Recently in Pharmacy Q&A Category

Q. I am a singer, so my voice is critical to both my livelihood and my sense of well-being. I was recently diagnosed with mild asthma and my doctor prescribed an inhaler called Flovent.

I am fairly certain that this medicine is affecting the quality of my voice. Is this my imagination or could this be a side effect? Are there any other complications I should know about?

A. Fluticasone (found in Flovent and Advair) is an inhaled steroid. Such cortisone-like drugs calm inflammation in the lungs with fewer systemic side effects than oral steroids. Nevertheless, hoarseness, throat irritation, sinusitis, oral yeast infections and voice problems are not uncommon.

One reader was livid that she was not informed of any fluticasone side effects. After years of regular use, she had developed cataracts, headaches and osteoporosis. Discuss your concerns with your doctor.

Q. My doctor recently prescribed Premarin Vaginal Cream. It has improved my life dramatically, reducing dryness and easing other symptoms of menopause. Are there any negative effects? Is it absorbed into my body?

A. Premarin Vaginal Cream contains conjugated estrogens just like Premarin pills. It has recently been approved by the FDA to correct vaginal dryness that leads to painful intercourse. The estrogen is absorbed into the body, so discuss the benefits and risks with your physician. According to The Medical Letter on Drugs and Therapeutics, the long-term safety of vaginal estrogen creams is unclear (Feb. 23, 2009).

Q. I have been taking Protonix for heartburn for at least six months. After I learned that long-term use might lead to complications, I tried to stop taking it. Big mistake!

After about a week, I had to start taking it again due to severe heartburn--the rebound effect, I suppose. I asked my pharmacist how to discontinue acid-suppressing drugs but she was unable to find out. Do you have any suggestions?

A. Rebound heartburn may make it difficult to stop medications such as Aciphex, Nexium, Prevacid, Prilosec or Protonix. As a result, people sometimes end up taking such drugs for years. The consequences might include an increased risk of pneumonia, hip fractures and vitamin B12 deficiency, which can lead to nerve damage or cognitive problems.

We spoke recently with Tieraona Low Dog, MD, Director of Education for the Arizona Center for Integrative Medicine. She recommends a gradual approach for discontinuing acid-suppressors.

Dr. Low Dog suggests taking ginger capsules and chewing DGL (deglycyrrhizinated licorice) tablets as you phase out Protonix. Probiotics may also be helpful during this time. There is much more information about the pros and cons of acid-suppressing drugs and many non-drug approaches for controlling reflux and heartburn in our book, Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online at www.peoplespharmacy.com.

Q. I have a problem and I don't know where to turn. My partner and I don't have sex very often anymore. We have been together for over five years.

I became depressed because of work, family and medical issues but worked through it with his help. He is a great man and I love him more than anything. The problem is that we only have sex three times a month if I’m lucky.

He says it’s not me, but rather that he is under stress from work, family and friends. Is there anything a woman can do to slow down her sex drive? I love this man and will do anything for him, even give up sex if I must.

A. It should not be necessary to give up sex. According to Dr. Ruth Westheimer, a difference in sex drive between two partners is not unusual. She suggests that in a loving relationship, one partner can help the other achieve sexual satisfaction even without intercourse.

Couples counseling can be helpful. He may need a medical checkup to rule out problems with low testosterone. If he is heavy, weight loss may help. A new study suggests that overweight men may have hormonal imbalances that diminish sex drive (Journal of Clinical Endocrinology and Metabolism, April, 2009).
No drugs are approved for lowering libido, but many antidepressants have this effect. So does the herb vitex (chaste tree berry).

Q. I had severe leg pain during the night and day for about four months. My doctor did blood work and found that my vitamin D level was 8. She prescribed me 50,000 IUs per week for twelve weeks and now my leg pain is almost non-existent.

A. Doctors are becoming increasingly aware of the importance of checking vitamin D levels. A surprisingly large proportion of the population has less than optimal levels of this important vitamin. Lower than 20 nanograms per milliliter indicates deficiency. Some experts believe that optimal levels should be at least 30.
Replenishing vitamin D stores can reduce muscle pain. It may also lower the risk of such varied problems as depression, diabetes and heart disease (Dowd & Stafford, The Vitamin D Cure).

Many readers are frightened by the idea of 50,000 IU at a time, but since this dose is usually taken just once a week it comes to about 7,000 IU a day. This is a common prescription dose for correcting a severe vitamin D deficiency like yours.

Q. You’ve heard from a lot of people with bad indigestion. I used to be one of them. One day quite by accident I forgot to buy milk. To my surprise the next day the indigestion disappeared. Since I have given up milk, I can literally eat anything, even Mexican food, without difficulty. I now use lactose-free milk and soy yogurt. I hope this helps others.

A. Many adults have difficulty digesting lactose, the sugar in milk. For them, lactose can cause bloating, cramping or diarrhea in addition to indigestion. Thanks for sharing your story.

Q. I have been on so many cholesterol-lowering drugs I have nearly lost count. Crestor, Lipitor, Zetia and Zocor all give me terrible pains in my shoulders, back and arms. I also have had dreadful muscle cramps in my calves, especially at night.

I don’t know how much longer I can stand taking Crestor, but my doctor just says without it I’m a heart attack waiting to happen. Is there any natural way to lower cholesterol? I want to stay healthy, but the pain interferes with my ability to exercise and has affected my quality of life.

A. If your medicine is preventing you from exercising, it could be counterproductive for your health. Many readers have lowered their cholesterol with red yeast rice. Here is one success story: “My cardiologist suggested I try red yeast rice. Within six weeks my LDL level had dropped from 187 to 123.”

Although readers who have written us about their experience with this dietary supplement rarely have troublesome side effects, some susceptible people do develop muscle pain or weakness while taking this product. If you decide to try it, your doctor should monitor your progress and your liver enzymes. Taking Coenzyme Q10 (CoQ10) might reduce the risk of muscle pain from statins or red yeast rice.

We discuss the pros and cons of cholesterol-lowering drugs and CoQ10 along with red yeast rice and other non-drug approaches in our Guide to Cholesterol Control and Heart Health.

 Vitamin D deficiency may make statin-induced muscle pain worse. Consider requesting a vitamin D blood test and taking supplements if your level proves low.

Q. I read in your column that Detrol might have a negative impact on memory. Both my sister and I have been complaining about memory problems since we started taking it for overactive bladder problems.

I phoned my doctor’s office about this issue and was told they have never heard about this reaction at all. Why are doctors not aware of this side effect?

A. Modern medicine is highly compartmentalized. Specialists in one area may not always be aware of developments in another field. That might explain why a urologist could be unaware of the cognitive impact of certain bladder medicines. The FDA has not required drug companies to highlight this complication.

There is increasing evidence, though, that drugs that affect the activity of the brain chemical acetylcholine can impair cognitive function, especially in older people (Neurological Sciences, online, Feb. 20, 2009). Medications like Detrol and Ditropan can cause dry mouth and constipation as well as confusion, disorientation and hallucinations.

Q. What do you know about prescription Lovaza? My eye doctor prescribed it for dry eyes and eye surface damage due to Sjogren’s syndrome.

I have great respect for my doctor, but I would like to know if other forms of omega-3 fats are just as effective. Lovaza is very costly. He also has me taking flax oil.

A. Lovaza is prescription-strength fish oil (omega-3 fatty acids) approved for lowering high triglycerides. A month’s supply may cost over $160.

Sjogren’s syndrome is an autoimmune disorder characterized by arthritis, dry mouth, dry eyes, dry skin and dry, brittle nails and hair. There is some preliminary evidence that omega-3 fatty acids found in both fish and flax oil might be helpful (American Journal of Clinical Nutrition, Oct. 2005). We see no reason why you couldn’t use high-quality OTC fish oil in lieu of Lovaza.

Q. I am not yet 50 but my doctor says I have something called osteopenia, which could put me at risk for osteoporosis. She has suggested Actonel, but says this decision is up to me. She mentioned that there are some side effects and questions about the quality of the bone that results from this type of treatment. Is it possible that treated bone might not be as strong as that which grows naturally? What else can you tell me about these drugs?

A. There is growing controversy about osteoporosis drugs such as Actonel, Boniva, Fosamax and Reclast (Journal of the American Medical Association, Feb. 18, 2009). Rare but serious complications such as jaw problems, severe muscle, bone and joint pain and unusual thigh-bone fractures have been reported.

One reader shared this story: “I had a right femur fracture in May, 2007 and a left femur fracture in February, 2008. I had been taking Fosamax or Actonel for about 10 years. Prior to breaking these bones I had unexplained thigh pain for several years.”

It seems paradoxical that drugs meant to strengthen bones might contribute to unusual fractures. So you can better understand this issue and other pros and cons of osteoporosis treatment, we are sending you our Guide to Osteoporosis.

Q. Commercials that advertise prescription medicines on TV are my pet peeve. How can we STOP them? I would like to see them go the way of cigarette commercials.

Doctors should be prescribing the drugs people need without the rest of the world being subjected to these irritating commercials. I’m sure many others agree with me. How can we make our voice heard?

A. We have taken many informal polls and found very few people enjoy watching prescription drug ads. Doctors aren’t fond of them either, since patients may try to press for brand name drugs they have seen on TV.

The FDA seems disinclined to do anything to curb these commercials. A ban would require an act of Congress.

Q. I have been on Effexor XR for the past seven years for depression. I decided to wean myself off it, since it wasn't a good mix with another drug I started taking.

The third day I was completely off the Effexor my head started spinning. I felt as if I was on a tilt-a-whirl nonstop! After two days of this, I ended up in the ER getting CT scans and MRIs of my brain.

The doctors finally decided all this was from the Effexor withdrawal. They gave me ONE tablet and all the spinning stopped within an hour! This medication is NOT easy to get off.

A. The whirling sensation you experienced has also been described as “head in a blender.” When people suddenly stop taking antidepressants like Celexa (citalopram), Cymbalta (duloxetine), Effexor (venlafaxine), Paxil (paroxetine) or Zoloft (sertraline) they may experience dizziness, nausea, sweating, insomnia, headaches, nervousness and electrical shock-like sensations.

We discuss the pros and cons of such medications, strategies for stopping them and non-drug alternatives in our new Guide to Dealing with Depression. Gradual tapering of the dose over several months may be the best way to minimize the unpleasant symptoms of withdrawal. Careful medical supervision is essential during this time.

Q. Boudreaux’s Butt Paste caught my eye in your column about diaper rash. Our beagle Buddy was bruising his nose, grinding it to the quick as he went about burying treats, small toys and other objects in some hidden nook of the carpet. He pushed and pushed outward with his nose, rubbing it raw.

Our veterinarian suggested Boudreaux’s Butt Paste, and we thought he was putting us on. Almost embarrassed to ask, I went into our drug store and whispered the name of the product. “Sure, right up here,” said the pharmacist as he reached to the top shelf for a tube of it. It worked! It’s heavy enough that even constant licking kept it in place long enough for Buddy’s nose to heal.

A. Boudreaux’s Butt Paste is a diaper rash ointment that contains zinc oxide. Our veterinary consultant confirmed that veterinarians sometimes recommend this type of ointment for a dog with a sore raw nose like Buddy’s. She cautions, however, that a zinc oxide product should be used for a short period of time and not in large quantities. Dogs do lick their noses frequently, and zinc oxide can be toxic if they ingest too much of it.

Q. I need more information about the generic for the epilepsy drug Keppra. I understand that the generic is fairly new.

Is it safe to take, and does it have the same active ingredient as Keppra?

A. Generic drugs are supposed to be identical to their brand name counterparts. We have received a couple of troubling reports about this epilepsy medicine, however. One reader wrote, “I take Keppra and recently I was switched to a generic version. Several days after I began taking the generic pills, I suffered multiple seizures. I had to go back on name-brand Keppra.” When we asked the FDA about this problem, we were told that the generic formulation was unlikely to be responsible for seizures.

Q. I have been taking thyroid hormones (first Synthroid and then Levoxyl) for more than 15 years. My doctor has recently started lowering my dose because he is concerned that the extra thyroid might weaken my bones.

Ever since the dosage was reduced I have had many troubling symptoms. My cholesterol is going up and so is my weight, although I am exercising and eating carefully. I am tired, cold and depressed most of the time. My skin is dry and my fingertips have painful cracks and my nails are splitting. My hair is thinning and my eyebrows are fading away. Along with all that, I have absolutely no interest in sex. What can I do?

A. Although excess thyroid hormone can weaken bones and contribute to osteoporosis, getting the dose just right is essential for good health. All the symptoms you have described could be linked to insufficient thyroid activity.

We are sending you our Guide to Thyroid Hormones with information on how to interpret thyroid lab results as well as treatment options so you can discuss this with your doctor.

Q. My daughter insists you get colds from catching a virus, NOT from being cold, wet, not fully dressed or walking in the rain. Her beautiful 15-year-old son does not use an umbrella and likes to wear just a T-shirt out in chilly weather. I suspect he is trying to get out of school.

She is so sure that ONLY a virus can cause a cold that she never tells him to take an umbrella or a jacket. It makes me frustrated. I went to school for 12 years and was never tardy or absent, so I feel like I know what I’m talking about.

A. Folk wisdom maintains that becoming chilled--especially if clothes, hair or feet get wet--is likely to lead to a cold. Researchers have dismissed this belief as an old wives’ tale. Like your daughter, they see viruses as the only cause of colds.

Scientists have squirted cold viruses into the noses of volunteers and then exposed them to cold temperatures to see if this makes a difference. Studies that were done decades ago did not find an effect.

More recently, though, researchers in Wales had 90 volunteers put their feet in cold water for 20 minutes. Ninety others served as control subjects. Those who were chilled with cold water were more likely to report cold symptoms over the next five days (Family Practice, Dec. 2005). The investigators concluded that the old wives may have been right after all, though they are not quite sure why.

Q. You recently had an article about treating diaper rash. My granddaughter had a very bad one, and I used an over-the-counter cream called Boudreaux’s Butt Paste. It is not expensive and it works really well.

A. Boudreaux’s Butt Paste contains zinc oxide cream, an established treatment for diaper rash. It provides a barrier to protect the skin from moisture.

The product you used also contains inactive ingredients (castor oil, citric acid, mineral oil, paraffin, Peruvian balsam and petrolatum). Peruvian balsam has antibacterial and antifungal activity, but it can also cause contact dermatitis. Parents should be alert to that possibility if the rash starts to get worse despite using the Butt Paste.

Another reader responded to the idea of using Maalox on diaper rash: “When I was a nurse on a surgical unit, one of our surgeons used this for his patients, especially ostomy patients with angry reddened skin. You boil down the Maalox to form a paste, stirring constantly until it thickens. We applied it with a tongue depressor and put a light dressing over it.”

Q. My son is on Tegretol to prevent seizures and one of the things he has to avoid is grapefruit. I have seen that grapefruit must be avoided by people taking other medicines. What could happen if he does eat some? The school system puts grapefruit in the school lunches.

A. Grapefruit increases blood levels of many medications, including Tegretol. That could lead to side effects such as dizziness, drowsiness, lack of coordination or nausea and vomiting.

Grapefruit can also boost the effects of some blood pressure medicines and cholesterol-lowering pills. One reader had this cautionary tale: “One of my healthy, hard-working professional friends took his Lipitor pill with grapefruit juice and had to be hospitalized. At the time, he had no idea that grapefruit juice enhances or multiplies the strength of this medication.”

We are sending you our Guide to Grapefruit Interactions for a more complete discussion and answers to frequently asked grapefruit questions.

Q. A couple weeks ago, my husband saw his endocrinologist and the doctor ordered a test of his vitamin D level. It was very low, so my husband was put on 2000 units per day.

My husband has been having a lot of pain in his shoulder with a limited range of motion. An orthopedic surgeon told him that he had a tear in his rotator cuff, and that the only option is surgery.

In less than a week and a half on the vitamin D supplement, he has NO pain and FULL range of motion. This is like a miracle! I think we need a second opinion on that surgery.

A. A second opinion might be wise. Rheumatologists have been reporting that vitamin D deficiency can result in significant joint pain, stiffness and fatigue. Correcting the deficiency often cures these problems, although it won’t repair a torn rotator cuff.

In many parts of the U.S., low vitamin D levels are common during the winter because of the lack of sun exposure. It doesn’t take much time in the sun for skin to make vitamin D, but in cold weather that is not practical.

Q. When I first met my friend Mike twenty years ago, he was going through bottles of antacids. He’d been doing this for 12 years, far longer than the bottle label recommended.

He had a severe bout of anemia and was told he had an ulcer. More medicine!

Finally, three years ago he learned he had gluten intolerance. Now on a gluten-free diet, he no longer suffers heartburn at all.

A. Gluten intolerance, or celiac disease, can lead to a wide variety of problems, from migraine headaches and itchy skin rashes to acid reflux or osteoporosis. With the correct diagnosis and treatment (a gluten-free diet eliminating wheat, barley and rye), those who suffer from celiac disease can avoid a lot of suffering and unnecessary medication.

Another reader shared her story: “As a child, I had stomachaches almost every night. No one could figure out why. I also was anemic for several years in grade school, again without a clue as to the cause.

“I am now 
in my 50s and have osteoporosis. I recently learned that my chronic abdominal pain, bowel problems, anemia and osteoporosis are all related to gluten sensitivity! I used to eat a piece of toast to calm my bowels down, not realizing that the toast was the culprit. When I modified my diet I was amazed at how much better I felt.”

Q. What are the best sites for financial help with very expensive drugs? I don’t qualify for Medicaid but my drug bills can reach $5,000 a month. I have multiple sclerosis, Crohn’s and atrial fibrillation. I am a retired nurse and scared about how I can afford these medicines.

A. You may qualify for assistance from the pharmaceutical companies that make your drugs. Go to www.helpingpatients.org to find out.

We are sending you our Guide to Saving Money on Medicine for more information about free medications and other tips for saving money such as ordering from legitimate Canadian Web sites.

Q. My 62-year-old husband had a prostatectomy a year ago. It was successful, but he continues to have bladder problems. His urologist put him on Detrol for this.

When he started acting confused and paranoid, I got concerned. At the urologist's appointment I explained this to the doctor and he matter-of-factly muttered that, “yes, a side effect is COGNITIVE DECLINE.”

I was shocked and very upset that this was not in any of the pharmacy inserts we got with the prescription. Why isn’t this information more accessible?

A. It is alarming that the pharmacy inserts did not mention mental impairment as a possible side effect of your husband’s medication. Drugs for overactive bladder or incontinence like Detrol or Ditropan have been linked with memory problems and confusion in some patients (Clinical Therapeutics, Feb. 2005).

Medicines that alter the action of a brain chemical called acetylcholine are notorious for causing side effects such as dry mouth, constipation, blurred vision and cognitive impairment. Many other drugs besides those for bladder problems can trigger such symptoms. They include the antihistamine diphenhydramine, which is used to control allergy symptoms and insomnia. It is found in such popular products as Advil PM, Benadryl and Tylenol PM.

Q. After reading all the complaints about Ambien, I would like to put in a good word for this sleeping pill. I’ve had trouble sleeping all my life. When I finally fell asleep, I had a hard time waking up.

A year ago my doctor prescribed Ambien. I only need half a pill to give me solid sleep. I wake up easily, feeling refreshed.

Before this I couldn’t go walking because I wasn’t able to get up early to beat the Florida heat. Now I walk a mile and a half every morning and feel great! I also work in the garden, paint, make quilts and knit. Ambien has changed my life for the better.

A. Like you, many do get a good night’s sleep on Ambien (zolpidem). Others have reported sleep walking or driving, which can be dangerous.

Q. My husband takes Actos, metformin and glyburide for type 2 diabetes, Lipitor for cholesterol and Diovan HCT for high blood pressure.

The doctor prescribed vitamin B12 because my husband’s low in this vitamin. He can’t get up the stairs without me behind him, pushing. He can’t stand up to work on anything for more than half an hour. When he stands still, he gets dizzy and teeters. As a result, he drags a chair around or uses a walker to go anywhere. He has bad cramps in his lower legs. Could any of his drugs cause the vitamin B12 problem?

A. Metformin is useful for treating type 2 diabetes but can lead to vitamin B12 deficiency. Lack of this vitamin can cause fatigue, peripheral neuropathy (numbness or tingling of hands and feet), trouble walking and confusion.

Lipitor may lead to leg cramps and weakness, while the diuretic HCT in Diovan HCT may interfere with good blood sugar control.

Your husband’s doctor may need to evaluate his treatment regimen, given his symptoms. To prepare for his next visit, we would like to send you our book, Best Choices From The People’s Pharmacy, with more information about treating type 2 diabetes, hypertension and high cholesterol. It is available in libraries, bookstores and online (www.peoplespharmacy.com).

Q. My son was prescribed amoxicillin for an ear infection. The prescription was sent electronically to the pharmacist. The pharmacy gave us prednisone with the wrong doctor’s name on the script. Even the address was wrong.

The pharmacy clerk tried to talk me into taking the prednisone. Then she said there were two meds that were prescribed--amoxicillin and prednisone.

The pharmacist finally called the doctor to confirm the prescription (which was for amoxicillin). The pharmacist explained the problem as “computer error.”

