Hello, dear readers! Welcome to a bonus letters column. We have several interesting questions to address, so we’ll get right to them.
-- We recently wrote about precautions for using opioid pain medications and how to safely discontinue them. We had letters from several readers on this topic like this one: “I was on serious painkillers for two months for a broken femur at the hip joint. At no time did my surgeon, primary doctor or druggist question whether I really needed to continue on them,” she wrote. “I was happy and without pain, but I realized I needed to get off the oxycodone. I didn’t want to become addicted. Unfortunately, I didn’t get advice and went cold turkey, which was difficult. I truly believe health care workers need to counsel and assist their patients on discontinuing opioids.”
Sadly, yours is not an isolated, or even rare, occurrence. Opioids can be effective pain medications. But due to the high risk of misuse, abuse and overdose, it is imperative that each prescription come with a thorough education. Patients need to know how to use them safely and the proper method for stopping. Thank you for sharing your own experience, which may be helpful to others in a similar situation.
-- A column about the artificial sweetener xylitol, which some studies suggest may affect cardiac health, prompted this question from a reader. “I have a huge problem with dry mouth, and my dental hygienist suggested XyliMelts, which have given me great relief,” she wrote. “They each contain a gram of xylitol, and I use two each night. I'm concerned that this may present a problem.” In the studies that found an association between xylitol and an increased risk of heart disease, the amount consumed was 30 grams or more per day. There has been no indication that the modest amount contained in saliva-stimulating products poses a health threat. That said, similar products that do not contain xylitol are readily available. And if your problem is severe, several prescription medications can be effective. Your doctor can offer guidance.
-- A column about foot fat pad atrophy -- when thinning of the protective cushions beneath the foot leads to discomfort and pain -- mentioned injectable fillers as a possible treatment. A reader requested more information. “My son has fat pad atrophy in both his feet, which has greatly affected his quality of life,” she wrote. “His podiatrist is not familiar with these methods and says there is not enough research to substantiate them. Do you have positive research we could share with the podiatrist? Is it possible to regrow the fat pads?” Unfortunately, no, foot fat pad atrophy is not reversible. However, there is persuasive research on the successful use of fillers. One study appeared in the July 2018 issue of the journal Dermatologic Surgery. Also, as this becomes a mainstream treatment, your son might have success with a different provider.
Thank you, as always, to everyone who took the time to write. We will be back soon with our regular monthly letters column.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)