Keith W Roach, MD

12/19/2025

Influenza is skyrocketing in my state, as in many others. Please, please, please get your flu shot if you haven’t, and wear a mask in crowded spaces, especially if you are at high risk. 

12/16/2025

DEAR DR. ROACH: I am a 68-year-old female who was first diagnosed with osteopenia and now osteoporosis. My physician has highly recommended medication or a monthly injection. I have completed hours of research and am very unhappy with the many personal stories of side effects. Evenity, the one drug that actually claims to rebuild bone, is not covered under Medicare, and the price is $2,086 per shot/per month for one year. (So sad!)

I read with great interest an article on the Osteoboost belt, which is the first medical device approved by the Food and Drug Administration. The clinical trial showed an average of 85% reduction in bone loss, and it was also used by astronauts to avoid bone loss while in space. Can this be true?

I asked my doctor about Osteoboost, and she stated that she doesn’t know anything about it. This was discouraging for me. I am hoping you have some insight or research you can share. I stay active with exercise and moderate weights, but Osteoboost has my interest. I hope some of the claims hold true. The price is over $900, so I’m hoping to hear some real and trusted information. -- K.S.R.

ANSWER: Osteoporosis is a big issue for many women and a few men, so new therapies are always of interest.

First, though, romosozumab (Evenity) is not the only medicine to rebuild bone. Older drugs like alendronate (Fosamax) slow the breakdown of bone, allowing the body’s natural rebuilding of bone to catch up. Anabolic agents like parathyroid hormone analogs (teriparatide) also directly increase bone growth.

Evenity is unique because it both slows down bone breakdown and stimulates new bone growth. It is usually covered 80% by Medicare in the United States when given in a doctor’s office, with most supplemental plans paying the rest. You should check with your insurance provider to see how much you would pay. There is a concern about Evenity increasing the risk of heart disease, so I have so far avoided recommending it to people who are at a higher risk for heart disease.

I have written before about the use of vibration machines like Osteoboost. Recent trials have shown an increase in bone density with the device but have not shown a reduction in fracture rates, as those trials need to be larger and of a longer duration than the trials that have been published so far.

Alendronate, teriparatide and romosozumab all have clinical trial data showing reductions in fracture rates. The vibration devices may reduce fall rates, which may help with fracture reduction.

Astronauts in space typically used resistive exercises to combat bone loss in low-gravity situations, although vibration studies performed on Earth were promising, and I saw a proposal for a trial on the International Space Station. Note that the device is not FDA-approved, but it is FDA-cleared, which requires less stringent scrutiny.

Drug-free regimens would be a large addition to the available therapies for osteoporosis, but I still await more studies before recommending vibration devices.

In addition to exercise, a diet high in natural calcium (such as dairy and fish with tiny bones, like anchovies and sardines) as well as vitamin D supplements can help prevent the progression of osteopenia and the worsening of osteoporosis. Five or six prunes a day also help to strengthen bones.

Recent trials have shown an increase in bone density with the device but have not shown a reduction in fracture rates.

12/15/2025

DEAR DR. ROACH: Everyone in my family except for me has converted to using almond milk instead of cow’s milk. I just saw something on the internet that says almond milk is possibly the worst plant-based milk substitute. I trust your opinion and research. Can you please educate me on what is best? Are plant-based milks really better than cow’s milk, and which plant-based milk is best? -- D.G.

ANSWER: When trying to compare plant-based milk substitutes with each other and with animal milks in their health impact, it’s important to look at what each of them have in terms of macronutrients and micronutrients.

Cow’s milk, like other animal milks, contains macronutrients like protein, sugars and fats as well as micronutrients like calcium. (Most cow’s milk is fortified with vitamin D.) While most North Americans consume adequate protein, many people try to increase their protein intake through cow’s milk.

Similarly, although the data are mixed, most experts agree that saturated fat, which is found in cow’s milk, increases heart disease risk. (Cow’s milk can be whole, low-fat, reduced fat or skim, varying in their percentages of overall fat.) However, cow’s milk contains beneficial fats like conjugated linoleic acid and methyl-branched-chain fatty acids. Most North Americans consume much more simple sugar than what is optimal with cow’s milk.

Almond milk has much less protein than cow’s milk (1 gram versus 8 grams), and the quality of the protein based on the amount of essential amino acids is less. Soy milk is much higher in protein than almond milk -- almost as much as cow’s milk, about 7 grams. Coconut milk has almost none.

