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Drugs: Oldies Can Be Goodies

Just because a drug is new, doesn’t mean it’s more
effective.  A recent
published in the Annals of Internal Medicine demonstrated that older
diabetes medications may be equally effective as some of the newer, more
expensive drugs.

Now this comes as no surprise to physicians, who know very
well that some of our “old standby” meds work just as well as their newer, more
expensive versions.

For example:

For mild to moderate acne treatment, good old Clearasil may be all you need.
A study
published in the Lancet found that over-the-counter topical treatments (benzoyl
peroxide based) worked just as well as more expensive new oral antibiotics
(including minocycline).

For mild to moderately elevated cholesterol, there doesn’t appear to be much
to taking a newer statin than on older one.  The cost difference may be as much as ten
times more, for small gains (if any).
For example, mevacor (lovastatin) is as inexpensive as 0.24 cents/pill
while lipitor (atorvastatin) can run up to $2.54/pill.

Charlie Smith
, former president of the American Board of Family Practice,
recommends these very cost effective medications to his patients as needed:

Hydrochlorothiazide for hypertension (from 8 cents to 20 cents/pill)

Bactrim (trimethoprim/sulfamethoxisole) for urinary tract infections (15

Ibuprofen for pain relief/arthritis (about 7 cents/pill).

So consumer beware – those medications that you see in all the TV ads may not actually provide substantial benefits over older, less expensive drugs.  Be sure
to ask your doctor if a less expensive medication might be appropriate for you… or
better yet, healthy lifestyle changes can sometimes make the difference between needing
a medication and not needing it at all.

*Drug prices may vary.

This post originally appeared on Dr. Val’s blog at

Spider Bite – Gory Photos!

This is a really gory series of photos (via KevinMD) of what happened to a man’s hand after he was bitten by a spider.  The venom created a necrotic reaction that burst open his skin and caused a gaping wound to appear by day 10.

What can you do to avoid a similar fate?  Well, first of all, most spider bites aren’t poisonous.  It looks like the man in these photos was bitten by a brown recluse spider – a nasty arachnid found in the central to midwestern United States.  As their name suggests, these spiders are non aggressive and tend to remain secluded – and they don’t bite unless you disturb them or handle them in some way.

But if you are bitten, there’s no good treatment (no anti-venom).  Ice, steroids, and antibiotics can be used to reduce inflammation and protect against bacterial super infections.  But basically, the severity of your reaction to the venom depends upon your body’s personal sensitivity.  Some people don’t mount a serious response, and others, like the unhappy fellow above, have a violent tissue-ravaging reaction.  Scary stuff.This post originally appeared on Dr. Val’s blog at

The Truth About Cellulite

It’s funny how cultures become obsessed with certain physical attributes.  In the middle ages warts confirmed the identity of witches, a gap between the front teeth was considered pleasing, and a “heart shaped face” was the epitome of beauty.  This past century we’ve vacillated between pleasantly plump to “rail thin” as a standard of loveliness… and in recent years women have become preoccupied with a new menace: cellulite.

Of course, no one had even noticed cellulite until the French coined the term 150 years ago.  And unhappily that plague crossed the Atlantic in the 1960s, terrorizing pleasantly plump beauties from that day forward.

An entire industry has sprouted up to combat this dimpled foe – everything from massage to liposuction to caffeinated lotions claim that they will restore a smooth appearance to irregular thighs.  Unfortunately, those promises are all empty.

Yes, that’s right – there is no research to suggest that any cellulite treatment has anything but the most modest of effects.  The bottom line is that dimply skin is determined by your genes – same as your eye color – and that the majority of women have some degree of cellulite no matter how thin they are.  Sure, estrogen can play a role – but basically there’s no escaping estrogen as a woman!

So if you’re one of those people who is a little more dimply than average – here’s what you can do:

1.  Wear clothes that cover the dimples.  Spanx and biker shorts can be worn underneath trousers and longer skirts to give a smoother appearance.

2.  Adjust the lighting in your bedroom and bathroom – diffuse light doesn’t reflect shadows from skin imperfections as much.  It’s amazing how lighting can emphasize (or de-emphasize) cellulite.

3.  Stay fit and tone your body as much as possible.  That way if the rest of your body is lean and firm, the cellulite won’t be that big a deal.

4.  Recognize that you will always have cellulite.  It’s not your fault, you didn’t cause it and you can’t solve it.  Don’t waste your money on creams and treatments that don’t work.

5.  Remember that the vast majority of guys don’t even notice cellulite (it’s virtually invisible due to their fixation on other anatomical parts).

6.  Blame it on the French.  If you fixate on your cellulite you are letting them win!  Show those French your best laissez-faire attitude by completely ignoring this “disease” that they concocted.

I vote that we go back to the days before the invention of cellulite and live a carefree, confident existence.This post originally appeared on Dr. Val’s blog at

Ringworm – What to do?

