Richmond Times-Dispatch - - HEALTH2 - BY JOE GRAEDON AND TERESA GRAEDON In their col­umn, Joe and Teresa Graedon an­swer let­ters from read­ers. You can email them via their web­site: www. Peo­ple­sPhar­ © 2019 King Fea­tures Syn­di­cate Inc.

QUES­TION: I use nal­trex­one off-la­bel to help me con­trol tri­chotil­lo­ma­nia [hair pulling]. It has been a god­send and helped me more than I ever thought pos­si­ble. I’ve strug­gled with the dis­or­der for al­most 40 years, and nal­trex­one has been most help­ful.

AN­SWER: Tri­chotil­lo­ma­nia in­volves com­pul­sively pulling out hair from the scalp, eye­brows or other parts of the body. It can be quite chal­leng­ing to treat.

The Food and Drug Ad­min­is­tra­tion has not ap­proved any med­i­ca­tions for this con­di­tion. Cog­ni­tive be­hav­ioral ther­apy may be ef­fec­tive.

Di­etary sup­ple­ments such as NAC (N-acetyl­cys­teine) and Inos­i­tol also may be help­ful (Archives of Gen­eral Psy­chi­a­try, July 2009; In­ter­na­tional Clin­i­cal Psy­chophar­ma­col­ogy, March 2017).

Nal­trex­one is ap­proved for treat­ing ad­dic­tions such as al­co­holism. Some re­search sup­ports the use of nal­trex­one to treat con­di­tions like com­pul­sive hair pulling, shoplift­ing and other be­hav­ioral ad­dic­tions (Euro­pean Ad­dic­tion Re­search, on­line, Sept. 7, 2017).

QUES­TION: I have been plagued with high choles­terol most of my life. Doc­tors put me on statins, and the re­sult was ter­ri­ble pain and loss of short­term mem­ory.

The statins low­ered my choles­terol from the 300s down into the 200s, but the side ef­fects were to­tally un­ac­cept­able. Switch­ing statins and low­er­ing the dosage didn’t help.

My new doc­tor pre­scribed Repatha, and within six weeks, my choles­terol dropped to 107 with no side ef­fects. I have been on Repatha for six months now and can’t say enough about the new treat­ment.

AN­SWER: Evolocumab (Repatha) is a rel­a­tively new in­jectable choles­terol-low­er­ing medicine. It is ap­proved for peo­ple with heart dis­ease or those who have fa­mil­ial (in­her­ited) su­per-high choles­terol.

Repatha usu­ally is pre­scribed to­gether with a statin. How­ever, some doc­tors are pre­scrib­ing it for pa­tients who can’t tol­er­ate statin side ef­fects.

A study pub­lished in the New Eng­land Jour­nal of Medicine (May 4, 2017) showed that Repatha plus a statin re­duced heart at­tacks, strokes and the need for stents more than placebo plus statin.

Side ef­fects are rel­a­tively un­com­mon. Some peo­ple ex­pe­ri­ence se­ri­ous al­ler­gic re­ac­tions; flu-like symp­toms, such as sore throat and cough; back pain; headache; mus­cle pain; dizzi­ness; and di­ges­tive dis­tress.

If in­sur­ance cov­ers the cost of Repatha, you are for­tu­nate. Oth­er­wise, the drug is very ex­pen­sive.

QUES­TION: When my hus­band and I were trav­el­ing in Mex­ico, we re­lied on ac­ti­vated char­coal for all our in­testi­nal woes, in­clud­ing flat­u­lence. Cap­sules take a lit­tle longer, or you can mix loose pow­der into water and drink it down. That is messier, but you can feel it work­ing from the time it hits your tongue. Be pre­pared to brush your teeth im­me­di­ately to clear the char­coal residue. Don’t be sur­prised if your doc­tor pooh-poohs it, but char­coal has been a sta­ple of our medicine cab­i­net for 30 years.

AN­SWER: Ac­ti­vated char­coal is a time-hon­ored rem­edy for flat­u­lence. Sup­pos­edly, it ab­sorbs smelly gases. How­ever, there is lit­tle re­search to sup­port this ap­proach (Amer­i­can Jour­nal of Gas­troen­terol­ogy, Jan­uary 1999).

An­other op­tion is Beano (con­tain­ing the en­zyme al­pha-galac­tosi­dase). One study con­cluded that “Al­pha-galac­tosi­dase re­duced gas pro­duc­tion fol­low­ing a meal rich in fer­mentable car­bo­hy­drates and may be help­ful in pa­tients with gas-re­lated symp­toms” (Di­ges­tive Dis­eases and Sciences, on­line, Jan­uary 2007).

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