BEGINNING THIS WEEK, DR. KEITH ROACH WILL BE ADDED TO THE BYLINE OF TO YOUR GOOD HEALTH.

DEAR DRS. DONOHUE AND ROACH: Will you please do a column on shingles? I have gone through 12 weeks of the nastiest, worst illness possible. I never hear anything on TV about it. — J.C.

ANSWER: I’ll have another go at shingles. Others probably think I overdo it. But it’s such a common problem of older people that it deserves repetition.

Shingles is the work of the reawakened chickenpox virus that has been asleep in nerve cells ever since a person was infected, usually in childhood. It’s a safe bet to say you were infected even if you don’t recall it; more than 95 percent of adults were.

The rash of shingles usually disappears in two to four weeks. Pain, however, can stay with you. The pain is now called postherpetic neuralgia. In making the trip to the skin, the virus damaged the nerve roots that it crawled down to reach the skin. Pain is a consequence of the nerve injury.

A large number of treatments exist for this aftermath of shingles. One is amitriptyline, whose primary use is relief of depression. It also has pain-relieving properties in doses lower than what’s given for depression. Neurontin (gabapentin) is a seizure-control medicine that often is successful in suppressing pain. The extended-release form of this drug, called Gralise, is given only once a day. Lyrica (pregabalin) has had a good record in quieting postherpetic neuralgia

Lidocaine skin patches, placed on the skin where pain is felt, are another way to ease pain without taking an oral medicine. Lidocaine is a numbing agent. The latest innovation for shingles treatment is Qutenza, another skin-patch medicine. The doctor has to apply this patch, and lets it stay on the skin for an hour. Then the doctor removes the patch, and the effect of the medicine lasts for three months. It is expensive.

In cases where no treatment brings relief, opioids — pain relievers of the morphine family — have a place in treatment, so long as they are supervised carefully by the doctor.

The booklet on shingles explains this problem in depth. Readers can order a copy by writing: Dr. Donohue — No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DRS. DONOHUE AND ROACH: I heard that heart attack risk rises when using the antibiotic azithromycin. I have occasional bouts of bronchitis for which I take this medicine. It usually works well for me. Is it safe? — M.F.

ANSWER: Azithromycin (Zithromax) is a popular antibiotic. It’s been found that cardiovascular deaths (heart attacks) have occurred with greater frequency than is expected when using this medicine. The increase in death rate is very small, and it probably results from a disturbance in the heart’s electrical activity.

You shouldn’t stay away from azithromycin if you truly need it.

Many cases of bronchitis are viral-caused and don’t respond to antibiotics. That’s a point worth remembering when taking any antibiotic.

DEAR DRS. DONOHUE AND ROACH: I suffered from an enlarged prostate, so I was sent to a urologist. He checked for cancer, but I don’t have it. He put me on Flomax and Avodart. After three years, the doctor said the medicines were no longer working and that I had to have surgery or my bladder would be damaged and I would have to carry a bag for the rest of my life. I am 57. I had a transurethral resection of the prostate, TURP. It’s been two months, and I still am passing blood clots. Is this normal. — J.G.

ANSWER: It’s normal to bleed after a TURP, but it’s not normal to be bleeding two months after the procedure.

Give the urologist a call. Let him examine you again and determine why the bleeding is lasting this long.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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