DEAR DR. DONOHUE: My husband has a problem with psoriasis. He is taking methotrexate, two 2.5 mg tablets, twice a week. I worry about this medicine, and that’s the reason why he doesn’t take Humira, another worry to us. He is constantly scratching and is always uncomfortable. He’s been talking about going to the Dead Sea. What is your take on this? Or do you have any other ideas? – C.D.

ANSWER:
Doctors have treated psoriasis with methotrexate for many years. It’s a medicine that demands respect, but not fear. It can cause liver and lung damage, but the prescribing doctor will monitor him for any changes that are headed toward trouble. You and your husband don’t have to feel that he is sitting on a time bomb. His dose is a modest one.

As for Humira (adalimumab), it is called a biological and it, and similar medicines, can pave the way for dangerous infections. But again, doctors are aware of this complication, rare as it is, and they take precautions to see it doesn’t happen. Humira sometimes works wonders. If the doctor suggested it to me, I would take it without any qualms.

Treatments for psoriasis exist in profusion. Clobetasol, a cortisone drug, has been long used, but there is a new way to use it – as a spray. Sprayed on the skin, its cortisone side effects are minimal.

How about light treatments? Ultraviolet B light is often effective. Ultraviolet A light, in conjunction with psoralens, medicines that make a person more sensitive to these rays, is another treatment option. UVA is associated with a slightly increased risk for skin cancer.

Many people have found that sunbathing next to and bathing in the Dead Sea a rewarding treatment. The Dead Sea is below sea level and the sunlight it gets has ultraviolet rays, as does all sunlight. The ultraviolet light is actually the more important factor in helping psoriasis than is bathing in the water.

DEAR DR. DONOHUE: What are the symptoms of jawbone destruction? I have taken Fosamax for years and read where it can cause this. And what is hyperlipidemia? Is it serious? – M.W.

ANSWER:
The osteoporosis drugs Fosamax (alendronate), Actonel (risedronate), Zometa (zoledronic acid) and Boniva (ibandronate) are bisphosphonates – medicines that stop bone absorption. Osteonecrosis (“osteo” for “bone”; “necrosis” for “death”) is associated with their use, and the bone most often affected is the jaw. However, this information has to be put in perspective. Osteonecrosis most often happens when these drugs are used in doses much higher than the ones used for osteoporosis, like the doses used for cancer that has spread to bone. And even then it is a rare event. And it usually happens when a user has to have dental surgery, like a tooth extraction.

Signs of jaw osteonecrosis include gum swelling, jaw pain, a sore on the gums and tooth loosening.

Keep in mind osteoporosis has bad side effects. A hip fracture is one of them. A broken hip is no fun.

Hyperlipidemia (HI-purr-LIP-uh-DEE-me-uh) is high cholesterol, high triglycerides or both. Its seriousness depends on how high the values are.

DEAR DR. DONOHUE: I have a problem I don’t understand too well. If a package says 400 mg of salt and there are four servings in a package, does that mean 400 mg in one serving or 400 mg in the entire package? That confuses me. I am only 92, and sometimes, some things don’t register. – J.L.

ANSWER:
The information on a label should apply to one serving – 400 mg of salt in one serving. It is confusing. Things are registering just fine with you.

DEAR DR. DONOHUE: My sweetheart has been told he has bladder cancer. Is it treatable, or is the prognosis dim? I am stressed. – P.D.

ANSWER:
Bladder cancer is treatable, often curable, and its prognosis isn’t dim. It strikes more than 60,000 North Americans yearly and causes more than 13,000 deaths each year. It’s the fourth most common male cancer, and the ninth most common female cancer. For every one woman who gets it, four men come down with it. Cigarette smoking has a heavy hand in its appearance.

The kind of treatment and the possibility of cure depend on how deeply it extends into the bladder wall and if it has spread outside the bladder. In its early stages, 90 percent of patients obtain a cure. If the cancer extensively invades the bladder wall or if it has spread, then the percent cured, quite naturally, drops.

Blood in the urine is its first sign. The urine can be red from blood or the blood can be so minute that it’s detected only with a microscope. Bladder cancer isn’t the only cause of bloody urine. It’s not even the topmost cause, but it is the most important cause.

A urologist with a viewing tube and special instruments can remove most early bladder cancers without having to make any incisions. The tube and instruments reach the bladder through the urethra, the tube that empties it.

Bladder tumors, even small ones, have a habit of coming back. Because of recurrences, the doctor schedules patients for follow-up bladder exams with the scope. In some cases, doctors instill BCG into the bladder. BCG is a bacterium that’s a distant cousin of the TB bacterium. It can heighten the bladder’s resistance to cancer cells.

Cancer is stressful, but your friend can have realistic hopes for a cure.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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