However, almond and soy milk have no saturated fat (or almost none) and more monounsaturated fats. Coconut milk has about the same amount of saturated fat as cow’s milk. Almond, soy and coconut milks are typically fortified with calcium to match what is found in cow’s milk, but the calcium in plant milks is not absorbed as well.

Almond milk can be bought unsweetened or sweetened with typically 7-8 grams of sugar per cup, compared to 12 grams per cup in cow’s milk. Cow’s milk has multiple other micronutrients naturally, while plant-based milk is fortified with vitamin A and D.

So, is your family right that almond milk is the worst? No, I don’t think so. In my opinion, the nonexistent protein and high saturated fat content of coconut milk makes it the least acceptable from a health perspective. Soy and almond milk seem like the better alternatives, but neither of them is really comparable to cow’s milk in terms of other micronutrients.

The choice of almond versus soy milk is not clear from a health perspective, so your taste preference should be your guide. In all cases of plant-based milks, I recommend unsweetened and unflavored products.

Almond milk has much less protein than cow’s milk (1 gram versus 8 grams).

12/15/2025

DEAR DR. ROACH: I get regular pedicures. I never go for gel, but I often use a bright color. When the polish comes off, almost every single one of my nails is quite mottled with brown and white spots. Of course, I thought about not wearing polish and allowing the new nails to slowly grow out, but I can’t stand the look of my toes.

I know this is just a cosmetic problem. My pedicurist seems to know nothing about it. The real question is, what causes such gross discoloration in some people but not in other others? -- N.W.

ANSWER: I’ll bet you have keratin granules, which represent damage to the nail. They are often described to be chalky white and happen in many people if nail polish is left on too long (more than 7-10 days). Experts recommend an acetone-free remover when it’s time to remove them. You can also use a base coat to protect the nail. Let the nails go without polish periodically.

Fortunately, keratin granules are not dangerous and will grow out. They can be mistaken for toenail fungus, so your regular doctor or a dermatologist can help if these tips don’t stop them from developing.

12/12/2025

In my home state of New York, there is a lot of flu! Not a lot of Covid or RSV, but definitely get your flu shot as soon as possible if you haven’t already.

12/12/2025

I hope this will be interesting to my readers, but I am posting it mostly because it’s really excellent science writing.

A new study implicates a pair of substances secreted by immune cells in inducing myocarditis among mRNA-based COVID-19 vaccine recipients — and proposes a strategy to mitigate this effect.

12/12/2025

Dear Dr. Roach: You recently posted a couple of articles about the respiratory syncytial virus (RSV) vaccine and the benefits versus the risks. I know the risks are based on data. But I wonder how many people have severe reactions to the vaccine, and it doesn't get reported because they don't end up going to the hospital or the doctor.

I recently received the latest COVID and RSV vaccines, and four days later, I started experiencing extreme nausea and vomiting for two days, along with muscle aches, tingling, and hot and cold flashes. I was miserable and couldn't sleep. This happened over the weekend. If it had lasted until Monday, I would have gone to urgent care. But by Monday morning, I was feeling better, so it was never reported.I'm a 67-year-old female in relatively good health. But I feel like someone older experiencing what I experienced over the weekend could be very dangerous. I tried to drink as much water as I could, but it made me nauseous, as did any food. So, I ended up being pretty dehydrated. My point is that my fairly severe reaction was not reported, and I wonder how underreported these data really are.

— T.B.

Dear T.B.: I am sure you are right that many adverse vaccine events are not reported. Most patients don't report expected side effects from vaccines, and even when they do, a minority of providers will make a report to VAERS, the Vaccine Adverse Event Reporting System at the Centers for Disease Control.

However, providers are mandated by law to report certain serious adverse events from vaccines (those that are listed in the table of reportable events, which is vaccine-specific) or any adverse event that is listed by the manufacturer, which would prevent the person from getting any more doses of this vaccine.

I report unexpected side effects to VAERS, although most of my colleagues do not always do so. Many people do not know that they can also self-report to the VAERS system by going to VAERS.HHS.gov/reportevent.html.

The data on adverse events that I generally use for my column do not come from self-reports or physician reports; they come from the original studies on the vaccines, where all adverse events are carefully reported.

