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Thursday, February 10, 2011 – Daily News – 5A FEATURES Hope for victims of granuloma annulare DEAR DR. GOTT: I would like to know of any effective treatment for granuloma annulare. DEAR READ- ER: This is a chronic skin con- dition that presents with raised red or flesh-colored lumps that gener- ally appear on the hands, feet, knees and elbows. The lesions often disap- pear within two years without treatment; howev- er, they may reappear at a later time, and the cycle will repeat itself. The skin may itch, but this is uncommon. When the con- dition becomes wide- spread, ringlike patterns may appear over the body and itching becomes more common. Your primary-care physician or a dermatolo- gist can often diagnose the condition through visual examination. When ques- tions remain, a skin biopsy for examination under a microscope might be done, or a KOH test might be considered. This simply involves scraping the skin onto a glass slide for the purpose of collecting dead cells that will ultimately be mixed with potassium hydroxide (KOH) to iden- tify or rule out fungal infection. Dr. Peter Gott will help? Is there some other factor that could be caus- ing me to feel this way? Any sugges- tions you can give me would be great- ly appreciated. DEAR READ- ER: Vitamin B12 deficiency would cause a number of significant signs, including fatigue, before it would cause true narcolep- sy, a chronic sleep disor- der. People suffer daytime drowsiness and drop off to sleep at inappropriate times without warning. They may awaken feeling refreshed, fall asleep again, and repeat the pat- tern. Sleep paralysis may occur, accompanied with vivid dreams and an inabil- ity to speak or move during falling asleep or waking. Diagnosis might be accomplished through polysomnography at a sleep center, a sleep laten- cy test that determines how long it takes a person to fall asleep, detailed sleep records and a sleep history presented to your doctor. Vitamin B12 deficiency Should you choose to treat your granuloma annu- lare, this might be accom- plished through corticos- teroid creams, ointments or injections, cryotherapy (freezing) or light therapy. For generalized granuloma annulare, some physicians prescribe topical cal- cineurin inhibitors. System treatments include hydrox- ychloroquine, isotretinoin or dapsone. Speak with your physician to deter- mine which treatment might be best. Good luck. DEAR DR. GOTT: For years, I thought I was suf- fering from narcolepsy. I can barely stay awake at work, and when I’m home, I do nothing but sleep. This has gotten progressively worse over the past three or four years. I just recent- ly found out that my B12 level is at 149, and my pri- mary-care physician thinks that is the cause of the hypersomnia. I’m getting B12 shots every other week for two months and then will get shots once a month. After three shots, I feel no better. I’m missing out on life because I’m just too tired to do anything. Walgreens carries a sublingual B12 supple- ment, which I am tempted to take. Do you think it is relatively rare because the body stores several years worth at a time and a healthful diet to include seafood, milk, cheese and eggs is readily available; however, those with perni- cious or megaloblastic anemia, Crohn’s, celiac or Grave’s disease, lupus and excessive alcohol con- sumption, as well as vege- tarians, vegans and the elderly, may be at increased risk. Oral B12 tablets are reported to contain more of the vitamin than is avail- able through injection; however, they are not absorbed as well as the injectable form. I recom- mend you speak with your primary-care physician to be assured this method is appropriate for you. You should also undergo rou- tine lab testing and perhaps X-rays to rule out other conditions to explain your fatigue. Only then can you get to the bottom of the issue. To provide related information, I am sending you a copy of my Health Report “Vitamins and Minerals.” Other readers who would like a copy should send a self- addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092- 0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com. Slothful spouse solicits separation Dear Annie: I am 26 and have been living with my ‘‘husband’’ for a year. We had a religious ceremo- ny, but didn’t file the legal paperwork. Now I realize it was a huge mistake. I des- perately want out of this so- called marriage. ‘‘Justin’’ lied about com- pleting his college educa- tion and was unemployed for the first six months we were together. He told me he was applying for jobs, but in reality, he spent his days playing video games and eating junk food. Justin finally found part- time minimum-wage employment, but I still do the cleaning, bill-pay- ing and cooking despite working 50 hours a week compared to his 20. I have asked, begged and nagged him to help more, but he refuses to lift a finger. When I insist, he whines and takes an hour to do a 20-minute task. Annie’s Mailbox by Kathy Mitchell and Marcy Sugar Justin suffers from depression. Whenever I bring up the idea of an amicable separation, he either becomes enraged and throws the furniture, or dissolves into a sob- bing mess and threatens suicide. I, too, have fought and won my own battle with depression through ther- apy, medication and a wonderful support network. I feel the need to provide a stable environment for Justin, but he refuses to seek treat- ment. If I leave him, I am terrified he will harm himself. Justin’s parents are less than sympathetic, and he cannot support himself. I have moved into the second bedroom, and we haven’t had sex for months. Justin insists we are married and everything is fine. Our friends and family have no clue that it’s not legal and our relationship is in shambles. We live in a small religious community. A messy breakup could cost me my career. Please help. — Cornered in Kansas Dear Kansas: As much as you want to help Justin, you are not responsible for his mental health or his unwillingness to seek treatment. At some point, his dependence is self- destructive to both of you. You could tell him you will consider staying if he gets therapy immedi- ately. But also talk to your local clergyperson about your ‘‘mar- riage.’’ Kansas recognizes com- mon-law marriages, and you could, in fact, be legally bound to Justin. If walking out is not possible, you may need to file the legal paper- work and then get an actual divorce or have the marriage annulled. Dear Annie: I am a divorced mother of two college-age girls. Over the years, their father hasn’t bothered to have much contact with them. The problem is, in the past two years, we have received a picture at Christmas of his four little girls by his second wife. This really hurts my daughters’ feelings and just makes me mad. It’s like he is throw- ing his new family in our faces. It even says ‘‘Merry Christmas from the family.’’ Do you think this is right? — Disgusted in Penn. Dear Disgusted: It is extremely insensitive, but we don’t believe Dad is trying to be deliberately hurtful. And his wife is likely the one who is doing a mass mailing without considering the recipients. Let your ex know that you appreci- ate his effort to stay in touch with his children, but ask that he please not send the photograph because it makes them terribly unhappy. We hope he cares enough to do some- thing about it. Dear Annie: Having suffered with body odor and been miserable for well over a decade, your column was a godsend. I followed your readers’ suggestions. I bought zinc supplements and immediately start- ed taking them. It didn’t seem to help, and then I saw a later column and tried apple cider vinegar. There were days the vinegar stung so severely that I gave up that plan in less than a week. However, by that time, the zinc had taken effect. I am now a very happy camper. Sincere thanks to you and your readers for solving an embarrassing problem when my dermatologist could not. — Smelling Better Dear Better: Thanks for letting us know. We love the way our read- ers look out for one another. 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.net, or write to: Annie’s Mailbox, c/o Creators Syndicate, 5777 W. Century Blvd., Ste. 700, Los Angeles, CA 90045. Enrollment open for certificate programs In partnership with The Localization Institute, Cali- fornia State University, Chico’s Center for Region- al and Continuing Educa- tion announces that enroll- ment is now open for the Localization Certification Program and Localization Project Management Certi- fication. Localization is an emerging field which encompasses the process of preparing products and services, and their support- ing messages, for the glob- al market. The internation- al market for outsourced language services is esti- mated to have reached more than $26 billion in 2010. 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