Dear Dr. Roach: My wife is in dire need of knee replacements (arthritis, and bone on bone), but she is allergic to nickel, which is found to some degree in all metals — including titanium — used in replacements. Is there any solution to this problem? R.B.
Dear R.B.: Nickel allergy varies in severity, and a lot of people have it. Not everyone diagnosed with a nickel allergy really has a nickel allergy.
This is true with many allergies: Many people report being allergic to penicillin, but some of those people had adverse reactions, not allergic ones. However, because penicillin allergies can be very serious, even life-threatening in rare occasions, we take them seriously.
Skin testing can be done (by an allergy specialist) prior to joint replacement to see whether the nickel allergy is significant. This is important, because putting a replacement in someone with a serious allergy can result in pain, swelling and failure of the joint. I had a patient with this issue, who needed to have a repeat surgery to take out the replacement and have a new one put in.
If she truly is allergic, there are nickel-free replacement joints available. Most joints are an alloy of several metals, but some of the titanium alloys contain no nickel at all. Her orthopedic surgeon has access to information about nickel content in the various implants available.
Dear Dr. Roach: My cholesterol had been in the 200-215 range for many years. (I am 84 years old now). I went home from the hospital with a prescription for Lipitor, along with other medications. A couple of months later, a blood test showed liver dysfunction, which was never a problem for me in 80-plus years. In reading info about statins, I discovered that this could be related to the Lipitor. Per other articles, I started including a handful of walnuts (about a quarter-cup) in my morning serving of oatmeal, and stopped the Lipitor without consulting my doctor. Six months later, my cholesterol was 190.
Now a year and a half later, my count is 170. It has not been this low for as long as I have medical records. I know you are in agreement with using as few medications as can be replaced by natural ingredients. I believe walnuts should have even more publicity than they now receive. W.K.
Dear W.K.: Walnuts contain monounsaturated fats and plant sterols, which can help lower cholesterol. Perhaps more importantly, there is moderately strong information that they also reduce the risk of heart disease. I do agree that diet is the best first-line therapy for cholesterol, and that with a better diet (and often some increased exercise), many people who would otherwise be recommended for medication will no longer need it.
The only part of your story I don’t like is that you didn’t consult your doctor; naturally, I think your doctor should be part of your treatment plan for your health. That being said, your doctor will, I am sure, be happy with your results, which are remarkable and better than I usually see.
Dear Dr. Roach: Is there a cure for herpes? Are they working on one? I met someone who has it and didn’t tell me beforehand. Now I have it. I feel I’m doomed. L.
Dear L.: You are not doomed. Research continues to work on better treatments and on prevention, but there are effective treatments now. Genital herpes is very common. Some people take medicine when an outbreak appears (or when they get the symptoms that an outbreak is about to), while others take medication all the time to prevent an outbreak. Men and women should talk to their regular provider; women also can consult their gynecologist. Disclosing your herpes status to any potential new sexual partner is difficult, but I think it is necessary.
The booklet on herpes and genital warts explains these two common infections in detail. Readers can obtain a copy by writing:
Dr. Roach, Book No. 1202, 628 Virginia Drive, Orlando, FL 32803
Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.
Email questions to ToYourGoodHealth@med.cornell.edu.