Dear Dr. Roach: I鈥檓 a white male, age 72, 200 pounds and in good health. I spin and lift weights three days a week. Approximately four years ago, I had blood clots in my lungs, and the cause was Factor V Leiden.
I have been on warfarin since then, and have had no problem keeping within the numbers. I watch my diet. I have never been a smoker, and before the blood clots, my alcohol consumption was a beer a month or less. Giving up the beer was not a problem. At times I would like to have a glass of beer, such as at my club Christmas party. The literature seems spotty regarding this. I am not going to endanger my life over a glass of beer, but what do you think? By the way, I have on occasion tried a non-alcoholic beer (as long as it is low in vitamin K), but it doesn't taste as good.
R.S.B.
Occasional mild alcohol use is not prohibited on warfarin; binge drinking is. I would not exceed two drinks in a day, but one once in a while is certainly OK.
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Dear Dr. Roach: My mom has shingles. She was diagnosed two years ago, and it has settled just above her right eye. She still has active blisters on her forehead. The pressure in the eye is now controlled using prednisone drops and acyclovir daily. Pain is low during the daytime; however, during the evening there are times when the pain is excruciating.
My question, sir: Should Mom 鈥� now 97 and in otherwise good health 鈥� get the shingles vaccine?
L.R.A.
Persistent blisters two years after diagnosis is very uncommon, and it may be that, due to her age, her immune system is unable to get rid of the infection, which is why her doctor has prescribed acyclovir. It is recommended that people who have had shingles take the vaccine only after all the shingles blisters are gone. The risk of recurrence is low in the four years after a bout of shingles, so it isn鈥檛 essential to administer the vaccine immediately after the infection clears.
The bottom line for everyone else is, the shingles vaccine is effective at reducing the likelihood of developing shingles and at reducing the likelihood of post-herpetic neuralgia, the sometimes excruciating pain that can go on for months after an episode of shingles. The vaccine is not effective in people with active shingles or those who currently are experiencing post-herpetic neuralgia.
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Dear Dr. Roach: Fourteen years ago, my eye doctor told me that she saw a 鈥渇reckle鈥� in my right eye. Her record states 鈥渃horoidal nevus.鈥� She took a picture of it. In September I went to another eye doctor, who also diagnosed choroidal nevus, was concerned about melanoma and said he would monitor it. Would you please explain what this is?
Anon
A choroidal nevus is a benign lesion below the retina. The concern is that they can transform into melanoma, a malignant eye cancer. About 10 per cent of choroidal nevi will transform to melanoma in 10 years. Larger, thicker nevi or those with orange colour or leaking fluid predict transformation to melanoma. People with choroidal nevi should have an eye exam at least yearly. Taking a picture can help determine if the nevus is growing, so the picture the first eye doctor took might be useful now to compare whether yours has stayed the same or changed.
Dr. Roach regrets he cannot answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
