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Dear Dr. Roach: I have nonstop postnasal drip. A Web search led me to a site selling homeopathic remedies that they claim are safe, natural herbs. I'm wary of it. Do you have any suggestions for this problem?

– M.W.

A: Postnasal drip is the drainage of fluid, usually mucus mixed with pus, from the lining of the sinuses and nasal passages. Postnasal drip is one symptom of the condition called chronic rhinosinusitis (which just means inflammation of the nose and sinuses lasting at least 12 weeks); this often is associated with other symptoms, including congestion, loss of sense of smell and pain or pressure in the face. It may be related to: abnormal anatomy, such as polyps; allergies to or infections by viruses, bacteria, fungi or nonspecific irritant chemicals; immune system diseases; and systemic diseases such as Wegener's or Churg-Strauss vasculitis. With such a large number of possible causes, it's impossible to make a specific recommendation without a thorough evaluation.

I frequently discuss herbal treatments for different conditions, as many readers want to have options beyond standard prescription and nonprescription drugs. Sometimes there are reasonable herbal options (although in this particular instance, I can't find any herbal preparations for chronic rhinosinusitis that have been proven to work better than placebo).

However, homeopathy involves diluting substances such as herbs, to levels where there can be no effectiveness of the preparation. The herbs themselves may or may not have shown any activity for the condition. There have been several comprehensive reviews with no good evidence that homeopathy is more effective than placebo (which it effectively is) for any condition. So save your money.

While I can't recommend a specific medical treatment, one treatment that provides at least some relief for most people is washing the nasal cavities with saline. This can be accomplished with a Neti pot or other type of nasal irrigator, including those with suction. You can buy sterile saline or make your own using boiled or distilled water. Don't use tap water, as rare infections have been reported.

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The booklet on asthma and its control explains this illness in detail. Readers can obtain a copy by writing: Dr. Roach Book No. 602, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.

Bunion surgery

Dear Dr. Roach: Is it true that surgery for bunion removal has advanced very little (i.e., has severe post-op pain, being on crutches and long recovery periods)?

– R.E.

A: No, not really. There have been over 150 surgical procedures published for treatment of bunion deformity, which is a deformity of the great toe on the metatarsal bone of the foot, where the toe points inward toward the second toe. The rates of patient satisfaction with surgery generally have improved over the years, with current rates between 50 and 90 percent satisfied. My own anecdotal experience confirms that the results are better now than they were 20 years ago, but that may be due to the fact that I am very cautious, and always try conservative treatments first. This may be better shoes and, if recommended by a podiatrist, a splint and/or orthotics. I send only patients with moderate to severe symptoms despite these treatments for consideration of surgery. A foot specialist who is expert in performing surgery is of the highest importance.

The average time to return to work after surgery is six weeks, which may seem a long time, but that's what it takes for the bone to heal.

Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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