Post-shoulder surgery, patient develops malodorous armpits
Question: I have a problem that you might not have heard about. I had shoulder surgery on my left shoulder two years ago and developed strong body odor on that side. I never had strong body odor before. I did an online search for this problem and found out that it’s not that uncommon. One article suggested not to use bar soap but to use shampoo instead. I tried this, and now I’m body odor free. — B.C.
Answer: I have two thoughts about this, but I’m not sure either of them is right. The first is that after surgery, you are likely in a sling or, at the very least, less able to move your shoulder. You also may be bandaged. I suspect that has changed the bacteria that live on your skin, which is what causes body odor.
The second possibility is that you may have had a nerve block at the time of the surgery. This can change the way you sweat, which in turn can lead to changes in your body’s normal flora.
In either event, the goal is to get rid of the bad bacteria. Soap and shampoo have different abilities to kill bacteria. I sometimes recommend a topical antibacterial, chlorhexidine (sold as Hibiclens and other brands).
Q: I am 70 years old and have been fighting acid reflux (GERD) for over 20 years. For years I took several antacid pills day for my GERD. My doctor prescribed 20 mg omeprazole (Prilosec), and for over 10 years I never thought again about my GERD. It was great! But then I read about the negative long-term effects of taking proton pump inhibitors like omeprazole. I weaned myself off the PPI (with my doctor’s approval) and started taking ranitidine in its place, but soon the ranitidine did little or nothing for my GERD, and I was back to taking antacids several times a day. My doctor prescribed Carafate (sucralfate) and that helped, especially at night, but I was still taking antacids. Now I buy 20-mg omeprazole tablets and cut them in half, taking 10 mg omeprazole a day. I still get occasional acid stomach, but I use the Carafate for those times. I am happy with this strategy. I have never had an endoscopy. — J.J.
A: Long-term use of PPI drugs like omeprazole increases risk for infections (pneumonia and diarrheal infections, especially Clostridium difficile) and may reduce absorption of calcium and magnesium (possibly leading to increased fracture risk). They possibly may worsen kidney function and are associated with dementia with no known causal relationship. They should be used at as low a dose as is effective, for as short a time as possible.
However, these drugs do prevent stomach ulcers in people at high risk, including some who take various medications (NSAIDs, steroids). They may reduce cancer risk in people with Barrett’s esophagus, and certainly help symptoms. Some people need long-term PPIs despite the risks.