I have read many articles lately about the dangers of HRT, both long- and short-term. However, my primary care physician is adamant that the benefits outweigh the dangers and he continues to prescribe them for me. I respect and trust this physician and have been his patient for more than 40 years, but given the fact that my sister had a double mastectomy (of which he has been made aware), I wonder if continued use of the hormone is safe for me.

I would appreciate your thoughts on this matter. Thank you in advance for any comments you may make.

DEAR READER:
I must congratulate you on the research you have done, as you are extremely well informed.

Levels of female hormones can vary before and during menopause and can result in hot flashes and vaginal dryness. HRT is prescribed to lessen or substantially reduce those unwanted symptoms. Therapy should be prescribed in the lowest possible dose for the shortest possible time to accomplish this. On the positive side, I must state that HRT may protect a woman against osteoporosis.

On the down side, however, it can increase the risk of breast cancer, stroke and heart disease. Certain types of HRT present a higher risk and each woman’s personal risk will vary, depending on lifestyle and family history.

You have a sister who underwent double mastectomy. I don’t know of a stronger family tie than that. In my opinion, you have been on HRT far too long. I am sure all symptoms of menopause have passed at this stage. If vaginal dryness is a concern, there are over-the-counter medicines available. If osteoporosis is a concern, add calcium-rich vegetables to your daily diet, or take calcium supplements.

You have a legitimate and legal right to advise your physician you are stopping the medication. Were I you, I would have done so a long time ago. However, giving him the benefit of the doubt, you might get a second opinion from another physician. In this way, you might feel more comfortable in going against his recommendations. If the action causes ill feelings with your long-standing physician, so be it. In my opinion, he’s wrong. He could have taken you off the medication more than 20 years ago, if even for only a trial period. He didn’t.

We are often fearful of angering a physician or someone of authority. What isn’t taken into concern is that you have only one body and, as long as you are in a proper frame of mind (which you certainly appear to be), you have every right to be in complete charge of it. Take a firm stand, advise him of your wishes, and be sure to stick to your guns. Enough is enough.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

What do you think I should do?

DEAR READER:
Initially, I recommend you speak with your physician about having the wound cultured to determine why it isn’t healing. Perhaps you have an infection that isn’t being eradicated. You may require a prescription antibiotic instead of iodine and Neosporin. The testing will provide the answer.

Then, ask if you can cover the wound with a dry, sterile dressing or use other methods to deter scratching. You must allow the wound to heal on its own without continually irritating it.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I went to my nurse practitioner who wasn’t sure what was causing this. She called in the physician whose office she works in, explained what I was complaining about and he just shook his head.

I’ve had osteoarthritis for years for which I take Celebrex twice a day. I also take Celexa for depression, Nexium for reflux, multi-vitamins, vitamin C, calcium and omega 3. Would you have any idea what is causing the burning sensations? They’re very uncomfortable, even though they only last a few minutes at a time.

DEAR READER:
Let’s review some of your medications. Celebrex can cause constipation, diarrhea, gas, headache, heartburn, nausea, stuffy nose and more. Severe reactions to the drug can cause chest pain, swelling of the hands and legs, rash, hives and itching. Nexium can cause drowsiness, shortness-of-breath, hives, tremor, and more. Severe reactions include gastrointestinal infection. I recommend you read the ingredient panel of your multi-vitamin. What is the recommended daily dose — one pill, two pills? Will you then consume 100% of the RDA? Does it contain vitamin C, calcium and omega 3? If the answer is yes, you can eliminate these last three drugs. If the answer is no, you might switch to a better multi-vitamin that does contain what you need.

I recommend you return to the prescribing physician for a review of your Celebrex and Nexium. If he or she feels you might be suffering from unwanted side effects, request a change to another product that might provide the relief you are looking for.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine“. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Also, should this drug be given long term?

