dear doctor. ROACH: I lost 14 lbs because I have C. diff. Now that I'm cured of C. difficile – thanks to a fecal transplant after all other treatments have failed – I wonder if my weight will come back or is it gone for good? I don't have 14 lbs to lose! — Hepatitis B
A: In my experience, weight loss that occurs during a major illness usually returns within a few weeks. I don't know how long you've been C. difficile free, but if it's not that long, I hope you've regained your weight. The body has a “set point” of weight it likes to maintain.
However, fecal transplantation may affect the set point. In laboratory animals and some preliminary studies in humans, a person's weight set point may be influenced in part by gut bacteria.
However, the potential to make someone lose weight by transplanting gut bacteria is limited because most data suggest that weight loss is not maintained. (A review of many studies showed that the weight loss disappeared after 18 weeks.)
A registered dietitian or nutritionist can help you regain your weight by giving you personalized advice on healthy eating.
dear doctor. Roach: I am a 76 year old woman. In your opinion, should I continue to have annual checkups with my gynecologist? — power amplifier
Answer: There is strong evidence that Pap smears are of little value to (most) women over 65, but I still think a woman should continue to see her gynecologist (or whatever gynecologist she has been seeing for routine gynecological care) people). Women worry about a lot as they age, and common conditions can benefit from a relationship with a female care professional.
dear doctor. ROACH: Is there anything I can do to reduce the pain and suffering of oral lichen planus? — Anon.
Answer: No one knows what causes lichen planus, a rare (less than 1% of people) skin disease that can also affect the mouth or vagina. It most often occurs between the ages of 30 and 60. It is more common in people with a history of hepatitis C.
Medical students are taught the four “Ps” of lichen planus: pruritus (itchy, often very itchy), purple, polygonal, and plaque (raised lesions). Plaques often have fine white lines, especially in the case you're asking, i.e. oral lichen planus. Oral lichen planus often causes pain, especially when eating.
The most effective treatment for oral lichen planus is a strong topical corticosteroid, such as clobetasol, usually applied to the affected area with a cotton swab. Your dermatologist can tell you some tips for keeping the medication in the affected area.
People who do not respond to topical steroids (which can take several months to achieve maximum effect) are often treated with stronger medications, such as tacrolimus. In my experience, lichen planus can usually go into remission with treatment – though maybe not 100%. For most people, lichen planus mysteriously disappears within a few years of onset.
Dr. Roach regrets that he is unable to respond to individual letters but will try to include them in columns whenever possible.Readers can email questions to ToYourGoodHealth@med.cornell.edu Or send an email to 628 Virginia Dr., Orlando, FL 32803.
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