Dear Dr. Roach: My 30-year-old and otherwise healthy grandson has been suffering from and treating hemorrhoids for two years. He is anemic due to his loss of blood. He’s had several bandings; they couldn’t complete the last one because he was in too much pain. They said they couldn’t anesthetize the area because his lack of feeling would prevent them from knowing if they were near a nerve. So, now they say he should have surgery, although it is said to be quite painful and difficult. Is the surgery as horrible to deal with as they say? — A.P.

Answer: Most people with a banding procedure do not need anesthesia, and nerve blocks are not used in hemorrhoidal banding because a feeling of pain is a useful indication that the band is not in the best position. When home treatments and office procedures (like banding, scleral therapy or infrared coagulation) are ineffective or can’t be used, it is time to consider surgical treatment.

The surgery’s reputation of being “horrific” is undeserved. I have had several patients in the last few years undergo this surgical procedure, and although they have certainly had a few days of pain after the procedure, all have been happy with the outcomes.

Dear Dr. Roach: My sister’s dog ran through a swampy area while we were on a walk and ended up with a lot of ticks. We picked off about 10 that day.

The interesting part was that the dog had just gotten his flea and tick medication. So, aside from the first couple of ticks we picked off, the rest were dead, showing the effectiveness of the medicine! Is there a reason that people cannot be treated in a similar way in order to ward off Lyme and other tick-borne diseases? — J.D.

Answer: I’m, of course, not a veterinarian, but I did look up the toxicity for three of the most frequently prescribed oral flea and tick medicines for dogs. All of them have the potential for toxicity in humans, and none have been studied extensively. There are topical treatments humans can spray on the skin to repel ticks, which — in combination with protective clothing and daily tick checks — is a moderately effective way of preventing tick-borne diseases such as Lyme disease, ehrlichiosis and babesiosis.