Our doctor will not give me a paper prescription any more because the office just transmits it electronically. I think from now on I’ll ask the doctor to write down for me the medicine and the dose. That way I will make sure what I pick up at the pharmacy is what the doctor prescribed.

A. Even the best computer programs rely on humans for input and interpretation, and that unfortunately still leaves room for mistakes. It is unconscionable that the pharmacy tech tried to cover up the mistake and give you the wrong drug.

Your idea of getting the name and dose of the medicine written down for you is excellent. We suggest that everyone who gets a prescription called in, faxed in or electronically transmitted make sure they have all the details on their drug in writing before leaving the doctor’s office.

Q. You ran a story about lisinopril causing cough. I had the same experience.

My regular doctor referred me to an audiologist who diagnosed acid reflux. I then went to an ENT doctor who had no suggestions. Finally I saw an allergist who immediately took me off lisinopril and replaced it with Cozaar. Cough gone!

A. Lisinopril is an ACE inhibitor. Although this type of blood pressure medicine works well, it can cause a relentless cough that does not respond to cough medicine. Cozaar is a different type of blood pressure pill called an ARB (angiotensin-renin blocker). ARBs are much less likely to cause chronic cough.

Q. One of your readers asked for advice regarding constipation caused by Fosamax and Lipitor. I was surprised you did not mention taking Metamucil to help with constipation.

I have had to follow that regimen for over 30 years, taking 3 teaspoonsful daily. Please pass this information on.

A. Psyllium, the active ingredient in Metamucil and similar products, works well to counteract constipation. It can also help lower cholesterol.

Psyllium must not be taken at the same time as Fosamax or Lipitor, however. It might interfere with the absorption and thus the effectiveness of these drugs.

Q. I'm a 26-year-old female in a committed relationship with a man I am deeply in love with and have been for two years. I've always had a healthy sex drive, but now I'm concerned.

In the beginning we had a very active and passionate sex life, but as time goes by he seems less and less interested. For a while I think he had sex with me just to keep me happy, and now he ignores my advances. I know we won’t have sex several times a day like we did in the beginning, but I don't know why we can't do it several times a week.

I used to send him sexy text messages throughout the day so that when he got home he'd be excited. Now if I do that he doesn't respond. I’ve tried to spice things up--toys, videos, you name it, I've tried it all, but nothing works.

Sex is one thing I truly enjoy. Having good sex relaxes me, relieves stress and allows me to sleep through the night, which I can't do on my own.

He’s gained a lot of weight, but he’s a really great guy and I have no desire to look elsewhere. Talking doesn’t work as he ignores my questions. I don’t know what to do.

A. Many people mistakenly believe that men always have stronger sex drives than women. But according to Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, up to one fourth of women have more interest in sex than their male partners.

Counseling for the two of you is the best place to start. Even if he is reluctant, you should seek guidance on your own. Your partner should also have his hormone levels checked, since low levels of testosterone are associated with being overweight and can reduce libido.

Sex expert Dr. Ruth Westheimer told us that when couples have different levels of interest, a partner can help the other achieve orgasm, even if he isn’t in the mood for intercourse.

We interviewed both experts on our radio show, The People's Pharmacy. For an hour-long CD on this topic, please order show # 680.

Q. I am a 63-year-old woman who had estrogen-positive breast cancer 10 years ago. I had bilateral mastectomies, no chemo or radiation.

Now I am extremely estrogen deprived and cannot have sex because of the pain from vaginal dryness. My doctor will not prescribe estrogen to help with this problem because it might increase my risk of cancer recurrence. Is there some other way to treat these atrophic changes?

A. Applying a lubricant such as olive oil or coconut oil daily may be helpful. For intercourse, you might want to consider a water-based lubricant such as Sylk. It contains kiwi-fruit vine extract and is available on the Web at www.sylkusa.com or by calling (866) 831-2920.

Q. I was on atenolol for high blood pressure and kept complaining to my doctor about fatigue, tiredness, light-headedness and swelling feet and ankles. I couldn’t breathe or walk up a flight of stairs without stopping to catch my breath every two steps.

As a military dependent I see different physicians. My current doctor switched me to propranolol. I am now noticing that my feet and ankles are beginning to swell with this medication also and I have developed asthma. There are days when I can't do anything but sleep.

Are there better drugs or natural approaches to control my blood pressure? I am convinced that these medications have caused me more harm than good!

A. Atenolol and propranolol are both beta blockers. Such drugs are rarely considered appropriate as the first-line treatment for hypertension. They can trigger fatigue and asthma and are not appropriate for people with breathing difficulties. You should not have to suffer symptoms from your blood pressure medicine.

We are sending you our new Guide to Blood Pressure with many natural approaches, including helpful foods, special juices and breathing exercises, as well as the pros and cons of many medications. We are concerned about your swollen feet and ankles and urge you to see a cardiologist who could evaluate this symptom.

Q. You ran a letter from a forensic crime scene detective who used Vicks VapoRub to mask nasty smells on the job. You should have said, Don’t put Vicks VapoRub in your nose, your horse’s nose or your meerkat’s nose! You idiots shouldn’t be writing a pharmacy column if you don’t know that Vicks will coat the lungs and should never be inhaled.

A. We warn readers not to put Vicks in the nose for fear of triggering chemical pneumonitis (lung inflammation). In fact, the column you are referring to closed with this caution: The manufacturer warns that Vicks VapoRub is “for external use only,” and should not be put in nostrils. Regular use of petroleum jelly in the nose may increase the risk for lung irritation.

This warning is more important than ever, since researchers at Wake Forest University recently reported a case in which an 18-month-old child developed severe breathing problems when her grandparents put Vicks under her nostrils for a cold (Chest, Jan. 2009).

Q. Please tell me if my blood work is good or if I need medicines. My total cholesterol is 156, LDL is 62.9, HDL is 89.5, triglycerides 18 and glucose 105. I am 79 plus years young and active with no problems that I know of.

A. Whatever you are doing, it is right for you! Your numbers are phenomenal and would be the envy of many younger people. We can’t imagine a doctor would want to prescribe cholesterol medicine for you.

Q. Can you please give me more information on the connection between Boniva and osteonecrosis of the jaw? I heard about this on the radio.

I have taken Fosamax and Actonel for osteoporosis but had to discontinue because of digestive problems. Now my doctor is insisting that I try Boniva.

I am skeptical of these drugs, but find that doctors dismiss the dangers of side effects until the damage is done. I want to arm myself with more information about these drugs for my next doctor’s visit.

A. A new study in the Journal of the American Dental Association (Jan. 2009) suggests that jaw bone death (osteonecrosis of the jaw) may be triggered by drugs such as Actonel, Boniva and Fosamax. In this investigation, up to 4 percent of Fosamax patients having a tooth extraction experienced this serious complication.

We are sending you our new Guide to Osteoporosis with an in-depth discussion of the pros and cons of all the drugs used to treat this condition. Other side effects of such drugs have recently come to light in The New England Journal of Medicine. They include unusual thigh-bone fractures (March 20, 2008) and a possible increased risk of esophageal cancer (Jan. 1, 2009).

Q. Please help me. I am 35 years old and have been addicted to Argo Corn Starch for the past four years. How can I stop eating it? It makes my mouth dry and my limbs cramp. I have mood swings and have gained weight. But just knowing I shouldn’t eat starch is not enough.

A. Please see a doctor and ask to be tested for iron or zinc deficiency. Pica, compulsively eating a substance that is not food, is frequently associated with such a mineral deficiency and often goes away when the deficiency is corrected.

Here is another woman’s experience: “I have been eating Argo Corn Starch on and off for about 15 yrs now. I started in my teens and am now 28 years old. The only time I didn't eat any AT ALL is when I was pregnant.
“At one point in time, I was going through 4 boxes a week but I've cut back a lot. I don't even want to eat a full box now. It makes me very tired, but I crave it. I hate the fact I eat starch but I can't help it.

“I went to the doctor once about this and he prescribed prenatal pills. They were helpful until they were all gone!”

The prenatal supplements she found so helpful may have corrected an iron or zinc deficiency. That’s why we urge you to get tested. Psychological help such as cognitive behavioral counseling might be useful, but only after you have corrected any physiological deficiency.

Q. When I was young I had an ongoing dandruff problem. This was about 45 years ago.

My uncle was a barber, and he told me to use the old brown Listerine. I have used it ever since, every time I wash my hair, and have never had another problem with dandruff. It works.

A. Thanks for the tip. Many other readers agree that old-fashioned Listerine can help fight flakes and itching on the scalp. That may be because the alcohol and herbal oils in Listerine have anti-fungal properties. Since dandruff is caused by yeast (a type of fungus), it is not that surprising that this mouthwash might be beneficial.

Although the makers of Listerine used to advertise it for “infectious” dandruff, the FDA no longer permits this claim. Nevertheless, rinsing with Listerine (or a generic house brand equivalent) seems like a cost-effective tactic for discouraging dandruff.

Q. I was put on Lipitor to control cholesterol and found it shot my blood sugar through the roof. My doctor suggested switching to Crestor. Would this drug also affect blood sugar?

A. You are not the first person to note that some cholesterol-lowering medicines might raise blood sugar levels. Another reader reported that after taking Crestor, his type 2 diabetes numbers also “went through the roof.” In addition, he reported: “my hands, feet and arms tingled so much I could hardly stand it.”

The official prescribing information for both Lipitor and Crestor mention elevated blood sugar as a possible side effect. A large study of over 17,000 patients (the Jupiter Trial) reported a higher incidence of diabetes in the subjects taking Crestor (New England Journal of Medicine, Nov. 20, 2008).

Researchers are not sure whether this is a real complication of statin-type drugs or just a coincidence. In the meantime, it is still important to control cholesterol since both it and diabetes can increase the risk of heart attacks and strokes.

Q. What can you tell me about testosterone to jump start diminished sex drive in women? I used to have a fantastic libido and enjoyed a great sex life with my husband. But ever since menopause I am rarely interested in sex and when we do make love I almost never have an orgasm.

A. The “APHRODITE” study published in the New England Journal of Medicine (Nov. 6, 2008) reported that a patch containing 300 micrograms of testosterone “resulted in a modest but meaningful improvement of sexual function.” During this year-long trial, women on the patch reported “increases in sexual desire, arousal, orgasm and pleasure…”

In the study a few women on testosterone were diagnosed with breast cancer. The researchers could not determine whether this hormone was responsible. Long-term side effects of testosterone have not been studied.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction with more details about testosterone and other approaches for men as well as women.  The FDA has not approved topical testosterone to improve female libido, though some doctors are prescribing it “off-label.”

Q. When I read in your column that a person was surprised that the blood pressure pill lisinopril caused his constant cough, I just shook my head and wondered why people don't know the side effects of the drugs they take. I take lisinopril too, but when my doctor put me on it I read the paperwork that listed adverse reactions.

I have found that you have to be very pro-active with your health. I research what I can or cannot eat with any of my prescribed medicines. I ask my doctor why I am on a medicine and if I have read something negative about it, I ask if something else would be as good. I also know that questioning a pharmacist is often the best way to get a helpful answer about a medication.

A. We applaud your prudent approach and only wish others were as careful.

Q. Ambien made me sleep-walk, -eat, and-drive! I would wake up with food in my bed not remembering anything that happened.

My mother said I would walk into the living room and start talking to her. I had no recollection this had happened.

A year ago I woke in the hospital with a broken femur, ankle, patella, fractured skull and broken finger. I had been sleep-driving!

I never wear pajamas when I drive, EVER! I had my pjs on when they found me so I believe I went sleep-walking to the car, started driving and totaled my car into a tree!

A. We have heard from many others that sleep-driving may be a complication of using Ambien (zolpidem). A police officer shared the following: “I took one Ambien CR after a meal and went to bed. Some time after that I proceeded to get up, get dressed, left my home in my personal vehicle and was involved in a crash. As a result of the accident I was arrested and lost my job.”

Ambien is not the only sleeping pill that may lead to bizarre behavior. According to the ad for Lunesta, “After taking Lunesta, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night…Reported activities include: driving a car (‘sleep-driving’), making and eating food, talking on the phone, having sex, sleep-walking.”

We are sending your our Guide to Getting a Good Night’s Sleep in which we discuss the pros and cons of sleeping pills and offer several non-drug approaches.

Q. Every winter, my wife and I are bedeviled by split skin on the tips of our fingers--tiny cuts that are painful. Can you give us suggestions for not getting them?

A. Split fingertips are common. If regular moisturizing is not enough, apply Vicks VapoRub  or Aquaphor before bed and wear cotton photographer’s gloves to protect the sheets. Liquid bandage on the cuts may help them heal faster.

Q. My sister and I were very concerned about my 73-year-old aunt and the tremendous number of medications she was on. She was in a terrible nursing home and was continually strapped in a wheelchair. She was always agitated and often spoke to people who had been dead quite awhile.

The doctors said her hallucinations were caused by a stroke and dementia. Her family was in complete denial. My sister obtained your Guide to Drugs and Older People with the Drug Safety Questionnaire.

We moved her to a different facility. Two weeks after the medicines were stopped or the doses were lowered, she has become herself again. Thanks for helping us get our wonderful aunt back!

A. We are pleased to learn of your success. Overmedication with some common drugs, such as those prescribed for overactive bladder or insomnia, can contribute to confusion, cognitive decline or even hallucinations. Our Guide to Drugs and Older People has a list of drugs that may be inappropriate for seniors along with the Drug Safety Questionnaire.

Q. Turmeric increases the anticoagulant effect of Coumadin. I have been on Coumadin for 15 years because of an artificial aortic valve.

I had read that turmeric was effective in lowering cholesterol and began sprinkling it on broccoli. My INR went up dramatically and my pharmacist said, “STOP!” Have there been any studies on the blood-thinning effect of turmeric?

A. You are not the first person to report this interaction between Coumadin (warfarin) and turmeric. Others have reported a spike in their INR lab values (a measure of blood anticoagulation) and we believe this is a dangerous combination. Our fear is that this could lead to a serious bleeding episode.

Q. My doctors were mystified by my anemia. The puzzle was solved after I read in your column that taking Nexium and other acid-reducing drugs can hinder the absorption of iron and other nutrients. Now I regularly take iron with my other supplements and am no longer anemic. Thank you!

A. Minerals like iron and calcium are absorbed best when there is acid in the stomach. Powerful acid-suppressing drugs like Nexium can interfere with this process, and may also hinder absorption of vitamin B12. Inadequate levels of this vitamin can also cause anemia.

Q. I have been taking lisinopril for seven months to control my high blood pressure. Soon I developed a hacking cough. When it wouldn’t go away I saw an ear, nose and throat specialist. He shrugged and said this comes with age.

When I complained to my regular doctor he gave me a course of antibiotics, but there was no relief. I called back and was given a different antibiotic prescription.

Eventually, my wife mentioned my cough to the pharmacist who pointed out this is a common complaint with lisinopril. When we brought this to my doctor’s attention, he agreed and finally took me off the drug. How could this happen?

A. Lisinopril is an ACE inhibitor. Like other blood pressure drugs in this class (Accupril, Altace, benazepril, captopril, enalapril, ramipril and quinapril), lisinopril can cause cough as an unpleasant and common complication. This kind of hacking cough won’t go away with cough medicine.

We are shocked that neither your lung specialist nor your regular doctor figured this out. Antibiotics are inappropriate for this kind of drug-induced cough.

There are other medications to control blood pressure. ARBs (angiotensin receptor blockers) such as Avapro, Benicar, Cozaar and Diovan are less likely to cause a chronic cough. For more information about pros and cons of hypertension medications and non-drug ways to lower blood pressure we are sending you our Guide to Blood Pressure Treatment.

Q. I read in your column a while back that a person heard music after taking the antidepressant amitriptyline. My urologist prescribed a similar drug (imipramine) for a mild urinary problem. After a few days, I too started hearing music. My music was a wonderful male chorus each evening. After I pinned the music down to that antidepressant drug I quit taking it. I did miss that wonderful male chorus, though!

A. Drug-induced auditory hallucinations are rare but documented in the medical literature. The person you refer to taking amitriptyline reported: “I hear music all day, both classical and rap.” When the drug was discontinued the music faded away.

One person taking an antidepressant heard a full orchestra playing dramatic classical music: “The final straw came when I was riding my motorcycle (not a quiet machine) and couldn't hear the sound of the engine and wind over the orchestra playing in my head! I took myself off the antidepressant, and the hallucinations disappeared.”

Q. A reader recently reported using zinc oxide to treat hemorrhoid symptoms. I just wanted you to know that I have been using zinc oxide for this purpose for years. I thought no one else knew about it!

It’s something I just tried on my own after little or no relief from such ointments as Preparation H. Zinc oxide provides almost instant relief. I told my doctor years ago, but she had never heard of using zinc oxide for hemorrhoids.

A. Zinc oxide appears to be a safe, inexpensive alternative to other external hemorrhoid creams. When we looked for it at the drugstore, we found it sold as a diaper rash cream.

Q. I have been hearing that something called CRP may be more important than cholesterol when it comes to heart disease. I don’t know much about it. What are normal CRP values?

My doctor says everything’s fine and that he does not have time to “chat.” But there was an opportunity to have blood work done at my college recently and my CRP was 6.7 mg/L. Isn’t that high? Is there any way to lower CRP other than taking Crestor?

A. Recent research showed that the statin-type cholesterol-lowering drug Crestor lowered CRP and reduced cardiovascular events even in people who started with normal cholesterol (New England Journal of Medicine, Nov. 20, 2008). Before this hit the headlines, many people had never heard of CRP or C-reactive protein. This marker of inflammation should ideally be at or below 1, so yours is elevated. Many cardiologists believe that CRP above 2 calls for treatment.

Crestor can lower CRP, but it is expensive and some people experience side effects. You may be able to fight inflammation with exercise and weight loss. Supplements such as fish oil and Coenzyme Q10 may also help. Your doctor should monitor your CRP level to keep track of your progress. We are sending you our new Guide to Cholesterol Control and Heart Health, in which we discuss CRP and offer a list of anti-inflammatory foods and non-drug approaches for heart health.

Q. Does Topamax cause complete lack of sexual desire? And I do mean complete!

A. Topamax (topiramate) is prescribed for epilepsy, but it is also used to prevent migraine headaches. Your short question implies a lot of frustration and sent us hunting for an answer.

“Decreased libido” has been reported as a side effect of Topamax in the prescribing information provided for doctors. It seems not to be very common, though, affecting just a few patients in a hundred.

Doctors have also described cases in which Topamax completely blocked women’s ability to achieve orgasm (Neurology, Oct. 25, 2005). About five days after discontinuing the Topamax under medical supervision, the women were once again able to climax.

Never stop an epilepsy drug suddenly without your doctor’s approval. An unexpected seizure could be devastating.

Q. I'm responding to a column in which a young woman committed suicide after starting Cymbalta. I worry that others will use this tragedy to say that antidepressants are dangerous.

I take the same pills she did: clonazepam and Cymbalta. These drugs allow me to have feelings again, beyond just the agony of despair. With counseling, I was able to step back and survey what had become of my life when I was most depressed: ruined relationships, lost money and jobs.

These drugs can be life saving for many people. I truly feel, though, that medication must be combined with therapy. It is not the doctor's fault for giving out samples of the medication. They usually come with the full information packet.

A. Many people do indeed benefit from antidepressants. Nevertheless, patients and families must be told to contact the prescribing physician if suicidal thoughts occur when starting a new medication.

Q. I had acid-reflux surgery because stomach acid was irritating my throat. After the surgery, the correct diagnosis of celiac disease was finally made. Eating wheat caused the acid in my throat.

People often write you about chronic heartburn. They should be told that surgery and drugs aren't always the answer. If I’d gotten the celiac disease diagnosis sooner, I might have been spared an unnecessary operation.

A. Celiac disease is an inability to tolerate gluten, a protein found in wheat, barley and rye. The immune reaction to this protein begins to destroy the gut and can cause a wide range of symptoms, from heartburn and migraines to fatigue and osteoporosis.

Celiac disease was once thought to be rare, but more recent research shows that it is far more common, perhaps one in 100 people (Proceedings of the Nutrition Society, Nov. 2005). It runs in families, so relatives of patients should definitely be tested. There are no medications to treat celiac disease, but it can be controlled with a gluten-free diet.

To learn more about the symptoms, diagnosis and treatment of celiac disease, we offer an hour-long CD of our radio interview with a leading expert, Peter Green, MD.

Q. I had shingles many years ago. So did my friend. Her doctor gave her a shingles injection so she won't get it again. My doctor said by having shingles I built antibodies to it and don't need the shot. Which doctor is correct?

A. Chickenpox during childhood can lead to shingles later in life. The virus (varicella zoster) can lie dormant in nerves near the spinal cord for decades. The virus can be reactivated and trigger an intensely painful skin reaction.

Zostavax was developed to prevent shingles in people over 60. The company excluded anyone who had previously experienced a shingles attack from the study. Consequently, the FDA does not allow the company to promote the vaccine for anyone who already had shingles.

We’re not surprised that the doctors disagree. Many were taught that shingles only happen once. That is not completely true. Although quite rare, some people can experience another bout with this virus (American Family Physician, April 15, 2000). The Centers for Disease Control and Prevention call for vaccination even for people who already had one attack.

