Keith W Roach, MD

Dear Dr. Roach: My husband recently died from anaplastic thyroid cancer. I always thought thyroid cancer was one of the most successfully treated cancers that exist. Could you please explain the difference between anaplastic thyroid cancer and regular thyroid cancer? Thank you very much. M.A.S. Dear M.A.S.: I am very sorry to hear of your husband.... Nearly all organs can have multiple types of cancer. Cancers vary by the cell type they start from and by how closely (or poorly) they resemble their original cell. In the case of thyroid cancers, those that are well-differentiated have a very good prognosis. Because well-differentiated thyroid cancer cells still behave to some extent like normal thyroid cells, they will take up iodine, a critical element for making thyroid hormone. Radioactive iodine is an effective treatment, and often used after surgery. The radioactive iodine is taken up and concentrated by the cancer cells, which are subsequently killed by the radiation. Unfortunately, people can still die from conditions that have a very good prognosis, and ANY cancer diagnosis leads to fear and disruption of one’s life, not to mention the sense of betrayal that a person’s body is not behaving as it should. Anaplastic (literally, backward growth) thyroid cancers don’t look much like thyroid tissue at all. The cancer cells grow uncontrolled. They are highly resistant to chemotherapy and radiation, and they don’t take up iodine like healthy thyroid cells or well-differentiated thyroid cancers. They spread early to other organs, especially the lungs, but also to the bone, brain or other sites. As such, the mortality rate from anaplastic thyroid cancer approaches 100%, and half of people diagnosed will succumb within three to seven months. There are chemotherapy treatments that can slow down the growth, but we desperately need better treatments. Fortunately, anaplastic thyroid cancer is rare, only one or two cases per million people per year. https://www.detroitnews.com//dr-roach-one-type-/115710706/

Dear Dr. Roach: I have two frying pans with Teflon coating that show signs of wear. Someone said I should not use them, as they can cause cancer. Can you shed some light on this? H.C. Dear H.C.: I have also heard that, but some research shows this to be a myth. It is true that many nonstick pans were made with a chemical (PFOA) that is carcinogenic, and which could be released as a gas if the pans were heated too high. Since 2013, nonstick pans (including those made with Te...flon) have been made with different chemicals, which do not increase cancer risk (as far as we know). The pans are safe unless heated to a very high temperature (over 570 F, 300 C). The flaking of the nonstick material is a different concern, but these particles are not absorbed by the body, and pass through you without interacting. However, it does mean that the pans are due for replacement. If you don’t want to periodically replace your nonstick pans, use stainless steel, anodized aluminum, ceramic or old-fashioned cast iron.

Dear Dr. Roach: I have been suffering for some time with jock itch. The resulting scratching leaves my groin area and thighs abraded and oftentimes bleeding. In addition to the ketoconazole I’ve been prescribed, I have tried several over-the-counter sprays and ointments, to no avail. My doctor prescribed generic Claritin (loratadine) and I use a cortisone cream to reduce the itching, but these effect no cure. Is there any advice that you can offer to help me? T.B. Dear T.B.:... In general, when a treatment isn’t working, the first thing to re-evaluate is whether your diagnosis is correct. Jock itch is a fungal infection caused by tinea cruris, but it can be confused for other conditions -- for example, inverse psoriasis, seborrheic dermatitis, erythrasma or a different fungal infection, Candida, among other possibilities. I would consider doing a diagnostic laboratory test, such as a fungal preparation, or refer you to a dermatologist. Dr. Keith Roach However, if the diagnosis is correct, it sounds like the scratching may be a big part of the problem. Constant scratching can worsen itching and lead to bacterial infection. Stopping scratching is critical, but steroid cream (cortisone) can sometimes make treatment of the underlying fungus less effective. Topical antihistamines and a pair of cotton gloves at night can help. Resistance to ketoconazole is possible, so you could try a different type of antifungal cream. Occasionally, people need an oral medication like terbinafine or fluconazole to treat this. I would not consider oral medicines unless the diagnosis was certain and if no topical treatments were working. Oral antifungal medicines can rarely cause liver damage. https://www.detroitnews.com//dr-roach-jock-itch/115702114/

Dear Dr. Roach: I read your recent column on tinnitus. I am 91 years old and suffered from tinnitus for years, but as I write this I hear no noises. Ten years ago, my doctor prescribed sertraline. The pill worked for me, reducing noise by 70% at first. Sometimes the tinnitus returns for short periods, but it soon disappears. The literature provided with the pills said sertraline is for depression. I have never been depressed in my life, but I am happy to be rid of the tinnitu...s. T.G. Dear T.G.: I thank T.G. for writing, as I was unaware that sertraline had been useful against tinnitus. A well-done study showed sertraline to be effective in reducing tinnitus severity as well as loudness among people with severe, refractory tinnitus. As T.G. noted, sertraline is more commonly used for depression and anxiety, and the same study found that sertraline was effective at improving depression and anxiety, both of which are common in the general population and may be more so among those with tinnitus. I’m not going to rush to prescribe this drug for tinnitus. Like all drugs, it has the potential for side effects, such as diarrhea, but since I hear so often from people with severe tinnitus, it may be worth trying for those whose symptoms are more severe.

