DEAR DR. ROACH: My husband has bad toenail fungus. He is not diabetic. He cannot take prescription medicine by mouth (like terbinafine) because he is on too many other prescription medications. What about laser treatment? Does it work? Is it expensive? Is it contagious? -- E.K.
ANSWER: Toenail fungus is caused predominately by Trichophyton rubrum. It is present in the environment, so most of us are exposed to it, but it's not really clear why some people get it and others don't. The oral medications itraconazole and terbinafine are the most effective treatments, but because they can have serious side effects, I recommend them as treatment only if the fungus is causing symptoms.
Since the last time I discussed this topic, I have received many suggestions from readers. One reader told me that laser treatment was very effective for her and recommended it to others despite being expensive. However, the published data do not yet support its effectiveness.
Other suggestions I received included tea tree oil (a few drops two or three times daily); soaking in Listerine 10 minutes twice daily; Nizoral shampoo (one drop twice a day); and Vick's VapoRub (apply daily for a year). Mostly, the information showing these worked was anecdotal (not from clinical studies), but none is likely to be harmful.
DEAR DR. ROACH: I have been taking 25 mg of hydrochlorothiazide for about five years. My blood pressure was 152/80 at a doctor's visit six months ago, and I checked it myself at the pharmacy recently, where it was 155/68. Is this normal? According to the chart at the pharmacy, it is way too high. -- T.A.
ANSWER: Yes, it is way too high. There remains some debate about whether less than 140 is the right goal, or if less than 130 is better. It probably depends on underlying conditions, such as kidney or heart disease. But greater than 150 systolic (that's the top number) is too high. Getting that number down will reduce your risk of heart attack and stroke. Many people need more than one medication to get the blood pressure to the optimum level.
Having your blood pressure checked by a nurse or doctor generally is more accurate than the automated machines at the pharmacy. In your case, they seem to match. But it's time to revisit the doctor and see if your medication needs to be switched or increased.
DEAR DR. ROACH: I am a 69-year-old female who's 5 feet 10 inches tall and weighs 164 pounds. I walk 5.5 to 6 miles every day, and have been doing so for three years. I have not lost nor gained any weight during this time. I am in perfect health. What benefits is my body gaining from this exercise? -- A.A.
ANSWER: I am delighted to hear that you are in perfect health. Walking is a great way to keep yourself in perfect health.
Regular exercise like walking unquestionably reduces risk for heart disease, probably reduces cancer risk and helps to keep bones strong. It reduces risk of falling, which is a very important benefit for women over 65. It greatly reduces risk of diabetes. Most people find that it relieves stress. Walking improves blood vessel and lymphatic vessel health. Along with a healthy diet, regular walking helps people maintain their weight.
I'm a big believer in walking. It's easy and fun, and takes no special equipment besides a comfortable pair of shoes. Walking with friends and family brings a social aspect too. I recommend for almost everyone to try to find ways to fit more walking in your day.
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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 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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