Doc: Check with pharmacist before trying new supplement

November 13, 2017 GMT

Dear Dr. Roach: I am 95 years old, and have been suffering from a very painful case of shingles. I take many medicines for pain, and for high blood pressure and glaucoma. My health-food store advertises a natural cure for shingles, and I wonder if it would interact with the medications I take.


Dear J.H.: As far as I know, there is no cure for shingles, natural or otherwise. There are treatments to help alleviate the pain, but pain following a shingles infection can last for months, years or, in some cases, a lifetime. Standard medical treatments for the pain following shingles include drugs that work on pain fibers — antidepressant medicines like amitriptyline, and anti-epilepsy medicines like gabapentin (Neurontin).

A natural extract of hot peppers, capsaicin, can be applied to the painful area, and this is successful in some people. I have read about numerous other putative treatments, such as olive leaf extract, but couldn’t find any reliable information on their effectiveness.

Your best resource for checking interactions between your medicines and any supplements is your pharmacist, but he or she will need the exact name of the treatment you are considering.

Dear Dr. Roach: In a recent column, you wrote about low body temperature. I am 66, and my temperature has always been 95 to 96. That being so, what would a high temperature reading be for me? Should I be concerned with a temp of 98 or 99?


Dear M.K.: There isn’t a precise answer to your question. It is true that in people whose body temperature is slightly lower than normal, a fever may not be as high as what we typically think of. It’s also true that older people (and there’s a big difference between someone who is 66 and someone who is 80 years old) may have lower body temperatures than younger people, even with serious infections. Finally, temperature is variable throughout the day: The lowest is early in the morning, and highest around 6 p.m. So, a single number doesn’t provide all the information we want. If an older person, whose normal temperature is a bit lower than the average, has a temperature over 99 in the morning, that would be enough to get my attention, and to at least consider whether there might be something really wrong. Pneumonias and urine infections in particular can be very subtle in older people.

Dear Dr. Roach: I have read the questions and answers in your column regarding the application of testosterone gel. Is it acceptable to apply it to the upper legs, above the knees, on the inside of the thighs?


Dear D.P.: There are four different testosterone gel preparations, and they all have specific instructions, which need to be followed for consistent results. For example, AndroGel is absorbed 30 percent better when applied to the arms and shoulders than to the abdomen. Fortesta is recommended to be applied to the front and inner thighs, and Axiron is supposed to be applied to the underarms. I recommend following the manufacturer’s directions, as absorption can be variable.

Email questions to ToYourGoodHealth@med.cornell.edu.