Q. My boyfriend was recently released from prison and believes there was saltpeter put in the food. How do you remove the effects after numerous years?

A. Saltpeter (potassium nitrate) is falsely believed to lower libido. Youngsters in boarding schools and summer camps as well as men in the military or in prison have perpetuated the myth that they are being fed saltpeter.
If time and support don’t overcome your boyfriend’s sexual difficulties, counseling may help. Hormonal assessment may also be needed.

Q. Once there was only one Robitussin cough medicine. Now there are lots. The one with DM almost killed me. I had such a hard time breathing I thought I was going to die.

I reported this to my pharmacist and was told that I might be allergic to the “DM” in Robitussin. He warned me to read all labels on cough medicines from now on. People need to be warned, especially parents who might give this to their children.

A. Dextromethorphan (DM) is the leading ingredient in most OTC cough medicines. Its effectiveness has been controversial, particularly in children. Parents have been warned to avoid cough and cold medicines for kids four and under.

Reviewers for the Cochrane Collaboration (an international organization that evaluates medical treatments) concluded: “There is no good evidence for or against the effectiveness of OTC medicines in acute cough.”
Although allergic reactions to DM seem quite uncommon, there are reports in the medical literature of serious breathing difficulties triggered by this cough medicine (Allergy, Aug. 2004). Follow your pharmacist’s advice to read labels carefully!

Q. As a teenager, I was blessed with relatively few blemishes. Now in my mid-20s, I have developed large deep pimples that heal slowly and have eroded my self-esteem.

I had tried everything from expensive department store skin care regimens to acid peels at the salon. Nothing was wholly effective and I had been considering seeking a dermatologist's help when I heard MoM mentioned on your radio program.

I tried Milk of Magnesia and my skin hasn't looked better in years! I apply a thin layer with a cotton ball 3 to 4 times a week, let it dry and then remove with a warm cloth before applying my normal cosmetics in the morning.

My skin keeps a matte finish longer through the day and I have been developing fewer and less severe blemishes. MoM works better than anything else I've tried and the price is certainly right!

A. We’ve heard from many readers that milk of magnesia (MoM) can be helpful for a variety of skin problems. One reader offered this: “MoM controls my seborrheic dermatitis very well and it is much cheaper than prescription Nizoral cream. I am a retired physician who has had seborrheic dermatitis for many years. My sense is that doctors are prescribing highly potent, pricey prescription agents. It is good to learn of cheaper, effective alternatives.”

We have written about many of these inexpensive practical remedies for acne, dry skin, eczema and wrinkles in our new Guide to Skin Care and Treatment.

Q. When I buy plain aspirin there is no country of origin listed. When I call the 1-800 number, I'm promised a reply to this concern but the call is not returned.

Is there any aspirin made in the U.S. with American ingredients?

A. An expose in the New York Times Magazine (Nov. 2, 2008) revealed that there are no major generic aspirin manufacturers in Europe or the U.S. Most aspirin is now made in China.

Many over-the-counter medications as well as prescription drugs now come from manufacturers in China, India or other parts of Asia. If country of origin labeling is important for clothing and food, why wouldn’t it be even more critical for medicine?

Q. I have high lipids and a stent in my heart. I have been on Lipitor, Vytorin and now am on Crestor.

While taking Lipitor and Vytorin I always had muscle weakness. Now that I am on Crestor, not only do I have severe muscle weakness, I have cramps in my legs, itching palms and brain fog.

Is there a more natural way to lower lipids? I am getting worried about my liver since I read somewhere that itching palms might signal liver problems.

A. Statin-type drugs lower cholesterol and inflammation that can lead to heart attacks. Since you have a stent, you need to control blood lipids aggressively.

Not everyone tolerates statin medicines like Crestor, Lipitor or Vytorin (which includes simvastatin). Severe muscle pain, weakness or cramping is a red flag. Ask your doctor to test liver enzymes, as itching could be a sign of trouble.

We are sending you our new Guide to Cholesterol Control & Heart Health with more information on the pros and cons of statins as well as many other ways to control blood lipids.

Q. Our 24-year-old daughter was experiencing anxiety. Her doctor prescribed clonazepam (also known as Klonopin). Along with that, he gave her free samples of an antidepressant called Cymbalta.

Our daughter took these medicines beginning on Thursday, but they made her feel bad. By Sunday evening she began talking about losing a desire to live. On Monday morning, she drove her beautiful 4-year-old daughter to school and then drove to her fiance’s home. When she got there, she took a gun and killed herself.

We are at a loss as to what happened. Our daughter might still be here if not for Cymbalta.

A. We are so sorry to learn about your family’s tragedy. The Medication Guide that comes with Cymbalta contains the following caution: “Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.” Patients or family members should contact the prescriber immediately if the patient feels agitated or has thoughts of suicide. We hope your experience will help others.

Q. I was recently traveling in France and ran out of the acetaminophen I brought from home for my painful arthritic knee. When I attempted to buy more acetaminophen from a French pharmacy, the pharmacist said acetaminophen is not sold in France. The pharmacist advised me to take a product named paracetamol. I took the French pharmacist’s advice and bought some, but I have some reservations about it. What is paracetamol and is it safe to use?

A. Acetaminophen (Tylenol, etc) is sold throughout the world as paracetamol. The two are identical.

Q. I struggled for years with hair loss, dry skin and tiredness all the time. I was finally sent to an endocrinologist who discovered I have Hashimoto's disease and prescribed Armour Thyroid.

Now that I take this natural hormone, my hair is not falling out, my fingernails and toenails grow, my skin is not as dry, my monthly cycle is not as heavy and to my amazement I have much better mental clarity. I used to feel like I was in a haze sometimes. I never understood why, but that is one of the symptoms of low thyroid as well.

Hashimoto’s disease is said to be one of the leading causes of thyroid problems. In this autoimmune disease, the body creates antibodies that attack the thyroid gland. I am grateful that my doctor finally listened to me and ran the blood test for this diagnosis.

A. We’re glad you were finally diagnosed correctly. Thyroid disorders are common and your symptoms were classic. Armour thyroid is an old-fashioned treatment for hypothyroidism and many doctors no longer prescribe it. Some readers report, however, that they feel better on this than on synthetic levothyroxine (Synthroid, Levothroid, Levoxyl) that only contains T4. We discuss the use of Armour Thyroid and the importance of balancing T3 and T4 in our Guide to Thyroid Hormones.

Q. I read your column about floating poop. When I experienced this about seven years ago I ignored it because there were no other symptoms. Luckily for me, I ended up in the emergency room with a kidney stone. This is likely the first time ever you have heard anybody say he was lucky to have a kidney stone.

When they performed a CT scan to find the stone, they found the cause of my floating poop--pancreatic cancer.

One of the reasons the survival rate for pancreatic cancer is so low is that it is rarely found early. By the time most people are symptomatic, it has metastasized. The tumor had blocked the bile duct just enough to cause the floating poop symptom.

I had a Whipple procedure and am one of the very few survivors of pancreatic cancer. Please tell the person with floating poop to see a doctor.

A. You are not the only reader who made a connection between “floaters” and pancreatic cancer. Several readers remembered a televised interview with the late Randy Pausch, author of "The Last Lecture," in which he talked about this as a symptom of his pancreatic cancer.

There are other causes of floating poop, and many are not serious. Just the same, it makes sense to discuss this symptom with a physician.

Q. Someone wrote to you about using zinc oxide as a deodorant. I tried it but it didn't work for me.

At the same time my hemorrhoids were burning and itching, and even Preparation H didn't seem to help. Since zinc oxide is used in diaper cream, I thought why not give it a try?

From the first time I used it I have not had any recurrence of the symptoms. At first I applied it every night but now I only use it once a week or less.

A. The person who wrote to us found that zinc oxide cream (commonly used for diaper rash or sunburn protection) was effective as an underarm deodorant. Your experience shows that it may not work for everyone to control body odor.

We could find only one reference to the use of zinc oxide for the itching and burning of hemorrhoids. A German salve (Mirfulan) that contains zinc oxide plus witch hazel, urea and vitamins A and D was reported helpful many years ago (ZFA Stuttgart, Oct. 20, 1979).

Q. Every winter my skin gets awfully dry and itchy. My hands and particularly my fingertips really suffer. At times they crack and bleed. I heard that you have written about solutions for these problems. I would be so grateful if you would send me any information you have.

A. As indoor heating systems come on, humidity drops. That may be why dry skin is worse in the winter. Washing hands frequently to avoid colds or flu also aggravates dry skin.

Readers have suggested a variety of solutions, including O’Keeffe’s Working Hands Cream, TheraSeal Hand Protection and Lotil Cream. Inexpensive farmers’ moisturizers such as Bag Balm, Corn Huskers Lotion or Udder Cream (an underwriter of our radio show) are also popular.

Cracked fingertips can be extremely painful and moisturizing isn’t always enough. Some readers use Chap Stick or liquid bandage on split skin. We are sending you our new Guide To Skin Care and Treatment with many other ways to help heal cracked fingertips, ease eczema and relieve itchy, dry skin.

Q. I am having trouble leveling out my Coumadin. Many foods are not included on the list the dietitian gave me. Cranberries are a puzzle, for instance. The nurse says eat them; the doctor says don’t. Can I eat cranberries or not?

A. Trying to maintain a steady anticoagulant effect from Coumadin (warfarin) can be a little like walking a tightrope. Too much medicine can lead to bleeding, while too little may permit blood clots to form. Coumadin interacts with many foods.

Several cases in Great Britain led the health authorities there to warn against combining cranberries or cranberry juice with the anticoagulant Coumadin (warfarin). Some people who had been on a stable dose of Coumadin had serious bleeding problems after drinking cranberry juice or eating cranberries.

Australian scientists have reported that cranberry significantly increases warfarin’s anticoagulant effect (British Journal of Pharmacology, Aug. 2008). We suggest you follow your doctor’s recommendation and avoid cranberries and cranberry juice while you are taking Coumadin.

Q. Can Aleve sometimes cause drowsiness? I only take one but later I find myself dozing off. Is there a hidden ingredient that causes this? Am I the only one who experiences this problem?

A. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as OTC ibuprofen (Advil, Motrin IB) and naproxen (Aleve) or prescription products like diclofenac (Cataflam, Voltaren), indomethacin (Indocin) and meloxicam (Mobic) can sometimes cause drowsiness, dizziness or confusion.

You are not the only one who gets sleepy or spacey on medications like Advil or Aleve. A nurse who wrote to us several years ago reported that ibuprofen made her mentally foggy. She feared early-onset Alzheimer’s disease, but found that stopping the NSAID improved her mental status.

We have prepared a Guide to Alternatives for Arthritis with a discussion of the pros and cons of medicines like prednisone and NSAIDs as well as non-drug approaches for easing joint pain.

Q. I'm so irked about erectile dysfunction ads. I'm a mature adult, married (with adult children), so I’m not ignorant or prudish.

I think, however, that if you have a problem, you know it and should see your doctor. These advertisements are so offensive, considering all the people who end up watching them.

A. Many people are fed up with TV ads for erectile dysfunction drugs. Only the U.S. and New Zealand permit any prescription drug advertising to patients.

The law could be changed to restrict such commercials. Let your Senator or Representative know how you feel.

Q I have read that cold medicines for children continue to be sold even though they have not been thoroughly tested. Sadly, some businesses are quick to put out OTC medications just to turn a profit (and a rather large one at that). After all, if it promises a miracle, what parent of a sick child wouldn’t spend money for it?

Unfortunately I work in a business that uses that trick time and again. I definitely don't like the lack of standards for children’s OTC cold products.

A. For years, millions of young children have been dosed with ineffective and potentially harmful cough and cold remedies. Pediatricians have been lobbying the FDA to crack down on the manufacturers of these medications. Under this pressure, the companies recently agreed not to market these products for children under four.

We’re not confident that older children will benefit either. In lieu of drugstore nostrums, home remedies may offer a safer approach. Some pediatricians are now suggesting chicken soup for colds or honey and lemon for coughs. For an interesting discussion of natural ways to boost the immune system for fighting off colds, you may want to listen to a podcast of our radio show #664 with Tieraona Low Dog, MD, at www.peoplespharmacy.com.

Q. You have saved my sanity! I’ve always enjoyed your column, but never needed your advice until last year.

I had been suffering in silence as my hair changed its texture from wavy to straight. Then my fingernails began to deteriorate. I thought it was another consequence of growing older, until I read in your column that too much selenium in the diet could affect hair and nails adversely.

At the time I was taking a supplement that contained selenium along with the lecithin I wanted. I immediately switched to a lecithin-only supplement. After about six months, the nails began to recover. In another four to six months, my hair had become wavy again, and my nails were much stronger. Thank you!

A. Problems with hair and nails are often difficult to diagnose, so we are glad we gave you the clues you needed. Selenium is an essential mineral, but excess selenium can be toxic. Loss of hair and nails has occurred both among Chinese people whose diets were naturally high in selenium and in Americans taking supplements with too much selenium.

The tolerable upper limit of selenium is around 400 micrograms daily. Brazil nuts are high in selenium and an ounce (roughly half a dozen) provides 800 micrograms. Overindulging regularly could lead to selenium toxicity.

Q. If the price is too good to be real, the drug might be a fake! With Nexium over $4 a pill, I ordered it from an online Canadian drugstore. When the pills came, they were from India and they were generic.

This medicine did not work and now I have my asthma symptoms and cough back. I don't know what I will do, since I can't afford the name brand!

A. Acid-suppressing drugs such as Aciphex, Nexium, Prevacid, Prilosec and Protonix can relieve reflux. Some people with this condition develop other symptoms such as asthma or cough as a result of acid irritation. If your medicine is not working, your condition might be aggravated.

You have discovered one of the pitfalls of using an online pharmacy. Not all “Canadian” pharmacies are located in Canada. Some online drugstores source their medicines from around the world to get a better price. The FDA has no control over the quality of such medicines.

We are sending you our Guide to Saving Money on Medicines with some tips on how to tell if an online Canadian pharmacy is legitimate.

Q. I was watching Oprah and heard a doctor on her show say that poop should NEVER float. Why?
I have not changed my diet at all, but all of a sudden about two months ago, every time I have a bowel movement, my poop floats.

Is there something wrong with my system? I feel fine and have no pain or anything unusual.

A. Health professionals have been debating the causes of “floaters” vs “sinkers” for decades. Some believe floating is caused by excess fat in the stool as a consequence of digestive disease. Others maintain that gas is the culprit.

If you feel well and have no diarrhea or other symptoms, it probably makes little difference. If it persists, tell your doctor at your next visit so she can rule out anything serious.

Q. I used Chantix to quit smoking on May 30. I don't recall any psychological side effects and have been recommending it to everyone.

After using it successfully, I figured all smokers should try it and wondered why they weren’t. Reading about the depression and rage some people report on your Web site (www.peoplespharmacy.com) answered that question.

A. Chantix is a unique medication that seems quite effective in helping people quit smoking. But there are potential side effects that can be terrible for some people. They include weird dreams, insomnia, depression, suicidal thoughts, irritability, aggression, nausea and headache.

Q. The recent melamine scare from China has me wondering. Due to the fact that supplements have little regulatory control, is there a risk that protein powders sold for dieters and muscle builders could contain melamine to increase the amount of protein when tested? Also, should I worry about my children's melamine dining plates?

A. You raise a fascinating question. Chinese producers have apparently added melamine to milk to cover up the fact that it was diluted. The same chemical was also added to the pet food ingredient gluten to make it appear higher in protein so it would be worth more.

No one has suggested that protein powder has been contaminated with melamine, though we don’t know how carefully the FDA has tested such products. If the raw ingredients in such powders came from China there might be cause for concern.

Melamine is high in nitrogen and is used to make countertops, dry erase boards and unbreakable dishes. We doubt that the dishes pose any risk to your children, since such plastic plates have been used for decades and are unlikely to release melamine into the food.

Q. As a forensic crime scene detective, I have used Vicks in my nose to block the smell of noxious odors for many years. No adverse effects have been apparent. However, I am aware that adverse effects may still present a serious concern over the long term.

A. We can well imagine that a forensic crime scene investigator would have to deal with some pretty stinky situations. The strong aroma of Vicks can mask other smells.

We have heard from readers that horse trainers sometimes utilize this unique property of Vicks:  “My friend raises and shows palomino horses. When she shows the stallions, she puts a little bit of Vicks inside their nostrils so they won't get a sniff of a mare in heat and act like a typical male and show off. If they can not smell the mare, they behave properly.”

A zoo in England has used Vicks to mask the scent of newcomers in a group of meerkats. Without some such intervention, they are likely to fight.

Our Guide to Unique Uses for Vicks offers intriguing applications for nail fungus, dandruff, bug bites and tennis elbow. The manufacturer warns that Vicks VapoRub is “for external use only,” and should not be put in nostrils. Regular use of petroleum jelly in the nose may increase the risk for lung irritation.

Q. My endocrinologist said my vitamin D level is too low and told me to take 2,000 IU daily. I have done that and find that my arthritis pain has disappeared. Is there a connection?

A. It’s possible. There is growing awareness that vitamin D deficiency can contribute to joint and muscle pain.

Q. I’m not a pill taker, but my doctors insist I get my blood pressure down to 120/80. I started on beta blockers (first propranolol, then atenolol and now metoprolol). They make my joints ache and I feel tired, depressed and disappointed. Diovan makes me weak and dizzy. My hair is falling out, my cholesterol is going up and my breathing is bad.

I used to feel great. I stayed active by walking and golfing. Now I can barely drag myself out of a chair. Are there any better medications or natural remedies I could ask my doctor about?

A. As important as it is to control hypertension, you should not have to curtail your activities because of blood pressure pills. Your medicines could well be contributing to your symptoms. Beta blockers are no longer considered the best first treatment for high blood pressure.

Exercise is important. Other natural approaches include pomegranate, grape or beet juice. Magnesium can also be helpful.

You will find more details on these and other natural approaches along with the pros and cons of various anti-hypertensive medicines in our Guide to Blood Pressure Treatment.

Q. I have been taking Prozac for the past five years. I am happily married, but I've definitely noticed a downturn in my ability to achieve a climax.

My doctor recently switched me to Celexa to see if it would offer an improvement in that area. It hasn't worked, although both drugs have been very helpful with my depression.

Are there any anti-depressants that don't cause this particular side effect? Or is there some way to overcome this problem with orgasm?

A. When Prozac-like drugs were first introduced, no one knew how common sexual side effects might be. Pre-market testing suggested that such complications were relatively rare (2 to 16 percent). Now we know that sexual problems may actually range from 30 to 70 percent of patients.

Drugs like Celexa, Effexor, Lexapro, Paxil, Prozac and Zoloft are prescribed for anxiety, bulimia, depression, chronic fatigue syndrome, hot flashes, obsessive-compulsive disorder, PMS and post traumatic stress disorder.

Many people report that such drugs can reduce libido, interfere with arousal, delay or block orgasm and cause erectile dysfunction. Some describe a numbness or lack of sensation as “genital anesthesia.” If they do achieve orgasm they experience little or no pleasure in the act. A recent article suggests that sexual side effects may sometimes persist indefinitely, even after the drugs are discontinued (The Open Psychology Journal, Vol. 1, pp 42-50, 2008).

There are no obvious antidotes for this problem, though some doctors have tried drugs like Viagra. An antidepressant such as bupropion is less likely to cause sexual dysfunction. Discuss your situation with your doctor to see what solution might be appropriate.

Q. A friend of mine just announced that she has genital herpes. She has had it for quite a few years and has never told her husband.

She claims she contracted herpes from a low immune system due to chronic arthritis. I always thought this disease could only be caught through a sexual encounter. Can you bring me up to snuff on the causes of 'genital herpes'?

A. You are correct that genital herpes is a sexually transmitted disease. Your friend is mistaken either about her diagnosis or about the way she acquired it. We are surprised that she has not informed her husband, since he is at risk for catching the disease whenever they make love.

Q. I believe my friend was sleep driving when he was killed in a car accident. A dump truck slammed into his car at an intersection he’d known all his life. It was only two blocks from his house.

I called his wife to get the story and she said he reportedly ran a blatant red light on his way to work. That is certainly not like him, especially because he was applying for a police job. If you’re doing that, you don't go through red lights, for sure.

When I’d talked with him not five days earlier, he had told me he was on Ambien. He said if he didn't get enough sleep he would do strange things. I feel the Ambien caused him, a husband and father of two, to be killed needlessly because he was probably sleep driving under its influence.

A. Ambien has been linked to “sleep driving.” Whether this sleeping pill was responsible for your friend’s accident is impossible to tell. Others have shared stories of bizarre behavior (including sleep driving) under the influence of Ambien (zolpidem).

Many people are able to take Ambien safely, but others need a different approach for dealing with insomnia. Some people wake early in the morning and cannot get back to sleep. For them, a shorter-acting drug like Sonata may be preferable.

We discuss the pros and cons of sleeping pills like Ambien, Sonata, Lunesta and Rozerem as well as non-drug approaches in our Guide to Getting a Good Night’s Sleep.

