Dear Dr. Roach: I was diagnosed with appendicitis. I’ve been sick for three days. My surgeon said that although the CT scan showed a ruptured appendix, he wants me to take antibiotics for a week or so, and then come back in six to eight weeks for surgery.
I don’t want to wait. Wouldn’t it be better to get this done now? I’m in pain and I’m worried I will get a very severe infection. Why do I need to wait? Why don’t they operate? I always thought that when you have appendicitis, they operate right away.
D.S.
The optimal treatment of acute complicated appendicitis is changing. In cases like yours, where the body has partially or completely walled off the infection, giving antibiotics and waiting for the inflammation to reduce make the operation safer. Of course, if a person is unstable, or if the perforation is free, that requires an emergency surgery. Observation by a skilled surgeon is still necessary for a period of time on antibiotics to make sure the person is not in need of urgent surgery.
I spoke with one of my surgical colleagues who noted that operating immediately in a case like yours may require removal of part of the colon because there is so much inflammation that extensive surgical dissection is required. Giving the body a chance to wall off the infection and the antibiotics time to kill the bacteria means that when they do surgery later, it is easy and with less risk of complication.
I understand you want the problem solved right away, but you are likely to have a better long-term outcome if you postpone the surgery.
Dear Dr. Roach: What would you recommend for tinnitus? Can any vitamins help?
E.R.H.
Tinnitus is the sensation of sound when there actually is none. Many people describe a ringing sensation, but buzzing and hissing can also occur. Tinnitus is almost always associated with hearing loss.
Medications are not particularly effective in the treatment of tinnitus. Although some prescription medications show limited benefit in specific situations, I don’t treat tinnitus with medications. Vitamins and supplements have been tried, but the data on gingko biloba, melatonin, niacin, zinc, copper and manganese have failed to provide convincing evidence of benefits.
Depression and anxiety are common in people with severe tinnitus, and these should be treated. Treatment leads to an improved quality of life. Two modalities have been proven effective for many people with tinnitus: tinnitus retraining therapy, which includes the use of external sound generators (often for one to two years); and cognitive behavioural therapy.
I recommend the American Tinnitus Association at ata.org for more information.
Dear Dr. Roach: Can someone use hand sanitizer after using the toilet?
E.E.
I recommend washing hands after using the toilet. Although hand sanitizers are good at killing bacteria, they don’t clean the hands, and some infections, especially C. diff (Clostridioides difficile, a serious diarrheal illness), have spores that are highly resistant to killing and need to be washed off. That takes soap, water and time — at least 20 seconds. Alcohol-based hand sanitizers can’t kill C. diff spores.
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