of stress, although he states he doesn’t feel stressed about things. He states the pain gets worse sometimes after a bowel movement. In March he had such discomfort and pain that we visited his pediatrician and an X-ray showed that his bowels were packed. The doctor recommended an enema or suppository. Instead, he took two doses of Milk of Magnesia over a two day period and he was able to empty himself out. He wants to take Milk of Magnesia again but I was told by our pharmacist not to become dependent on it.

In April we visited a pediatric GI specialist and after taking a history, feeling his stomach and getting a blood test, he found nothing. My son has missed more than 20 days of school this year and has missed out on many other outings due to his stomach pain and bowel movements.

Some family history includes anxiety issues and Crohn’s disease, along with IBS but the GI specialist did not find signs of Crohn’s.

Would an endoscopy be recommended? A fiber laxative? Any recommendations, directions or guidance would be appreciated. Thank you. I enjoy reading your column.

A: H. pylori infection is a bacteria that infects the stomach. It is more common during childhood and most individuals are unaware they even have such an infection because they don’t have any symptoms. When they do, they are treated with antibiotics.

IBS (irritable bowel syndrome) is a chronic condition that affects the large intestine, causing abdominal pain, constipation and diarrhea, cramps, bloating and gas. For some, diet modification, avoiding stressful situations and some lifestyle changes will help. For others, medication and perhaps counseling may be more appropriate. Common triggers include stress, specific foods including milk, soda and other carbonated drinks, broccoli, and chocolate.

Milk of Magnesia is recommended as a laxative to relieve occasional constipation. It should not be used for general stomach pain, nausea or vomiting because the symptoms are vague and could represent an entirely different but critical issue. Further, it is not recommended for longer than seven days without medical advice and should not be taken in conjunction with vitamins or herbal products.

An endoscopy is an instrument with a small camera attached that allows a physician to view what is going on inside your body. An upper GI endoscopy may assist a physician determine the cause of such things as abdominal pain, unexplained weight loss, nausea, vomiting, abnormal growths, and more.

I feel your son should be seen either by his pediatric gastroenterologist or he should seek a second opinion. He may also benefit from stress counseling. His symptoms cannot be treated unless and until they are diagnosed. Until a physician works with you to rule out some disorders and hone in on others, you and your son will continue to have unanswered questions. You know he has bowel issues. You know he needs better control over his diet. And you know he should avoid stressful situations whenever possible. That’s a good start. Now you need to determine what causes him to have the debilitating issues that he constantly suffers from.

Keeping toenail fungus at bay

Q: I recently lost a toenail, probably the result of fungus. Would it help to apply Miranel or some other product on the nail bed to deter the reappearance of the fungus?

A: Yes, it certainly would. A nail fungus is technically known as onychomycosis, a condition that begins as a white or yellow spot under the tip of the nail. As the infection continues, the fungus may have caused your nail to discolor and thicken, become brittle and crumble, and turn dark because of the buildup of debris under the nail. Causes for a fungus to form may include yeasts and molds, both of which love environments such as the feet, simply because warm, dark, moist shoes provide a perfect setting for a fungus to form on toenails. And, the toes have less blood flow than do finger nails, making it more difficult to eradicate the infection. Factors that may increase a person’s risk for developing an infection include walking barefoot in public areas such as a fitness center or gym, near a swimming pool or locker room, wearing socks that hinder adequate ventilation, having diabetes or circulatory problems, being diagnosed with a skin condition, or athlete’s foot. You may also have a suppressed immune system or be older and have diminished circulation to your feet.

There are a number of over-the-counter medications such as the Miranel you mention which should help your new nail grow free of infection. An option is oral anti-fungal drugs that can also be prescribed by your physician. On the downside, oral medications may take up to 12 weeks to be effective and the end result will not be observed until your nail grows in completely which could take an extended period of time. You don’t indicate your age but the success rate with medication is markedly reduced in individuals over the age of 65 and success appears most apparent when a combination of oral medications and OTC Miranel or others are used simultaneously. Oral antifungals have the potential for liver damage so your physician may insist on periodic blood testing to be assured things are okay. Keep in mind that repeat infections are common, so don’t despair.

Antifungal medicated nail polish is now available that can be painted on infected nails. The polish is applied to the nail and surrounding skin once daily for a week. At the end of that time period, the layers are wiped off with alcohol and the process is repeated all over again – for up to a year!

On the home front and to prevent re-infection, keep your nail(s) trimmed. Wear socks that are a blend which will allow the wicking away of moisture and allow for better ventilation. If possible, rotate your shoes so the insides can dry completely between wearings. Treat your shoes with a disinfectant or anti-fungal powder between wearings. Refrain from going barefoot in public areas such as shower rooms and instead, keep a pair of flip flops available for such occasions. Be sure to wash your hands after working on or touching any infected nails.