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Monday, July 5, 2010 – Daily News – 5A FEATURES Chronic yeast infection needs better care Feuding females fracture family DEAR DR. GOTT: I am a 70-year-old active woman who has had a yeast infec- tion for almost five years. I have gone to several doctors and have been given prescrip- tions for all of the usual medicines for yeast infec- tions, the latest being Premarin vaginal cream plus rate gynecologists. Do you have any advice or help to offer me? Dr. Peter Gott clobetasol propionate cream. All of these pre- scriptions have worked, but the infection always comes back within two months. The last time the infection was almost to the staph stage. After my last infection, a biopsy was done. The report said: “Vulvar Biop- sy: Ulceration with very severe active chronic inflammation and numer- ous plasma cells. A serolo- gy for spirochetes was negative.” The microscop- ic description said: “The skin surface is covered by squamous epithelium which is moderately to extensively eroded. There are superficially dilated capillaries and there is a dense infiltration of lym- phocytes and plasma cells in the upper dermis. Warthin-Starry stain is negative with appropriate- ly reacting controls. Immunostain for AE1/AE3 is negative for epithelial component. Pos- itive and negative controls worked as expected.” My concern is that the Premarin cream is now making my ankles swell, and my blood pressure has gone up. (It is usually nor- mal.) Also, when I call my OB/Gyn, I am no longer asked to come; they sim- ply call in a prescription. I am never told to return for a follow-up and feel that this is because I am on Medicare. So far, this has happened with three sepa- DEAR READ- ER: Let’s start with the biopsy report. First, ulcer- ation is easy to understand. This simply means that you have a sore. Whether it was caused by scratch- ing or something else is unclear. Inflamma- tion means swelling. Again, this could be caused by scratching or the infection itself. The identification of numerous plasma cells is more telling. These cells are a type of short-lived antibody-producing leuko- cyte (a type of white blood cell) that binds with a for- eign substance (or what the body perceives to be a foreign substance) and then begins to neutralize or destroy it. Lymphocytes are another type of leuko- cyte and determine the specificity of the immune reaction to foreign sub- stances and infectious agents. All of this indicates that your body is fighting off an infection of some sort, is incorrectly attacking normal cells, or is overre- acting to a substance you have come into contact with, such as perfumed feminine-hygiene prod- ucts. Now, on to what is causing your so-called yeast infection. First, you do not say what symptoms you are experiencing, so I will first review them. These can range from mild to severe and include red- ness and swelling of the vulva; itching, irritation, pain and/or soreness of the vulva and vagina; a thick, white, odor-free vaginal discharge similar in appearance to cottage cheese; and a burning sen- sation. Yeasts are typically pre- sent within a normal vagi- na and in most instances do not present problems. For several reasons, yeasts can multiply and cause symptoms of an infection. In most cases, Candida albicans is the culprit. Thankfully, this type of yeast can be treated easily. People who have never had a yeast infection before, have more than four a year, or fail to improve with treatment may require extensive test- ing, including cultures of any discharge or vaginal secretions. Long-term or multidose oral medications and maintenance regimens may be appropriate. If you truly have a yeast infection, it is either not being treated properly and eradicated completely or it is the result of an underly- ing condition, such as long-term antibiotic use, uncontrolled diabetes or something else. Return to your gynecologist and demand answers or get a fourth opinion. Dr. Peter H. Gott is a retired physician and the author of several books, including “Live Longer, Live Better,” “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cookbook,” which are available at most bookstores or online. His website is www.AskDrGottMD.com. Dear Annie: I have three daughters, all in their 40s and married with children. The prob- lem is, the two oldest are not speaking to each other. They had a feud nine years ago when ‘‘Stefani’’ got married, and she and her older sis- ter, ‘‘Jessica,’’ had some disagreement at the wed- ding. Quite honestly, I am not sure what hap- pened. Although the rift was repaired, things remained cool. When babies were born, everything at least seemed civil. Then, two years ago, Stefani and Jessica had a contentious phone call and the rela- tionship deteriorated. None of us lives in the same area, but we com- municate via phone calls, e-mails and visits. I work at a hospice and try to make my girls under- stand that life is short and they shouldn’t hold grudges against loved ones. My father refused to communicate with his siblings, and it took 50 years and a trip to the doctor for the reality of those lost years to hit him. Jessica did e-mail Ste- fani to apologize for her behavior that day on the phone, but Stefani will not respond or discuss it. I am trying to mediate. I was going to write each of them the same letter to explain how this erodes Pick a Rib with Us Daily Specials Jack the Ribber All you can eat ribs $ Friday Night Rib Dinners 1400 1150 Monroe St. 527-6108 family relationships and that they need to teach their children how to resolve conflict. My youngest daughter has a good relationship with both sisters and does not want to take sides. Should I write the letters? Or do I leave it be and hope they see this in the newspaper, recognize them- selves and realize they need to fix things? — Concerned Mom Annie’s Mailbox by Kathy Mitchell and Marcy Sugar Dear Mom: Some sib- lings simply rub each other the wrong way, and their arguments are never-ending. In a healthy relationship, sib- lings tolerate each other’s personalities. In less for- giving circumstances, there are rifts and estrangements. Please continue to encourage them to stay in touch so their children will know their cousins and so that they will have the oppor- tunity to mend fences. If you think you can do that in a letter, go ahead. But don’t expect too much. We hope there will be time enough to fix this. Dear Annie: My wife is a 50-year-old mother of three grown children, and she is a self-mutila- tor. Right now, she’s in the hospital for the third time. BOOK BARN Used Books Tues-Fri 10-5 Sat 10-2 Serving Tehama County since 1994 619 Oak St., Red Bluff (530) 528-2665 Our family does not understand this disease, and we need help finding a support group so we can figure out why she does this and how we can help her. Please answer soon, as her life, not to mention our marriage, may depend on it. — San Pedro, Calif. Dear San Pedro: Self-muti- lation is the way your wife deals with emotional pain. She does not know how to express difficult emotions and cuts because it is a way to find relief, albeit tem- porarily. She needs to talk about the triggers that lead to cutting and find alternative methods of dealing with stress and pain. Talk to your wife’s doctor, and ask for a referral to a therapist who deals with self-muti- lation. We also recom- mend a 12-step support group at selfmutilator- sanonymous.org. Annie’s Mailbox is written by Kathy Mitchell and Marcy Sugar, longtime editors of the Ann Landers column. Please e-mail your questions to anniesmailboxcomcast.n et, or write to: Annie’s Mailbox, P.O. Box 118190, Chicago, IL 60611. COMPLETE AUTO REPAIR All makes and models. We perform dealer recommened 30K, 60K, 90K SERVICES AT LOWER PRICES Smog Check starting at $ (most cars and pick-ups) 2995 + cert. Pass or FREE retest 527-9841 • 195 S. Main St. PAID ADVERTISEMENT I For information on participation in Kids & Families call (530) 527-2151 P.A.W.S. (Partners for Animal Welfare & Safety) A Volunteer Program Dedicated to the Prevention of Litters, Not the Destruction of Unwanted animals. HOW CAN YOU HELP? CALL US! 528-8018 Please leave your number we WILL call you back P.O. Box 8908, Red Bluff CA 96080 For information on participation in Kids & Families call (530) 527-2151 P.A.W.S. (Partners for Animal Welfare & Safety) P.A.W.S. SAYS...”Things they are A’ Changing”... • We are in the middle of making some significant changes with the PAWS programs. 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