Dear Dr. Roach: My husband has a problem. His foreskin gets so tight that it is painful to pull back. It has been to the point where it bleeds. His doctor gave him some cream but said the next step was surgery. He has high blood pressure, diabetes and high cholesterol. Is there anything else he can do?
It sounds as though your husband has phimosis. Phimosis is the inability for the foreskin to be retracted over the glans penis — a too-tight foreskin.
Uncircumcised men, particularly those with phimosis, are at risk for a condition called balanitis — inflammation of the foreskin. Balanitis can be inflammatory or infectious. Infectious balanitis is especially common among diabetics, and I have had several cases where the first time diabetes is suspected is when the man has come in for balanitis. It may be caused by bacteria, yeast or both. Treatment is with antifungal creams, and often with oral antibiotics as well. Repeated bouts of this infection can cause scarring of the foreskin, so that eventually it can become impossible to retract. Steroid creams often are effective, so surgery is not always required.
If it is, the surgical treatment is circumcision (or closely related surgery), which is not a simple procedure. It is done by a urologist, usually under general anesthesia.
Dear Dr. Roach: I have been plagued by actinic keratosis since age 45. I am now 75. My dermatologist tells me he can do nothing for me except freeze them off, and it has worked, but at a cost of $30 to $35 each. My insurance does not cover this. My problem is that I have hundreds on my back and stomach — some the size of a quarter. I’ve had many removed from my face. Is there anything I can do to keep these brown growths from occurring?
Actinic keratosis is a precancerous skin condition. They are, as you say, usually brown in appearance, and typically rough and scaly. They can look almost like warts, though usually flatter. Because they can turn into skin cancer, they should be removed. The major risk factor for getting these is sun exposure. Although you may have had extensive sun exposure in the past, limiting your sun exposure now can help prevent new lesions.
Most insurance, including Medicare, pays for removal, as it is a medical and not a cosmetic issue. Either you have the least-expensive dermatologist I know, or could the $35 be your copay?
Dr. Roach writes: Back in January, I published a letter about an 85-year-old woman with depression who complained that food smells and tastes rancid to her. A reader wrote in to ask whether this could be a brain tumour. I did some further research and found that indeed, brain tumours are a rare cause of abnormal odour sensation. However, it seems to be even more common that the abnormal smells and tastes start before, and may be a cause of, depression. The antidepressant venlafaxine has been helpful in anecdotal reports at improving the abnormal odour. Parkinson’s disease is another possibility of the underlying cause of the abnormal smell sensation.
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