DEAR DR. ROACH: My sister has been diagnosed with erythromelalgia/red neuralgia. Is there a cure? Or just pain management? She has seen her PCP, a neurologist and now sees a pain-management clinic. She is taking oxycodone and has had several “blocks.” She is in so much pain. Please advise. — V.M.

ANSWER: Erythromelalgia (“erythro” is “red,” “melo” is “extremity,” and “algia” is “pain”) is a rare disorder of peripheral nerves, which directly causes pain and which also affects the blood vessels in the skin, causing the characteristic red coloring and warmth. It usually occurs in the feet, but it can occur in the hands, face or other parts of the body. It may occur by itself or as a result of other conditions, such as autoimmune diseases or blood disorders like chronic myelogenous leukemia. Some medications also are associated with this disease. The pain varies among different people, but it can be disabling.

Flares of erythromelalgia often are caused by warmth or exercise, although exercise that keeps the affected body part cool, such as swimming, may be helpful. Ice or other cooling can be dangerous, however.

Making the diagnosis is difficult, and many people with this condition have seen specialists or have been misdiagnosed. Although there is no cure for erythromelalgia, there are several different treatments, and sometimes it takes multiple tries to find one medicine — or, more likely, a combination of medicines — that helps.

I found a very useful website at www.erythromelalgia.org.

DEAR DR. ROACH: Can you provide a safe and simple way of disposing of unused and/or leftover antibiotics? I have several almost-empty bottles of antibiotic eardrops, as well as a few pills. Is there something they can be mixed with to make them harmless? —A.H.

ANSWER: The recommended way of disposing of any prescription medication is to remove it from its container, put it into garbage, preferably mixed with something like coffee grounds or cat litter, and place the whole lot into a sealable bag or empty can to keep it from breaking out. Don’t flush it down the toilet (unless the patient information sheet specifically tells you to). This keeps the medication from getting into the water supply, and keeps children or pets from inadvertently taking the medication. Some communities have take-back programs to allow for proper disposal.

DEAR DR. ROACH: My younger brother called me about seeing dark blood in his semen. He’s 52. Is this a concern? — N.J.

ANSWER: Although scary, blood in the semen (hematospermia) usually is not a sign of serious illness, but it should still be checked out by a urologist, since occasionally it can indicate a problem, especially in the prostate.

I get one or two somewhat-panicked calls a year about this, and have yet to have a patient have a serious problem.

DR. ROACH WRITES: Several people have asked me about who should not get the shingles vaccine. People who should NOT get the shingles vaccine are those with immune system problems. This includes people with HIV or AIDS, people on chronic steroids with doses greater than 20 mg per day, people with cancer who are undergoing chemotherapy or radiation, or people with bone marrow cancer such as leukemia. However, the vaccine is safe for people with an egg allergy. As always, your doctor knows you better than I do.

READERS: The booklet on varicose veins explains why they happen, what can be done to prevent them and how they are treated. Readers can obtain a copy by writing: Dr. Roach — No. 108, 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 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.

(c) 2013 North America Syndicate Inc.

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