DEAR READER:
Seroquel is an anti-psychotic medication used to treat conditions such as bipolar disorder. It is not approved for behavioral problems related to dementia. Black box warnings for elderly patients with a dementia-related psychosis indicate an increased risk of serious side effects, including pneumonia, heart attack, stroke, and death.

The product is available in doses from 25 to 300 mg tablets or capsules by prescription only. When the drug is prescribed for the elderly, the recommended initial dose is 25 mg daily. Contraindications are noted for those individuals with a history of hypertension, stroke, thyroid disorder, diabetes, high cholesterol, seizures, or heart attack.

Side effects can include fever, sweating, uncontrolled muscle movements, severe headaches, visual and gait disturbances, and more. Be sure to speak with the prescribing physician should any symptoms occur.

Seroquel XR extended release tablets also contain black box warnings because of an increased mortality rate in elderly patients with dementia. XR is indicated for the treatment of schizophrenia, a name given to a group of mental disorders in which a patient loses touch with reality and is unable to think or act in a rational manner. The condition is often treated with tranquilizers and specific drugs to lessen the degree of depression. Extended release tabs are not recommended for the elderly.

Adverse reactions include dry mouth, dizziness, orthostatic hypotension, constipation, a feeling of sedation, and more.

There are a number of interactions with this drug. Be sure to advise your physician of any medications you are taking to assure there will not be a negative response should he or she choose to prescribe Seroquel XR.

The long-term effectiveness (more than six weeks) has not been fully evaluated. All prescribing physicians should re-evaluate patients on a regular basis.

You are correct that the drug can be dangerous for elderly patients with dementia. I can only hope the prescribing physician fully researched all the options before prescribing it and that the dose is a reasonable one.

All patients regardless of age that are treated with anti-depressants or anti-psychotics for any condition should be carefully monitored for negative alterations in behavior, especially during the early stages of a new medication. Family and caregivers must be observant and should report those changes accordingly

If you continue to have unanswered questions and have the legal right to be involved with the care of the individual in question, return to the prescribing physician with a list and request answers. If you remain dissatisfied, seek a second opinion.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

It has reared its ugly head several times during the past few years. Once I ended up spending several days in the hospital. This was preceded by a high fever and chills. Many times I’d awaken with my clothes wet from the fever having broken. Another time a lump started forming on my right thumb knuckle. The area got red, sore, and looked like a big boil.

Still another time my right hand and fingers swelled up, only to subside with antibiotics. At times my eye swells and my lips are affected. In fact, my lower lip is now covered with thick, heavy crusted scabs that burn and itch.

I can’t see a doctor for almost a month and am at my wits’ end.

DEAR READER:
Cellulitis is a bacterial skin infection that appears as a swollen red area, hot and tender to the touch. It occurs when there is a break or crack in the skin, as can occur with puncture wounds, cuts, ulcers, dermatitis, athlete’s foot and other conditions that allow bacteria to enter. Certain types of insect and spider bites can also transmit cellulitis. It most commonly appears on the lower legs or ankles, but can present anywhere on the body. Children and the elderly commonly have the condition on the face.

Complications arise when the tissue under the skin is affected, allowing bacteria to spread to lymph nodes and the blood stream. Those with diabetes, compromised immune systems and senior citizens are particularly susceptible.

Prescription antibiotics that treat both staphylococci and streptococci are most often prescribed. Positive results are generally seen within a few days following ingestion of the drugs. Because it will be quite some time before you can see your physician, I would speak with him or her about keeping a prescription in your medicine cabinet for unexpected outbreaks. Antibiotics are not to be taken unnecessarily, yet you appear to know what to look for and could nip the condition in the bud between visits to the office. Do your best to keep your hands away from the lesions to prevent further skin contamination.

Prevention includes washing the area(s) daily with soap and water, applying antibiotic cream, keeping your fingernails trimmed, and covering the lesions with dry dressings to avoid further contamination. When the condition occurs, it should be brought to your physician’s attention promptly so it can be identified and treated.

