Most people have some benefit that isn't permanent.
DEAR DR. ROACH: I read in a medical advice column that tea tree oil can help cure the nail fungus that I have had for more than 10 years on my big toe. It did dramatically reduce the inflammation around the nail, but the nail is unchanged, and the inflammation subsequently returns. Recently, though, I have seen or heard of several nail fungus treatments that do not present a danger of liver damage. Are there any new treatments for the nail fungus that actually are effective? – J.S.
ANSWER: According to the Natural Medicines Comprehensive Database, 100 percent tea tree oil cream, applied twice daily for six months, is effective at curing infection in only 18 percent of people who try it. Most people have some benefit that isn't permanent, as you did.
The only highly effective medicines I can find good evidence about, with cure rates of 50 percent to 75 percent, all have the possibility, albeit small, of liver damage.
DEAR DR. ROACH: I am 72. Several years ago, because of bad back pain, I had tests and X-rays. The orthopedic physician assistant I was directed to afterward said I'd need hip replacements, or I could get a shot. No more comment than that. At my own insistence, I tried physical therapy instead of a shot. It merely aggravated the situation.
Twice since, I've seen the same PA. We have a little conversation, and he bills me for the same advice. He did not display the X-rays, and I didn't think to ask. I've yet to see the licensed doctor in that office.
Walking is the one exercise that generally doesn't bother me, so that's how I keep a bit active. Judging by charts, I am about 30 pounds overweight. My leg and hip pains now do have me thinking about having at least one hip replaced. How do I initiate this? What sort of improved mobility can I expect? How long is recovery? Might my insurance cover a second opinion? What options are there? Which implants are best? – J.W.
ANSWER: You need a different orthopedic surgeon. He or she will go over all the questions you have — all of which are reasonable, but can be answered only by someone who has examined you, listened to your concerns and knows your particular orthopedic problem. Almost all insurances will let you seek a second opinion.
If you are feeling kind, let the orthopedic surgeon you didn't see know the treatment you got from the PA. It has been my experience that physician assistants give out very good care, within the scope of their expertise, but this one is not giving good care to you, and I'm sure the surgeon would like to know.
The booklet on back problems gives an outline of the causes of and treatments for the more-common back maladies. Readers can order a copy by writing: Dr. Roach – No. 303W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: I am so tired of gastric juices coming up and spraying my mouth. I am currently on a "last resort" medicine. My doctor wants to try it for three weeks. If it doesn't work, he's going to perform a Nissen fundoplication. From what I've read, there would be nothing more coming up. Could you explain this procedure? What will happen with swallowed air, and what will happen if I get sick to my stomach and (shudder) need to vomit? – S.S.
ANSWER: Large volumes of stomach acid coming into the mouth is an accepted indication for surgical treatment of reflux disease. Sometimes, the acid is associated with excess saliva and is called "water brash."
Prior to considering surgery, it is worthwhile to make sure the medication treatment is as good as it can be. Proton pump inhibitors such as omeprazole should be taken 30 minutes before eating. Weight loss is helpful if overweight. Raising the head of the bed 6 to 8 inches (by inserting blocks under the legs of the head of the bed or using a plastic wedge under the mattress) and avoiding dietary triggers (coffee, chocolate, carbonated drinks, high-fat foods) should be tried. Baclofen, a powerful muscle relaxant with many possible side effects, may be the "last resort" medicine you are taking.
When all else fails, surgery may relieve symptoms. A Nissen fundoplication is when the upper part of the stomach, the fundus, is plicated (wrapped) around the esophagus and stitched in place. This can be done via endoscopy or as an open procedure. It is effective at reducing symptoms in 85 percent to 90 percent of patients.
Most people are unable to vomit and have less or no ability to belch, leading to bloating, increased intestinal gas and flatulence. Discomfort during eating is common. There are modifications of the surgical procedure designed to reduce side effects and complications while maintaining effectiveness, but a description of what these all are technically is in your surgeon's domain.
Readers: The booklet on acid reflux, heartburn and hiatal hernia explains these common gastrointestinal disorders in greater detail. Readers can obtain a copy by writing: Dr. Roach – No. 501W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: I have been riding my bike outdoors, same saddle, 130 miles a month for over three years. Out of the blue my left sit bone, or the tissue around it, is so sore. I can't quit riding. Help! – A.D.C.
ANSWER: A good rule of thumb for an athletic injury or sudden soreness is that resting it for a period of time usually is a good idea. Get off the bike for a while and try some different types of exercising: walk, run, swim or lift weights, but give your soft tissues a chance to recover. You may simply have overdone it. If things don't get better, go ahead and make an appointment to get checked out.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved.