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Laser

Can I keep using minoxidil for my beard after a CO₂ laser session for acne scars?

Hello, Javier: After a fractional CO₂ laser session, it is advisable not to apply minoxidil to the treated area until the skin has restored its barrier function. The CO₂ laser produces a controlled renewal of the skin through microcolumns of treatment. During the first few days, the skin remains inflamed, more sensitive and with a reduced ability to protect itself from potentially irritating substances. Most minoxidil formulations in foam or solution contain alcohol or other excipients that can cause stinging, intense irritation, delay healing or promote greater absorption of the medication while the skin has not yet recovered. In general terms, I advise waiting between 3 and 5 days before resuming minoxidil. However, if the treatment was more intense or recovery is slower, it may be preferable to wait until the crusts, intense redness and sensation of irritation have disappeared. In some patients this may require 5 to 7 days, or even more, depending on the intensity of the procedure. During that period, the most important thing is to follow the post-laser care correctly: • Keep the skin well hydrated with the cream recommended by the specialist. • Avoid irritating products, such as exfoliating acids, retinoids or products containing alcohol. • Use a broad-spectrum sunscreen and avoid direct sun exposure. • Do not pick at the crusts or the areas that are healing. If you use minoxidil on another area that has not been treated with the laser, such as the scalp, you can continue applying it as usual, making sure it does not come into contact with the treated skin. If in doubt, always follow the instructions of the doctor who performs the treatment, since recovery time can vary according to the power of the laser, the depth of the treatment and each patient's characteristics. I hope I have resolved your question and I wish you an excellent recovery. Kind regards, Dr Florian André Vallecillo Cabrera

— Javier

Second opinion

I was prescribed enalapril 5 mg without being hypertensive, only to control the blood pressure spikes that appear during my fibromyalgia flare-ups. Instead of enalapril 5 mg, could I take amlodipine 5 mg?

Hello, María. In principle, it is not advisable to replace enalapril with amlodipine on your own initiative, even though both medications are used to treat high blood pressure. Enalapril and amlodipine belong to different families and act through different mechanisms. The choice of one or the other depends on factors such as age, associated conditions, kidney function, other treatments and the reason why blood pressure rises. If your blood pressure spikes appear only during fibromyalgia pain flare-ups, it is important to assess whether these rises are a transient response to pain and stress. In many cases, the best treatment is to control the fibromyalgia flare-up properly, since as the pain decreases, blood pressure usually normalises. If enalapril was prescribed specifically for those occasional spikes, I advise you not to switch it for amlodipine without first consulting the doctor who knows your medical history. If you have had side effects with enalapril, such as a persistent cough, dizziness or any other discomfort, there are alternatives that may be more suitable, but the decision must be individualised. In addition, it would be advisable to have several blood pressure measurements, both during flare-ups and in pain-free periods, to confirm whether hypertension really exists or whether these are only transient rises related to pain. Key points: • Do not replace one antihypertensive with another without medical indication. • Intense pain can cause transient rises in blood pressure. • If elevated readings persist outside the flare-ups, a work-up to rule out hypertension is advisable. • Seek urgent care if you have very high blood pressure accompanied by chest pain, difficulty breathing, visual disturbances, weakness or neurological symptoms. I hope this has been helpful. Kind regards, Dr Florian André Vallecillo Cabrera

— María

Laser

I had a laser treatment three days ago and my skin is still red and a bit warm. Is this normal or should I be worried?

Redness and a mild sensation of warmth during the first few days after a laser treatment are usually part of the skin's expected reaction. They generally subside progressively. It is advisable to keep the skin well hydrated, apply sun protection and avoid direct sun exposure. If blisters, intense pain or discharge appear, or if the redness increases instead of improving, a medical assessment is recommended to rule out any complication.

— Laura, 34

salud femenina

I am 50 years old, I have a hormonal IUD and I am following hormone therapy for menopause. For the past week I have started having light bleeding and I am very worried. Could it be cancer?

