Ask Dr. John


Dianna writes: "I came down with psoriasis in February. I have had mild erythrodermic with two visits to the ER. I am on steroid cream twice daily. I am scared of some of the medications for psoriasis. Is there a safer medication to try?"

Psoriasis is a common skin condition that causes red thick patchy skin that can be very irritating. In most cases these patchy skin areas flare up, go away and then flare up again. Although the exact cause of psoriasis isn't known, it's thought that an overactive immune system plays a big role. There isn't a cure for psoriasis, but there are ways to keep it controlled. Treatment consists of topical ointments, light treatment or systemic medications. Topical treatments include steroid creams, topical retinoids and possibly even tar preparations. Steroid creams in particular can cause skin thinning and discoloration over time and should not be used indefinitely. Light treatment means UV therapy which has proven to be very effective in managing this skin condition. If these treatments don't seem to be doing the trick, systemic medication could help. These are oral or injected medications that are used to attack psoriasis from within. Although they are very strong and effective medications, they also sometimes have severe side effects, so are used sparingly when needed. The bottom line is that when it comes to psoriasis there are many different types of treatments and most often a combination of the three types provides the most effective and long-term relief.

Dan writes: "I have a question about femur breaks in people taking Fosamax. Everything talks about women having the possibility of breaking their femur. What about men who take the drug?"

Fosamax is one of the so-called bisphosphonate medications used to help fight osteoporosis. Like all medications, a person and their doctor need to weigh the benefits of the drug against the risk of taking that particular medication. In the case of Fosamax, looking at the benefits one can get from the medication, helping with osteoporosis, needs to be weighed against the risk of its side effects, including abdominal pain, musculoskeletal pain, necrosis of the jaw and esophageal problems. Not every patient has every side effect. But on October 13, 2010, the FDA issued a drug safety communication about Fosamax and other bisphosphonate drugs. This communication does warn about femur fractures on these types of drugs, but also states that it happens in less than 1% of cases. According to the FDA: "The bisphosphonates affected by this notice are only those approved to treat osteoporosis, including Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia and Reclast (and their generic products)." So, to more directly answer your question, Fosamax does increase the risk of a femur fracture in both men and women, although according to the FDA it's a risk that less than 1% of people on this medication will suffer.

Judy writes: "I am taking Neurontin 300mg twice a day, along with Mirapex for Restless Leg Syndrome. Can the Neurontin cause depression and fatigue? Also, what are the side effects if I stop taking the medication?"

Neurontin was originally used as an anti-seizure medication, but lately it's been used for Restless Leg Syndrome and certain nerve pain syndromes. Like all medications, it has certain side effects. In the case of Neurontin, the side effects include both fatigue and depression. The complicating things is that Mirapex, a Parkinson's medication, also has side effects including sleepiness and malaise. It can be tough to differentiate which side effects are caused by which medication. Your doctor can help you sort this out and can also help you determine if you need to change medication. One word of caution is to not change or stop medications without informing your doctor.

Martin from Colorado Springs: "Avodart literature states, "May affect PSA test results." Can you explain how Avodart affects PSA testing?"

Avodart is the brand name for the medication Dutasteride. This medication is used to treat an enlarged prostate. Because it acts directly on the prostate, it can interfere with the PSA test, causing it to be higher than before someone was taking the medication. Oftentimes, your doctor will recommend getting a new baseline PSA 3-to-6 months after starting Avodart, so you both can keep track of whether this blood test continues to go up or not while you are on the medication.

Sandy from Colorado Springs: "I have an 11-year-old granddaughter who I'm concerned about being over-medicated. She is currently taking three medications for depression. Geodon 60mg, 2 in the morning and 2 at night; Bupropion XL 300mg, 1 daily; and Citalopram 20mg, she takes 2. After her morning meds, she is excessively tired and sleeps most of the day. Should I be concerned?"

