Dear Dr. Roach: My daughter has had symptoms of Guillain-Barr茅 syndrome since her 20s. She is now 64 and has been doing fairly well. She is ambulatory and curious about her future.
P.B.
Guillain-Barr茅 syndrome is a type of acute muscle paralysis that occurs after an event, usually an infection. (Campylobacter jejuni, a sometimes-severe bacterial infection, is the most common recognized cause.) But it also can happen after surgery or, rarely, a vaccination.
The weakness usually starts in the legs, and progresses over two weeks or so. The degree of paralysis ranges from mild difficulty walking to complete paralysis of all muscles, including those needed for breathing. Between 10 and 30 per cent of people will need the support of a ventilator. Pain, sensory abnormalities and loss of reflexes are common. The nervous system controls many functions besides muscle strength, and these can be affected, especially regulation of heart rate, bladder function and blood pressure. Severe abnormalities of nervous system function can cause sudden death. About three to seven per cent of people with GBS will die within one year of diagnosis, despite intensive support.
Because the severity of the disease is so varied, it is hard to discuss long-term prognosis. Since your daughter must have had her initial episode about 40 years ago, she may not have been treated with either of the two modalities now known to shorten the course of the disease: intravenous immune globulin or plasma exchange. Among people who were not given one of these treatments, about 10 per cent had relapses, and two to five per cent will develop chronic relapsing weakness, called chronic inflammatory demyelinating polyradiculopathy.
Eighty per cent of people with GBS are walking six months after the event.
It sounds as if your daughter has had partial but not complete recovery. However, it can be difficult to separate relapsing GBS from CIDP. I suspect your daughter鈥檚 doctors have far more expertise than I.
听
Dear Dr. Roach: I read about a new product you drink called Uvo to protect you from sun damage. Is this really effective for preventing skin cancer, such as melanoma?
R.C.
On the one hand, the theory makes sense. There are substances that can increase the skin鈥檚 ability to resist sun damage, and many of these substances are in the product, according to the website. It also shows pictures comparing skin redness after sun exposure with and without consuming the supplement, and the skin appears less red after using the supplement.
On the other hand, the best kind of study 鈥� a randomized, controlled trial 鈥� failed to show a benefit of beta carotene (one of many nutrients in Uvo) in preventing skin cancer.
More importantly, I strongly recommend against using this kind of product as one鈥檚 sole protection against the sun. The most effective way to prevent skin cancer is to avoid the sun in the first place. This means using protective clothing and avoiding the sun entirely in the most intense part of the day. A sunscreen that is effective against both UVA and UVB (most authorities recommend an SPF of 30 or greater) needs to be applied liberally and frequently in order to have effect.
Diet or supplements might some day have a proven role in preventing skin cancer. However, the company鈥檚 website emphasizes that both physical protection and sunscreen are to be used, even with their product.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
