DEAR DR. ROACH: How does an adult handle getting rid of persistent infestation (over five months) of body lice? Are there doctors or professionals skilled in dealing with this problem? If so, how would you find them? Who would be qualified to actually identify parasites like various kind of lice? — R.I.
ANSWER: There are several different types of lice, each specific to humans. Body lice are Pediculus humanus corporus; head lice are Pediculus humanus capitus; and pubic lice are Pthirus pubis. They all are very small: The body louse is about the size of a sesame seed. Body lice live on clothing, not on a person’s skin, and they can be found by careful examination of the clothing with a magnifying glass. First-line treatment is thorough bathing and disinfection of all bedding and clothing (the lice can be killed by washing in hot water, by dry cleaning or by ironing, with careful attention paid to the seams, where the insects often are found). Sometimes, the body lice nits (eggs) can be found on body hair. In this case, I usually prescribe permethrin 5 percent cream applied to the entire body; it is left on for eight to 10 hours.
Most general doctors are familiar with body lice, which affect every socioeconomic status, but are especially found in children and in people with no access to bathing facilities.
In a persistent infection such as you are describing, I would be concerned that the person is being reinfected, probably from inadequate disinfection of clothing and bedding, and possibly by close contact with someone who has not been treated. Less likely, the diagnosis may be wrong: Scabies sometimes can be mistaken for body lice. A dermatologist is most likely to have expertise in making the diagnosis and prescribing treatment for recurrent cases.
DEAR DR. ROACH: I am a 6-foot-2, 80-year-old male, who weighs 194 pounds and is pretty active. I have been diagnosed with spondylolisthesis (L4-L5) and stenosis. My orthopedic doctor has in the past prescribed physical therapy and epidural injections. I respect him for trying the least-aggressive treatment before recommending surgery. The epidurals (four to date) helped early on, but lately have been of diminishing value. The pain from this keeps me awake at night. I have numbness in my feet, lose my balance and have pain in my lower back and down the outer side of my legs. My remedies are red wine (too much) and some generic Aleve. My question is whether I should trust my orthopedic doctor or go to a neurosurgeon. — J.J.
ANSWER: Spondylolisthesis is when one vertebra doesn’t line up exactly on top of the one below it, but instead is pushed forward or backward. This puts pressure on the spinal cord or nerve roots. Spinal stenosis is when bony changes in the vertebrae compress the spinal cord or nerve roots. The two often can occur in the same person, as in your case.
Both orthopedic surgeons and neurosurgeons may have expertise in spinal surgery, and I have seen good and bad results from both types of surgeons. In my experience, there is no clear difference in results from one type of surgeon. Instead, it is the individual’s experience with the particular surgery that is the most important factor. The fact that you have trust in your orthopedic surgeon is important.
Red wine, alas, is not an effective treatment and has too many other bad effects for me to recommend it. At 80 years old and with back problems, you need to be careful how much wine you consume, as you are at higher risk for falls.