Dear Dr. Roach: I am a male, 83, and my bladder leaks continuously since I had a hip replacement surgery. The surgeon used a catheter during the surgery, and when it was first removed, I could not urinate. I went home with a new Foley catheter. Five days later, it was removed, and I have dripped ever since. It has been over two months since the surgery, and the leakage has not abated. I typically use absorbent underpants and pads that I must change four times a day. I also ur...inate 100-300 milliliters several times during the day and at night. This is my third joint replacement in the past four years, and nothing like this happened in the previous two surgeries, or in earlier surgeries I have had. What might have happened, and what are my options other than an inserted catheter worn constantly? I have not seen this problem addressed in your column, which I faithfully read. W.A.M. Dear W.A.M.: Inability to urinate after surgery is common, especially in men. However, I am concerned that the Foley catheter itself may have caused additional complications. Urine infection, bladder spasm and bladder contracture all are complications of having a catheter. Damage to a nerve during surgery is possible as well. You should have seen a urologist two months ago, when this started, and it is urgent that you get in to see one now. The urologist will evaluate for these possibilities. A long-term indwelling catheter is probably not your best option. https://www.detroitnews.com//keith-roach-bladde/115698832/

Dear Dr. Roach: I get severe nerve pain in my calf area due to diabetes. I saw an ad for Lyrica on TV and found that its generic medicine, called pregabalin, is available now. I requested my primary doctor prescribe it for me. But he declined, saying that it is in the category of opioids and cannot be prescribed by him. Please let me know if this is true, that his license has restrictions on prescribing such medicines. If so, should I change my doctor? J.M. Dear J.M.: Prega...balin (Lyrica) is not an opioid. It works on a different receptor, called the GABA receptor, similar to how drugs like diazepam (Valium) work. However, it is a controlled substance, although it is classified as having the lowest risk for abuse potential. Some physicians do not have the ability to prescribe controlled substances. They must apply to do so. Both pregabalin and the closely related gabapentin (Neurontin) are effective treatments for diabetic neuropathy. They are not right for everybody, and there are alternatives that are not controlled substances, such as amitriptyline. Rather than asking for a particular treatment, such as Lyrica, you might ask your primary doctor for what he thinks is the best treatment for your severe calf pain. He may wish to get additional information, choose a different treatment or refer you to an expert in treating nerve pain in people with diabetes.

Dear Dr. Roach: After I wear my cloth mask, I spray it with disinfectant inside and out, and hang it up to dry for 24 hours instead of washing it every time. Do you think that’s good enough? H.B. Dear H.B.: I am sure the spray will disinfect the mask, but I would recommend against this method. The residual chemicals left on your mask after spraying are not good for you to breathe in or to rub up against your face. Just washing your mask by hand with hot water and soap is fine.

Dear Dr. Roach: With all the masks, hand-washing, sanitizing and social distancing, will we all have weak immune systems when life goes back to normal? J.D.H. Dear J.D.H.: No. The immune system remembers pathogens for life, and constant exposure to germs is not necessary for the immune system to function correctly.... The hygiene hypothesis suggests that excess cleanliness is responsible for immune system dysregulation, leading to conditions such as asthma and autoimmune disease. While it may be true that exposure to friendly bacteria is beneficial in reducing the risk of asthma and other conditions, exposure to dangerous bacteria increases the risk of infection and probably does not have any benefit. Exposure to some viruses, such as rhinovirus, seems to increase the risk of asthma. I do wonder what normal is going to look like after the pandemic is under control. Judging from the experience in other countries with viral pandemics, I expect to see more people wearing masks to prevent sickness during flu season. I do not think that this will have adverse effects on the immune system, but it will be a societal change. https://www.detroitnews.com//dr-roach-will-retu/115695512/

Dear Dr. Roach: I am 75 years old and was planning to get the COVID vaccine when I can. I have been taking anastrozole for almost five years and have had a few people tell me that I should not get the vaccine because of this. Your thoughts? W.N.S. Dear W.N.S.: Beware of what some people tell you. The people who matter are your regular doctor and your oncologist.... Many people with autoimmune diseases or serious immune system problems, such as cancer and its treatment, are concerned about getting the COVID-19 vaccine. Some vaccines are made with live but weakened strains. These can be dangerous when used by people with very weakened immune systems. However, the vaccines available for use at the time of this writing are mRNA vaccines made by Pfizer and Moderna, and the Johnson & Johnson vaccine. These are not risky, as none are live vaccines. They may not work quite as well, especially immediately after some types of chemotherapy. While I can say from what you have told me that the vaccine should be OK, you need to check with your doctors for confirmation.