Q. I am seeing a new guy and the stubble on his face has left a large chapped area on my face that almost feels burned. It’s an unpleasant aftermath of an enjoyable kissing session. I'm putting Vaseline on it. Is there anything else that might help more?

A. We checked with cosmetics expert Stanley B. Levy, MD, of Chapel Hill Dermatology in North Carolina. He said you can use 1 percent hydrocortisone cream for a few days. It is available over the counter.

To prevent or soothe irritation, Aquaphor (made by Beiersdorf) would feel and work better than Vaseline. It too is OTC.

Dr. Levy continued, “Make sure you are not sensitive to his aftershave, moisturizer or lip balm. Although the grizzly look is in, you could also ask him to shave more frequently.”

Q. I am concerned about all the drugs my 81-year-old mother-in-law takes. Her forgetfulness has gotten progressively worse and she is dizzy much of the time.

She is taking: amitriptyline, Aricept, Arthrotec, aspirin, Avapro, Chlor-Trimeton, Levothroid, Lexapro, Lortab, Norvasc, Symbicort and Tylenol Arthritis. Do you see any red flags?

A. You have reason to be concerned. Her medications might be contributing to her dizziness and mental decline. Amitriptyline is prescribed for depression or pain relief. It is rarely appropriate for older people, as it may increase forgetfulness and confusion. The antidepressant Lexapro might push levels of amitriptyline higher than expected.

Both blood pressure medicines (Avapro and Norvasc) can cause dizziness. So can the pain reliever Lortab. If dizziness caused a fall, it could be devastating.

She is getting a double dose of acetaminophen from Lortab and Tylenol Arthritis. This could put a strain on her liver.

We are sending you our Guide to Drugs and Older People with a Drug Safety Questionnaire to encourage her doctors to review side effects and interactions.

Q. You wrote recently about Voltaren Gel for sore joints and said it is a prescription product. I bought a tube over the counter when I was in New Zealand a few years ago.

It works very well. I recently used it on a knee I hurt trying to get into a window seat in an airplane. It helped a lot.

A. Countries have different regulations regarding which drugs require prescriptions and which are available over the counter (OTC). Topical diclofenac (Voltaren) requires a prescription in the U.S., but not in New Zealand. This gel is used to ease the pain in joints, tendons, muscles and ligaments due to arthritis, bursitis, sprains and strains.

Q. Last night my boyfriend became so violent I was afraid he was going to hit my 22-year-old daughter or me.

He threatened to burn down our home and he tried to kick me out. I just realized that he started changing in the last two weeks right after he started taking Chantix to quit smoking.

He has never acted like this before. He was so threatening and said such cruel and hateful things.
I read on your Web site about possible violence and aggression from a combination of Chantix and alcohol. My boyfriend drinks beer. As soon as he gets home from work I’ll tell him to stop taking Chantix. There needs to be a warning about this drug. If nothing else, this frightening reaction can ruin relationships that were going beautifully.

A. Some people taking Chantix have become violent. We have heard from others that alcohol may aggravate aggression linked to Chantix.

Even without alcohol, this stop-smoking drug may trigger extreme emotions. One woman wrote: “I took Chantix exactly as prescribed, and within two days, I was a changed person: irritable, with wild mood changes, yelling and screaming at everyone. I would even become violent with close family when things didn't go my way.”

Find more stories about psychological reactions to Chantix at www.peoplespharmacy.com.

Q. Can Synthroid and ferrous sulfate be taken at the same time of the day?

A. No. Iron supplements such as ferrous sulfate interfere with the absorption of Synthroid (levothyroxine) taken to treat thyroid problems. Wait at least two hours after Synthroid before taking iron, calcium or other minerals.

Q. My teenage daughter has been taking antibiotics to treat her acne for years, but she’s also had terrible GI problems (stomachaches and diarrhea) for much of that time. I didn’t think of a connection until recently, but now I wonder if the antibiotics might be responsible.

She has taken Prilosec, as per her doctor’s recommendation, but it really hasn’t helped. Is there anything else that might help her overcome these symptoms? Her dermatologist says if she stops the minocycline she is taking her acne will come back bad, and I hate for her to have to deal with that at the start of the school year.

A. It is possible that years of antibiotic treatment have altered the ecology of her digestive tract, contributing to her pain and diarrhea. Antibiotics kill good bacteria as well as the bad ones.

Repopulating the digestive tract with good bacteria can sometimes help reverse that problem. Such probiotic bacteria may be found in yogurt with active live cultures or capsules such as Culturelle, Enzymatic Therapy or Florastor.

Q. I have normal LDL cholesterol but low HDL, as low as 26. With diet and exercise I can get my HDL to the mid-thirties, which is not great. Lipitor lowered my LDL below 80 but sadly my HDL didn’t budge.

After being on Lipitor for a couple of months I woke up one morning and had no idea what day of the week it was or that the company picnic was the day before. At work I could not make simple postings of dollar amounts from hard copy to electronic spreadsheet (I would forget the amounts).

At a meeting, I could not remember names and later at home I kept asking my wife the same question, as I could not remember her answer. She took me to a doctor, who thought I had a mini-stroke. Ultrasound, brain scans and all other tests were normal, so no stroke.

I mentioned Lipitor but the doctor dismissed it (“no way”). At the end of the evaluation I was diagnosed with transient global amnesia.

Not wanting to be a vegetable for the rest of my life, I stopped taking Lipitor. I now take Niaspan (prescription niacin) and my HDL has improved to 43. My LDL is 80 and my memory is better than ever. I hope this story helps others.

A. We received a startlingly similar story from Duane Graveline, MD, a retired astronaut and family physician, in 2001. He too was taking Lipitor when he had a scary experience with transient global amnesia (TGA).

Subsequently we heard from others who also experienced TGA or other kinds of memory problems while taking statin-type cholesterol-lowering drugs. Anyone who would like to hear Dr. Graveline’s story and learn more about this complication and other ways to control cholesterol may be interested in a CD of a radio interview we conducted with him and several other experts.

Q. I’ve had an odd experience. I’m 66 and in good health, but my eyesight has deteriorated. The ophthalmologist says it’s just due to my age.

When I take Lunesta to go to sleep, the next day my eyesight is crystal clear and needs no correction—just as if I were 18 again. Then, the following day if I don’t take the sleeping pill, my eyes are so blurry and out of focus I have a hard time even with my glasses.

I only take the Lunesta twice a week. Has anyone else reported this weird occurrence?

A. We have searched the official label information and the medical literature and could find no reference to beneficial effects of Lunesta on vision. Thank you for your fascinating report.

Have you considered the possibility that getting a good night’s sleep makes the difference? If others have noticed an improvement in vision linked to Lunesta, we invite them to report it to the Web site: www.peoplespharmacy.com.

Q. My nails break, crack, split and peel and grow out very slowly. They’re not strong enough to open a soda can.

I take Synthroid for my thyroid, hydrochlorothiazide for blood pressure control, simvastatin for high cholesterol and Prevacid for heartburn. Could any of these affect my nails? Is there anything natural I could take or use to help my sad nails? Nail hardeners seem to make the problem worse.

A. Many things may affect nail health. The proper balance of thyroid hormone has an impact. Cholesterol-lowering drugs like simvastatin (Zocor) have been linked to nail changes and so has the acid-suppressing drug lansoprazole (Prevacid).

Avoid nail hardeners, since they may aggravate the situation. Some readers report that taking a dietary supplement called MSM (methylsulfonylmethane), commonly used for arthritis, may be helpful. Others tell us that moisturizing the nails with products like Elon, Epilyt or almond oil is the ticket.

For more details on these approaches, we are sending you our new guide to Hair and Nail Care with a discussion of nail problems and many natural approaches for improving nails.

Q. I have a question about Valtrex.

I know this drug is prescribed to treat genital herpes. If someone is exposed to a partner with herpes, will taking Valtrex right away destroy any of the virus that may have been acquired before it has a chance to take hold and become dormant? In other words, can Valtrex be used as sort of a "day after" medication if taken soon enough?

A. We were intrigued by the idea that Valtrex might protect someone against genital herpes, so we asked the manufacturer, GlaxoSmithKline. We learned that GSK has never done a study to investigate this scenario. The company has only done studies in people known to be infected with herpes simplex virus. As a result, there aren’t any clinical data to support the use of Valtrex as a "day after" medication or as a prophylactic drug in uninfected individuals whose sexual partners have genital herpes.

Q. I take Coumadin to prevent blood clots and have paid attention to potential interactions with food and other medicine. I read in a health newsletter that a full adult dose of Pepto-Bismol is the equivalent of eight aspirins. How serious is this interaction?

A. The maximum daily dose of Pepto-Bismol contains 2080 mg of salicylate. This aspirin-like drug could well interact with the blood thinner warfarin (Coumadin). Such a combination could increase the risk for bleeding. Symptoms include bruises, dark stool, nosebleeds or bleeding gums.

People who use arthritis rubs containing methyl salicylate (oil of wintergreen) may also be at risk for this interaction. Products such as Arthritis Formula BenGay, Icy Hot Cream, Mentholatum Deep Heating and Thera-Gesic all contain methyl salicylate. Anyone taking Coumadin must be extremely vigilant to avoid potentially life-threatening interactions.

Q. I read about a topical form of diclofenac called Voltaren Gel. It is supposed to be applied to the skin over painful joints like the knee. Is this an over the counter or a prescription product?

A. Americans are familiar with oral nonsteroidal anti-inflammatory drugs like celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), indomethacin (Indocin), meloxicam (Mobic) and naproxen (Aleve, Anaprox, Naprosyn). Such medicines can relieve arthritis pain but the price can be increased blood pressure, ringing in the ears, blood clots, stomach upset and bleeding ulcers.

Applying the medication right on the painful joint may reduce the dose needed to get relief and reduce the likelihood of serious side effects. Voltaren Gel is new to the U.S. market and requires a prescription.

We offer more details on topical diclofenac (found in Voltaren Gel and Pennsaid) as well as natural treatments in our Guide to Alternatives for Arthritis.

Q. I was alarmed to read in your article on sunscreens that benzophenone-3 (BP-3) could be a hormone disruptor. I looked at my sunscreens and found that they did indeed have the active ingredient benzophenone-3.

What sunscreen does not have BP-3? My 12 year old plays tournament tennis, so we as a family spend a lot of time in the sun and need to be protected! I know a lot of other concerned parents would be interested as well.

A. Most parents don’t want to expose children to a compound that might disrupt hormones. That is why the concern about BP-3 (also known as oxybenzone) got such attention. This compound, found in many sunscreens and lip balms, can mimic estrogen.

The Environmental Working Group, a non-profit organization that raised the alarm on this issue, has made some sunscreen recommendations on its Web site: www.ewg.org. Products that rely primarily on zinc oxide or titanium dioxide as the blocking agents are generally on their approved list, which features brands such as Keys Solar Rx, Trukid Sunny Days Facestick, and oxybenzone-free products from Badger, Blue Lizard, California Baby and CVS.

Q. I heard that eating an Atkins diet could raise good HDL levels. Surely that is not true! Presumably all that saturated fat raises bad cholesterol even more.

A. In a recent study (New England Journal of Medicine, July 17, 2008), a low-carb Atkins-style diet resulted in higher good HDL cholesterol and lower triglycerides than a standard low-fat diet. Bad LDL cholesterol was not significantly different.

Q. I have an underactive thyroid and take Synthroid. After three years I do not feel any better.
I asked my doctor if I could try an alternative to Synthroid like Armour Thyroid. She told me she prefers the synthetic over the natural form. I was surprised at that, because many people seem to do well on it.

I feel that adding T3 from the natural product might help, but I do not think my physician is going to be willing even to try it. Do you have more info on treating thyroid problems if Synthroid is not working well?

A. If you are experiencing symptoms such as fatigue, depression, hair loss, constipation, puffy eyes, dry skin and brittle nails, you may indeed be suffering from too little thyroid hormone. Although the research is controversial, some people report feeling better when they get a mixture of T3 and T4 forms of thyroid hormone. Synthroid contains only T4 (levothyroxine).

We are sending you our Guide to Thyroid Hormones with a discussion of natural vs. synthetic thyroid replacement and how to balance T3 and T4. Dried thyroid glands have been used for more than 100 years, before the FDA existed. Doctors may prescribe Armour or other natural thyroid preparations.

Q. I was prescribed Advair for asthma. It worked well for my breathing problem but my skin became thin and I started bruising badly. Then I experienced horrible damage to my skin with deep gashes from a slight bump. One day I leaned on the bathroom counter and several inches of the skin on my arm peeled off.

My lung specialist insisted Advair was not responsible for thinning skin. One day I asked my pharmacist, “Have you ever seen anything like this?” She looked at my bruises and said, “It could be from taking steroids.”

She checked my meds and told me Advair contains a steroid. I spoke to my doctor but he still said it was not the medication. I switched to another clinic and got a different asthma medicine, Serevent. My health care provider, a nurse practitioner, told me she had seen a few others whose skin reacted as mine did. After several weeks off Advair, my skin returned to normal and I no longer have bruises or serious gashes.

A. We’re surprised the specialist you consulted was unaware that Advair can affect the skin. The official prescribing information lists bruising and wounds as potential adverse reactions.

The steroid in the asthma inhalers Advair and Flovent is fluticasone. Although not as risky as oral prednisone, there can be some systemic side effects with this drug. A higher risk of cataracts, glaucoma and pneumonia has been reported with long-term use.
 

Q. I was given erythromycin for an infection and immediately started having heart palpitations and shortness of breath. My doctor didn't believe that the drug could have caused the problem, so he gave me something generic but still in the same family of erythromycin. I had the same reaction. A couple of years ago I found something on the AMA website stating that erythromycin had been responsible for several cardiac deaths!

A. You may be more susceptible than average to heart rhythm disturbances caused by certain medications. People with “long QT intervals” may react to erythromycin and many other drugs in a dangerous way. The long QT interval shows up on an electrocardiogram, so you may need to be tested. There are lists of drugs that might be dangerous if you do have long QT interval at www.qtdrugs.org.

Q. My mother, a retired nurse, encouraged me to write you regarding my son's acne problem. He is 19 and has been through many rounds of antibiotics with limited success. I don't like his taking antibiotics for such long periods of time. Any suggestions?

A. You will laugh at our suggestion and dermatologists will cringe. We have heard from readers that putting milk of magnesia on the skin can be helpful for acne. One mother recently shared the following story:

“I wrote you several months ago about my son who almost died back in October 2007 from vitamin A poisoning. The dermatologist taking care of him had prescribed Accutane, and that seems to have been the cause.

“He has been using milk of magnesia topically at bedtime for months now. Our pediatrician ran a test to make sure he wasn’t getting too much magnesium, and also retested the vitamin A level to see if it had come back to normal.

“The happy news is that both magnesium and vitamin A levels are normal. My son looks great and feels well.”

Q. I am a woman with over-the-top libido. My doctor says I may have PSAS--persistent sexual arousal syndrome. I’ve been dealing with this problem for a year, ever since I turned 40. The anti-depressant Pristiq has helped immensely, but I wonder if there is a more natural approach to this condition.

A. Persistent sexual arousal syndrome can be a serious problem. In this situation, a woman experiences frequent intrusive genital arousal—tingling or other sensations—without sexual desire. The arousal is not always relieved by orgasm.

No single treatment works for everyone, but antidepressants are sometimes helpful. Pristiq (desvenlafaxine) is a relatively new antidepressant that is related to Effexor (venlafaxine). Side effects may include high blood pressure and withdrawal symptoms upon stopping as well as insomnia, nausea, dizziness, excessive sweating and sexual difficulties.

We are glad Pristiq is working for you. Because PSAS is a relatively rare diagnosis, there is very little research to suggest natural approaches might be effective.

Q. My husband takes hydrochlorothiazide and lisinopril for high blood pressure. I suspect that these medicines are responsible for his dizziness and erectile dysfunction. His blood sugar is also up.

Could the medicine be responsible? Are there any natural remedies that might help lower blood pressure? I have heard that beet juice might be helpful.

A. Diuretics like hydrochlorothiazide (HCTZ) can cause dizziness and raise blood sugar. Erectile dysfunction is a fairly common side effect of both hypertension and the medicines used to treat it.

A low-sodium, high-vegetable diet (the DASH diet) has been shown to help control blood pressure. Drinking beet juice may also help.

For more details on natural approaches to lower blood pressure, including beet juice, the DASH diet and breath training, as well as information on various medications, we are sending you our Guide to Blood Pressure Treatment.

Q. My husband took Flomax for a prostate problem. Recently he needed cataract surgery. Who knew that Flomax would cause complications?

Not only was the surgery very painful, but I have heard that some surgeons won’t operate on a man who has taken Flomax. It has been three weeks since the surgery and he still cannot see very well. The doctor said it would be at least five or six weeks before he can judge the success of the cataract procedure. Please alert other men to this problem.

A. Flomax (tamsulosin) relieves prostate problems by helping smooth muscle relax and improving urine flow. In 2005, ophthalmologists reported that patients taking Flomax sometimes developed a complication known as small pupil or intraoperative floppy iris syndrome (IFIS) during cataract surgery. It appears to be caused by excessive smooth muscle relaxation in the iris itself in reaction to Flomax.

In some cases, men were taking Flomax at the time of surgery, but in at least one documented case the man had stopped the drug a year before his cataract operation. Forestalling this complication requires special equipment and surgical techniques. Cataract surgeons should always be notified that a patient has taken Flomax so they can plan accordingly.

Q. In 2001 I had a very strong urge to chew on ice. After reading in your column that this could be a sign of anemia, I told my doctor about it. The blood work showed anemia and I was advised to get a colonoscopy. This test showed cancer in the colon.

I had surgery and received six months of chemo. The operation removed 10 inches of my colon. Testing the lymph nodes showed the cancer had spread to three out of 15 tested.

I wouldn’t have mentioned the craving for ice cubes had I not read about it in your column. I thank you for that timely article. I have been cancer free for these past seven years.

A. Unexplained cravings for ice, laundry starch, cornstarch or other peculiar substances often signal a deficiency of iron or zinc and should be investigated. We are pleased your doctor took your anemia seriously and looked for the cause. The colonoscopy and subsequent treatment of the cancer may have saved your life.

Q. Here in Hawaii, we call head lice "Ukus." We’ve had quite a problem with them this year and I have found the medication costly and ineffective. I’m glad you wrote about Listerine, because I never would have thought to use it. We tried it and it worked.

A. Many traditional lice treatments have lost effectiveness. The alcohol and other ingredients in Listerine may help kill lice. One mother described saturating the scalp with Listerine and covering the hair with a shower cap for two hours. She then combed out the dead lice.

Q. I seem to recall reading on your web site about a reliable Canadian site from which to get less expensive legitimate prescription drugs. I am in the Part D doughnut hole and a 90-day supply of my Actos is more than $500.00.

Can you direct me to that Canada information once again so I can get some much-needed help with my drug costs?

A. We did some checking and found that in the U.S. the diabetes drug Actos might run you anywhere from $570 to $692 for a three month supply. The same medicine in Canada could cost between $161 and $382. The savings are significant.

When people enter the dreaded “doughnut hole” in their Medicare Part D prescription plan, they have to pay 100 percent of the medication costs. Buying from Canada can be helpful, but caution is necessary. Some Web site that claim to be Canadian are actually based elsewhere.

We are sending you our Guide to Saving Money on Medicine with guidelines for determining which online drugstores are legitimate Canadian pharmacies. Medicare participants who spend more than $4050 out of pocket become eligible for catastrophic coverage. If you think your drug bills will be a lot more than that, you should probably continue buying your medicine in the U.S.

Q. I was on Lipitor for a number of years and have severe muscle and nerve damage to the extent that I am in a power wheelchair. Do you think Lipitor could be to blame?

A. Statin-type cholesterol-lowering drugs such as Crestor (rosuvastatin), Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin) are linked to muscle pain, weakness and nerve damage. Most physicians have assumed that muscle problems are an extremely rare side effect. Many readers have experienced this problem, however. Here is one example:

“I’ve been taking Lipitor for years. Two months ago I stopped, since I suspected it was responsible for the major pain and weakness I am experiencing in the muscles of my arms, shoulders, hands and feet. I felt like a lump of spasmodic pain with extreme fatigue and brain fog.

“My doctors did not think Lipitor was the cause. Stopping the Lipitor banished the brain fog so I can think and remember things again. I am still plagued with pain, muscle spasms and weakness.”

New research (New England Journal of Medicine, online, July 23, 2008) suggests that some people are highly susceptible to muscle-related complications from high-dose statins. This genetic vulnerability may affect up to one-fourth of the population. Others are unlikely to experience such problems.

Q. I was recently diagnosed with shingles and prescribed Valtrex. I had no idea it was used for anything else until I picked up the prescription and read in the flyer that it is used for herpes.

I thought this would be comforting for the woman who wrote to you that she was so ashamed about having herpes she did not want to seek treatment. She was afraid people at the pharmacy would look down on her. These drugs have multiple uses, so who would know?

A. Valtrex (valacyclovir) is indeed used to shorten an attack of shingles as well as to treat genital herpes. You are right that a prescription for Valtrex is no cause for shame.

