Many drugs help kill shin­gles pain

The Weekend Australian - Travel - - Health - LINDA CAL­ABRESI

It is now more than 12 months since my hus­band, then 79, con­tracted a se­vere case of shin­gles on his face. It was treated within 24 hours with the usual med­i­ca­tion. He was in great pain for about three months. Since then he has suf­fered an aching head with a very itchy scalp. Are you aware of any­thing that might help? WHILE post-her­petic neu­ral­gia (the name given to post-shin­gles pain) is rare, it is, un­for­tu­nately, more com­mon as you get older. Usu­ally, start­ing the an­tivi­ral med­i­ca­tion soon af­ter the rash ap­pears to de­crease the risk. Hav­ing said that, there are a num­ber of treat­ment op­tions avail­able, even af­ter 12 months. Pre­sum­ing the pain and itch has been re­sis­tant to the usual painkillers, your hus­band’s doc­tor might con­sider pre­scrib­ing a tri­cyclic an­tide­pres­sant. It is not the an­tide­pres­sant ef­fect that is im­por­tant here, but rather the ef­fect th­ese drugs have on the nerve end­ings, which is why this older class of drug is more ef­fec­tive than the newer an­tide­pres­sants. Sim­i­larly, a class of drugs more com­monly used to treat epilepsy, such as gabapentin, has been shown to be ef­fec­tive for pain as­so­ci­ated with the neu­ro­log­i­cal sys­tem. There are also some creams and oint­ments avail­able that help pro­vide re­lief, though they are usu­ally used on top of other oral treat­ments rather than just on their own. In par­tic­u­lar, a prepa­ra­tion known as cap­saicin (brand name Zostrix) is now avail­able specif­i­cally for this type of pain. While a to­tal cure for your hus­band’s con­di­tion can’t be guar­an­teed, his doc­tor should be able to pre­scribe some­thing to make the prob­lem man­age­able. I’ma 40-year-old wo­man with aching vari­cose veins that de­vel­oped dur­ing my first preg­nancy and got worse with two sub­se­quent preg­nan­cies. It has been rec­om­mended that I have the veins stripped rather than in­jected. Is this the best op­tion? Strip­ping is the best op­tion for ma­jor vari­cose veins. While pop­u­lar, in­ject­ing veins isn’t al­ways suc­cess­ful, es­pe­cially with large vari­cose veins. In­jec­tions (also known as scle­rother­apy) tend to be re­served for smaller vari­cose veins and spi­der veins. Th­ese days the strip­ping op­er­a­tion can of­ten be done as a day pro­ce­dure and the scars are usu­ally very, very small. As in your case, vari­cose veins tend to get worse with ev­ery preg­nancy, so it is usu­ally rec­om­mended that you leave any op­er­a­tion on such veins un­til you’ve fin­ished hav­ing chil­dren. I ama 70-year-old man who was di­ag­nosed with stom­ach can­cer in 2001. I un­der­went a gas­trec­tomy fol­lowed by chemo­ther­apy that fin­ished in early 2002. Since then I have had reg­u­lar check-ups, ini­tially three­monthly then six-monthly at the hospi­tal. They do a blood test and a phys­i­cal checkup. This year I was told the hospi­tal visit was no longer nec­es­sary, as I had reached the five-year mark. They sug­gested I reg­u­larly see my GP in­stead. Would you rec­om­mend any fur­ther fol­low-up? IF can­cers, not all, but most, are go­ing to re­cur af­ter be­ing treated they will do so in the first five years af­ter di­ag­no­sis. That is the real dan­ger pe­riod, which is why in med­i­cal cir­cles we talk about five-year sur­vival. If you sur­vive five years you are ba­si­cally likely to sur­vive. In Aus­tralia, stom­ach can­cer has a fairly low five-year sur­vival rate (about 23 per cent), but once you join that group of 23 per cent your longer-term sur­vival out­look is very good. Of course, hav­ing had the con­di­tion, you are at greater risk of a re­cur­rence than some­one who has never had can­cer so a reg­u­lar, usu­ally an­nual, check is likely to be worth­while. This can eas­ily be done by your GP. Linda Cal­abresi is a GP and med­i­cal ed­i­tor of Med­i­calOb­server . Send your queries to lin­da­cal­

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