For RSV in particular, this means a study published in 2022 from Belgium, which showed that 72% of vaccine recipients (and 28% of the recipients who received a placebo, plain salt water) had at least one adverse reaction. The most common symptom was pain at the injection site (61%), but headache, fatigue and muscle aches were also fairly common.

Nausea and vomiting were not reported as side effects in the paper for RSV. However, nausea and vomiting were reported in 9% of Moderna COVID-19 vaccine recipients, compared to 8% in the placebo group. Taking the two vaccines at the same time makes side effects more likely and also makes it impossible to tell for certain which vaccine caused the side effect.

You are correct that there is underreporting of adverse effects from vaccines; however, in the vast majority of cases, the side effects from the vaccine are relatively mild and much less dangerous than getting the actual disease.

The Vaccine Adverse Event Reporting System (VAERS) is a national early warning system to detect possible safety problems in vaccines used in the United States. VAERS accepts and analyzes reports of adverse events (AEs) after a person has received a vaccination. Anyone can report an adverse event to....

12/11/2025

Dear Dr. Roach: I have benign prostatic hyperplasia (BPH), and I am taking tamsulosin daily. It works and helps with my daily urination. How long should I continue to take it? Are there any related side effects? Or should I consider an eventual prostatectomy? Thank you.

— A.

Dear A.: Tamsulosin is an effective treatment for most men with symptoms of an enlarged prostate. (BPH signifies noncancerous growth of the prostate gland.) It works by relaxing special muscle fibers in the prostate ("smooth muscle"), which allows the urethra — the tube that carries urine from the bladder outside of the body, going straight through the prostate — to drain the bladder faster and with less pressure.

The most common side effect of tamsulosin and similar medicines (called "alpha blockers") is lightheadedness, especially upon standing. Newer medicines like tamsulosin and alfuzosin are less likely to have this side effects compared to older medicines like doxazosin, but it can be a problem, especially when first using it.I tell my patients to first sit up on the bed, make sure that you are OK, stand up, make sure that you're OK again, then walk to the bathroom. Headaches, runny or stuffy nose, and ej*******on problems are other possible side effects. If you haven't developed these within a few weeks, you aren't likely to.

Before having cataract surgery, any person who has ever taken an alpha blocker should tell their eye surgeon. Tamsulosin is particularly likely to cause a problem called "intraoperative floppy iris syndrome," so the surgeon needs to be prepared just in case.

For my patients who are getting a good result with this class of medicine, I don't recommend changing it unless it stops working or they develop side effects. Before considering prostate surgery or another prostate procedure, such as laser, steam, freezing or embolization, I often recommend a second class of medicines, the 5-alpha reductase inhibitors finasteride or dutasteride. These take longer to work but have a benefit of reducing prostate cancer risk by about 60%.

Most men have a good outcome with traditional prostate surgery or one of the newer, less-invasive techniques. However, I have had a few of my own patients and many readers tell me that their symptoms worsened after this treatment. This is why I don't recommend surgery unless the medicines aren't working and the symptoms are bothersome enough to consider a procedure.

It works and helps with my daily urination.

12/11/2025

DEAR DR. ROACH: In a recent column, you mentioned a class of drugs called SNRIs for pain. I know about SSRIs for depression. What are SNRIs? -- D.S.

ANSWER: SSRIs, the selective serotonin reuptake inhibitors, are among the most-used drugs for mental health problems, especially mood disorders like anxiety and depression. They have usefulness in other conditions such as eating disorders, menopausal hot flashes, premature ej*******on and others.

SNRIs are serotonin-norepinephrine reuptake inhibitors; SNRIs and SSRIs are related drugs. They are also useful for anxiety and depressive disorders but are more commonly used for chronic pain than SSRIs are.

These drugs should not be used lightly. They have the potential for serious side effects, especially in combination with other drugs that work on the serotonin receptor. However, when used properly, they are safe and effective for many purposes.

Also: What are the most common side effects when taking tamsulosin?

12/10/2025

DEAR DR. ROACH: I am a 74-year-old woman who is in better-than-average shape for my age. I only take blood pressure meds, walk for exercise, and am only slightly overweight.

I have had seven COVID vaccinations from February 2021 to September of this year. I asked my primary doctor if I should get more, and he said “no.” His reasoning is that Paxlovid cures COVID, so we don’t have to get vaccinated anymore. He, himself, is not getting any more shots. I never contracted COVID that I know of. Any thoughts? -- J.A.