This seems like a large amount of medication for an average 11-year-old, but it is possible your granddaughter has issues that warrant this combination of medications. The issue is that some of these medications interact with others. For instance, Geodon and Bupropion. This combination can increase your granddaughter's risk of seizures, so the recommendation from drug manufacturers is to consider lowering doses of Bupropion. Citalopram and Geodon can also combine to increase the risk of what is known as Serotonin syndrome. Taking this information to your granddaughter's doctor can help make sure you understand why she is taking these three medications and if anything can be reduced or eliminated.

Fran from Coal Creek: "My thyroid was destroyed via radioactive iodine. I was taking thyroid hormones, for about 25 years, but have stopped. What are the repercussions of this? Are the hormones necessary?"

The thyroid produces hormones that influence almost all of the metabolic process occurring in your body. In your case, since your thyroid was eliminated for medical reasons, your body doesn't have the ability to produce these hormones. Without them, you can feel fatigued and sluggish, notice dry skin and weight gain. But, it can also become more serious involving muscle weakness and depression. In some severe cases, you can develop a condition known as myxedema, which can be life threatening. Without an active thyroid, you will need medication to replace the hormones not being produced. Depending on how your body responds, you might need more or less than someone else in your same condition and these medications will be adjusted to best suit your needs.

Mary from Colorado Springs: "I've been feeling depressed and was wondering if Sam-e might be a help to me."

Sam-e, which also goes by the chemical name S-Adenosyl methionine, has been around since the 1950s. It's been used for everything from psychiatric illnesses to infertility, but it hasn't always been effective. Unfortunately, when it comes to depression, studies looking at Sam-e haven't shown much success. Depending on how your depression is and how much it affects your lifestyle, there are many other medications that have been shown to help. Going over your symptoms and the various choices with your doctor is your best bet.

Maria from Colorado Springs: "I bought liquid Hoodia/pomegranate. Do you know anything about this product?"

Hoodia comes from Hoodia gordonii, a flowing plant from South Africa, where indigenous tribesmen used it for centuries to suppress their appetites while crossing desert areas. It is now being touted as a weight loss/suppressant here in the U.S. Although it shows some promise as a whole plant, the extracts being sold haven't shown much success in clinical trials. Pomegranate is the fruit with multiple juicy seeds. Its juice does contain many antioxidants, much higher than other fruit juices. As a whole, I'm not sure this liquid will do much for you, especially in the weight loss category. However, you can't beat the pomegranate part for antioxidants, unless you simply go out and get the pomegranate by itself.

Yvonne from Colorado Springs: "I take 50,000 IU of vitamin D3 every day. It seems to keep me healthy. Can I give that same amount to my athletic, 17-year-old daughter?"

Vitamin D is a very important part of your daily diet and new research is showing that it's even more important than we've thought in the past. However, the recommended daily dose of vitamin D3 is much, much lower than what you are currently taking. Excessive amounts of this vitamin can cause weakness, fatigue, headaches and can lead to high levels of calcium in the body. For both you and your daughter, a physician can do a simple blood test to determine what your current levels of vitamin D3 are. Then you and your doctor can sit down and figure out how much extra, if any, vitamin D you need every day.

Cindi from Divide: "Do blood thinning medications cause brain tumors to grow more rapidly? A person with an inoperable brain tumor has developed blood clots in one leg. We were informed blood thinning medications would cause the tumor to grow faster. Would aspirin help and be alright to take?"

Blood thinners, like Coumadin or Plavix, aren't known for making tumors grow more rapidly. What they are known for are making tumors, which normally have more blood vessels than other parts of the body, bleed more readily. This bleeding can make the tumor swell and can lead to severe complications. Like all medications, you are trading off a risk for a benefit. If the blood thinner is being used to keep someone from having another heart attack or stroke, then the benefit of taking it might be greater than the risk of bleeding at the tumor site. Only you and your doctor can decide if these medications are right for you.

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