Dear Dr. Donohue: Two months ago, I broke out in a shingles rash. I had some pain, but not a lot. After the rash left, the pain increased, and it's still there. I need some relief from this pain. I didn't think shingles lasted this long. Would the shingles vaccine help?
R.M.
Shingles doesn't last that long. What you have now is postherpetic neuralgia, nerve damage caused by the shingles virus. That's the source of your pain.
When you were a kid, you had chickenpox. Even if you don't remember, even if there's no record of it, the chickenpox virus infected your body. It remains in a deep sleep inside nerve cells until later in life, when something wakens it and the virus makes its way down the nerve to the skin. There, it produces the typical rash and pain of shingles. The rash is gone in about two weeks.
Between 10 per cent and 15 per cent of those who have shingles will face one of its dreadful complications: postherpetic neuralgia, pain that lingers long after the rash is gone. Pain relievers and time are the only things that treat this. Sometimes antidepressants, in low doses, can ease the pain. Amitriptyline is an example of such a drug. Seizure-control medicines are another group of drugs that can control postherpetic neuralgia. Lyrica and Neurontin are two such drugs. Capsaicin cream, available without a prescription, applied to the area of pain, might soothe it. Qutenza is a patch impregnated with a high concentration of capsaicin. It's the latest treatment of the aftermath pain of shingles. A health-care professional has to apply the patch to the skin. It's left for an hour, then removed. It is expensive. Make sure your insurance covers it.
Often, doctors have to resort to a combination of treatments to control postherpetic neuralgia.
The shingles vaccine won't help you now. If given before an outbreak, it prevents shingles in 50 per cent of recipients and has a 66 per cent record of heading off postherpetic neuralgia.
Dear Dr. Donohue: When I turned 50, I had a colonoscopy on the advice of my doctor. The procedure was a snap compared with the preparation for it. I am scheduled for another scope exam. The doctor removed a suspicious polyp the first time around. Have any changes been made in the prep?
T.H.
The preparation involves cleaning the colon, and it isn't a picnic. Some hospitals have adopted changes in the prep. It involves Miralax (a laxative) diluted to about two litres with a soft drink of your preference. The mix is taken the day before the scope.
Other facilities split the preparation into two phases. Half of the dose is given the day before. The other half is given five hours before the procedure.
As part of the preparation, take only clear liquids the day before your exam -- water, broths and drinks like apple juice. Coffee and tea are fine, but don't add milk or cream. Don't eat nuts or seeds for five days preceding the test.
Dear Dr. Donohue: I am a widow living alone. I have had strokes. I always buy items with zero trans fat. My daughter says that items marked "zero trans fat" can have some trans fat in them. Do they?
Enclosed is the label from a box that says "no trans fat." I eat quite a bit of it. The label also says 11 per cent total fat with 8 per cent saturated fat. What is the other three per cent?
I am 83.
E.W.
Trans fats are truly bad fats. They lower HDL cholesterol -- good cholesterol, the kind that doesn't cling to artery walls and leads to strokes and heart attacks. In addition, trans fats raise LDL cholesterol --- bad cholesterol.
A manufacturer is allowed to print "zero grams trans fat" if its product has less than 0.5 grams of trans fat in one serving. That's a very small amount of trans fat, not an amount that will do you harm.
The label says the product has a total fat content of 11 per cent, with eight per cent being saturated fat. Saturated fat also raises cholesterol, but not to the degree that trans fat does. Eight per cent is not a health threat. The other three per cent of fat must be monounsaturated or polyunsaturated fat, fats that don't create trouble.