The lesions on your lower lip are of concern to me. Make it a point to visit the doctor’s office during an outbreak to determine you are dealing with cellulitis in this case and not an unrelated condition.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I’ve taken Fosamax for almost seven years for mild bone loss and recently read of a scientific study indicating the drug can cause heart abnormalities — including atrial fibrillation, congestive heart failure, blood clots, and stroke! I stopped taking the Fosamax immediately.

Is my atrial fibrillation a chronic condition now or does the discontinuation reduce and eventually end the symptoms? Is there a SAFE bone-loss drug available? Have you any idea why this important information for women is not well known? Is there some sort of pharmaceutical cover-up?

DEAR READER:
Atrial fibrillation is a condition that presents as rapid, abnormal, irregular heart beats. The lower chambers of the heart can beat 130 times per minute while the upper chambers can send out more than 350 electrical impulses per minute. The irregularity results in a decreased amount of blood pumped to the body. The disorganized contractions of the upper heart chambers can cause clot formation.

Now for the Fosamax. I don’t know of any medication, to include aspirin, that does not have the potential for some side effects in some individuals. On the up side, research has shown Fosamax reduces the incidence of hip fracture by 63%. This is a significant finding for post-menopausal women. Now comes the down side. Fosamax appears to double a woman’s chances of developing atrial fibrillation, even if no history of heart abnormalities is present. This was not known when the drug was test marketed, nor was it known for several years thereafter. To my way of thinking, herein lies the problem. New drugs enter the market and promise to cure every condition known to mankind. Long-term effects of drug use are not known for years.

The manufacturer did not conceal the news; the bad press made headlines in newspapers and on television across the country. The drug is still being used and has not been recalled, but doctors are aware of the devastating potential side effect. Many have rightly converted their patients to a different drug without the side effect you experienced. You were wise to discontinue the medication. Hopefully your condition isn’t chronic and you will not experience repeat episodes.

Safer alternatives include calcium and vitamin D, calcitonin, and more. Speak with your physician about your best alternative. He knows your complete medical history and is your best bet for the suggestion of a substitute.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I had my blood checked to see if it is too thin, but that test was negative. A thyroid test was slightly low, but I haven’t talked to my doctor about that yet to see if there is a connection. My medications are Spiriva, Albuterol and Armour thyroid. I was previously on Symbicort, but it made my tongue swell and become raw, so I was switched to the Spiriva that doesn’t work as well. I’ve been on the thyroid medication for 50 years and expect to have to take it for the rest of my life.
I really would appreciate your input.

DEAR READER:
Your Spiriva prescription has an uncommon side effect of rash for a very few individuals. If the rash appeared once you made the switch from Symbicort to Spiriva, you have your answer; your leg rash is drug-related. If, however, you had the rash prior to the switch, you must look elsewhere.

Your tongue swelling was an indication you could have had an allergic reaction to the components of the drug and your physician was correct to make the change to Spiriva.

While you sent a photograph of your rash the condition is difficult to diagnose since there are so many possibilities. It could be viral or bacterial in nature, a form of plant dermatitis, Lyme disease, pityriasis, Sjogrens, or other conditions.

I would rule out the Armour thyroid, because you have been on it for so long. The combination of the three drugs, however, could interact and present in the form of unexplained rash. The only true way of determining this is to eliminate one drug at a time to see if the rash disappears. Because of your COPD, I would urge you to speak with your physician or cardiologist before even considering making any changes. In the interim, you should make an appointment with a dermatologist if you haven’t already done so. See him or her while the rash is in full bloom so a diagnosis can be made.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Statin drugs are effective in lowering cholesterol levels and reducing the risk of heart attack and death in patients with known coronary artery disease. Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Zocor (simvastatin), and Crestor (rosuvastatin) fall into the statin category. If you are on any of these medications, you are taking a statin.

