Strep skin infections may be worse than strep throat
DEAR DR. DONOHUE: Please help me. My healthy 9-year-old was just released from the hospital. She had a strep skin infection. It ate her tissues. She also had scarlet fever. This baffles me, since she didn’t have strep throat. The skin infection was in the same place our dog scratched her. She still has an open wound. My husband thinks this happened because she skipped one nightly bath three days before she got sick. Is this my fault? How does it happen? It spread so very fast. — C.N.
It’s not your fault. Your daughter’s missing one bath had nothing to do with her infection. Strep germs are everywhere. No one can avoid them. The germs could have penetrated her skin through the dog scratch, but even that isn’t a sure bet. These bacteria can enter the skin through openings so trivial that they are never noticed.
The strep of skin infections often is the same strep as the strep of strep throat. Only a few such skin infections reach the destructiveness that your daughter’s infection did. They begin with a reddening of the skin at the site of entrance of the germ and then spread very rapidly. They can destroy the skin and the tissues beneath the skin. Often, all this takes place within 24-72 hours. The infected person becomes deathly sick with a high fever and severe pain.
Immediate treatment with high doses of antibiotics and removal of any dead tissue turns the tide in favor of the patient.
Scarlet fever, a red rash, is a consequence not only of strep throat but also of other strep infections It’s due to a particular material produced by some strains of the strep germ. Antibiotics take care of it as well as the infection.
I’m sorry your daughter had to suffer from this traumatic experience but am happy to hear she made a good recovery. No one is to blame.
DEAR DR. DONOHUE: I am 81 and have had essential tremor for 30 years. My neurologist prescribed Inderal for it. Two years ago, I had surgery, and the surgeon stopped the Inderal because my pulse rate was slow. My family doctor refuses to restart it. He said it would lead to my having a pacemaker. I had the low pulse rate for many years without any difficulty. The Inderal did help reduce the shaking. The family doctor told me that it is better to shake than to have a pacemaker installed. The neurologist told me I should take it for life. Now my hands shake severely. I can hardly use them. I would appreciate your opinion. — W.F.
Essential tremor is a common kind of tremor that comes on when people make purposeful movements, like bringing a spoonful of soup to the lips, handwriting or doing any kind of simple hand chores. The head may shake, too. It can be incapacitating. Inderal is a medicine often chosen to control the tremor. One side effect is slowing of the heart. I haven’t read or heard that its use leads to the need for a pacemaker. You need a second opinion. Life is tough enough without having to contend with essential tremor.
If it turns out Inderal isn’t for you, primidone (Mysoline) is a medicine that can control the tremor without slowing the heart.
Get in touch with the International Essential Tremor Foundation. The toll-free number is 888-387-3667 and its Web site is
DEAR DR. DONOHUE: With the alarming obesity rise and its well-published risks, don’t members of the medical profession share some of the blame because they chicken out when it comes to telling their patients they need to lose weight? I have it on good authority that this is so. — R.A.
Maybe some doctors are reluctant to confront their overweight patients with the risks of carrying too many pounds. Doctors I know harp on body weight constantly. You’re quite right. Obesity is a major health problem, and its complications affect many organs.
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

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