Dear Dr. Roach: I am wondering about oral herpes. Have there been any advances made for treating or preventing oral herpes? I know about and use Abreva, but is there anything that works better?

-- L.P.

A: Herpes simplex virus type one is the cause of oral herpes, usually called "cold sores" or "fever blisters." These often start as a clear fluid-filled blister on the lips or in the mouth. Many people carry the virus, and some people experience periodic outbreaks of these painful lesions.

Docosanol (Abreva) is an over-the-counter cream that prevents viral entry and replication of the virus. Several, but not all, studies show that it is effective at speeding healing. However, it is not as effective as the prescription cream penciclovir at reducing the size and number of herpes lesions. Unfortunately, the cost of penciclovir cream is prohibitive for many, with a single 5-gram tube retailing for around $800 in the U.S. Another over-the-counter medication, benzalkonium (Viroxyn), was shown to be about as good as or better than Abreva at making cold sores go away faster, and it also contains an anesthetic to ease the pain.

We really need better treatments for this common, painful condition. There is hope for a vaccine in the future.

Lymphedema

Dear Dr. Roach: I have some questions after a recent surgery. I had a lumpectomy on my left breast, and five lymph nodes were removed. I was told not to have my blood pressure taken from, shots given into or blood taken from that arm. I have asked a few doctors and nurses how long I have to wait to use that arm again for these procedures. I have been told anywhere from a year to the rest of my life. I also wonder what happens if I am in an accident and cannot talk and the medical responders use that arm. What is going to happen? No one seems to be able to tell me.

-- W.S.

A: The concern is that you may develop a condition called lymphedema. The lymphatic vessels normally take up fluid from the soft tissues of the body and return it to the circulation. If these vessels are damaged, through radiation, cancer or other means (sometimes we never know how it happens), then the affected limb can swell. The swelling from lymphedema doesn't get better overnight as well as the swelling that comes from leaky valves in the veins (venous incompetence).

Because of the surgery, and especially if the lump was cancerous, you are at risk for developing lymphedema, which can be triggered by a simple medical procedure of the type you describe. Your condition is sometimes referred to as "stage 0 lymphedema," meaning you have risk but no symptoms. In an emergency, of course the priority is to get you resuscitated. Even if you have an IV or blood pressure taken, you are not likely to develop lymphedema, but not getting these procedures done reduces your risk. Lymphedema has a very significant impact on people's quality of life, so it is much better to prevent this disease than it is to have to treat it.

I would recommend avoiding procedures on that arm for life. Also, any minor injuries on that arm, as simple as a paper cut or insect bite, should be treated aggressively with topical antibiotics, moisturizers and anti-itch medication to reduce any damage to the skin. It's infection that is the biggest risk for triggering symptomatic lymphedema.

The booklet on edema and lymphedema provides information on the causes of foot and ankle swelling. Readers can order a copy by writing: Dr. Roach, Book No. 106, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.

Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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