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Even the best treatments have limitations

DEAR DR. ROACH: Your recent response to a woman who, later in life, experienced “people talking to me” was that she was having auditory hallucinations and that she should go to a doctor right away, “as there is very effective treatment to stop the voices and get your life back.”

If there really is such treatment, what is it? My son, diagnosed with schizophrenia at 18, has had voices screaming at him for 25 years now. He has had excellent medical attention, taken every drug known and never has had any relief. Promising effective treatment (for anyone and everyone) seems like a stretch. But if there really is a magic cure, would you mind sharing this info with me (his mother)? — Anon.

ANSWER: I am very sorry to hear about the difficult time your son has had. I also am very sorry for implying that schizophrenia always can be successfully treated. Unfortunately, “very effective” treatment is not the same as perfectly effective treatment; there are people whose schizophrenia cannot be successfully controlled. There is no “magic cure.” There are treatments that help the majority of people with schizophrenia, but I can’t suggest anything that hasn’t probably been tried in 25 years of doctors who know more about him, and more about schizophrenia, than I do.

There are conditions that current medical science is able to successfully treat or even cure in the majority of people — even in the vast majority. Unfortunately, I have seen people die from cancers that should have been curable, and from infections that people aren’t “supposed” to die from. It is a humbling experience.

If I have made it seem like I have all the answers, I apologize, as I don’t.

DEAR DR. ROACH: You recommended estrogen cream for UTI problems. I had breast cancer, and it was estrogen-positive. I was on tamoxifen for six years; it is an estrogen blocker. As a result, I am reluctant using any medicine that pertains to estrogen. Do you think this cream is safe to use in spite of my history of estrogen-positive breast cancer? — R.E.

ANSWER: To be specific, I recommended considering estrogen cream in post-menopausal women who have recurrent urinary tract infections due to vaginal atrophy.

Although a recent opinion by the American College of Obstetrics and Gynecology stated that “Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms,” neither I nor they recommend using any kind of estrogen preparation, vaginally or by mouth, without a thorough discussion with the woman’s oncologist. Nonhormonal treatments certainly should be tried first, and the risks of estrogen need to be carefully balanced against the possible benefits.

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