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Q. My wife had breast cancer in 1994. After chemotherapy...

September 22, 1998|By Dr. Allen J. Douma.

Q. My wife had breast cancer in 1994. After chemotherapy and radiation, she is into early menopause. (She is 44.) What can she take to ease up on the menopausal symptoms such as mood swings and hot flashes? Her medications include Megace, Xanax and Zantac. Her therapist wants her to try Zoloft. Will that help her symptoms?

A. As you know, menopause is the time in a woman's life when the functions of the reproductive cycle cease. Decreasing estrogen levels associated with menopause can cause a variety of symptoms such as hot flashes, fatigue, irritability and insomnia. Mood changes, anxiety and depression also can occur around menopause. And because your wife's menopause is occurring at a particularly difficult time in her life, she may have an increase in these symptoms.

Estrogen-replacement therapy may reduce some of the emotional effects. It also is often recommended because long-term estrogen treatment has beneficial effects on osteoporosis and cardiovascular disease and also may help prevent Alzheimer's disease and some cancers.

However, estrogen-replacement therapy is not recommended for most women with breast cancer. In addition, estrogen has side effects.

It's helpful for some women to take anti-anxiety drugs such as Xanax or anti-depressants such as Zoloft, in conjunction with therapy, whether or not they are taking estrogen. But before deciding, please ask your wife to talk with her therapist, including whether she should take Xanax and Zoloft at the same time.

I'm sure that you, your wife and her therapist can work together to develop a treatment plan that includes the right combination of love, support, communication and medication so she can get through this difficult time.

Q. My 18-year-old daughter was diagnosed with mono. She just got a job as a hostess at a restaurant. Should she try to do it? I am insisting on bed rest and healthy eating. But she is very social and popular, and I expect war from her. She is not really as tired as I would have expected.

A. I know how young people always want to be on the go and often eat poor diets. But advise your daughter to slow down, drink more fluids and eat a well-balanced diet. It will help her body fight the infection and possibly minimize complications.

Infectious mononucleosis (mono) is a viral infection caused by the Epstein-Barr virus. It usually occurs between the ages of 10 and 35, and is probably transmitted by saliva. That's probably the reason for its nickname--the kissing disease.

Symptoms vary but can include fever, fatigue, swollen lymph nodes and spleen, sore throat, and rash. Mono may be difficult to diagnose because other infections can act like it. Antibody tests are available, but they're not positive for at least three weeks after the beginning of symptoms.

Anti-viral medications are not very effective against this virus. People with mono should decrease activity until the fever, sore throat and general feeling of illness is gone. Aspirin is effective for fever and discomfort.

Most symptoms disappear within a few weeks, but the fatigue can last for weeks to months. Complications such as strep throat, anemia, hepatitis and inflammation around the surface of the heart can occur. It's very important to keep an eye out for symptoms of these complications and treat them as needed.

Because I don't know the severity of your daughter's condition or how long she's had mono, I can't advise you whether or when she should work or travel. Get her to ask her doctor for recommendations concerning her health and the dangers of transmitting the infection to others.