Q. I want to warn others about taking too much calcium and vitamin D. Apparently I took more than my limit and ended up with soft tissue calcifications.

My doctors doubted that this caused my calamity, but I am certain that it contributed. The calcium in my left arm caused a lot of pain. My mammogram also showed calcification. Calcium and vitamin D are very popular these days, but you can overdo.

A. Thanks for the words of caution. Women have been urged to increase their calcium intake to maintain strong bones, but a study from New Zealand also sounded a warning (British Medical Journal, Feb. 2, 2008).
Postmenopausal women were studied for five years. In addition to calcium in their food (roughly 850 mg daily), they took either 1000 mg calcium or placebo. The women taking extra calcium were more likely to suffer a heart attack during that time. Another study did not confirm this risk, but there is some concern that excess calcium and vitamin D might contribute to calcification.

Q. I have read your articles on licorice raising blood pressure, but you don't state if it is black licorice or both red and black licorice.

I have never suffered from high blood pressure and I enjoy red licorice once in a while. I don't notice any side effects from eating it. Is it safe?

A. Red licorice is totally safe. It doesn’t contain the ingredient (glycyrrhizin) found in black licorice that may raise blood pressure.

Q. Five years ago I developed duodenal ulcers after taking Fosamax for six weeks. I was also taking ibuprofen for headaches at the same time.

Last year, after taking baby aspirin for a few months, an endoscopy revealed more ulcers. I was diagnosed with H. pylori and treated with antibiotics.

I have bad osteoarthritis pain in my right knee and hip and would love to take ibuprofen instead of Tylenol, but I don't want to take omeprazole long-term and don't want to risk another ulcer.

Since the H. pylori is gone, could I risk the ibuprofen? Or is there some other agent I could take that would relieve the pain without causing ulcers?

A. The combination of Fosamax with the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen was a prescription for trouble. Both medications can cause ulcers. A study of Fosamax together with a different NSAID, naproxen, showed that ulcers were more likely in women taking both medicines (Archives of Internal Medicine, Jan. 8, 2001).

Helicobacter pylori (H. pylori) is a stomach infection that increases the risk of ulcers. Even without H. pylori, you might still be susceptible to ulcers if you take aspirin or an NSAID.

We are sending you our Guides to Digestive Disorders and Alternatives for Arthritis, with information on arthritis drugs that are less likely to cause ulcers as well as non-drug approaches to relieve arthritis pain. Ask your doctor about either Disalcid or Trilisate, anti-inflammatory drugs that are less likely to cause stomach irritation.

Q. My brother-in-law sent me an email about how to remove ticks. It was attributed to a school nurse who suggested applying a glob of liquid soap to a cotton ball and covering the tick with the cotton ball for 20 seconds. Presumably when you remove the cotton ball the tick will come out on its own and be stuck to the cotton ball.

Is this really a good way to remove ticks? We are having a bumper crop this year.

A. According to Snopes.com, this email has been circulating on the Internet for more than two years. It sounds credible, but it is not true. Putting liquid soap, petroleum jelly, Vicks VapoRub, fingernail polish or any other goo on a tick will not make it let go faster. Aggravating a tick might cause it to regurgitate saliva into the bite, increasing the risk of infection.

The CDC recommends grasping the tick with tweezers as close to the skin as possible. Use a gentle steady motion to pull the tick straight away from the skin.

Prompt removal reduces the risk of infection. Symptoms such as rash, fatigue, chills, fever, headache, muscle and joint aches could signal either Lyme disease or Rocky Mountain spotted fever. Both require prompt medical attention.

Q. My husband took Lipitor and had a bad reaction with muscle weakness. Now my doctor is recommending that I take it, but I am reluctant. My total cholesterol is 284. My LDL is 156 but my HDL is 114. Doesn’t that count for something?

A. Your good HDL cholesterol is extremely high, which is great for your heart. The ratio of total cholesterol to HDL cholesterol is an important measure of heart risk. Your ratio is 2.5 which is excellent.

Your bad LDL is also high, but you may be able to get it down with natural approaches such as the soluble fiber psyllium, walnuts or fish oil. We offer details on these and other natural approaches as well as medications besides Lipitor in our Guide to Cholesterol & Heart Health.

Q. My wife has a problem with noise in her right ear. The noise is so constant that it affects her ability to sleep. It started several years ago when she was treated for the flu. The doctor prescribed a strong antibiotic and the noise started the same night and has not gone away.

When we spoke with doctors they said this is part of the aging process and nothing can be done. An audiologist suggested putting the radio on between stations to generate “white noise.” It sure would be great if any of your readers told you of a cure.

A. Many things can cause tinnitus (ringing or buzzing in the ears). Exposure to loud noise can damage the tiny hair cells inside the ear and trigger tinnitus. Various medical conditions like high blood pressure and infection can also cause it. Dozens of medications, including aspirin and certain antibiotics can also lead to this problem.

There is no magic bullet to cure ringing in the ears. Some folks benefit from white noise, while others find it annoying. There are “retraining” programs that help some people cope with tinnitus.

Although the FDA has not approved any medications to treat tinnitus, a small study suggested that misoprostol (Cytotec), a drug used to protect the digestive tract from ulcers, reduced symptoms (Otolaryngology—Head & Neck Surgery, May 2004).

Q. You have written about people having a hard time getting off antidepressants without awful side effects. I had a terrible time getting off Xanax, a highly addictive medication. A pill can only be cut into so many pieces. So the doctor told me I could have a local custom pharmacy make up “gummies” (like the kids’ candy). Each week or two they would put in a little less of the drug until it got down to a minute amount. It took weeks but it helped lessen the side effects.

A. We have heard from many readers who have had great difficult withdrawing from anti-anxiety agents such as Xanax (alprazolam). Symptoms may include nervousness, agitation, difficulty concentrating, headache and insomnia.

Getting off antidepressants like Effexor, Paxil and Zoloft can also be challenging. Having the doctor prescribe a gradually decreasing dose for the compounding pharmacist to include in gummy candy is an innovative solution to a thorny problem. Thanks for sharing this approach.

Q. I've been advised to use diaper rash ointment containing zinc oxide to keep my horse's muzzle from getting sunburned while he's grazing. I've been wondering if this would also work to keep me from developing a "horse-woman's tan." All of the sunscreens I have tried help me avoid sunburn, but I have brown arms from the edge of my gloves to the edge of the short-sleeved shirts.

A. For decades lifeguards have used white zinc oxide to keep their noses from burning. It blocks both UVA and UVB rays and provides excellent protection.

You could try the diaper rash ointment or get a sunscreen that contains both zinc and titanium. New formulations contain microfine particles that don’t leave a distinctive white color. Human sunscreens can also be used on horses to keep pale skin from burning.

Q. I have a history of sleeping problems. I just started taking half an acetaminophen PM tablet (1/4 the adult dose) just before bed. This allows me to sleep through the night. Is this safe?

A. If pain is not an issue, you don’t need the acetaminophen. The PM part of the pill is diphenhydramine (DPH). This is the antihistamine found in Benadryl and it makes people drowsy. At the dose you are using, there should be few, if any, side effects.

Q. I take hormone replacement in the form of bio-identical hormones from a compounding pharmacy. The prescription is a triple-estrogen compound with progesterone. The compounding pharmacist stated that because all three forms of estrogen are used, the risk that accompanies Premarin or Prempro does not exist. Conventional hormone replacement does not contain all three forms of estrogen.

Is this accurate? I have tried conventional hormone replacement in the past and was completely miserable, while I feel great using the bio-identical product.

A. Conventional hormone replacement therapies such as Premarin and Prempro contain a variety of estrogenic compounds. These are, however, estrogens that horses make, so they may be somewhat different from the estrogens your pharmacist used in compounding your prescription.

There are many claims that compounded hormone therapy is safer than conventional HRT. There are no studies to prove that statement, however. The FDA considers claims that bio-identical hormones are safer or better than conventional therapies to be false and misleading.

To better understand the pros and cons of hormones, we are sending you our Guide to Estrogen: Benefits, Risks and Interactions.

Q. I desperately need your help. I was diagnosed with genital herpes three years ago, and this diagnosis has left me full of emotions. I am crying as I write this letter.

For fear of scorn and rejection, I cannot disclose this to anyone. I won’t ask for a prescription because if I got it filled, anyone who works in the store would know, even the kids they hire after school.

Are there any over-the-counter vitamins I can take to help with the discomfort and pain? I feel tremendous pressure to maintain this secret. The only reason I haven’t killed myself is because I have kids. I am afraid I could pass this on to them, so I constantly wash my hands and disinfect the house and car.

A. You are not alone. It is estimated that one in five Americans (45 million) is infected with genital herpes. Counseling can sometimes help overcome the emotional strain of this infection.

There are effective antiviral medications to prevent outbreaks or shorten the duration of an attack (Current Opinion in Infectious Diseases, Feb. 2008). Your doctor could prescribe acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex).

You should not worry about the pharmacy where you purchase the medication. Your privacy is protected. If you prefer, though, you could use an online or mail order pharmacy service. That way you wouldn’t even have to go to a pharmacy.

The virus that causes genital herpes is spread primarily by sexual contact, so you won’t infect your children. Of course, during an outbreak, frequent hand washing is advisable.

Q. Is chewing Aspergum as effective as chewing an aspirin if you think you are having a heart attack?

A. Physicians frequently advise patients who think they may be having a heart attack to dial 911 and chew a baby aspirin while they wait for the ambulance. Aspergum contains 227 mg of aspirin per gum tablet and should work about as well. Another quick way to get aspirin into the system is to dissolve an uncoated tablet in a glass of sparkling water.

Q. My 81-yr-old Mom is currently prescribed allopurinol to prevent gout, enalapril and labetalol for high blood pressure, metformin for diabetes, Plavix to thin her blood, Zocor to control cholesterol plus extra Magnesium and potassium (Klor-Con).

She exhibits confusion, symptoms of dementia, dizziness, and has fallen several times. I think these medications may be excessive and at this stage some may even be counterproductive. Opinion?

A. Your mother’s medicines could be having an impact on her overall health. A physician who specializes in geriatric medicine should review her situation because we have detected some potential problems.

Allopurinol can cause sleepiness, while labetalol and Plavix both may cause dizziness and fatigue. Some readers have reported severe muscle weakness and memory problems with statin-type cholesterol-lowering drugs like Zocor (simvastatin). Metformin can deplete the body of vitamin B-12, which may lead to confusion and forgetfulness.

Far more worrisome is the combination of potassium with enalapril. This could lead to a life-threatening complication.

If your mother were to fall again, she might break a hip. Such an accident could have devastating consequences. We are sending you our Guide to Drugs and Older People with a Drug Safety Questionnaire to encourage her doctors to review side effects and interactions.

Q. I have a much higher sex drive than my partner. He is in his late 30s, while I am in my mid 20s. I would prefer to have sex every couple of days while he is fine with having it once every week and a half.

I find it difficult to deal with this situation because I feel that it's not normal for me, a woman, to have the higher sex drive. I worry that I might make sex seem like a chore to my partner if I ask him to have it with me more often. I often wish that I could take medication that would lower my sex drive so that I could be happier.

A. We consulted two of the country’s leading sex experts about the concerns you raise. Dr. Ruth Westheimer suggested that your partner could help you achieve sexual satisfaction even if he isn’t in the mood for intercourse.

Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, pointed out that you are not unusual. In focus groups it was discovered that 25 percent of women often have a higher sex drive than their male partners.

It may be worthwhile for your partner to have a medical workup and have his hormonal levels checked to make sure everything is within normal limits. Dr. Goldstein mentioned that there is an experimental drug that may improve libido for both men and women called flibanserin. The FDA is expected to review it during the next year.

There are no approved drugs to lower libido. However, the herb vitex (chaste tree berry) may reduce sex drive.

Q. I have back problems and have been taking Vicodin daily for pain. The last six months, my breathing has been terrible. I’d have to stop and catch my breath with any little thing.
I’ve been off Vicodin for a week and my breathing is much better. Could the Vicodin be responsible?

A. The prescription pain reliever Vicodin contains acetaminophen and the narcotic hydrocodone. According to the manufacturer, in sensitive people or at high doses, hydrocodone can produce respiratory depression and irregular breathing. We don’t know if that is what you experienced, but you should report it to your physician.

Q. I developed a dry cough soon after my doctor diagnosed me with hypertension and put me on Altace. I would cough and cough until I would gag and throw up at work into my trashcan because the coughing would just come on so suddenly I didn't have time to make it to the ladies room. I even had to carry a small trash bag in my car because I was afraid that I would throw up during my commute to and from work.

I asked my doctor for another medicine. He prescribed lisinopril, and I am still having the same problem. What’s going on?

A. Both of your blood pressure medicines are ACE inhibitors and can cause a persistent cough in susceptible people. We are surprised that your doctor didn’t mention this side effect.

A survey of participants on the iGuard.org Web site revealed that only one patient in four on lisinopril had been told that the drug could cause cough. More than a third of the respondents had a chronic cough.
The iGuard.org Web site offers personalized estimates of drug risk and interaction concerns. To give you more information about other hypertension drugs, including non-drug approaches, we are sending you our newly revised Guide to Blood Pressure Treatment.

Q. Have you heard of using milk of magnesia on severe acne? My son has cystic nodular acne. He is 16 and has been under a dermatologist’s care for many years.

We have spent thousands to no avail. He has recently tried a home remedy: applying milk of magnesia to his face at night before bed. He looks the best he has in four years. Can you tell us why this is working so wonderfully well?

A. Milk of magnesia (aka MoM) is a solution of magnesium hydroxide and is best known for its laxative action.

We don’t know why MoM might combat acne, but we have heard that this laxative can help clear up seborrheic dermatitis. In this condition, yeast on the skin causes redness and flakes, rather like dandruff, but on the forehead and chin as well as scalp and eyebrows. Here is one reader’s report:
“I have been using milk of magnesia on my face for the past two months and my face flakes are gone! I pour it in my hand and massage it on my face (forehead, eyebrows, around the eyes, nose, cheeks and chin) while showering, and rinse it off at the end of the shower. End of problem. It’s a great, cost-effective alternative to expensive Nizoral, and it works better, too.”

Q. I have taken both lithium and Wellbutrin for 15 years to control bipolar disease. Recently I have become very thirsty. It is most noticeable when I'm speaking to large groups. (This is part of my job that hasn't changed for more than 25 years.)

My doctor says thirst has always been a possible side effect of both medications. Is there anything I can take to relieve the thirst, even if only for the periodic speaking engagements?

A. The antidepressant Wellbutrin (bupropion) can cause dry mouth. Real thirst, though, is a common side effect of lithium. The fact that you are bothered with thirst now although it has not been a problem for years might suggest you are more susceptible to the drug. Perhaps your kidneys are not coping with it as well. We recommend you see your doctor for a thorough check-up and blood test to make sure the dose of your lithium medication is still right for you.

Q. I have suffered with insomnia for years. My doctor prescribed Ambien, which gives me eight hours of restful sleep. Then the pharmacist switched me to generic zolpidem for under $15. He said it was identical to Ambien.

It wasn’t! I haven’t had a decent night’s sleep since switching. If I do fall asleep I have horrible nightmares. I cannot afford $130 for regular Ambien. What else can I do? I need my sleep to be alert at work.

A. Dozens of other readers have also reported problems with generic Ambien (zolpidem). If your insurance company won’t cover the brand name medicine, you may wish to consider some non-drug options. They include a small high-carb bedtime snack such as milk and graham crackers, dietary supplements such as magnesium, melatonin, passionflower or valerian, a hot bath an hour before retiring and acupressure wristbands.

We describe these approaches and others in greater detail in our newly revised Guide to Getting a Good Night’s Sleep. We also discuss OTC sleeping pills and prescription drugs such as Lunesta, Sonata and Rozerem.

Q. I need your help to solve a horrible problem I have developed since being diagnosed with type 2 diabetes several months ago. My doctor prescribed medicine to help control my blood sugar. I’ve been watching my diet and have lost 30 pounds.

My problem is TERRIBLE gas. I cannot control it. This never happened before. I can hardly move, let alone walk or bend without outbursts that are both loud and long, just like a motorboat.

In addition, my sex life is nonexistent. Because I can’t control the gas my husband is very annoyed.

I try to stay away from people at work, but that is difficult because I am a secretary. Beano just made things worse. Could this be due to my medication? My doctor seems unconcerned.

A. Some pills for type 2 diabetes are notorious for causing digestive distress and flatulence. Be sure to tell your doctor how much this is interfering with your quality of life. There are a number of alternatives for type 2 diabetes, and another medication might be less troublesome for you.

Q. Is it safe to sleep in the same room/bed when your spouse has the flu if he is being treated with Tamiflu?

A. Tamiflu is an effective antiviral medication. It can shorten the duration of an influenza attack if taken early enough, but we don’t know how soon the drug can limit the spread of viruses in a household. Tamiflu can be used preventively, so you may want to ask your doctor whether a prescription could protect you from catching your husband’s flu bug.

Q. My mother-in-law is 86 years old and in reasonably good health. Several months ago, she started complaining about increased pain and seemed very weak and confused. Within a month, she could not walk and was forced to leave her home and move in with her granddaughter.

I looked her medications up and found a drug interaction between simvastatin (40 mg) and verapamil. We brought this to the attention of her doctor who said, "There is no interaction."

On our own, we stopped the simvastatin and within 4 weeks she had improved dramatically. Two months later, she is now walking without a walker and feels pretty good.

She saw the doctor again the other day and her cholesterol was high, so he ordered Vytorin 10/80. I don’t get it: If she could not tolerate 40 mg of simvastatin what makes him think she can take 80 mg as part of a combination? How critical is it to lower cholesterol aggressively in a person her age? She has no history of heart disease.

A. The blood pressure drug verapamil can indeed boost blood levels of simvastatin (Clinical Pharmacology & Therapeutics, Aug.1998). Older people like your mother-in-law may be especially sensitive to the side effects, particularly muscle pain, weakness and mental confusion.

There is no convincing data showing that lowering cholesterol aggressively will extend life in an otherwise healthy person her age. If she can’t walk, the quality of her life and the risk of a fall could easily outweigh the drug benefits.

We’d like to send you our Guides to Drugs and Older People and Cholesterol-Lowering Drugs for an in-depth discussion of the pitfalls of medications for senior citizens.

I found a recipe for home cleaner spray--a simple mixture of white vinegar, water and a few drops of essential oil for fragrance. I spray this mixture everywhere, confident that I could eat it if I had to. It does a great job on the stainless kitchen sink, microwave, countertops and bathroom sink.

I'm under the impression that vinegar will be enough to kill germs, especially bacteria. Is that true? Do I need to add something more caustic to get the germs?

A. Vinegar is a great cleaner, but we didn’t know how well it could kill germs. We asked germ guru Charles Gerba, PhD, a microbiologist at the University of Arizona, Tucson. He has done field studies on household germs.

Dr. Gerba said that vinegar is useful as a cleaner and has some antimicrobial properties, but it is not considered a sanitizer or disinfectant. For disinfecting, dilute bleach is still best.

Q. What do you know about compounded testosterone cream? I am a 64-year-old woman with a very low libido.

A friend of a friend uses this cream before sex, applying it to the inner thighs. She has great results with desire and orgasms, but my gynecologist says it is not FDA approved and won't prescribe it.

A. Low testosterone levels in men or women are associated with diminished sexual interest, arousal and enjoyment. Some small studies suggest that testosterone therapy may boost libido, even in women (Menopause, May-June, 2006). Too much of this male hormone can cause facial hair growth, acne, deepening of the voice and clitoral enlargement.

Your doctor is correct that the FDA has not approved testosterone for improving women’s sex drive. Nevertheless, a physician who specializes in sexual medicine may be able to assist you.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction for more information on the benefits and risks of testosterone to counter low libido.

Q. I enjoy using my outdoor hot tub in the winter, but I get an itchy rash on my legs. I think it is eczema. How can I continue to enjoy my spa?

A. You may have “hot tub folliculitis.” This rash may be caused by pseudomonas bacteria that grow in hot tubs that are not properly maintained (Journal of the American Academy of Dermatology, Oct. 2007). Check with your dermatologist to see whether you need an antibiotic.

Q. My doctor prescribed Toprol-XL several years ago and it worked well. Last week my pharmacist refilled my prescription with generic metoprolol succinate. Two days later my blood pressure shot sky high to 190/100.

Luckily, I found some leftover pills of the brand name Toprol-XL. My blood pressure came down to 140/90--high but okay.

Is there a problem with this new generic? This has never happened to me before.

A. Toprol-XL (metoprolol) is a slow-release beta blocker prescribed to control high blood pressure and irregular heart rhythms. Many other readers have reported rapid heart rate and higher blood pressure after switching to some generic forms of metoprolol succinate.

One patient experienced pounding headaches with blood pressure of 225/125 after one week on metoprolol. Another wrote, “I have bouts of ultra-fast heart beats, atrial fibrillation, and severe PVCs (premature ventricular contractions) which have been controlled with Toprol-XL for years. On the generic, it is as if I'm not taking anything.”

We urge anyone having a problem with a generic drug to discuss the problem with the prescriber. The FDA insists that all generic drugs are equivalent, but our readers describe varied reactions.

