DEAR DR. ROACH: I read in a medical advice column that tea tree oil can help cure the nail fungus that I have had for more than 10 years on my big toe. It did dramatically reduce the inflammation around the nail, but the nail is unchanged, and the inflammation subsequently returns. Recently, though, I have seen or heard of several nail fungus treatments that do not present a danger of liver damage. Are there any new treatments for the nail fungus that actually are effective? — J.S.
ANSWER: According to the Natural Medicines Comprehensive Database, 100 percent tea tree oil cream, applied twice daily for six months, is effective at curing infection in only 18 percent of people who try it. Most people have some benefit that isn’t permanent, as you did.
The only highly effective medicines I can find good evidence about, with cure rates of 50 percent to 75 percent, all have the possibility, albeit small, of liver damage.
DEAR DR. ROACH: I am 72. Several years ago, because of bad back pain, I had tests and X-rays. The orthopedic physician assistant I was directed to afterward said I’d need hip replacements, or I could get a shot. No more comment than that. At my own insistence, I tried physical therapy instead of a shot. It merely aggravated the situation.
Twice since, I’ve seen the same PA. We have a little conversation, and he bills me for the same advice. He did not display the X-rays, and I didn’t think to ask. I’ve yet to see the licensed doctor in that office.
Walking is the one exercise that generally doesn’t bother me, so that’s how I keep a bit active. Judging by charts, I am about 30 pounds overweight. My leg and hip pains now do have me thinking about having at least one hip replaced. How do I initiate this? What sort of improved mobility can I expect? How long is recovery? Might my insurance cover a second opinion? What options are there? Which implants are best? — J.W.
ANSWER: You need a different orthopedic surgeon. He or she will go over all the questions you have — all of which are reasonable, but can be answered only by someone who has examined you, listened to your concerns and knows your particular orthopedic problem. Almost all insurances will let you seek a second opinion.
If you are feeling kind, let the orthopedic surgeon you didn’t see know the treat- ment you got from the PA. It has been my experience that physician assistants give out very good care, within the scope of their expertise, but this one is not giving good care to you, and I’m sure the surgeon would like to know.
The booklet on back problems gives an outline of the causes of and treatments for the more-common back maladies. Readers can order a copy by writing: Dr. Roach — No. 303W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
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. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2016 North America Synd.