Embarrassing itch requires super-sleuthing

Q. I have been experiencing an embarrassing anal itch for two months. My physician doesn’t seem interested beyond prescribing lotions that don’t do much after the first few minutes.

I tried sponging the area with Bragg’s apple-cider vinegar, which seems to help with the burning itch that kept me awake at night. I also am wondering whether a bidet might help.

A. Diagnosing anal itching (pruritus ani) can be challenging. There are many potential causes, including hemorrhoids, pinworms, yeast infections or contact dermatitis. Toilet paper or pre-moistened wipes may contribute.

One reader offered this story: “My anal itching worsened for months despite everything I tried to make it better. At its worst, it looked like I’d sat on flaming charcoal. It woke me during the night, so I was a walking zombie at my new job, and I almost dozed off while I was driving.

“I found an article in JAMA Dermatology (online, June 21, 2010) showing that many moist towelettes contain preservatives that can trigger allergic itching. I stopped using them 10 days ago, and my skin is healing fast. I’m furious that these products contain a known allergen! What I was using to help soothe the area was making everything worse.”

Cleaning with warm water from a bidet is popular in Europe and Japan. Toilets can be retrofitted with such affordable plumbing devices.

Q: My mom is on Detrol for a bladder problem, and I fear that it is causing mental confusion. She also is on two blood pressure drugs (losartan and amlodipine) that make her dizzy. Last week, she fell and injured her shoulder. Now she can’t lift her arm to brush her hair. What can we do?

A: As people grow older, the doses of blood pressure pills that once were just right may become excessive. Have your mother’s doctor review all of her medicines and eliminate any that are not essential. A fall caused by dizziness can be life-threatening.

Detrol (tolterodine) and other bladder drugs may contribute to forgetfulness and cognitive decline. Dozens of prescription medications also can cause brain fog and are inappropriate for senior citizens.

To help you prepare for the visit with her doctor, we are sending you our Guide to Drugs and Older People, with a list of drugs that seniors usually should avoid as well as a list of medicines that may cause confusion. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. O-85, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Q: Recently, you mentioned Vicks as a possible treatment for nail fungus. I’ve struggled with this condition on both feet for the past eight months. Neither tolnaftate nor undecylenic acid was helpful. I also tried OTC foot soaks.

Nothing worked until I read about Vicks. It cleared the fungus up quickly! Now I can see only a faint trace of it under one nail.

A: Vicks VapoRub contains several antifungal herbal oils, including thymol and eucalyptol. Persistence in applying it morning and evening is usually the key. One study actually showed a “positive clinical effect” (Journal of the American Board of Family Medicine, January-February 2011).