Every once in a while a friend or family member is in a bind and asks me if I can prescribe them some medication.  When people have a case of painful otitis externa (external ear infection), some tinea corporis (ringworm), or just need an allergy medicine refill, for example, and can’t get an appointment to see their doctor for weeks, I generally feel badly and offer to prescribe them something to tide them over.  I know it’s not right to prescribe medications to folks who aren’t technically your patients, but it just seems worse to watch them suffer with a time-sensitive illness that has a simple cure.

Today I had to look up all the various and sundry treatments for ringworm.  According to my Pharmacopoeia (and pretty much any antifungal cream on the market is a possible treatment for it… so how is a doc to choose the best therapy?  Is it trial and error?  Is it pick the cheapest medicine on the list and cross your fingers?

There are times when many different medicines are appropriate treatment options, and the best choice requires a bit of guess work mixed with past experience.  Since I can’t find any literature suggesting that one topical treatment is more effective than another, I just chose a common, inexpensive cream.  Sometimes medical decision making has its gray areas…  Wouldn’t it be nice if everything had one clear answer?

Oh, and if you do have ringworm, keep in mind that 1) you can catch it from your dog – and yeah, Fido could catch it from you 2) you are contagious to others 3) it’s easy to treat with pretty much any anti-fungal cream or lotion (apply twice a day for 2 weeks or so) 4) if you can’t get to see your doctor, using over the counter Monistat may do the trick in a pinch.  If your skin is not responding to the cream – better get checked out to make sure it really is a fungal infection and not something else.This post originally appeared on Dr. Val’s blog at

Is that your real skin?

I’ve been thinking about skin cancer lately.  A young, fair skinned friend of mine
recently had a small mole removed from her leg.
It turned out to be melanoma!  It
didn’t take me too long to make the connection between her complexion and mine,
and the fact that I’d been avoiding the dermatologist for several years,
worried that I’d come out like a punch biopsy pin cushion since I have quite a
few freckles and moles (and I’ve heard that dermatologists like to err on the
side of caution and biopsy anything remotely suspicious).  But the melanoma story galvanized me into
action.  I made an appointment with a
dermatologist (yes, I had to wait 4 months to get an appointment!) and got a
skin check.  Luckily for me, all was fine.  But I started to reflect on various conversations
I’ve had about my skin recently.  All you
Irish types out there will relate…

Conversation 1

Coworker A: Val, are you ok?
You look kind of sick.

Me: I’m just fine.

Coworker A: But Val, you look a little… bluish…

Me: That’s just my skin color.  My veins show through my skin because it has
no melanin.

Coworker A: (Appearing sympathetic) Oh, well glad you’re

Conversation 2

Coworker B: (in the middle of a conversation with me, sitting
across from one another on chairs.  I’m wearing a skirt.  Suddenly she lunges forward
and touches my knee and gasps).  Is that
your real skin?

Me: Um… yes.  What
else would it be?

Coworker B: Well, I thought you were wearing white pantyhose.

Me: Nope.  It’s too
hot for pantyhose so I just go bare legged.

Coworker B: (still in shock).  But that’s your skin?  Just like that?

Me: Yeah.  I don’t

Coworker B: (appearing sympathetic) Oh, wow.

Conversation 3

Dermatologist: Hi, I’m Dr. XXX. (Peering at me, seated on the examining table
in a paper gown.)  Are you Scandinavian?

Me: No, I’m part Welsh – you know, “Jones.”

Dermatologist: Oh, well the Vikings probably invaded Wales
at some point.

Me: (to myself) well thanks for alluding to the raping and pillaging
of my ancestors.

Dermatoligst: You’re high risk for skin cancer.  People like you need to have careful skin
exams every year.

Me: Yes I know.  But
please don’t take any unnecessary biopsies!
I think my moles are all fine.

Dermatologist: Well let’s see…(tearing the paper gown in two).  You definitely need to wear SPF 50…

Me: Sigh.  I know…

Conversation 4:

Husband: (giving me what I thought was a tender look.  He leans in…) Your eye lids are kind of pinkish purple

Me: Yes, that’s the color of the capillaries that show
through my lid skin.  Hard to get a tan
there you know.

Husband: You don’t need a tan – I like your color.  Kind of pastel pink and blue. (He leans in even closer to inspect my eye lids.)

Me: Yeah, not exactly attractive in a bathing suit. (I pull away.  He laughs.)

Husband: Well, yeah.
It’s better not to be out in the sun or on the beach, but you can still
go outside!

Me: Thanks.

Conversation 5:

Asian manicurist: (looking at my hands) Your skin is so white!

Me: Yes, I’m afraid my past efforts to alter that have failed.

Asian manicurist: How did you get your skin so white?

Me: I didn’t do anything.
It’s like that naturally.

Asian manicurist: (looking closer at my hands) I wish I had skin like yours.

Me: Why? (Hoping she’d say something flattering after all).

Asian manicurist: It looks clean.

And so I guess despite all the people I’ve worried with my vaguely cyanotic appearance, there’s one thing for sure: I look clean.  I guess I can live with that.

This post originally appeared on Dr. Val’s blog at

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