DEAR DR. ROACH: My 30-year-old and otherwise healthy grandson has been suffering from and treating hemorrhoids for two years. He is anemic due to his loss of blood. He’s had several bandings; they couldn’t complete the last one because he was in too much pain. They said they couldn’t anesthetize the area because his lack of feeling would prevent them from knowing if they were near a nerve. So, now they say he should have surgery, although it is said to be quite painful and difficult.
Do you agree that they can’t anesthetize the area for banding, and is the surgery as horrible to deal with as they say? Under what conditions would you say it is advisable to have the surgery? — A.P.
ANSWER: Most people with a banding procedure do not need anesthesia, and nerve blocks are not used in hemorrhoidal banding because a feeling of pain is a useful indication that the band is not in the best position. When home treatments and office procedures (like banding, scleral therapy or infrared coagulation) are ineffective or can’t be used, it is time to consider surgical treatment.
The surgery’s reputation of being “horrific” is undeserved. I have had several patients in the last few years undergo this surgical procedure, and although they have certainly had a few days of pain after the procedure, all have been happy with the outcomes. Surgeons often use long-acting local anesthetics, and the pain is greatly reduced when they are combined with better surgical procedures, compared to older surgical techniques and anesthesia.
DEAR DR. ROACH: My sister’s dog ran through a swampy area while we were on a walk and ended up with a lot of ticks. We picked off about 10 that day.
The interesting part was that the dog had just gotten his flea and tick medication. So, aside from the first couple of ticks we picked off, the rest were dead, showing the effectiveness of the medicine!
Is there a reason that people, especially those who work or live in areas prone to ticks, cannot be treated in a similar way in order to ward off Lyme and other tick-borne diseases? (I am not suggesting using veterinary medicine on people; I’m just asking why there isn’t a similar medical treatment for people when there’s such an apparently effective preventative for dogs.) — J.D.
ANSWER: I’m, of course, not a veterinarian, but I did look up the toxicity for three of the most frequently prescribed oral flea and tick medicines for dogs. All of them have the potential for toxicity in humans, and none have been studied extensively. I hypothesize that the cost of conducting studies on humans is so great, and the expected demand for such a product is so low that drug companies have not thought it worth the costs to proceed.
In the meantime, there are topical treatments humans can spray on the skin to repel ticks, which — in combination with protective clothing and daily tick checks — is a moderately effective way of preventing tick-borne diseases such as Lyme disease, ehrlichiosis and babesiosis. There currently isn’t an available vaccine for Lyme disease, but at least one is undergoing clinical trials now.
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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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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