DEAR DR. ROACH: I love my doctor. He is very caring. But why do doctors feel they must always give you a prescription if you visit? When I go to see my doctor, it is because something in my body isn't right and I want to know what it is. If he has a diagnosis and has medicine to "cure" me, fine. If he doesn't know, that's OK; I'll deal with the pain or discomfort on my own terms. In my opinion, people take way too many unnecessary drugs because our doctors feel the need to help, even when they can't. Why take a painkiller with 10 pages of warnings when a simple tried-and-true aspirin will do? -- S.W.
ANSWER: I ask myself that question, too, and I don't have a good answer. Many physicians want to validate their patients' concerns by prescribing a medication. It's certainly clear that we want to help, and want to feel that we are adding value. However, I agree with you that writing a prescription might be not only unnecessary, but harmful (antibiotics and pain medicines probably are the worst offenders, but any drug has the potential for harm, even aspirin).
There have been many times when I've seen a patient and don't know exactly what is causing the symptoms. I am comfortable enough to tell my patients that I don't know, but that it doesn't sound serious, and that they should come back if the symptom doesn't go away on its own. Sometimes clinical syndromes take time to develop, and a repeat exam and history are necessary. However, the physician must be looking for early presentation of potentially serious conditions and stand ready to order tests to evaluate persistent symptoms.
DEAR DR. ROACH: I want to thank you for your response to the question of essential oils. I had been using tea tree oil on my toenails (and getting it on my skin) for some time. I then started using an oil blend containing lavender on my skin (wrists/neck) and inhaling it, thinking it was "safe." After several weeks, I noticed some tenderness and aching in my breasts. I was confused by this, and lay in bed several nights wondering why just lying there on my left side, my right breast was actually painful. Very soon after this, I read your column and researched what you reported about lavender's estrogenic effect and the combination of tea tree oil and lavender causing gynecomastia in prepubertal boys. I stopped both, and my symptoms resolved.
My concern now becomes: How many women with an estrogen receptor-positive breast cancer (or at risk for one) unknowingly use these oils and may be harmed by them? Please share my experience with your readers so that more people may know the truth. -- Anon.
ANSWER: Many people have been asking me about this after my recent column. It is true that lavender oil has estrogenlike activity. It is readily absorbed through the skin, and the fact that it can cause breast development in boys proves its biological effect. Therefore, I would recommend against its use on the skin in women with a history of estrogen-sensitive tumors like ER-positive breast cancer. I suspect the risk is low; however, the risk isn't zero, and reducing risk is prudent. The use of lavender as aromatherapy still should be fine.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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