Dear Dr. Solomon: We who have diabetes are quite interested in the experimental implantation of cells that will eventually eliminate the need to take insulin. Where would these cells come from? -- Mrs. M.L.
Dear Mrs. M.L.: Islet cell transplantation designed to provide blood glucose control has been performed in animals since the early 1970s. These transplants have been shown to be effective in preventing an elevated blood sugar level and in reducing the complications of diabetes, including cataract formation, retinopathy and neuropathy. Unfortunately, experiments with humans have not been as successful. No one has ever achieved lasting freedom from the need for insulin.
In recently years, fetal pancreatic tissue has been used for this purpose. While some insulin has been produced by this method, it has not been possible to achieve normal blood sugar levels. In addition, questions have been raised about ethical issues involved in the use of fetal tissue.
A pancreas transplant is the only currently available method of establishing blood sugar control in patients with insulin-dependent diabetes.
The success of this procedure is reflected in the one-year graft survival rate, which rose from 5 per cent for all pancreas transplants performed from 1966 through 1977, to 56 per cent for thdddddde years 1986 through 1988.
Dear Dr. Solomon: What can be done about a fungal infection of the toenails? Would you need a prescription or over-the-counter medication? -- Ms. E.P.
Dear Ms. E.P.: Fungal nail infections (enychemycosis) become more common in people over age 40. At that time, the nails become thicker and grow more slowly, and this increases their susceptibility to these infections.
Nail infections are difficult to treat, and spontaneous healing is rare. Although oral antifungal agents are available, treatment must be continued for a long time, and adverse side effects may be a problem. The side effects may include skin reactions as well as diarrhea and vomiting.
Treatment of fingernail infections is generally more successful than treatment of toenail infections. The reason is that shoes and socks provide the kind of warm, damp conditions that encourage fungal growth.
An alternative to the use of oral medications is removal of the infected nail, followed by treatment with an antifungal cream.
Dear Dr. Solomon: My mouth and throat are often very dry. Is there anything I can do about this? -- Mrs. C.W.
Dear. Mrs. C.W.: A number of conditions can cause a dry mouth, including diabetes, anemia, Sjogren's syndrome and stress. Certain medications and aging itself may also cause some decrease in salivary flow. Treatment includes the use of saliva substitutes or saliva stimulaters. Some temporary relief may be obtained by sucking on sugarless lemon drops to stimulate the flow of saliva.
In some cases, dry mouth may occur simply because the person is not drinking enough water. If that's the reason, the solution obviously is to increase the intake of water.
Dear Dr. Solomon: My husband is able to achieve an erection, but he seldom reaches orgasm. This has been going on for about two years. He can go for months without having an orgasm unless I'm extremely aggressive or we have oral sex.
I feel that it's my fault even though I've been told that it isn't. He's very embarrassed by this and refuses to go for professional help. Can this be a physical problem? -- Mrs. M.L.
Dear Mrs. M.L.: One of the first questions that comes to mind is whether your husband is on medication. A number of drugs commonly used today can not only lead to impotence, but to anorgasmia (inability to achieve orgasm). Any exploration of a sexual problem such as you present would have to include information about drug therapy.
The fact that your husband apparently has no difficulty in achieving an erection and occasionally does reach orgasm suggests that treatment could be effective.
If the problem is medication-related, a simple adjustment in dosage or a switch to another drug may be all that is necessary.
But regardless of the cause, I would urge your husband to at least discuss the problem with his physician. A satisfactory resolution of the problem would be well worth a little embarrassment.
11 Dr. Neil Solomon will answer questions from Baltimore area readers in his Tuesday column in Accent on Health.
To leave a question for Dr. Solomon, call SUNDIAL, the Baltimore Sun's directory of telephone information services at 783-1800, or 268-7736 in Anne Arundel County. You must use a touch-tone phone to be connected. It is a local call and there is no charge to ask your question.
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