Ask Dr. Keith Roach M.D

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: In your recent column about the prognosis for a patient with esophageal cancer, what about offering the patient the option of just doing nothing? I suspect this may contradict your training.

Clearly this course would seem especially hard, given her caregiver role. But in some cases, perhaps like this one, the range of treatments and odds of recovery may suggest that some reasonable folks might just decline additional medical help. Shouldn't this be an option, too? — R.J.A.

ANSWER: Doing nothing always is an option, and I feel that physicians should explain the likely course of the disease without treatment, as well as how the course could be affected by the different treatments we propose. That way, an individual can make the bestinformed decision possible. We do have to admit that sometimes the condition takes an unexpected turn, like the woman who recently wrote that her mother's colon cancer apparently went away without treatment (I have had several similar letters).

However, it certainly is in our training to want to help. That may be something as simple as explaining what is expected to happen with the condition, or it might be prescribing treatments to ease pain and suffering. It doesn't have to be treatment designed to prolong life.

In the column you are referencing, a reader with advanced esophageal cancer clearly wanted to do everything she could for the best chance of successful treatment, in part so she could continue taking care of her mother.

DEAR DR. ROACH: I found your response to the male with shingles after he received the vaccine disturbing. I received the vaccine quite a number of years ago, and am fearful of getting shingles. Do you recommend getting another shot? – F.C.P.

ANSWER: Some individual physicians recommend getting a booster shot for shingles, since a recent study shows that its effectiveness does seem to wear off after eight years or so, but that is not yet a general recommendation. The guideline writers are awaiting results of ongoing studies. A newer type of vaccine is in development.

The current vaccine is not indicated as a booster, but for people who are very worried about shingles, it wouldn't be unreasonable to repeat the vaccine at age 70, for example, if you were vaccinated at 60. The major downside is the expense, since it is costly and would likely not be covered by insurance. Still, I don't recommend a booster shot in general until we have more information.

DEAR DR. ROACH: I am concerned about Zika virus and other mosquito-borne illnesses. What is the best way to keep mosquitos from biting? — K.P.

ANSWER: One way is to stay away from where the mosquitos are, especially sources of stagnant water. They are most active at sunrise and sunset, so it's especially important to stay away then. Protective clothing is also helpful.

According to a recent study, the most effective insect repellent is DEET, with 25 to 35 percent solutions being the optimum balance between effectiveness and skin irritation for most people. DEET has been in use for more than 50 years, and multiple studies have confirmed its safety.

Alternatives include picaridin and IR3535. One other alternative is an extract from the lemon eucalyptus plant, which is about as effective as DEET products. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.