A. Your wife is right. It takes about 30 seconds of vigorous scrubbing and rinsing to wash off most germs. If everyone followed your wife’s good example, there’d be fewer colds passed around each year.

Q. Is it important to have a bowel movement at the same time every day? My late mother-in-law used to insist this was the most important health advice.

A. No one wants to be constipated, but not all healthy people need a bowel movement daily. Some people with excellent bowel function go every other day or every third day. Others need more than one daily trip to the bathroom.

The belief in the importance of a daily BM has led many people to use harsh laxatives, such as senna. We offer more natural approaches to achieving regularity in our Guide to Constipation.

Q. You have had questions from people with skin cracking on their fingertips. I have another option to add to your suggestions: Acid Mantle from Doak Dermatologics.

I learned about it many years ago from the cook at my children's camp. Her hands cracked and split from being washed and dried so often until she found Acid Mantle.

We initially used it for sunburn relief, but it’s also wonderful for chronic dry skin or the chapped area under your nose when you have a runny nose. Doing home remodeling (sanding, sheetrock) can be very drying because the protective oils of the skin get removed or the natural acid pH is disturbed.

Acid Mantle is expensive (about $44 for a 1-lb jar). But a little goes a long way, so the large jar lasts a year or more.

A. Ten years ago a scrub nurse wrote to us about Acid Mantle: “What a relief! It reversed the burn caused by the base pH in soaps, and returned my skin to normal.” The product contains petrolatum, glycerin and synthetic beeswax as well as other moisturizer ingredients.

Q. A few months ago, I finally yielded to my doctor’s pressure and went on a blood pressure medication, against my better judgment. I am a 63-year-old female. The medication is metoprolol succinate.

If you could tell me some of its side effects, I would be grateful. I am not feeling well and I am guessing this new med is the culprit.

A. Metoprolol, like other beta blocker blood pressure medicines, may cause fatigue, dizziness or diarrhea. Some people develop an itchy rash while taking the medicine, while others may find themselves short of breath. It slows heart rate, sometimes by quite a lot.

Many cardiologists are reassessing beta blockers, though. Such drugs are rarely considered first line treatments for hypertension these days (Lancet, Oct. 29, 2005). Blood pressure control is very important, so don’t stop your medication on your own. (It is dangerous to stop a beta blocker drug suddenly.) Discuss your symptoms with your doctor and ask about other possible treatments.

Perhaps this reader’s experience will help you: “I was told I need to be on blood pressure meds. I don't like to take pills so I tried breathing exercises and going to the gym. I didn't have high blood pressure at my last visit.”

Q. How do you advise people to dispose of their prescription and over the counter drugs safely? I worry about this stuff being flushed down the toilet and contaminating the water supply.

A. Flushing unused or outdated medications down the toilet is a bad idea for that very reason. The government is suggesting that unused drugs, especially potent pain relievers or sleeping pills, be mixed with something nasty before putting them in the trash. Used kitty litter has been proposed to make the pills unpalatable to children, pets and drug addicts.

One veterinarian complained to us, however, that mixing drugs with used kitty litter is dangerous for dogs and some other animals that find used kitty litter appetizing. Ask a pharmacist about other ways to dispose of unused medicines.

Then I went for a routine physical, which included blood work and urinalysis. Both my internal medicine doctor and I were shocked that my creatinine level was very high—indicating I was close to kidney failure.

After careful consideration of the medications I was using, we determined that ibuprofen was the culprit. I quit taking it immediately on my doctor's orders. My creatinine levels have been normal ever since.

I don't think many people consider kidney damage as a side effect of regular ibuprofen use. I certainly had no idea.

A. Millions of people take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen every day to relieve pain and inflammation. Many assume such OTC medications are risk free.

These pain relievers can be hard on the kidneys, especially when taken for a long time. Other complications may include liver damage, fluid retention, high blood pressure, heart failure and stomach ulcers. No one should take NSAIDs for more than 10 days without careful medical supervision.

Thank you for sharing your story. It may help others avoid a similar problem. We are sending you our Guide to Alternatives for Arthritis with detailed information about the dangers of NSAIDs and prednisone plus many non-drug alternatives for pain relief.

Q. I have tried many statin drugs for high cholesterol but had muscle pain with all of them. Two years ago my doctor prescribed cholestyramine. It is in powder form and I take one packet a day in juice or water. It is terrific and has lowered my cholesterol with no muscle pain.

A. Cholestyramine was a common prescription drug for high cholesterol long before the statins were invented. It binds to bile acids in the digestive tract, which leads to lowering of cholesterol. Side effects may include constipation, flatulence and digestive upset.

Q. I recently read your answer to the person with smelly feet. I’d like to tell you what worked for me for 30 years. I was a waitress and had to wear solid shoes and nylons for long hours. My feet ached and smelled so bad I couldn’t stand them. I tried everything. Finally, Campho-Phenique worked wonders. It may help someone else.

A. Campho-Phenique contains camphor and phenol as main ingredients along with eucalyptus oil. It is primarily used for relieving minor skin irritations, cuts, scrapes and insect bites. Perhaps the antibacterial and antifungal nature of these old-fashioned ingredients helped clear up a lingering infection responsible for foot odor.

Q. I have just begun treatment for hypothyroidism and for the first time in over 20 years I feel like I'm emerging from a fog. I was diagnosed with depression and attention deficit disorder for years. My mental clarity and concentration were terrible.

Since starting on Synthroid, I feel like a new person. My question is about my daughter. She is 17 and has some of the same symptoms. Is she too young to have her thyroid tested? I would hate for her to go through life feeling like I did.

A. Thyroid problems can run in families, so it makes sense to have her thyroid function checked. Depression has many causes and is not always recognized as a symptom of insufficient thyroid hormone.

Lack of concentration and even clumsiness can be symptoms of thyroid disorder, along with more classic symptoms such as fatigue, constipation, hair loss, weight gain and cold intolerance.

We are sending you our Guide to Thyroid Hormones, which describes symptoms of thyroid imbalance and treatment options as well as how to interpret lab results.

My new girlfriend has an extremely high sex drive (yes, I am blessed), but we’d like to hold off until we know that we have a real future together. Your advice will be appreciated.

A. Many prescription drugs lower libido as a side effect. Antidepressants such as Prozac or Zoloft can do this, but such medications carry other risks.

The hormone progesterone is notorious for reducing sexual desire, but it too has numerous side effects including blood clots, breast tenderness, headaches, dizziness and depression. One alternative is chaste tree berry extract (Vitex agnus-castus). This herb has mild progesterone-like effects and is reputed to reduce libido. There is no clinical research to support this claim, however.

Q. Recently on two separate prime-time TV shows I heard the character playing the parent of a young child suggest giving the youngster a baby aspirin. It has been some time since I worked as a pediatric nurse, so maybe things have changed. We never gave aspirin to children due to its connection with Reye’s syndrome. If this has changed, please set me straight.

A. You are absolutely correct. When children or even teenagers take aspirin for chickenpox or flu, they run an increased risk of Reye’s syndrome, a rare but potentially deadly condition. Parents should not give children aspirin for fevers.

Q. I was interested in a column about a person who developed cough while taking lisinopril. I myself was put on this medicine for high blood pressure and immediately began having violent coughing spells. If they started in a meeting, I’d have to excuse myself. It became extremely embarrassing. Nothing worked, no cough syrup or cough drops.

I never got more than 30 minutes of uninterrupted sleep at a time. Sometimes the coughing was so severe it caused vomiting. My doctor put me on different medicines but never took me off lisinopril.

Then I went to a new doctor who immediately switched me from lisinopril to Benicar. The coughing stopped immediately.

A. Not everyone develops a bad cough while on an ACE inhibitor like lisinopril for high blood pressure. But you are certainly not alone.

Another reader wrote: “My doctor was pleased with the results of the ACE inhibitor, but my cough became so frequent and violent that I could not sleep for weeks. I couldn’t even lie in bed. When coughing, I would involuntarily empty my bladder, so I could barely leave the house. We eventually found another medication (Benicar) that I do not react to, and my blood pressure is even lower than when I was on the ACE inhibitor.”

We discuss the pros and cons of common blood pressure medicines in our Guide to Blood Pressure Treatment.

We wash to remove germs, not kill them. Dirty hands are oily and oils are more soluble in warm water. So is soap. Warm water works faster and is more effective than cold water for rinsing off germs. Even my third-grader knows better than you.

A. Several other also readers took us to task for suggesting that warm water is no more effective than cold for removing germs. To try to get a more objective answer, we checked with Charles Gerba, PhD, Professor of Environmental Microbiology at the University of Arizona. He is one of the country’s leading researchers on germ contamination.

Dr. Gerba told us that he has “not seen studies comparing hot vs. cold water for hand washing. Warm water might be somewhat more effective, but the difference is probably so small as not to make much difference. Washing is too quick for the heating to kill much or the soap to dissolve better.”

To wash hands well, wet the hands, apply soap and rub the hands together vigorously for 15 to 20 seconds. Then rinse the lather off thoroughly.

Q. I have been battling statin side effects for years. My doctor has prescribed Lipitor, Crestor, Pravachol, Lescol and Zocor, but I cannot tolerate any of them because of muscle pain and weakness.

It is imperative for me to keep my lipids under control because of coronary artery disease. What can you tell me about niacin and other ways to control LDL cholesterol? I would also like to know how to raise HDL cholesterol.

A. Although statin-type drugs are extremely effective at lowering LDL cholesterol, many people cannot tolerate side effects such as muscle problems, nerve damage (neuropathy) or memory impairment. There are other ways to lower cholesterol, however.

Niacin can be a very effective way to lower LDL and raise HDL cholesterol. It also reduces triglycerides. A doctor must supervise niacin use, since it can cause liver toxicity as well as uncomfortable side effects (flushing and itching).

Other strategies include fish oil and the soluble fiber psyllium. Non-statin prescription drugs that can help control cholesterol include WelChol, Tricor and Zetia.

We are sending you our Guides to Heart Health and Cholesterol-Lowering Drugs with more information about niacin, fish oil and other strategies. They can be downloaded for $2 from this Website. 

Q. My physician recently found that my vitamin D level is very low. I find this hard to believe since I drink nearly a gallon of milk weekly and take a multivitamin and supplement of calcium plus D each day.

I also take prednisone, tramadol, gabapentin, methotrexate and leucovorin. Could one of these drugs interfere with vitamin D absorption?

A. Many Americans have low vitamin D levels, especially in winter when they don’t get regular sun exposure. A glass or two of milk daily combined with vitamin supplementation does not always correct the imbalance for healthy people.

Your medications are likely making the situation much worse. Prednisone, gabapentin and methotrexate can all interfere with vitamin D.

You may need at least 2,000 International Units daily which is much more than you are getting from your supplements and diet. Have your doctor monitor your progress. Vitamin D is crucial for immune function, muscle strength, balance and blood pressure control as well as bone density.

Upon hearing this, he suggested I try Tagamet, the heartburn medicine. I began taking generic cimetidine (200 mg per day). The wart went away in less than two weeks and has never returned.

A. This unconventional use of the acid-suppressing drug cimetidine has been known for more than a decade. You may have been exceptionally lucky that your wart responded so well. A recent review of studies of this therapy concluded that “Current data do not support the use of H2-antagonists [cimetidine and ranitidine] for the treatment of common warts” (Annals of Pharmacotherapy, July/Aug. 2007).

Q. I have a lot of swelling and pain in my joints. A cousin with arthritis recommended a compounded cream called ketoprofen gel. What can you tell me about this medicine, its side effects and interactions with other drugs?

A. Ketoprofen, like ibuprofen, is a nonsteroidal anti-inflammatory drug. You won’t find this on the shelf in a chain store, but some pharmacists can compound this topical treatment without a prescription. Putting the pain reliever right on the joint minimizes side effects such as stomach irritation or elevated blood pressure. Many people find it is helpful in reducing joint pain.

Q. I have gotten conflicting information from my doctor, a couple of pharmacists and patient information inserts about how to avoid interactions between statins and grapefruit:

Don't take the medication with grapefruit juice.

Don't have grapefruit products at the same time of day as a statin.

It’s OK to have grapefruit products after, but not before, a statin.

Don't have more than 1 quart (though one said 8 oz.) of grapefruit products a day.

Don't have any grapefruit products at all while taking statins.

This warning applies to other citrus products beside grapefruit.

I hope you can clarify this. I have been avoiding grapefruit (though not other citrus) completely, and would like to be able to eat it again if it is safe to do so.

A. Certain cholesterol-lowering drugs such as atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) interact with compounds in grapefruit and its juice. These natural chemicals can slow the rate at which the drugs are processed by the body. This may result in a higher blood level of the drug and consequently a greater risk of side effects.

Only grapefruit and bitter orange (not regular oranges) contain the active compounds. The enzymes that are affected may show changed activity for more than 24 hours after a person drinks a glass of juice, so the idea that one could have grapefruit for breakfast and take a pill before bedtime is mistaken.

Some people are far more susceptible to this effect than others. We are sending you our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs for lots more information on the interaction and on statin drugs that are not affected by grapefruit.

Q. I want to respond to your reader who wanted to know why you would disagree with using bourbon as an effective cough suppressant for children.

When I was a child, my mother would give me a tablespoon of whiskey when I had a stomachache. Today, at the age of 42, guess what I am? Yep, an alcoholic (in recovery thank my higher power).

Was the remedy the cause of my alcoholism? I can't help but wonder. A child should never be given alcohol. Period.

A. We’ve heard from readers on both sides of this issue. One reminisced: “My grandparents used the same cough remedy in the 1930's--bourbon, honey and freshly squeezed lemon juice. I still use it.”

Pediatricians caution parents not to use cough medicines for young children (under 6) because there is no evidence that they work. That is especially true of alcohol-containing cough medicines, home-made or over the counter.

Q. Do you know any doctors who will write prescriptions for quinine sulfate to prevent leg cramps? I am desperate to find one. I have taken quinine for this for 20 years with miraculous results and no problems. Now with only a two-week supply left, I’ve been told the FDA has banned it for leg cramps and my doctor will not write me a script.

Before I started taking quinine, my leg cramps were so terrible I had to call the paramedics or scream for my husband to knead them out. The next day I could not walk. That was 20 years ago. I know I could not withstand it today. It would kill me.

A. The FDA banned quinine for preventing leg cramps because the drug can cause potentially lethal reactions. It may result in heart rhythm disturbances, serious allergic reactions or a dangerous blood disorder.

We can’t steer you to a doctor who would be willing to prescribe quinine sulfate for your leg cramps, but we can make some other suggestions. Tonic water still contains quinine and some people find it is helpful for preventing leg cramps.

We have many other suggestions in our Guide to Leg Pain, including magnesium supplements, low sodium V-8 juice, pickle juice or B vitamin complex.

Q. Be careful taking over-the-counter potassium! It can build up in your body and eventually stop your heart. Consult your doctor about the proper dosage before starting. I nearly killed myself taking potassium on my own a few years ago.

A. Potassium is one of those “Goldilocks” minerals—both too little and too much can be deadly. A physician should use a blood test to monitor anyone who takes a potassium supplement, whether it is prescription or over the counter.

A. You are absolutely right that warm water is no more effective than cold for removing germs. Soap and water don’t kill germs but only wash them off the surface of the skin.

If we had to guess, we would venture that it is far more pleasant to stick your hands in warm water than ice-cold water. The longer you wash and rinse, the more effective the process. Sing the alphabet song as you wash to get the timing right.

As it is, few people wash their hands as often as they should (after using the bathroom, before eating, after coughing or sneezing and so on).

This is a particularly serious problem in hospitals, where it is often difficult to get health care workers of all kinds to wash hands between patients. A worker who fails to wash can take germs from one patient and give them to the next.

Q. I find many prescription drug commercials to be totally inappropriate. My kids and I are watching TV when suddenly we see a commercial for Cialis for erectile dysfunction.

I am also fed up with all these intials! ED, RLS? Who on earth ever heard of restless leg syndrome? Are they for real? What’s next--AIW for age induced wrinkles?

A. People have been complaining about restless legs for decades, but “RLS” didn’t become a familiar abbreviation until a drug was developed to treat it. We agree with you that prescription drug commercials are annoying. Only one other industrialized nation (New Zealand) permits prescription drug advertising directly to consumers.

Her condition deteriorated rapidly and she ended up confined to a wheelchair and unable to speak. She passed away in July at the age of 57 from ALS, Lou Gehrig’s disease.

I truly believe this was brought on by Lipitor and was fascinated to read of a connection in your column. She was in vibrant good health until she started the Lipitor and it was the only drug she ever took.

A. We are indeed sorry to learn of your mother’s death. Scientists have not yet determined whether cholesterol-lowering drugs such as Lipitor, Crestor or Zocor can actually trigger motor neuron diseases like primary lateral sclerosis (PLS) or amyotrophic lateral sclerosis (ALS).

In a previous column, we reported that the World Health Organization drug-monitoring center had found an unexpected association between statins and ALS-like syndrome (Drug Safety, June 2007). Since that time, we have received dozens of heartbreaking stories similar to yours. Many people were diagnosed with PLS after developing severe muscle weakness or cramping on cholesterol-lowering drugs. This condition is not considered fatal but it can be incapacitating.

Others report symptoms such as stumbling, falling, slurring speech or having difficulty swallowing after taking the statin-type cholesterol-lowering medicines. In many instances, the condition was diagnosed as ALS. There is no cure for this disease that causes degeneration of muscles and nerves.

Such reactions may be reported on this website, where more details are available. We will forward case reports to researchers and the FDA for further review.

Q. I am a physician who treats many patients in chronic pain. I am convinced that generic oxycodone is only about half as effective as the brand name OxyContin. This is a huge problem for my patients. How can we get someone to investigate?

A. As a physician, you can report therapeutic failure to the FDA MedWatch program and to the generic manufacturer. Patients taking a narcotic drug of this sort are unfortunately regarded with suspicion, so your voice on your patients’ behalf is especially important.

Despite FDA reassurance about the equality of generic drugs, we have now heard from hundreds of patients who have had difficulties. For more information go to www.peoplespharmacy.com and www.ConsumerLab.com.

I understand he wants the doctor to get a good view of his colon and is afraid taking the drink the day before is not going to be enough. He also thinks he would possibly feel better if he took this.

A. Your husband may be watching too much cable television, where they talk about detoxification and colon cleansing. After he does this once, he may not be so enthusiastic about repeating the procedure right away. It is unlikely to make him feel better.

If your husband follows the doctor’s instructions carefully, his colon will be clean for the procedure. Side effects may include nausea, bloating, cramping and anal irritation.

Q. Is there a safe and easy improvement on the method of removing head lice? My wife is a kindergarten teacher and this annual ritual is wearing us both out. Her students bring lice from home, and they spread to the teachers and other students. Please help!

A. There is one novel approach that is both easy and safe. Dampen the hair, coat it with the facial cleanser Cetaphil and then use the blow-dryer. The Cetaphil hardens and forms a barrier that suffocates lice. Leave it on overnight, then shampoo it out in the morning (Pediatrics, Sept. 2004).

Q. I have had anxiety attacks several times in the past 15 years. Always before I have been given Xanax and in several days I would be okay. Then I would take the pills as needed occasionally.

Last week when I went to the doctor and told him I was having anxiety attacks again, he prescribed the blood pressure pill atenolol. Have you ever known atenolol to be given for anxiety? When I tried it I developed an upset stomach and lost my appetite.

A. Atenolol has not been approved for anxiety. Such beta blockers are primarily prescribed for blood pressure and heart problems. Doctors sometimes prescribe propranolol or atenolol for the physical symptoms associated with stage fright, but these drugs are not appropriate for general anxiety (Journal of Clinical Psychiatry, Aug. 2006 Suppl.). Alprazolam (Xanax) is approved for anxiety and short-term use is often quite effective.

I have read that a stomach infection with H. pylori bacteria could cause bad breath. What can I do about this?

A. Bad breath may result from gum disease, but there are other causes. Many years ago we spoke with Nobel Prize laureate Barry Marshall, MD. He discovered that the bacterium Helicobacter pylori could cause stomach ulcers. He told us that these germs are behind some cases of hard-to-treat bad breath.

Over the years we have heard from readers who reported success after curing the infection: “When I read about a blood test for a germ in the stomach that causes bad breath and gastritis, I saw my doctor. He hadn’t heard of this but he gave me the blood test. It turned up positive. Now I am fine, after years of bad breath.”

Treating H. pylori requires medical supervision, so you will need to see your doctor. Multiple medications are often required to rid the stomach of this bug.

For more details about this infection and its treatment, we are sending you our Guide to Digestive Disorders.

Q. I have reached the donut hole in my Medicare Part D plan and my medications are costing me a fortune. I would like to know what online pharmacies could help me with the cost so I can afford my medications. At this point, I have had to quit taking three of my medications. Can you help me locate a reliable online pharmacy?

A. Not taking prescribed medicines could be dangerous to your health, so we suggest you discuss this problem with your doctor. Ask if your state or county provides assistance for senior citizens who can't afford their drugs.

Another possible option is to ask your doctor to help you apply for financial assistance from the drug manufacturer. You can find out more about these pharmaceutical industry programs at www.helpingpatients.org.