The most common side effects are elevated liver enzymes and leg cramping. If you are on a statin, your doctor should schedule periodic laboratory testing to determine if your levels are within normal limits. If the cholesterol level remains high despite the medication or the liver enzymes start to rise to dangerous levels, he or she will likely make a determination to change to another drug that will be more effective.

I don’t wish to be offensive but it is just plain foolish to be taking any drug without knowing what it is, why you’re taking it and how long. It is also important to know if it should be taken with food or on an empty stomach, if there is an equally effective yet cheaper generic brand and what the consequences might be if you miss a dose. Because statin drugs can have serious side effects, it is often necessary to undergo a trial period of two or three weeks to determine if you can tolerate it. Diet modifications must be made before any cholesterol-lowering medication is prescribed. A low fat, low salt diet may even eliminate the need for statins and should be continued once you have been diagnosed with elevated cholesterol levels.

I urge you return to your primary care physician with a list of questions. Take a spouse, relative or friend with you if you wish. Two heads are often better than one when it comes to remembering important information. You owe it to yourself to be an informed consumer and your doctor owes it to you to explain why he or she is recommending you subject your body to medication.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Staphylococcus (staph) is a type of bacteria that can lead tp infection of the skin. It can cause sores that may be swollen, painful and appear as a boils, furuncles and pus-filled lesions. There are over 30 different types of staph on the skin of up to 30% of all healthy adults. In the majority of cases the bacteria do not present a problem because of natural protective workings of the body. However, when skin is compromised because of a cut, scrape or other breakdown of the skin surface, bacteria can slip in and infection results.

Illness can range from very mild requiring no treatment to very severe which can be potentially fatal. Virtually anyone can develop an infection. People with chronic medical conditions, lung disorders, and injecting drug users are at greater risk than are others. Newborns are also susceptible.

A physician should view any potential infections to determine the proper course of treatment that can range from over-the-counter ointments to IV antibiotic therapy. When doubt remains, laboratory cultures should be obtained to determine the particular strain an individual has contracted so the right treatment can be administered.

If the antibiotic your physician has prescribed is not doing the job, return to him or her for an exam and change of medication.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

First, my wife was given a prescription that instructed her to take one pill three times a day. She is of the opinion that she is to take the pill morning, noon and evening in the same time frame as breakfast, lunch and dinner. When I saw the instructions, take one pill three times a day, my thoughts were that my wife is to take one pill every eight hours.

Second, my wife is 78 and I am 86. We spend more time than I like in our doctor’s waiting room. As soon as we check in to wait for our appointment, my wife reads magazines that sick people have handled while waiting for their appointments. I think my wife’s habit is not the best thing for her to do.

DEAR READER:
Generally speaking, a medication prescribed three times a day signifies morning, noon and night. People are not expected to set an alarm clock to awaken in the middle of the night to take medication.

I agree with your wife’s theory. She might stretch the program by taking the first pill in the morning, the second around 3 o’clock, and the third at bed time. The difficulty here is that it’s too easy to forget. If pills are taken with meals, a person is much more inclined to take them.

People in a doctor’s office are there for a variety of reasons. They read magazines, lick their fingers to turn pages, cough, and do all sorts of unpleasant things. Common cold viruses can live from a few seconds to 48 hours depending on strain, environment and object.

Let’s take this to another level. Did you close your front door when you last headed out, or kiss your wife? Did you touch the door handle of your automobile, take public transportation and touch the rails on either side of the door as you entered the bus? Did you go to the grocery store and put your hands on the bar of a shopping cart? Handle money? Did you open the doctor’s office door or use the bathroom once you arrived? If so, did you flush the toilet, wash your hands at the sink and turn the faucets on and off? Well, you subjected yourself to more germs than you want to know about. So, reading a magazine in a doctor’s office is just another step in the exposure game.

I recommend you keep antibacterial, waterless hand gel available in the glove box of your car, in your wife’s hand bag, or in other appropriate areas. Then, if you feel you have been exposed to germs, you can use the gel to reduce your risk of contamination.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.