Q: A neurologist gave my teenage daughter samples of Lexapro for migraine headaches. It helped. We knew nothing about antidepressants or even that Lexapro is one.
I would give her a pill as she walked out the door to school every weekday. Weekends were less structured, and she very seldom took a pill. After a while, I started realizing that by Monday night of a three-day weekend, she was having suicidal thoughts. When I searched online, I realized she was having withdrawal symptoms.
Remember, she was not depressed when she started this med. Luckily, we had enough pills left that she could wean off them very slowly. It was one of the scariest times of my life. I’m sure these meds help a lot of people, but I think you should never take any meds blindly without research, no matter how much you trust your physician.
A: The Food and Drug Administration has approved Lexapro (escitalopram) only for depression and anxiety. The neurologist was prescribing it off-label. There is a boxed warning: “Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies.” You should have been warned!
Q: I read somewhere, possibly your column, that it’s advisable to have Lp(a) levels analyzed along with cholesterol at your annual wellness visit. This year, my routine blood work came back with acceptable numbers for cholesterol, HDL and LDL. However, my small LDL particles were way too high.
My doctor said that most annual blood work does not include Lp(a). I wonder why not, since this lab value seems really important for predicting the risk for stroke or heart attack.
A: We don’t understand why many physicians seem reluctant to order a blood test for lipoprotein a, abbreviated Lp(a). This compound combines two troublemakers: LDL cholesterol and apolipoprotein(a). It can lead to calcification of aortic valves and clogged arteries. When there is a family history of heart disease, Lp(a) is often the culprit.
You can learn much more about Lp(a) and many other risk factors for cardiovascular disease in our “eGuide to Cholesterol Control & Heart Health.” This online resource can be found under the Health eGuides tab at peoplespharmacy.com. In it, you will discover ways to order these blood tests for yourself and some ways to improve your lab results.
Q: I have suffered from canker sores for decades. One on the left side of my tongue was recurrent and so severe that it resulted in precancerous cells. I had to have a portion of my tongue that contained the cells removed. I don’t need to tell you how painful that procedure and the healing were.
At a dental appointment a few years ago, my old dentist noticed a canker sore and suggested I use Parodontax toothpaste. It did make a difference, but the biggest difference occurred when I started using Dr. Tichenor’s mouthwash, a very strong product that must be diluted. I finally conquered canker sores when I stopped using any toothpaste containing sodium lauryl sulfate. Both my toothpaste and mouthwash have peppermint oil listed as the first ingredient. Peppermint oil is antibacterial and virucidal. My mouth is finally pain-free.
A: Many readers agree that avoiding the surfactant and foaming agent SLS (sodium lauryl sulfate) in toothpaste helps them prevent canker sores. This was also the conclusion from a review of four randomized trials (Journal of Oral Pathology & Medicine, May 2019).
You are correct that peppermint oil has antimicrobial properties (Journal of Agricultural and Food Chemistry, August 2012). We don’t know if that makes a difference for canker sore prevention, as we have not seen research linking these sores to a pathogen.