We are sending you our Guide to Saving Money on Medicine, which describes these and other approaches, including guidelines for buying less expensive medicines online.

Q. The story about the person who became depressed on Chantix caught my eye. My husband and I were both on Chantix to quit smoking back in June. Neither of us has a history of depression, but after he was on it he tried (with no warning) to take his own life.

I tell everyone thinking about taking Chantix to make sure they talk to the doctor about ALL of the possible side effects. In rare instances, suicidal ideation and psychotic episodes may happen. That is stated in the prescribing information, which also says that depression and anxiety are frequent side effects.

A. Chantix (varenicline) is a relatively new oral prescription medicine to help people quit smoking. Separating drug side effects from nicotine withdrawal can be tricky.

When people quit smoking it is not unusual to feel angry and irritable. Other symptoms may include anxiety, depression, impatience, and problems concentrating.

Some readers have noted similar experiences to yours, though. One person reported: "Two weeks after being on Chantix my emotions have been off the scale: from crying to yelling to feeling totally helpless. I have, twice before, quit smoking cold turkey and NEVER felt so depressed.

"After 48 hours without Chantix I am full of energy and ready to fulfill my responsibilities. I think, for me, that the depression must be a side effect and not just the nicotine withdrawal, based on my cold-turkey experiences."

Q. I was rubbing some Vicks VapoRub on my daughter and by accident I touched my nose after sneezing. A miniscule amount of it went into my nostril. Will this be harmful to me? For a few hours I could taste it even though I rinsed my mouth out immediately.

A. We have warned in the past about keeping Vicks VapoRub out of the nostrils where it could be inhaled. The petrolatum base might then accumulate in the lungs and cause inflammation called chemical pneumonitis.

This caution is directed at the practice of deliberately daubing Vicks in the nose as some people do. We doubt the miniscule amount that got into your nostril will cause you any harm.

Q. Do you have any suggestions for relieving constipation? I have tried many different things but nothing really seems to work for long.

A. For controlling constipation, the basics are fluid and fiber. If you can’t get enough fiber from your diet, you might consider a product such as Metamucil, Citrucel or Unifiber with lots of water.

Some people find that simmering two tablespoons of flax seeds in three quarts of water for a quarter of an hour makes about two quarts of solution. Two ounces a day in juice is reported to move everything along. Sugar-free gum containing mannitol or sorbitol can also be useful.

We are sending you our Guide to Constipation, with a list of high-fiber foods, and recipes for Power Pudding and Pumpkin-Bran Muffins to banish constipation.

Q. There seems to be conflicting information on the relationship between consuming shellfish and cholesterol. What does the latest research show? If shellfish is a high-cholesterol food, how much is too much?

A. For years dietitians counseled people to avoid foods high in cholesterol. The theory was that eating cholesterol would raise cholesterol in the blood. As a result, many avoided eggs and shellfish, even though there was little, if any, data to suggest that such foods posed a problem.

There was a flaw with this advice, however. The old tests that were used to determine that shellfish was high in cholesterol were inaccurate. Clams, lobster, mussels and crab contain relatively little cholesterol. Even shrimp is not considered worrisome any more.

Eating cholesterol-rich foods, such as eggs, does not necessarily raise cholesterol (Journal of Nutrition, Oct. 2006). In one study people ate lots of red meat and eggs with almost no starch. Their bad LDL cholesterol did not go up and their triglycerides actually came down (Mayo Clinic Proceedings, Nov. 2003).

Old wives’ tale or not, it works. The antibiotic ointment helps to prevent infections.

A. We heard from other nurses and even a vet who have not forgotten this old-fashioned treatment. One wrote: “As a nursing student in 1961, I worked at a small hospital that routinely used a mixture of milk of magnesia and sugar to cure bedsores. It seemed to be successful in many cases.”

Another objected to our terminology: “Using sugar for bedsores is not a wives’ tale. I have been a registered nurse for 45 years. When I was a student, it was very common practice to use sugar packs.”

The veterinarian said: “Many wounds have been shown to heal 3 times faster with the use of sugar granules on a saline wet-to-dry bandage. The sugar helps to pull the bacteria from the wound and the saline feeds the tissue to promote rapid healing of the skin beneath.”

Q. I have had a violent cough for several months and have been treated with four different medications, a chest x-ray and blood test, all to no avail. I started taking lisinopril about the time this all began and noted that a cough was one of the side effects. When I asked my doctor, though, I was told that the drug was not the cause.

I have not been able to get restful sleep because of the constant coughing. Have you ever heard of such a reaction to this medication?

A. ACE inhibitors (benazepril, captopril, enalapril, fosinopril, lisinopril, quinapril and ramipril) are prescribed to lower blood pressure. They’re very effective and usually well tolerated.

A persistent cough that doesn’t respond to cough medicine is a common complication, however. One study from South Korea found that a daily iron supplement, ferrous sulfate, may help ease this symptom (Hypertension, Aug. 2001). If not, your doctor might consider a different blood pressure drug.

The first application certainly had a positive effect on my skin. I did not follow through as I should have, so I don’t know how well it works long term. Have you ever heard of this remedy?

A. We could find no research on this intriguing remedy for seborrheic dermatitis. This skin condition is characterized by itching, flaking, scales and redness. It frequently occurs on the scalp as super dandruff or even on the eyebrows, forehead, around the nose or on the chin. It appears to be an inflammatory response to yeast on the skin called Malassezia.

Dermatologists frequently treat this problem with anti-fungal creams (such as clotrimazole, the active ingredient in Lotrimin AF). Topical steroid creams such as hydrocortisone are also used. Dandruff shampoos containing ketoconazole, selenium sulfide, or zinc pyrithione can be helpful.

Readers claim that applying milk of magnesia to the armpits is a gentle and effective way to reduce sweating and odor. Perhaps the drying effect and alkalinity of MoM together with the antifungal activity of Lotrimin AF discourage Malassezia yeast.

Q. How much ibuprofen can a person take and for how long before needing to talk to a doctor? I have read that stomach upset may indicate problems. I can’t really take any NSAID or aspirin unless I eat a 'mini-meal' at the same time. Otherwise, my stomach hurts.

I was taking 1600 to 2400 mg/day of ibuprofen for weeks before surgery, and I expect to need some medicine to help with pain relief throughout my physical therapy.

As long as I eat with each dose, my stomach feels OK, but I'm trying to lose weight. I am also concerned about what the medicine could be doing to my insides. Any information you can provide on other approaches to pain relief would be greatly appreciated.

A. Ibuprofen, like all NSAIDs, can be irritating to the digestive tract. Stomach ulcers are always a risk. Other complications include high blood pressure, kidney damage, fluid retention, heart failure and toxic skin rash. The high doses you are using require medical supervision.

Topical NSAIDs may be a safer alternative. Canadian pharmacies sell Pennsaid (diclofenac and DMSO) if you have a prescription. You may also find fish oil or herbs like boswellia, ginger or turmeric beneficial.

We are sending you our Guide to Alternatives for Arthritis in which we discuss the complications of NSAIDs and options like Pennsaid and non-drug approaches.

Q. I experience overwhelming anxiety and have problems flying and riding in elevators. This problem has gotten worse lately. My doctor prescribes an anti-anxiety drug when I occasionally fly. Is there an alternative to taking prescription drugs to get relief from the anxiety?

A. You may want to consult a therapist who uses cognitive-behavioral therapy to treat fear of flying. This approach can be very effective.

Anti-anxiety medicine can be helpful. However, if you take it on a regular basis to help you ride the elevator to your office, beware of stopping the medicine suddenly. Some people report withdrawal difficulties from medicines like Ativan (lorazepam) or Xanax (alprazolam).

I also noticed a lot of food being delivered while I was there. The nurse said that pharmaceutical reps keep the staff well fed with cookies, brownies, pizza, BBQ, chicken, and the like. It seems to me there is something wrong with this picture.

A. The pharmaceutical industry spends an extraordinary amount of money promoting medications to physicians. One way to get in good with the office staff is to provide lunch. We hear that in some doctors’ offices the staff expects lunch to be provided for everyone and complains if the food doesn’t meet certain standards. These “Lunch and Learn” sessions are one way sales reps get face time with busy doctors, but the free lunches will ultimately be paid for at the pharmacy when patients pick up their prescriptions.

Q. A friend of mine traveled in Costa Rica and now doctors think she has something called “jardia.” What can be done to cure it?

A. Giardia lamblia is a single-celled intestinal parasite that is a common hazard for travelers. Drinking untreated water from ponds, lakes, rivers or streams in the U.S. can also cause infection.

Giardia may lead to digestive distress, including diarrhea, nausea, cramps and flatulence. Doctors usually treat the infection with a prescription antimicrobial drug called metronidazole or a similar medicine called tinidazole. People taking such drugs must avoid alcohol during the five days of treatment for Giardia. Pregnant women should not take either medication.

Q. I am taking Chantix to quit smoking.  I have had no urge to smoke, but I am seriously depressed.

In the past I was diagnosed with depression and anxiety. I attempted suicide 10 years ago and was hospitalized for depression.

I am concerned that my recent bout of severe depression may be a result of taking Chantix.  Has this topic been researched? I want to stop smoking but I don't want to be this depressed. I am still seeing a therapist. Should I tell him about this?

A. Chantix is a relatively new oral prescription medication to help people stop smoking. It works in a completely different way from nicotine replacement gum, lozenges and patches.

In clinical studies Chantix was somewhat more effective than another oral medication, Zyban (bupropion SR), in helping people stay off cigarettes.

The most common side effects of Chantix are nausea, headache, sleep problems and strange dreams. Although depression is not listed as a common side effect, it was frequently reported among people who participated in the clinical trials.

Please contact your therapist about your depression. Your doctor may consider whether Zyban, which also has antidepressant activity, might be more appropriate for you.

Is there anything she could take before she comes that would help make her stay more enjoyable? How can I make it more comfortable for us all?

A. This sounds counter-intuitive, but vacuuming during your sister’s visit may actually make her symptoms worse. Some vacuum cleaners actually spew small particles into the air and make the environment more allergenic.

The next time you shop for a vacuum cleaner, why not consult Consumer Reports (Oct. 2007)? The magazine’s experts chose the following upright machines as good values for picking up tiny allergy-causing particles: Kenmore (Sears) Progressive 35922, Eureka Boss Smart Vac Ultra 4870, Hoover Tempo Widepath U5140-900. In canister-style vacuums, they chose Kenmore Progressive 27514.

An over-the-counter allergy nasal spray that can be helpful is NasalCrom. If your sister starts using it a few days before her visit it may prevent some of the symptoms that make her miserable.

We discuss many other strategies against allergies in our book, Best Choices From The People’s Pharmacy. It is available from libraries, bookstores and online.

Q. I'm surprised you haven’t mentioned an important issue facing asthmatics. The FDA has decided that generic albuterol inhalers should be taken off the market. The result is that these stalwarts of asthma relief will no longer be available.

Instead, the generic inhalers are being replaced by the exact same medicine with a different delivery system. That means it will cost substantially more. How could a generic magically turn into a more expensive brand name drug?

A. The FDA has determined that asthma inhalers may no longer contain CFCs (chlorofluorocarbons). These propellant gases damage ozone and the U.S. agreed years ago to eliminate them from spray cans, air conditioning units and refrigerators.

This means that lower-cost generic albuterol inhalers will disappear. People with asthma may have trouble finding such products even before the 2008 deadline.

They are being replaced by alternatives that use HFA (hydrofluoroalkane). Brand names like ProAir HFA, Proventil HFA and Ventolin HFA all contain albuterol, but they do cost more than the old generic CFC powered inhalers.

Q. My doctor insists I must take statins to lower my cholesterol even though I experience pain with all of them. Sometimes the pain gets so bad that I struggle not to cry when I walk down the hall of my child’s school.

My doctor says I should accept what he calls “a little discomfort” because studies show statins reduce heart disease. He gets angry if I refuse to take them.

Who is ultimately responsible for my health, me or my doctor? He says this pain is rare but I know a lot of people who have had the same severe muscle pain.

A. We too have heard from many patients who experience debilitating muscle pain as a side effect of statin-type cholesterol-lowering drugs. One reader wrote: “I have had problems with Lipitor and Vytorin. I had severe muscle and nerve pain. My doctor said he didn't believe it was from Vytorin. I stopped the medication and slowly got better. It took 7 weeks.”

Some doctors don’t believe that statins can cause side effects such as muscle or joint pain or memory problems. Others have seen so many cases they have developed different strategies for lowering cholesterol. If your doctor isn’t taking your complaint seriously, you may need to see another doctor.

We are sending you a CD of a radio interview we conducted with several physicians who have studied such issues.

Q. I am a veterinarian and read your advice about the benefits of using sugarless gum containing xylitol for dental health. I have seen several canine patients with toxicity from this sweetener. Your astute readers should be very cautious with its use around pets.

In dogs, xylitol can lead to a precipitous drop in blood sugar, as well as liver disease and seizures.

A. Thanks for the warning. It is important to keep candy, chewing gum and other products that may contain xylitol out of the reach of dogs. Other food items that can be toxic to dogs include avocado, chocolate, garlic, grapes, macadamia nuts, onions and raisins.

Q. I've been troubled with irregularity most of my life until I discovered Fiber One cereal. I take it with me everywhere, on cruises, to Europe, even to the hospital. Fiber One bars come in handy when there's no milk supply available.

It's the only remedy that's ever worked for me. I can't stand liquid Metamucil, so I tried their capsules with no results. Benefiber also did nothing for me, so I'm a Fiber One fan forever.

A. Thanks for sharing your constipation solution.

Q. Is there a link between acid-suppressing drugs and forgetfulness? My mother has been on Tagamet, Zantac and now Prilosec for many years, and her forgetfulness seems unusual.

A. A recent study reported an association between the use of acid-suppressing drugs such as Pepcid (famotidine), Tagamet (cimetidine) and Zantac (ranitidine) and declining mental function. The subjects were older African Americans in Indianapolis (Journal of the American Geriatrics Society, Aug. 2007).

One possible explanation for such problems might be depletion of vitamin B12. This nutrient is essential for normal mental functioning. Vitamin B12 is absorbed best when there is acid in the stomach. Long-term use of acid-suppressors may make it harder to maintain adequate B12 levels.

Q. I had my thyroid removed due to cancer more than a decade ago. Since then I have been on Synthroid. The past few years I was switched to Levoxyl.

My doctor has lowered my dosage twice in the last six months. Since then I have noticed the following changes: from reduced libido to NO libido, elevated cholesterol, fatigue and brittle nails splitting down the middle. I’ve lost the outer third of my eyebrows. Is there any way to reverse these symptoms?

A. Talk with your doctor about your symptoms immediately. They suggest you may be getting too little thyroid hormone. Perhaps the dose of your medicine was lowered too much. Other readers report that when they are switched from one thyroid formulation to another the dose must be adjusted carefully.

We are sending you our Guide to Thyroid Hormones, with discussions of diagnostic difficulties and tests as well as various thyroid hormones.

Q. A few months ago, I sprayed insect repellent containing DEET on my legs to keep mosquitoes away. Then I lay down on the grass on my stomach to pull weeds out of my pond. Two days later the grass where my legs had been was dead. None of the other grass was.

If this product kills grass, what does it do to skin?

A. DEET was developed for the U.S. Army and has been used by the public for more than 50 years. Skin irritation has been reported as the most common side effect. There have been some reports of neurological side effects, including seizures, particularly at high concentrations.

DEET is the most effective mosquito repellent on the market. There are some effective alternatives, however. They include picaridin (Avon Skin So Soft Bug Guard, Cutter Advanced, Off Family Care Clean Feel) and oil of lemon eucalyptus (Repel Lemon Eucalyptus).

Q. I am about to fall into the Medicare Part D “donut hole” and would like to buy my drugs from Canada to save money for the remainder of this year. How do I know which online pharmacy to select?

A. Many senior citizens who signed up for the prescription drug benefit from Medicare are shocked when they hit the so-called donut hole. When drug expenses come to a total of $2400, patients must pay 100 percent of their medication bill. If drug expenses eventually exceed $5,451, Part D kicks in again with catastrophic coverage until the end of the year.

If you don’t think your drug expenses will get that high, you may want to consider purchasing your medicines from Canada. (These do not qualify to get you out of the donut hole, though.) Be sure that you are shopping from a legitimate Canadian online pharmacy. Fraudulent pharmacies may be doing business from other countries without the quality control we expect from Canada.

To help you evaluate your options we are sending you our Guide to Saving Money on Medicine with guidelines for buying medicines from Canada and pros and cons of generic drugs.

Q. I am a 58 year-old woman, and I suffered from severe vaginal dryness after menopause. I have found great relief from Estring. It has stopped the everyday irritation I was experiencing.

My libido is still a problem but I find that once foreplay is underway, I am able to enjoy sex. I feel the ring has played an important part in this. Perhaps my experience will help others.

A. Estrogen has long been used to relieve menopausal symptoms such as vaginal dryness. Concerns about side effects such as blood clots or an increased risk of cancer has left many women in a quandary.

Estring is a vaginal estrogen delivery system that releases 2 mg of estradiol gradually over three months. It has been available in this country since 1996. Women whose main menopausal symptom is vaginal dryness often find Estring helpful.

Although the amount of hormone in this vaginal ring is small, it is not appropriate for women with estrogen-sensitive cancers or for those who may be pregnant.

Q. My 86-year-old father was taking Avandia for diabetes. When concerns began to appear in the news, I did my own research and asked his doctor to take him off the drug because of fluid retention.

The difference is amazing. While he was on Avandia, he had two liters of fluid removed from around his lungs twice. His pants waist size had increased several times during that time. All of the fluid is gone now that he has been off Avandia for a while.

The doctors could not determine what had caused the fluid build-up, but I was relieved that I figured it out. Avandia should be reconsidered as a treatment for diabetes.

A. The maker of Avandia warns that this drug can cause fluid retention and congestive heart failure. Patients are cautioned that swelling, rapid weight gain, breathing problems or unusual tiredness may be serious and deserve immediate medical attention. It’s a shame your father’s physicians did not identify Avandia earlier as the cause of his fluid retention.

Q. Is there anyone collecting and disseminating information on personal experiences with Achilles tendonitis caused by the antibiotic Levaquin? I have had this problem in both legs for several weeks after receiving the medication.  My doctor seems not to have heard of this complication until now.

As a consumer I have found considerable information on the Internet, but nothing regarding the time frame for relief from this painful condition.

A. Unfortunately, inflammation and in rare cases even rupture of tendons, including the Achilles tendon at the back of the ankle, are possible side effects of Levaquin and similar antibiotics. We have heard from other readers with similar problems. One person’s experience suggests the time frame for recovery may be months rather than weeks: “I took 750 mg of Levaquin for a sinus infection for 9 days. I got rid of the sinus infection but have been dealing with tendinopathy in my legs and one shoulder for the past three months.”

Q. What can I do about a flagging libido? I'm 66 years old and in very good health, with no bad habits. My only medication is Lipitor to lower cholesterol.

My much younger wife and I used to have a vigorous and inventive sex life, but my interest in sex has practically disappeared. The only time I get aroused is around 4 am, which is impractical to say the least. What do you suggest?

A. We suggest you talk with your physician. Lipitor (atorvastatin), Zocor (simvastatin) and other statin-type cholesterol-lowering drugs may interfere with sexual desire and performance. The authors of a Dutch study propose that lowering cholesterol with these drugs may alter testosterone production (British Journal of Clinical Pharmacology, Sept. 2004). That is because cholesterol is a building block for hormones like testosterone.

Rather than stopping the drug on your own, please get your doctor’s guidance about how to lower your cholesterol without ruining your love life. We are sending you our Guides to Sexual Dysfunction and Cholesterol Lowering Drugs. If testosterone levels are low, a prescription for testosterone may restore your lost libido.

Q. I have read about how people experience muscle pain with Zetia and statin-type cholesterol drugs. That happened to me as well.

My doctor prescribed TriCor instead and it has lowered my cholesterol and triglycerides. Maybe this will help someone else.

A. TriCor (fenofibrate) works differently from statins and Zetia. It can be an effective cholesterol-lowering drug that rarely causes muscle pain.

As with many other cholesterol medications, liver enzymes should be monitored. Gallstones are another possible complication. TriCor is pricey, though, and can cost over $100 a month.

Q. I have been using an applesauce-fiber mixture I learned about from you. It works well to combat constipation.

Now I have to go abroad for two weeks. Do you have any suggestions on how to take this mixture with me? Constipation while traveling is a big problem, starting with the long flight.

A. Dehydration is a frequent result of air travel. It complicates constipation, so make sure you get lots of liquids. Sugarless gum can also help.

The mixture of applesauce, bran and prune juice you have found helpful needs refrigeration and will be too difficult to take with you. Instead, try something like psyllium cookies (Metamucil brand for example). Magnesium supplements are also easy to carry and should help with regularity.

We are sending you our Guide with Ten Tips to Controlling Constipation. It also includes the recipes for Power Pudding made of bran, applesauce and prune juice and dynamite pumpkin-bran muffins.

Q. On my last visit to the dentist our hygienist recommended we chew gum containing xylitol. She raved about its potential to stop the formation of cavities. Is this true? Is xylitol safe?

