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Dear Dr. Roach: There are a lot of flu cases in my state, and people are very worried. My mom, a retired nurse, says that I should wash my hands several times a day for at least 20 seconds each time, including under my nails, between my fingers, and the backs of my hands, because that will also prevent colds and other respiratory illnesses. She had to do this before entering an operating room, but this seems like overkill otherwise. Won't a flu shot take care of any problem?

— P.L.L.

Dear P.L.L.: Both hand-washing and the flu vaccine provide some, but incomplete, protection against the flu.

Hand-washing, done properly, can reduce the risk of developing flu by about half. That means washing your hands before and after contact with any person who might have flu; i.e., everyone. That's an awful lot of handwashing if you are interacting with a lot of people. Fortunately, hand sanitizers are effective and easier than the correct and effective handwashing technique your mother taught you. Still, handwashing is necessary periodically, as your hands start to feel sticky after using hand sanitizers too much. You should also wash after using the bathroom or eating.

The flu shot is also partially effective at reducing flu risk. At the time of this writing, there is not an interim analysis of the effectiveness of this year's flu shot: Last year it was about 47% effective.

The combination of careful hand hygiene and a flu shot might provide up to 75% protection against the flu. Unfortunately, there is nothing that is 100% effective if you get exposed, and nearly all of us potentially get exposed during flu season.

Dear Dr. Roach: A couple of years ago a sports medicine doctor diagnosed pain in my right knee as chondrocalcinosis. I had never heard of this previously. He told me there was no surgical solution. I do rub Voltaren 2.32% (brand name, which I get from Mexico) on my knee when it is flaring with pain, which does help. The pain is especially bad when I am on my knees doing work around the house. I am 77 years old and otherwise in pretty good health. Why is Voltaren only available as 1% in the U.S.?

— O.D.

Dear O.D.: Chondrocalcinosis, also called pseudogout, is caused by the deposition of calcium pyrophosphate crystals into the cartilage of joints, usually the knees. It can be diagnosed by X-ray. The surgeon is right that there is no surgical treatment, but there certainly is medical treatment. Oral Voltaren (diclofenac) is an effective treatment. The joint can also be treated with injection of steroids directly into it. Colchicine can be used in people who cannot tolerate anti-inflammatories, such as diclofenac. Diclofenac applied topically is not well absorbed into the joint or blood and is not going to be as effective (even though there is a prescription strength 2.5% available). Most experts recommend treating during flares, and it sounds like it's during flares when you really need relief.

Chondrocalcinosis is not as well-known as gout, but your internist should be able to treat this more effectively. If not, a rheumatologist would be the expert in medical treatment of this condition.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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