Keith Roach, M.D.

Dear Dr. Roach:

I have a friend who had gallstones and ultimately had her gallbladder removed. When they went in, they saw lots of infections, cleaned her out and put drains in her liver. She’s been feeling awful and weak, and she wants to get a second opinion. Which type of specialist should she see? — D.L.G.

Answer:

Treatment for a complex problem like hers often takes a team of specialists — in this case, certainly a surgeon and very likely a gastroenterologist and an infectious disease specialist. The ideal person to see now might be any of these specialists, especially one who saw her in the hospital and knows her case. However, it sounds like she may have lost confidence in the team who treated her initially.

Getting a useful second opinion would require getting this specialist the information they’d need, which would include imaging studies, operative reports and microbiology reports at a minimum. A surgeon is unlikely to be interested unless it’s clear that further surgery may be necessary, so I suggest that she starts with a generalist or gastroenterologist.

I’ve been involved in cases where a person who had a complex hospital course at a different medical system was admitted to my inpatient service, and getting the necessary information required many hours of work. With electronic medical records that can talk to each other (sometimes), this can be done much more easily now. It’s more feasible in the inpatient setting, but I hope your friend doesn’t get any sicker that she needs to go in the hospital.

Dear Dr. Roach:

My son is going to be spending several weeks on a lake. I was looking at a permethrin-impregnated sleeping bag liner, and I’m wondering if this type of treated sleeping bag is good to prevent bites from various insects. Is it worth the money? — J.M.M.

Answer:

Permethrin-impregnated clothing is highly effective. Studies have shown an 80% to 90% reduction in bites when it’s used. (Permethrin can’t be used on skin as it’s inactivated by skin oils.) Sleeping bag liners and bed nets aren’t as well-studied, but they’re still recommended by expert groups.

While I can’t answer whether it’s worth the money to you, I’d want myself or my child to have as much protection as possible. The permethrin in factory-applied gear lasts longer than self-applied permethrin, but it’ll gradually become less effective, especially when it gets exposed to sunlight and oxygen. The cost for a sleeping liner online was about $80 when I checked. A bottle of spray is about $25 and lasts for about six weeks on clothing or gear.

There’s an additive effect of using permethrin-impregnated products and topical skin repellants, and I certainly recommend both. I think it’d be worth it just to avoid itchy and unpleasant mosquito bites. If he’s going to be in an area with high amounts of tick-borne diseases — like Lyme disease, ehrlichiosis or babesiosis — I’d say that it would help prevent an infection, which could ruin his time on the lake or even cause health issues that might require him to leave.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu. Copyright 2026 North America Syndicate Inc. All rights reserved.