DEAR DR. DONOHUE: Third letter, same request. Please tell me how to get rid of fungus under a toenail. — B.K.

ANSWER: Toenail fungus is prevalent among older people, and often, the infected person has no idea where he or she picked it up. The big toe’s nail is the one the fungus seems to like the best. The nail turns yellow, becomes thick and brittle, and has crumbly material extending from its edge under the nail to its base. The nail doesn’t usually hurt or itch. It just looks awful.

Treatment for nail fungus is less than a huge success. Penlac (ciclopirox) Nail Lacquer is applied directly to the nail. The cure rate isn’t impressive. Oral medicines have the best results, but the results aren’t something to write home about. Further, they’re expensive, and often are not covered by insurance. One such medicine is Sporanox (itraconazole). It’s taken twice a day for one week of each month, for three or four months. Liver enzymes should be monitored while using it, because it can, but rarely does, damage liver cells.

Some people opt for nail removal.

A new treatment employs a laser. As with oral medicines, it’s expensive and most insurers don’t cover the cost. Results are promising but not guaranteed.

If the nail isn’t bothersome, if it’s not leading to infections of the toe or foot and if a person isn’t a diabetic, many decide to live at peace with the infected nail. It isn’t likely to shorten life.

Home remedies abound. They include Vick’s VapoRub, bleach and vinegar. I don’t have a lot of faith in them, and I would not use bleach. Studies on Vick’s, applied daily for 48 weeks, show a success rate of 22 percent.

DEAR DR. DONOHUE: My husband died of hepatic encephalopathy, which you wrote about. His doctors performed a liver biopsy, which showed cirrhosis. Later I read about Tylenol causing liver damage. Due to a neuropathy he had, he was taking a lot of Tylenol and some sinus meds with Tylenol in them. I think Tylenol killed his liver. This is my curiosity and perhaps a warning to others not to use excessive amounts of Tylenol. — H.W.

ANSWER: Tylenol (acetaminophen) has been safely used by a huge number of people for decades. It’s harmless and effective when used according to the instructions on the bottle. It is also found in combination with 600 over-the-counter medicines. Recently, the manufacturer lowered the maximum daily dose of Extra Strength Tylenol to 3,000 mg from 4,000 mg. Changes in other Tylenol products may be forthcoming.

I don’t know if your husband’s liver damage resulted from too much of this drug. Add up his total daily intake from all brands of medicine containing acetaminophen.

Alcoholics or people drinking three or more alcohol drinks daily either should not take Tylenol or should talk to their doctors before they do.

DEAR DR. DONOHUE: I read your item on multiple myeloma. I have an 84-year-old friend who was diagnosed with it in 2003 and has taken thalidomide for it with no chemo or radiation. She is still alive today. — B.P.

ANSWER: I wasn’t able to mention every treatment for myeloma in that short answer. Thalidomide is a treatment for selected multiple myeloma patients. Readers might remember that drug as being responsible for severe congenital malformations when it was used in pregnant women in Europe to combat morning sickness. The leadership of a female doctor at the Food and Drug Administration kept it out of use in the United States. It now has found a place in the treatment of this cancer.

I also didn’t mention treatment with autologous stem cells, stem cells obtained from the patient before they’re given high-dose chemotherapy.

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.