Hello Julia, I fully understand your concern. It is very common for unexpected bleeding to cause fear, and for the first thing that comes to mind to be the possibility of cancer. However, I want to reassure you: the vast majority of bleeding in this situation is not caused by cancer. At 50, during perimenopause or the early years of menopause, the body goes through significant hormonal changes. In addition, using a hormonal IUD together with hormone replacement therapy can promote small bleeds or spotting, especially during the first months of treatment, after a dose change, or even after a long period without any bleeding. There are many benign causes that can explain this type of bleeding, such as the endometrium adapting to hormone therapy, small uterine polyps, slight thinning or thickening of the endometrium, or simply changes typical of this stage of life. This does not mean it should be ignored. Any bleeding after menopause or during hormone therapy deserves to be assessed, but assessing it does not mean there is a serious problem. In most cases, a gynaecological examination and a transvaginal ultrasound make it possible to identify the source of the bleeding and confirm that everything is within normal limits. Only in certain circumstances may the gynaecologist consider it necessary to perform an additional test, such as an endometrial biopsy. My advice is to book an appointment with your gynaecologist so they can assess you calmly. In the meantime, try not to anticipate the worst-case scenario. In my practice I often see this type of situation and, fortunately, most have a completely benign explanation. You should seek care sooner if the bleeding is heavy, lasts several days, is accompanied by intense pain, or if you feel dizzy or weak. I hope I have reassured and guided you. Kind regards, Dr Florian André Vallecillo Cabrera

— Julia, 50

medicamentos

Can I take Pax Noche if I took loratadine an hour ago?

Hello, Ana: It depends on the exact composition of the Pax Noche preparation, as some cold products contain sedating antihistamines in addition to other active ingredients. If Pax Noche contains another antihistamine, combining it with loratadine may increase drowsiness and other side effects, so in general I do not advise combining them without first checking the composition. In addition, many cold medicines contain several active ingredients and are not always necessary. It is usually preferable to treat only the symptom the patient actually has. If you have doubts about the specific product you bought, send me the full name or a photograph of the packaging and I can advise you more precisely. I hope this has helped. Kind regards.

— Ana

General

I'm 62 and my vitamin D is 12.21. I've been prescribed Hidroferol and also Demilos 2000. Should I take both?

Hello, Carmen: A vitamin D level of 12.21 ng/mL indicates a significant deficiency, so it is reasonable to start treatment to correct it. In many cases, Hidroferol® (calcifediol) is used to quickly restore adequate vitamin D levels, while Demilos® 2000 IU (cholecalciferol) is usually used as maintenance treatment or as a supplement in patients with osteopenia or osteoporosis. Therefore, they are not necessarily incompatible; in fact, in certain situations they can be part of the same therapeutic strategy. However, since the two doctors may have had different goals, my recommendation is to confirm with the professional coordinating your treatment whether they want you to take them at the same time or whether one should be started once the other is finished. Regarding calcium, Hidroferol does not provide calcium. If there is bone loss, it is also important to ensure adequate calcium intake through diet or supplements, whenever indicated. Since you mention that you have digestive problems, it is advisable to individualise the treatment and monitor vitamin D levels with follow-up blood tests to avoid both deficiency and excess. I hope this clarifies your question. Kind regards.

— Carmen, 62

medicamentos

When I take enalapril I feel strange: my eyes feel heavy, I feel a bit “drunk”, my hands sweat and look pale. Is this normal?

Hello, Isabel: The symptoms you describe should not be ignored. Enalapril can cause, especially at the start of treatment or after a dose increase, an excessive drop in blood pressure. This can manifest as dizziness, a feeling of unsteadiness, blurred vision, weakness or a sensation of “floating”. However, it is also true that anxiety, low blood sugar or other medical problems can cause similar symptoms. The first thing I would recommend is to measure your blood pressure when those symptoms appear. That information can help determine whether there really is a drop in pressure related to the medication. Do not stop the treatment on your own, but it is important to consult the doctor who prescribed it to assess whether the dose is appropriate or whether it would be advisable to switch to another antihypertensive. If, in addition to that sensation, you develop chest pain, difficulty breathing, loss of consciousness or neurological symptoms, you should go to an emergency department. I hope this has been helpful. Kind regards.

— Isabel

medicamentos

I take levothyroxine (T4) and metformin. Can I take NAD+ and resveratrol?

