Q. Whenever I turn on the television and see another report about West Nile virus, it scares me. I live in Florida and play golf at least three times a week and also work outside in the yard. The mosquitoes are voracious, so I apply lots of DEET insect repellent to my legs, ankles, arms, face, neck, socks and shirt. I try not to inhale the stuff, but I know I breathe in some of it. I worry about using so much DEET and would like some alternative approaches.
A. According to public health authorities, DEET is the most effective repellent available. A recent study in the New England Journal of Medicine reinforced this message and downplayed toxicity concerns.
Although this report suggested that oral compounds are ineffective, we occasionally hear from readers who have had good luck with such an approach:
"Brewer's yeast really works. Before I went to Alaska I took several capsules a day for three weeks. Those huge Alaska mosquitoes flew all around me, but not a one ever lit on me. I did not have a single bite."
People differ in their reactions, so you might not do as well with brewer's yeast as this reader did. Other non-DEET options include Bite Blocker (soybean oil) or products like Fite Bite or Repel Lemon Eucalyptus Insect Repellent (eucalyptus oil).
Q. I was on hormone replacement therapy for years and developed breast cancer. I am convinced the hormones were responsible.
I now have osteoporosis in my spine. The doctor wants to put me on Evista, but I am hesitant about taking hormones again. I was on Actonel for a couple of weeks, but landed in the hospital with horrible heartburn and a diagnosis of a bleeding ulcer.
What can you tell me about Evista, soy isoflavones and herbs like black cohosh instead of HRT?
A. Don't worry about Evista triggering a recurrence of breast cancer. If anything, this osteoporosis medicine might protect the breast.
Preliminary research suggests that soy isoflavones might help increase bone density. But there is not enough research to tell whether soy would be effective in preventing fractures. Black cohosh is an herb that shows evidence of reducing hot flashes, but it is unlikely to prevent osteoporosis.
Getting adequate calcium, vitamin D, magnesium and exercise are simple but useful steps for reducing the toll of osteoporosis.