DEAR DR. ROACH: I am a 93-year-old male. In February 2012, I fell on a hospital sidewalk. Along with some other minor injuries, I cut my upper lip. The hospital’s emergency room put three sutures in my lip to close the wound. In a few weeks the cut had healed, but to this day a small lump remains on the inside of my lip that feels like a blister. The lump is about the size of a split pea. The lump interferes with my being able to drink from a cup or glass. Since a year has passed since the injury, should this be? What can be done to correct it? — C.R.

ANSWER: This probably is scar tissue, especially if it’s deep inside the lip. However, there are minor salivary glands that line the inside of the mouth. These can form cysts, which can be drained by a dentist or oral surgeon. Your dentist will be able to tell if it’s a drainable cyst. If it’s scar tissue, the scar can get softer and smaller over time, even after a year. A steroid injection may be worth trying, too.

DEAR DR. ROACH: I will be 86 next month, have been on hormone replacement therapy for at least 20 years and came off it approximately two years ago. Since then I have had about 10 urinary tract infections, and was put on different antibiotics each time. Now the urologist wants me to take an antibiotic once a day for three months. Since I have IBS with diarrhea, I am very reluctant to do this. May I have your advice, please? — H.I.

ANSWER: Recurrent urinary tract infections in older women can be a real problem, and they have many different causes. However, the fact that yours began after stopping hormone replacement suggests that you may have atrophy of the lining of the urethra (the tube that allows urine to drain from the bladder). Estrogen is necessary for the health of the lining of the vagina, and also the end of the urethra. Without a normal lining, the urethra can’t close completely, and that allows bacteria to enter and cause a urine infection (and sometimes causes urinary incontinence, too).

Some urologists and internists aren’t as diligent as we should be about doing a careful vaginal examination in women with recurrent infections or incontinence. Once properly diagnosed by a good exam, treatment is usually effective, especially with a topical estrogen like estradiol. Go back and see a urologist or your gynecologist before taking the step of prophylactic antibiotics (to prevent, not treat, a urine infection).

The booklet on urinary tract infections provides a summary of typical signs and symptoms of UTI and the appropriate treatment. Readers can order a copy by writing: Dr. Roach — No. 1204, 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.

DR. ROACH WRITES: I recently wrote a column about leg cramps, and my readers did not disappoint. The most common advice was tonic water, but pinching the skin during a cramp, air-filled compression stockings, and turmeric were other suggestions. The Food and Drug Administration has warned against using prescription quinine for leg cramps.

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 P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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