A. Xylitol is a natural sweetener derived from birch trees and other plants. It is used in sugar-free gum and candy, especially in Europe where significant research has been conducted on its benefits. In a review published last year, dental researchers concluded that “Sufficient evidence exists to support the use of xylitol to reduce caries [cavities]” (Pediatric Dentistry, March-April 2006).

If you chew too much xylitol-containing gum, you may develop diarrhea. Other than that, xylitol appears to be safe.

Q. During sleep I am awakened five or six times a night by erections. I'm 53 years old and take Flomax, venlafaxine, fosinopril, trazodone and vitamin B12. Can any of these medications cause this problem?

A. Men frequently experience erections during rapid eye movement (REM) sleep. This is normally when dreams occur. The erections have nothing to do with the content of the dreams but are a physiological reaction to this stage of sleep.

The antidepressant trazodone (Desyrel) has been linked to prolonged painful erections (priapism). This can occur during sleep or even during the daytime.

Flomax can also trigger this reaction. Both drugs together might make matters worse. A prolonged erection can be damaging and requires medical intervention.

Q. My husband has excessive gas. We eat a very healthy diet and he drinks no soda or carbonated beverages, not even beer. He takes medicine to lower his cholesterol.

We eat lots of vegetables but we have eliminated the ones that bother him most. Milk was a real problem so now he uses lactose-free milk.

Despite these changes, he still gets gas with some foods. We cannot eliminate all fruits and vegetables. How can we deal with this to make him feel more comfortable?

A. Some medications can contribute to flatulence, including several drugs to control cholesterol. Your husband should check this out with his physician.

Taking Beano (alpha-galactosidase) with troublesome vegetables can be helpful. An adequate dose is necessary to get the benefits.

Other options include probiotics, fennel tea and Angostura bitters. We have listed common drugs that cause gas and provided details on many natural approaches for flatulence in our book, Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online (www.peoplespharmacy.com).

Q. After reading about the difficulties people have getting off certain antidepressant medications, I want to tell you about my success. I planned a weekend at home with no distractions or plans and took Dramamine all weekend to stay somewhat sedated.

By the time Monday rolled around, I was free of the sweating, the shock-like sensations in my brain and all the rest. My neurologist had told me I might just have to stay on the medication because of the withdrawal issues. Glad I didn’t!

A. Thanks for sharing your strategy. There is no data on the usefulness of Dramamine in withdrawing from an antidepressant.

For many people, a weekend is not long enough for phasing off an antidepressant like Paxil or Effexor. They may need to lower the dose gradually over weeks to reduce the risk of side effects such as electric shock-like sensations or a feeling of sloshing inside the head (also described as head-in-a-blender).
Symptoms such as nausea, sweating, shakiness, dizziness and insomnia can also be disconcerting. With careful medical supervision, however, most people can discontinue antidepressants successfully.

Q. I have been fascinated with letters from people reporting that Lipitor weakened their muscles. I believe Lipitor triggered my ALS. Until last month, my doctors wouldn’t listen to me, but then a report from the World Health Organization (WHO) showed a link. Please warn others.

A. The article authored by WHO researchers was published in Drug Safety (June 2007). It points out that an unexpectedly high number of people developed Lou Gehrig’s disease while on a statin-type cholesterol-lowering drug. Lou Gehrig’s disease is also known as amyotrophic lateral sclerosis, or ALS. There is no cure for this degenerative disease of muscles and nerves.

The connection between ALS and statins is controversial. The FDA is not convinced there is a link.
The WHO report advises doctors to discontinue statin therapy if patients develop “serious neuromuscular disease such as the ALS-like syndrome.” People who believe they have experienced such an effect may report it to us at www.peoplespharmacy.com. We will forward such cases to researchers and the FDA for further review.

Q. I have tried many statin drugs for cholesterol, but all gave me muscle pain and cramps. My doctor put me on Zetia and insists it can't cause muscle pain since it is not absorbed into the blood stream. I still have muscle pain, cramps and tingling in my legs and feet. Can Zetia cause this?

A. Although Zetia works differently from statin cholesterol-lowering drugs such as Lipitor or Zocor, it is absorbed into the bloodstream. Muscle side effects seem to be less common with Zetia than with the statin drugs, but they can happen. Ask about another approach for cholesterol control.

Q. I have been diagnosed with celiac disease.  One of the early symptoms was leg and foot cramps, often screamers, early in the morning. The tonic water was by my bed at all times, just in case, as it would provide quick relief. Mustard helps too, if nothing else is available.

I started taking extra calcium, magnesium and zinc to prevent the cramps. That helped, but it wasn't until I went on the gluten-free diet that I found reliable relief.

I was diagnosed with celiac disease by finally becoming anemic due to improper absorption of iron. The person who wrote to you about terrible leg cramps should be checked for this possibility. Celiac disease reduces normal absorption of a lot of necessary minerals.

A. Thanks for sharing your story. Doctors are discovering that celiac disease is not nearly as rare as they once thought. It occurs in almost 1 percent of the population, which means millions of people are affected.
Celiac disease is an inability to digest gluten, a protein found in barley, rye and wheat. When people with celiac disease eat foods with gluten, their bodies react and cause damage to the lining of the small intestine. This can interfere with the absorption of many crucial nutrients.

To learn more about the subtle symptoms, diagnosis and treatment of celiac disease, readers can request a CD of our radio show on the topic. It is an hour-long interview with one of the country’s leading experts.

Q. I read that Proscar and Avodart both cause impotence. My boyfriend is on Proscar and recently said he would rather have a backrub than sex! He used to worship me and now we are just pen pals. He still seems to like me but there is no sexual component.

According to his doctor, my friend has the smallest prostate he’s ever seen. Why do the doctors want to shrink it to nothing? Is it sex or death? If I had a choice like that to make, I’d go for sex. I’m only 74 and he is younger.

I have heard that it is possible for healthy people to have sex for life. Maybe some men are too embarrassed to discuss this subject with their doctor. I still think there should be a way to get around this side effect. Would it help if he didn’t take the pill for the weekend?

A. Drugs like Avodart and Proscar shrink the prostate by altering testosterone metabolism. This can lead to reduced libido and erectile dysfunction. Although impotence may be treated with medications like Viagra or Cialis, there is no approved remedy for low libido.

It is not clear that a “drug holiday” on weekends would restore his sex drive. He might ask his doctor whether a lower dose might solve the libido problem and still protect his prostate.

Q. I have battled toenail fungus off and on for the past 25 years. I have been on Lamisil three times and tried all sorts of OTC and prescription topical medicines.

I decided to try two of the remedies I read about in your articles. I apply hydrogen peroxide with a cotton ball to my toenails after I bathe daily. Then I apply VapoRub to my feet and toenails and put on socks to sleep in.

Within a month, I had no more toenail fungus. I have the most beautiful toenails I have ever had in 25 years. I also like the fact that I can polish my toenails and still use these remedies. Thank you!

A. Toenail fungus can be tough to treat. Prescription medicines like Lamisil are expensive and require medical monitoring for liver problems and other potential side effects.

Success with home remedies like the ones you are using requires patience and persistence. Not everyone will benefit, but we are pleased that the remedies are working for you.

Q. I have been on thyroid hormone replacement for more than 20 years. Now I have been diagnosed with osteoporosis.

My doctor prescribed Fosamax and then Actonel. I have heard that such drugs can cause jaw bone deterioration. This happened to a friend of mine and I am quite concerned.

What other options are available for treating osteoporosis?

A. Too much thyroid hormone can weaken bones. Although medications like Fosamax and Actonel are popular treatments for osteoporosis, they have been linked to osteonecrosis of the jaw. Jaw bone death does not seem to be common, but it is a frightening side effect and extremely difficult to treat. It appears to be triggered by dental extractions or other invasive procedures. People with known dental problems should have them taken care of before starting such medication.

There are a number of other medicines that can strengthen the bones. Ask your doctor to discuss Menostar, Evista, Miacalcin and Forteo as possible alternatives. Each of these works differently from Fosamax and all are used to treat osteoporosis.

There is lots more information about treatments for osteoporosis and hypothyroidism in our new book, Best Choices From The People’s Pharmacy. You can find it in your library, local bookstore or online (www.peoplespharmacy.com).

People with low bone density should be sure to get adequate vitamin D along with calcium and magnesium. That would be at least 1,000 IU vitamin D a day.

Q. I read your column about a person concerned about a prescription that was a couple of months past its use-by date. Whenever I receive a prescription from a pharmacy, I ask for the date on the bottle the medication was dispensed from so I can record that date on my prescription bottle and prescription documents. That way, I'm not constrained by the 1-year time frame most pharmacists put on the bottle.

I also save money because I'm not throwing away perfectly good medication and getting new prescriptions filled. I hope others find this helpful.

A. Thank you for the suggestion. If you make your request at the time you give in your prescription, the pharmacist can allow for the extra time it takes to note the manufacturer’s expiration date. In some states, pharmacists are legally required to display a one-year use-by date, but they are not forbidden to give you the additional information you request.

Q. Months ago I heard about a new prescription drug for weight loss that also lowered cholesterol and blood sugar levels. It was awaiting approval. Has it become available?

A. The drug is rimonabant. Although it is now available in Europe, a panel of experts recommended to the FDA that it not be approved due to an increased risk of depression or suicidal thoughts.

Q. I have just been through detox hell after stopping the antidepressant Cymbalta. After a week of dizziness, nausea, diarrhea, sweats, chills, itching, disorientation, mood swings and headaches, I am angry! My doctor did not tell me that this might happen.

I had been on the drug for about a year and was weaned off it by gradually dropping the dosage. I expected some emotional repercussions, but I didn’t expect to be unable to function for over a week, a prisoner in my own home.

I would have assumed I was dying of a strange flu, but I found accounts of similar withdrawal problems on the Internet. My doctor was out of town and his fill-in confirmed that these were typical symptoms of stopping Cymbalta.

I just don’t understand why I wasn't warned. Why hadn’t I had been told up front, before starting the drug, about the possibility of severe withdrawal?

Is it up to the consumer to read every line of the insert to determine the safety of a medicine before taking it?

It terrifies me to think about other patients going off this drug with no idea of what may happen to them! The withdrawal hell should be explained so the patient can know what to expect and prepare himself for the possibilities.

A. It often comes as a rude shock when patients discover that stopping antidepressant medications can cause distressing withdrawal symptoms. We have heard from folks who stopped Effexor, Paxil or Zoloft who felt disoriented and dizzy. Many report distressing shock-like sensations in their heads.

We are sending you our Guides to Antidepressant Pros and Cons and Psychological Side Effects that discuss these problems in greater detail and offer some withdrawal strategies.

 Q. I have an embarrassing question. What are your suggestions regarding penile fracture?
I admit to being too wild and crazy one night. I bent a fully erect penis about 90 degrees. It was very painful and turned purple, black and blue. It no longer hurts but has a tendency to veer to the left.

Urination and ejaculation work painlessly. Should I look into surgery or will the tissue repair itself?

A. From your description it seems as if you are suffering from Peyronie’s disease. A penile “fracture” that occurs during overly vigorous intercourse is actually a tear in the tissue. This leads to bruising which can cause scar tissue. During an erection, this fibrous area cannot expand normally which leads to the kind of curvature you have observed.

Physicians frequently recommend prompt surgical repair to reduce painful symptoms and prevent complications such as erectile dysfunction. Although Peyronie’s disease sometimes disappears all by itself, you should consult a urological surgeon for an assessment. For more details you may wish to search our Web site for Peyronie’s (www.peoplespharmacy.com).

Q. I had constipation for five years. I was using Citrucel and extra bran on my cereal. I drank lots of water but still had very hard rabbit-like stools.

At water aerobics a friend told me about taking magnesium. It has worked wonders for me.

I take 500 mg before going to bed and have a good response, usually before noon the next day. I asked my internist and cardiologist if it was safe to take and they both said no problem. The cardiologist even said it is good for the heart as well. I thought you might want to pass this along.

A. Magnesium has long been used to counter constipation. Milk of magnesia, for example, is a well-known laxative. Too much of this mineral can cause diarrhea, though. Most people tolerate 300 mg with no problems, but those with kidney problems must avoid extra magnesium.

Q. You had a letter from a woman worried about her husband’s lack of energy. He was on atenolol, Norvasc and furosemide for high blood pressure. She asked about his low potassium.

As I read her letter, I became concerned that he may have heart failure. I’ve been a cardiology nurse for 14 years. Fatigue is one of the hallmark first complaints of heart failure, which is common in people with hypertension.

Norvasc can worsen undiagnosed heart failure. I hope he will see his doctor for evaluation of his "no energy" complaint. Heart failure is the number one reason for admission into the hospital today and there are safer blood pressure medications.

A. Heart failure is extremely dangerous and is increasing at an alarming rate. Symptoms may include shortness of breath, nighttime cough, fatigue and swollen ankles.

The current controversy over the diabetes drug Avandia involves an increased risk of heart failure. Norvasc also seems to increase this risk (American Heart Journal, Jan. 2007). Atenolol can also contribute to fatigue.

Our Guide to Blood Pressure Treatment discusses the pros and cons of various types of blood pressure medication and lists high-potassium foods for those on diuretics such as furosemide or hydrochlorothiazide.

Q. I suffer from chronic leg pain. My doctors have tested me and all they can say is that it might be due to nerve damage. They suggest support hose.

I bought some medical support hose but they are very expensive. I thought I could save money with regular support pantyhose.

It feels strange to wear them but they really help my legs feel much better. Is it a problem to wear women’s pantyhose? My wife bought them for me but she worries someone might think I am gay for wearing them. Is there anything else I could use or is she worried over nothing?

A. Pantyhose don’t provide as much support as medical support hose. On the other hand, if they relieve your leg pain, we see no reason to spend money on more expensive stockings. As long as you are not parading around in shorts, you shouldn’t attract undue attention.

If you are trying to start a family, pantyhose might be troublesome. They could raise testicular temperature and reduce sperm count. If that’s not an issue, your wife can relax.

Q. My husband and I are 63. I am on nine prescriptions and my husband is on four prescriptions for his asthma. Our insurance does not cover prescriptions.

We estimate our prescription cost this year is approximately $11,000. Do you have any suggestions where we can buy our prescriptions to save money?

A. Without drug insurance or Medicare coverage you are vulnerable. You get charged full price at the pharmacy, whereas insurance companies and the government negotiate discounts.

Buying brand name prescription drugs from Canada can save you money. Be careful, though. Not all online pharmacies that claim to be Canadian are legitimate. Look for the Provincial pharmacy license number on the Web site.

Generic drugs can also result in substantial savings, but we worry about lax FDA oversight. Readers of this column have reported some problems with generic drugs.

We are sending you our Guide to Saving Money on Medicine with tips for using generic drugs safely and guidelines for buying medicines from Canada. It can  be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. When I was a child, my sister and I used to compete for first dibs on licking the bowl and beaters when Mother baked. It was a part of growing up.

Recently, I was baking with my grandchildren and asked which of them wanted to lick the bowl. Their mother, my daughter, swooped between them and me with the bowl, and said, "No! No! Don't put that in your mouth! It has raw eggs in it!" Do raw eggs--especially this minute amount--really hurt you? Or is my daughter just an especially picky mother? Why were my sister and I not damaged as kids by our bowl-licking habits?

A. You may think that your daughter is being especially picky, but she is actually following accepted recommendations for food safety. Back when you were little, nobody worried much about salmonella in raw eggs. Perhaps that was because eggs were less likely to be contaminated.

Food safety scientists might not have realized then that licking the bowl did make some children sick. It makes sense to be careful even though it means one of childhood's pleasures--licking the beaters--is taken away.

Pasteurized egg whites in liquid or powdered form are available. Your daughter shouldn’t object to the children licking the beaters if the eggs are pasteurized.

Q. I am currently taking amoxicillin for a sinus infection but my wife is allergic to penicillin. Is there any possibility that she would have a bad reaction if we had unprotected sex?

A. There are reports in the medical literature of women reacting to a medicine in their husband’s semen. The concentration is usually very low, but for sensitive people, even a little exposure can be risky. Over 20 years ago we heard from a reader who reported the following reaction:

"I know this sounds bizarre, but I’m convinced I have been reacting to the penicillin my husband has been taking for a strep throat. When I was 10 I had an allergic reaction to penicillin. Last week I experienced hives and wheezing soon after we made love.”

Men may also react to medicines their wives are taking. It would be prudent to use a condom.

Q. The expiration date on all my medicine is one year after the prescription is filled. Does this mean the Percocet I have on hand for a bad back becomes toxic after that time or is it just ineffective?

A. If your pain medicine is only a few months out of date it is unlikely to be ineffective or toxic. The one-year discard date is for the convenience of the pharmacist and does not necessarily reflect the manufacturer’s actual expiration date.

Q. A few weeks ago I could not get out of my chair to go to bed. I was telling my body "stand up" but my back and legs just wouldn’t respond.

I eventually managed to lever myself up with my arms but I had considerable difficulty getting to bed. This was odd because I am in pretty good physical shape.

About a week before this event I had bought two gallons of grapefruit juice because it was on sale and had been consuming quite a large quantity daily. I have been on Lipitor for about 18 months. Could my back pain and muscle weakness be explained by Lipitor plus grapefruit juice?

A. Grapefruit interacts with dozens of drugs, raising blood levels. This may increase the risk of side effects.
Cholesterol-lowering drugs like atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) are all affected by grapefruit. Since muscle weakness and pain are possible side effects, it is conceivable that your experience was triggered by a grapefruit interaction that resulted in an overdose. Other drugs that are affected by grapefruit include some anti-seizure medicine, estrogen hormones, heart and blood pressure pills and sleeping pills.

We discuss this issue in far greater depth in our Guides to Grapefruit Interactions and Cholesterol Lowering Drugs. They can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I’ve been using Rogaine (minoxidil) for more than 12 years to slow hair loss. I started taking the oral medicine Proscar when I heard that this drug could also help grow hair. (Proscar was cheaper and stronger than Propecia.)

It worked well to give me denser hair, even better than Rogaine, but it had negative side effects. The climax during intercourse was less than climactic.

To get around this, I tried splitting the 5 mg Proscar tablets into five chunks of 1 mg each. That’s hard, so I ground up five 5 mg tablets and put them into a one-month supply of Rogaine liquid. I mixed the drugs together and put the solution on my scalp. It works like a charm and I have no more sexual side effects.

I tried not using the Proscar and my hair began falling out again immediately, so the mixture is better than Rogaine alone. I warm the solution before I put it on my scalp and it soaks in quickly. I’ve checked the bottle at the end of the month and there’s not a speck of residue.

A. Finasteride is the active ingredient in both Proscar (for prostate enlargement) and Propecia (for male pattern baldness). It blocks the conversion of testosterone to dihydrotestosterone (DHT), which causes both problems.

Oral finasteride has been linked to sexual side effects. Your experiment may have sidestepped this problem. We could find no scientific study of this combination.

One caution: finasteride in any form must be kept away from pregnant women. DHT is essential for a male fetus to develop masculine characteristics.

Q. Does aspartame affect bleeding if you are taking a blood thinner like Coumadin? I know that cranberry juice poses a potential problem with this drug. How can I keep up with Coumadin interactions?

A. Coumadin (warfarin) is a life-saving drug but it can be tricky to use. This medicine reduces the risk of blood clots that can lead to strokes or heart attacks. Getting the dose right, however, poses a significant challenge. Too much or too little drug can be dangerous.

Many foods and other medications can interact with Coumadin. When a person taking Coumadin drinks a lot of cranberry juice, the risk of dangerous bleeding may rise. Several cases have been reported, but scientists are still debating the clinical significance of the interaction.

Aspartame (Equal, Nutrasweet) is an artificial sweetener that may increase bleeding time (Clinical Pharmacology and Therapeutics, Feb. and May, 1998). Although this interaction is controversial, we would encourage anyone consuming aspartame and taking Coumadin to monitor the impact on bleeding very carefully.

Sorting out all the dangerous food and drug combinations with warfarin is complicated. Our free Guide to Coumadin Interactions is available at www.peoplespharmacy.com.

Q. I have taken Lipitor for several years. I’ve begun to notice numbness in my feet along with sporadic memory loss and difficulty balancing my checkbook and using the computer. I have a PhD, so this is alarming.

My doctor says Lipitor is not to blame. He says that my cholesterol is great (below 160) and not to stop. Is there any evidence that Lipitor could be connected to symptoms like depressed mood and trouble with balance or memory?

A. Statin-type cholesterol-lowering drugs like Crestor, Lipitor or Zocor reduce the risk of heart disease. Most people tolerate these drugs quite well, but some develop debilitating muscle pain. Others report mood, memory or nerve (neuropathy) problems.

Many doctors don’t believe that statins can cause such side effects. Others, however, have seen too many cases to disregard. We are sending you a CD of a radio interview we conducted with several physicians who have studied such issues. To order a CD of this one-hour conversation on “The Dark Side of Statins,” please send $16 to: People’s Pharmacy (CD-523), P. O. Box 52027, Durham, NC 27717-2027. It is also available at www.peoplespharmacy.com. Look for radio show No. 523.