Hello, Miguel: In general terms, there are no known significant interactions between levothyroxine, metformin, NAD+ or resveratrol. However, this does not mean that these supplements are suitable for everyone. Levothyroxine should always be taken on an empty stomach, with water only, and it is advisable to wait at least 30-60 minutes before eating breakfast or taking any other medication or supplement so as not to reduce its absorption. As for NAD+ and resveratrol, although there is growing interest in their possible role in healthy ageing and cellular metabolism, the scientific evidence in humans is still limited and does not justify their universal use. If you decide to use them, my recommendation is to do so under medical supervision, especially if you have other conditions or take more medication. In addition, if you are on levothyroxine, it is advisable to have periodic thyroid function checks to confirm that the treatment remains effective. I hope this resolves your question. Kind regards.

— Miguel

medicamentos

I took losartan 50 mg and, four hours later, pentoxifylline. Can it affect my blood pressure?

Hello, José: In general, taking pentoxifylline a few hours after losartan is not usually a significant problem. However, both medications can promote a slight drop in blood pressure in some people, especially at the start of treatment or in elderly patients. If, after taking the medication, you notice dizziness, weakness, blurred vision or a feeling of unsteadiness, it would be advisable to measure your blood pressure and consult your doctor if the symptoms persist. Do not stop either treatment without medical advice. If both medications have been prescribed, they can usually be used together, as long as there is appropriate monitoring. I hope this resolves your question. Kind regards.

— José

Second opinion

A neck ultrasound found a 5 mm left subclavicular lymph node with no visible fatty hilum. I have hypothyroidism and I've been referred to a specialist. I'm very worried.

Hello, Pilar: I completely understand your concern, but I would like to reassure you. A 5 mm node is a very small node. It is true that the absence of a fatty hilum may lead the radiologist to recommend further investigation, but this finding alone does not mean there is a serious disease. Lymph nodes can change for many reasons, such as recent infections, inflammatory processes, autoimmune diseases and even reactive changes of no clinical importance. The referral to a specialist is an appropriate decision, as it will make it possible to assess the finding within your clinical context, perform a complete physical examination and decide whether any additional test is needed, such as blood tests, a follow-up ultrasound or, in specific cases, other imaging studies. My advice is not to draw conclusions before the medical assessment. The vast majority of small nodes do not correspond to malignant diseases and must be interpreted together with the rest of the clinical history. I hope I have been able to reassure you. Kind regards.

— Pilar

General

I've had throat discomfort for almost a month. In the mornings I have a cough as if I had phlegm, and during the day I feel hoarseness. What could be causing it?

Hello, María: When throat discomfort persists for several weeks, a medical assessment is advisable to identify the cause. The symptoms you describe (hoarseness, a feeling of phlegm and a morning cough) may be linked to different processes. One of the most common causes is laryngopharyngeal reflux, in which stomach contents rise up to the throat, causing irritation without necessarily producing heartburn. Other possibilities include a respiratory allergy, sinusitis with postnasal drip, smoking, dry air or overuse of the voice. If the discomfort has already lasted a month, it would be advisable for a physician to examine the throat and, if necessary, request an assessment by an ENT specialist to view the larynx. In the meantime, try to stay well hydrated, avoid tobacco, reduce alcohol and very large meals at night, and avoid straining your voice. You should seek prompt care if you develop difficulty swallowing, unexplained weight loss, prolonged fever, blood when coughing or hoarseness lasting more than three or four weeks. I hope this has been helpful. Kind regards.

— María

medicamentos

I'm taking gabapentin 100 mg. Can I also take diclofenac with vitamin B12?

Hello, Carlos: In general terms, gabapentin can be taken together with diclofenac and vitamin B12, as there is no significant interaction between these medications in most patients. However, the combination only makes sense if it has been prescribed to treat a specific problem, such as neuropathic pain accompanied by inflammation. Diclofenac can be effective for inflammatory pain, but it should be used with caution in people with a history of ulcer, gastritis, kidney disease, heart failure or high blood pressure. In addition, vitamin B12 only provides a benefit when there is a deficiency or when it is part of a specific treatment. My recommendation is not to self-medicate for long periods and to consult your doctor if the pain persists, worsens or is accompanied by loss of strength, sensory changes or fever. I hope this clarifies your question. Kind regards.

— Carlos

General

I'm 20 and I've had a lot of reflux for a year. I've tried several treatments, but it always comes back. Sometimes I just feel burning and other times reflux. I feel very sad because I can't get better. What can I do?