ANSWER: Yes, I have a strong opinion about this, and I completely disagree with your doctor. It is fantastic that we have Paxlovid as it absolutely helps people get better faster, and it reduces the risk of severe COVID by about half.

This is most important for people who are at a higher risk of hospitalizations because people who are at a low risk, including most healthy people who are up-to-date with their vaccines, don’t benefit much from Paxlovid. Being 74 and slightly overweight and having high blood pressure puts you at higher-than-average risk for severe COVID -- but not as high as a person with lung disease or severe immune system disease.

Without vaccinations, the risk for serious, even life-threatening cases of COVID increases, and Paxlovid is not completely effective. Also, Paxlovid does not help much at preventing persistent symptoms after a COVID infection (“long COVID”). I have several patients who continue to have long COVID symptoms that are affecting their daily life, despite it being years after their initial infection.

Finally, it is possible that new variants of COVID will arise that are not susceptible to Paxlovid. While I have confidence that new drugs will be developed, it is far better to prevent COVID than it is to treat it.

COVID hasn’t gone away; it is here to stay. There will be additional “waves” of COVID infection, and during these times, it will be wise to once again bring out the surgical masks when in crowded areas, in addition to staying up-to-date with vaccines. I continue to get my COVID vaccines as soon as they are recommended.

Dr. Roach: It is far better to prevent COVID than it is to treat it.

12/10/2025

DEAR DR. ROACH: Your recent discussion regarding taking an antibiotic before dental procedures for cardiac issues didn’t mention my situation. I am 86 years old, and four years ago, I had my mitral valve replaced with a porcine valve. I had no history of heart disease and never saw a cardiologist before this.

I have been told to take 2,000 mg of amoxicillin one hour before any dental procedure for the rest of my life. Is this an appropriate recommendation? -- P.H.

ANSWER: Although antibiotics before certain medical and dental procedures are recommended much less frequently than they were years ago, there are still instances when it is appropriate. A prosthetic valve is one of these times when antibiotics are recommended. Two grams taken orally 30-60 minutes before a dental procedure is the recommended regimen for people who can take penicillin drugs.

Similarly, people with an assist device or an artificial heart should take antibiotics, as well as those with some types of congenital heart disease. Heart transplant patients with an abnormal valve and people who have had a left atrial appendage occlusion (LAAO) device (such as the WATCHMAN) within the first six months of the device placement are also included in this category.

Dental procedures such as extractions and oral surgery are riskier than routine dental cleanings. The overall risk for all invasive dental procedures is approximately 10 cases per 10,000 without antibiotics and 4.5 cases per 10,000 with antibiotics. However, good oral hygiene and prompt treatment of any dental problems are probably more important than antibiotics.

12/09/2025

DEAR DR. ROACH: I recently got married again after being single for six years and have had five urinary tract infections (UTIs) in 14 months. My primary care doctor, a urogynecologist, and a urologist have all agreed on estradiol cream. I was basically put on this treatment for a pr*****ed bladder and to build up my vaginal walls since I am sexually active again.

In reading your recent column about hormone replacement therapy (HRT) in older women, I am concerned since I underwent menopause 20 years ago (instead of under 10) and just started this treatment two months ago.

I might add that I had not had a UTI for 50 years prior, but vaginal dryness may be contributing to these UTIs. My doctor has not recommended a progestin, but I have also been introduced to taking a cranberry supplement once a day in tablet form to keep bacteria from multiplying.

Would you have recommended the same treatment knowing that I have not had a period for 20 years? -- L.E.

ANSWER: The risks from estrogen replacement in postmenopausal women are from systemic estrogen, meaning estrogen that gets absorbed into the blood. This includes estrogen pills and patches.

Topical estrogen, such as vaginal creams, rings and gels, are not well-absorbed in the body and do not significantly increase the risk of heart disease, which is the major reason that I recommended caution to women who underwent menopause more than 10 years ago.

Similarly, progestins need to be used in women with a uterus when they’re taking systemic estrogen -- but not topical estrogen. (Topical estrogen is absorbed slightly in women with atrophy of the vaginal lining, so it is always worth a consultation with an oncologist for women with estrogen-sensitive tumors, such as breast cancer.)

I don’t generally advise systemic HRT more than 10 years postmenopause, but there still may be some times when it’s appropriate after a thorough discussion between a woman and her doctor. In your case, however, the risk of heart disease, breast cancer or blood clots is negligible from topical estrogen.