New onset Asthma in middle age

Can I develop asthma at the age of 67? I have never smoked and worked in an office all my life. I only have high blood pressure, which is well controlled. On a recent visit to my doctor, he told me I had developed asthma because of the chronic cough that I have had.

The majority of asthma cases are diagnosed in childhood or in the early teenager years. When one develops new onset asthma and a cough, this is a cause for concern. It is unlikely that one can have asthma out of the blue in the later years of life if the past medical history has been uneventful. Moreover, if you do not smoke or have no chemical related work history, then you definitely need more work up. The first thing to do is ask your doctor to get a chest x-ray and a referral to a lung specialist. Asthma may be related to the heart but this can easily be ruled out by obtaining an x-ray. If your doctor does not intend to work you up more thoroughly, you need a new doctor. At your age, something more ominous should always be ruled out first.

Generic statin

Can I take generic statin?

All statins currently available work in the same way. These medications inhibit a certain enzyme in the body, which prevents cholesterol build up in the body. However, the major difference between the statins is not their effectiveness but cost. Stains are expensive medications. The most expensive are rosuvastatin and atorvastatin. Individuals who have been prescribed these expensive medications should speak to their doctor about the generic statins. At the moment, mevacor, pravachol and zocor are available in generic form and for 1/3^rd the price. 

Many insurance companies may require that you try a generic statin before they will pay for a brand name statin. Some insurance cover all types of statins, after you pay a certain deductible. Statins bring a lot of money to the pharmaceutical industry, and usually doctors have little idea what generic brands are available.   

Remember statins have to be taken for life and can cost a fortune. If you really want to lower your cholesterol cheaply, then eat right and walk regularly. There is absolute no reason why generic statin will not work as effectively as the expensive brands. So, do not believe the hype that the more expensive statins are better than the cheaper brands. I personally believe that these medications are a rip off and instead recommend life style changes for my patients.

Chemotherapeutic drugs and numbness

Why do I have numbness, tingling and painful sensations in my leg after undergoing chemotherapy

Unfortunately, some chemotherapeutic drugs can affect nerves and induce peripheral neuropathy. Common chemotherapeutic drugs that have been linked to neuropathy include vincristine, docetaxel, cisplatin and paclitaxel. In general, these drugs affect the nerves in the hands and feet. Some patients may complain of pain or paresthesias in the fingertips. In rare cases, there may be muscle weakness of the finger, toe of foot.

In most people, the numbness or tingling pain sensation is not severe and does not affect daily living activities. However, if the symptoms are severe, your doctor may decide to discontinue the medications.

Most cases of peripheral neuropathy, which occur with chemotherapeutic drugs generally, improve once the medication has been stopped. This recovery may take anywhere from a few months to a few years. Unfortunately in some people with severe neuropathy, the symptoms may not completely recover

If you continue to have neuropathy symptoms, speak to your doctor. The decision to continue your medications will be made on the severity of the symptoms and the impairment that you have.

Bed wetting and DDAVP

I am a 28-year-old female and often wet my bed at night. Is there anything I can take to correct this problem? Is DDAVP effective?

I think what you have is nocturnal enuresis. It is not a rare problem by any means but because people do not brag about it, the exact incidence is not known. In any case, you have several options when it comes to medications. You may want to ask your doctor for DDAVP, which is available as an inhaler. In some people, it does reduce nighttime urine production. However, it does not work in everyone and it is also an expensive medication. I would say try it for a week and see what happens, if it fails to work in 7-14 days, it is unlikely to work at all. DDAVP seems to work much better in children compared to adults. You should know that as soon as the medication is stopped, the enuresis will return. Good luck.

Lost condom in the butt

 I recently had anal sex with my boyfriend and it appears that the condom came loose and is lost in my rectum. Should I do something?

No, I would not worry at all. In most cases, the condom will just pass out with the feces. It is very unlikely that it will remain in your rectum. During my younger days as a surgeon, we used condoms as tubes when doing colonic surgery. The condoms were stitched on the inside of the bowel so that the fecal material would not come into contact with the bowel lumen, giving the sutures time to heal. After 5-8 days, the condoms then spontaneously fell out. There were never any problems. However, I should warn you- losing a condom in the butt is one thing, but if you were to loose a sex toy or a dildo, that will require removal either with a scope or surgery.

Incomplete colonoscopy

I has just underwent a colonoscopy and the doctor tell me it was incomplete and now recommends a barium enema

Polyps can occur anywhere in the colon but are most common in the left or sigmoid colon. Some polyps tend to grow and eventually turn cancerous. Thus, colonoscopy is a useful tool to screen for polyps and remove them if possible. However, all consumers should understand that in nearly 30% of patients, colonoscopy cannot assess the whole colon. The reason for this failure may be technical (incompetent doctor) or poor bowel preparation. When the doctor is unable to visualize the entire colon, the options are to repeat the colonoscopy or undergo a barium enema. Barium enema is an imaging study whereby contrast is inserted into the rectum and picture of the colon are obtained. Barium enema unlike colonoscopy does not always visualize polyps less than 5 mm. Moreover, during a barium enema one cannot even do a biopsy or remove the polyp. Therefore, if your colonoscopy is unsuccessful, you should discuss the topic with your doctor and find out why it was unsuccessful and perhaps be referred to another doctor who is more proficient at the technique

Arm Acne

I have severe acne on my upper arms. What is the best way to treat it?

Upper arm acne is just as common as acne on the face. Many people have upper arm acne but often do not notice it. The only difference between arm and facial acne, is that the former is usually concealed with garments. Arm acne is common in young people and tends to be slightly more common in men than women.

The treatment of arm acne is the same as for facial acne. There are non prescription and prescription medications that can be used to treat arm acne. The best advice is to first try an over the counter product. If that fails you can see a doctor for a prescription medication.  Unfortunately over the counter products like salicylic acid, clindamycin or benzyl peroxide suck.

In addition, you need to know that arm acne is often made worse by excess sweating, tight clothing and wearing damp sweaty clothes (eg after exercise) 

The first object should be to maintain good skin hygiene. Shower regularly, wear loose cotton garments and change clothes if they are damp after exercise. When showering do not scrub the acne lesions- Scrubbing is not a treatment of acne and can cause scarring. If you have long hair that falls on your arms, trim your hair.

There are 100s of herbs, lotions, potions, solutions, creams, ointments, enemas, solutions, etc etc for acne- the only thing they have in common is none of them work-so avoid wasting your money on BS products. If you have acne, go and see a decent skin doctor. Avoid GPs because they know very little about the skin and will probably prescribe an antibiotic without even examining you.

The good thing about arm acne is that unlike the face, it can be concealed by clothing.