Hello, Laura: First of all, I want to tell you that I completely understand how you feel. Living with reflux for so long can greatly affect quality of life and cause anxiety or low mood. The good news is that, in most cases, it is possible to find the cause and improve the symptoms with the right approach. When reflux persists despite treatment, it is important to review several aspects: confirm that it really is gastro-oesophageal reflux disease, assess whether there is a hiatal hernia, a Helicobacter pylori infection, functional disorders of the oesophagus or even stress-related factors, which can heighten the perception of symptoms. It is also worth reviewing some habits that greatly influence reflux: avoid large meals at night, do not lie down until two or three hours after dinner, reduce alcohol, tobacco, coffee, carbonated drinks and very fatty or spicy foods, and maintain a healthy weight if overweight. If you have had recurring symptoms for a year, it would be advisable for a digestive-system specialist to assess the need for a gastroscopy or additional tests to reach an accurate diagnosis and tailor the treatment. Most importantly, do not lose hope. Many people with chronic reflux manage to control their symptoms once the cause is correctly identified and treatment is individualised. I hope this has helped, and I wish you a swift improvement. Kind regards.

— Laura, 20

medicamentos

My son has had an allergy since yesterday. I gave him Benadryl® and this morning dexchlorpheniramine, but he isn't improving. I gave him the latter about an hour ago. Can I give him cetirizine?

Hello, Daniel: I understand your concern, especially when it involves a child. In general, I do not recommend combining several antihistamines without medical indication, as increasing the dose or switching from one to another within a few hours does not usually provide additional benefit and can increase the risk of side effects, such as excessive drowsiness or irritability. The most important thing is to identify the cause of the allergic reaction and assess whether it really is an allergy or another skin or infectious problem. If the child only has itching or a mild rash and does not improve with treatment, the most sensible thing is for him to be assessed by his paediatrician to adjust the medication. On the other hand, if difficulty breathing, swelling of the lips or tongue, hoarseness, repeated vomiting or significant listlessness appear, you should go to an emergency department immediately. I hope your son recovers very soon. Kind regards.

— Daniel

medicamentos

My father is 98. Can he take lorazepam at night and Codeisan® three times a day for a cough?

Hello, Antonio: In a 98-year-old person, it is important to be extremely cautious with any medication that can affect the nervous system. Both lorazepam and Codeisan® (codeine) can cause drowsiness, reduced alertness and respiratory depression. When given together, these effects can be enhanced, increasing the risk of falls, confusion, difficulty breathing and other problems, especially in very elderly people. Before using codeine to treat a cough, it is advisable to know the cause producing it. Not all coughs should be treated with a cough suppressant and, in some cases, it may be preferable to address the underlying problem. My recommendation is that this treatment be supervised by his usual doctor, who will assess your father's general condition, his respiratory function and the rest of the medication he is taking. If, during treatment, difficulty waking him, slow breathing, significant confusion or excessive drowsiness appear, you must go immediately to an emergency department. I hope this has been helpful. Kind regards.

— Antonio

General

Can I take honey or propolis if I am allergic to pollen?

Hello, Laura: Being allergic to pollen does not necessarily mean you cannot consume honey, but some caution is advisable. Honey can contain small amounts of pollen and other components from plants. Most people with seasonal pollen allergy tolerate it without problems, since the pollens that cause allergic rhinitis are mainly airborne, such as those from grasses, trees or weeds. However, allergic reactions to honey have been described, although they are rare. These reactions may appear as: • Itching or tingling in the mouth or throat. • Swelling of the lips, tongue or face. • Hives. • Difficulty breathing. • In exceptional cases, a severe allergic reaction. Regarding propolis, it is advisable to be even more cautious. It is a substance made by bees from plant resins and can cause allergic reactions, especially contact dermatitis, mouth irritation or reactions after ingestion. The risk may be higher in people sensitive to bee products, to balsam of Peru or to certain plant resins. If you have consumed honey before and never had symptoms, you can probably continue taking it normally. However, if you have never tried it, have a history of significant allergic reactions, poorly controlled asthma or an allergy to bee-derived products, it would be preferable to consult an allergist before consuming honey or propolis. I do not recommend doing a "test" at home by taking a small amount if an allergy is suspected. When tolerance needs to be confirmed, the assessment must be individualised and, in some cases, done through a test supervised by a specialist. In summary: pollen allergy does not automatically require avoiding honey, but propolis has a higher allergenic potential and should be used with more caution. Kind regards, Dr Florian André Vallecillo Cabrera

— Laura