Rx for Readers

A month ago, my five-year-old daughter suddenly began to emit a bad odor. It is uncomfortable for us to be near her.

A month ago, my five-year-old daughter suddenly began to emit a bad odor. It is uncomfortable for us to hold her or be near her since the smell is foul. We can't figure out where it's coming from, and neither can her doctor. She brushes her teeth twice daily, washes her hands often, doesn't have any sores or infections, hasn't changed her diet and is careful to clean herself after using the bathroom. The dentist found no problems, including with her gums. She has had a cold. What could the cause of the smell be? B.W., Nof Ayalon Judy Siegel-Itzkovich comments: The Jerusalem Post consulted with several physicians in various specialties, and no one was able to come up with the answer without examining the girl. The Post recommended that the mother take her child to an otolaryngologist (ear-nose-and-throat specialist). Among all the experts this column consulted, only Prof. Mel Rosenberg, a microbiologist at Tel Aviv University who is a leading expert on smell but who is not a physician, suggested a possibility that turned out to be absolutely correct. Here the mother explains what the cause of the smell turned out to be: I took her to an ear-nose-and-throat specialist as you suggested. He found a foreign body inside her nose and sent us to the emergency room. A doctor found a piece of sponge there. It hurt when he took it out with tweezers, but then she was fine. When asked, she remembered putting a piece of sponge in her nose one day in kindergarten a few weeks or even months ago. The ear-nose-and-throat specialist told me that if a child has a cold and only one side is running with mucous, then probably something is stuck inside. I wish I had gone to the ear-nose-and-throat specialist earlier. B.W., Nof Ayalon I am a 20-year-old man with a fungus infection on my toenails for about eight to 10 years. I've tried different treatments with varying success, but none was permanent. Lately I was offered an oral medication and told the following: that the treatment is not for everyone; a biopsy of the nail was needed to verify that it would work; even after the the biopsy, the medication has only has a 75 percent success rate; and the medication may cause liver problems and must be closely monitored. I also heard rumors of a new laser treatment that would be less risky and have a higher success rate, but I couldn't find more information. What are my options? B.Y.S., Jerusalem Dr. Julian Schamroth, a veteran Jerusalem dermatologist, replies: Fungal infection of the nail plate (onychomycosis) is a very common disorder usually caused by fungus Trichophyton rubrum. It may affect both fingernails and toenails and is extremely resistant to therapy. It is usually not a health issue; it may spread to other nails and even onto the surrounding skin, but it usually does not invade the body and does not affect one's health. Many patients with onychomycosis therefore decide to leave it untreated, even though it is an esthetic problem. But if the patient is diabetic, it would be wise to insist on treatment, since diabetics often have vascular problems in the feet and are very prone to bacterial cellulitis; such infections on their feet may damage the skin and open a portal of entry for bacteria. The diagnosis of onychomycosis is often made clinically by a dermatologist who may send nail scrapings to the laboratory for microscopic examination and culture, but a nail biopsy is unnecessary. Onychomycosis usually requires oral therapy, as topical treatments with anti-fungal creams, drops and nail paints are usually ineffective, unless the fungal infection is very superficial and does not deeply invade the nail plate. Oral anti-fungal drugs are widely used and safe (even for children). However, even oral therapy only has a 75 percent to 80% success rate; the treatment period usually takes three to six months or even more; even if successful, the fungal infection has a tendency to recur; blood monitoring is often necessary during the course of treatment; and the drugs commonly used are quite expensive, even when bought through your health fund. Home remedies and supplementary medicine therapies are aggressively marketed, but from my experience, they are a waste of time and money and give false hope. Lasers are still experimental and if approved will probably be very expensive. Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel- Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and residence.