Dear Dr. Roach: Conflicting advice is circulating about whether taking NSAIDs after the vaccine will reduce immunity. For those who want the anti-inflammatory action of NSAIDs for muscle and joint pain, is it safe to take them? If not, how long after the second shot should one wait before taking them again? R.J. Dear R.J.: Many people are concerned that taking nonsteroidal anti-inflammatory drugs such as ibuprofen will reduce the effectiveness of the vaccine. Previous studi...es have shown that pretreatment with these medications can reduce the antibodies induced by the vaccine. It is not clear that this will make the vaccine significantly less effective. However, to be safe, don’t take Tylenol or an anti-inflammatory BEFORE vaccination. If symptoms develop after vaccination, it is OK to take these medicines to relieve your symptoms. It is safe to restart your anti-inflammatories hours after the vaccine.

Dear Dr. Roach: I have a problem with chronic urine infections. I am 78 years old, and suffer often from it. I frequently go to the bathroom five or six times during the night and feel pressure under my stomach. My doctor suggested a biopsy and found blood in my urine, which was later tested for cancer. I was told a week later that I do not have cancer. My doctor is aware that I cannot take antibiotics because I get side effects. He gave me Monurol. I had no aftereffects, but... still get recurrences of pressure, burning with urination and a burning sensation in my vaginal area. How can I treat this uncomfortable feeling? Must I be on antibiotics for the rest of my life? W.W. Dear W.W.: Your doctor may have done a comprehensive evaluation, but I don’t have enough information to say exactly why you continue to get these symptoms. Even so, there is some advice I can give. Recurring symptoms of urine infections can come from either a series of new infections or a single infection that is only partially treated and then comes back. The doctor can settle this by getting several cultures of the urine to see what bacteria are growing. If it’s the same strain each time, that is likely a persistent infection; different organisms indicate recurring new infections. If it is recurring new infections, the bacteria are having an easy time getting into the bladder. Some women have this issue with sexual activity, but in a 78-year-old woman, one very common reason is that lower estrogen levels lead to thinning of the lining of the vagina and vulva and that includes the lining of the urethra, where urine exits the body. If this lining is thin, bacteria can get into the bladder through the urethra. It is normally treated by vaginal estrogen cream, which is very effective. Persistent infections lead the doctor to suspect an abnormality in the kidney, bladder or ureters, which are the tubes that connect the kidneys with the bladder. A stone is a common source of persistent infection, and it would also explain the blood. I am puzzled by your doctor recommending a biopsy. Did he see something on exam or study that worried him? Fosfomycin (Monurol) is a unique antibiotic, not chemically related to others. It is a good choice for urine infections in people with multiple allergies or sensitivities. But chronic antibiotic use is a last resort. If your doctor hasn’t done a thorough job of investigating the possibilities, I would recommend consultation with an expert. A urogynecologist would be the ideal specialist. https://www.detroitnews.com//dr-roach-determine/115686328/

Dr. Roach writes: Recent data have shown that the number of breast cancer diagnoses in the past year is dramatically down. This is not good news, since it means there are more cases of undiagnosed breast cancer. Anecdotal reports from my breast cancer colleagues confirm that women are showing up with more advanced breast cancer than in the past. I am sure that part of this is due to people who need mammograms not being able to, or feeling uncomfortable about, going to get them during the pandemic. I am sure also that this phenomenon isn’t limited to breast cancer. All kinds of screening and preventive care needs to be done in a timely fashion, for both women and men. Please come back for your routine visits.

Dear Dr. Roach: Could you please provide your recommendations on how we should conduct ourselves after we get the COVID vaccine? Please include an explanation of how immune we actually will be. T.S. Dear T.S.: Three vaccines are approved under an emergency authorization at the time of this writing: Two mRNA vaccines, made by Moderna and Pfizer, and the Johnson & Johnson vaccine, which uses a different virus and DNA to teach our cells how to respond to COVID-19.... The available mRNA vaccines are both nearly 95% effective at preventing disease after two doses; the single-dose Johnson & Johnson vaccine was 66% effective in preventing moderate to severe COVID-19 but 100% effective at preventing COVID-19-related hospitalization and death. This is very good protection, but given how prevalent the infection is throughout North America, exposure to the virus is very likely unless you take proper precautions. This includes mask-wearing and hand-washing, but also avoiding high-risk exposures, such as eating indoors or being in a large group of unmasked people. Even those who had the vaccine can still get COVID: 66% and 95% are good, but not perfect. Also, that high protection takes time two to three weeks after the full series. A second issue is that we just aren’t sure whether the vaccine keeps people from being contagious. It may be that even people protected from COVID-19 illness may still be infectious for a time after they get exposed. Recent data suggest the vaccines are very effective at doing so but the data is not yet conclusive. For these two reasons protecting yourself from COVID-19 (imperfect vaccines) and protecting others (unknown protection against possible asymptomatic spread) experts recommend continuing to take precautions. As more and more people get the vaccine, the pandemic will subside. As the prevalence decreases, life will return to normal, and masks and social distancing can be stopped. How soon that will be depends on how fast the population can be vaccinated, and how careful people are about masks and social distancing until then. https://www.detroitnews.com//keith-roach-precau/115683162/