For chronic nerve pain, en­list neu­rol­o­gist’s help Keith Roach

Cape Breton Post - - LIFESTYLES/ADVICE -

DEAR DR. ROACH: Two years ago, my grand­fa­ther (a 90-years-young Navy vet­eran) had a nasty fall and, in an at­tempt to break his fall, frac­tured a bone in his hand. He was taken by am­bu­lance to the hos­pi­tal, where he was dis­missed with the sug­ges­tion of a sprain, with­out any di­ag­nos­tic imag­ing.

Cut to months of con­stant pain be­fore an X-ray was or­dered, in­di­cat­ing a poorly healed, dra­matic frac­ture that likely led to nerve dam­age. His in­tense pain is con­stant and on­go­ing. An or­tho­pe­dist in­ex­pli­ca­bly rec­om­mended carpal tun­nel surgery. The pain hasn’t im­proved at all, and re­cov­ery from surgery made his pain worse, lead­ing to a Di­lau­did pre­scrip­tion. Though he has an at­ten­tive and thought­ful pri­mary care physi­cian, noth­ing seems to have been able to re­duce his pain. When­ever I see him, he tries to mask the pain he is in, and is try­ing a va­ri­ety of hot and cold com­presses.

The fam­ily is at a loss. Do you have any sug­ges­tions as to pos­si­ble med­i­ca­tions or ex­er­cises we could try? — N.I.

AN­SWER: It hurts me to hear sto­ries like this. I don’t know if I can help. The longer the pain lasts, the harder it is to treat, in gen­eral. How­ever, if he were my pa­tient, I prob­a­bly would try some med­i­ca­tions that re­duce pain from dam­aged nerves, such as amitripty­line and gabapentin, and I cer­tainly would find another hand sur­geon. I also might con­sult with a neu­rol­o­gist, who might be able to pre­cisely iden­tify the source of the pain, which might help the hand sur­geon de­cide how to act.

Please let me know if he finds re­lief.

DEAR DR. ROACH: Do all nuts cause con­sti­pa­tion? — J.R.

AN­SWER: Nuts do not cause con­sti­pa­tion in most peo­ple. Most nuts have mod­est amounts of fiber, along with pro­tein and fat. Al­monds have more than oth­ers, so these would be least likely to cause con­sti­pa­tion. The ef­fect on the body of spe­cific foods may dif­fer greatly from one per­son to another. Some sub­stances are highly vari­able. Cof­fee, for ex­am­ple, pro­motes bowel ac­tiv­ity in most, but con­sti­pa­tion in oth­ers.

DEAR DR. ROACH: My fa­ther had de­men­tia be­fore he passed away from blad­der can­cer in Septem­ber. I would like to know if de­men­tia is hered­i­tary. — G.B.

AN­SWER: There are sev­eral types of de­men­tia, the most com­mon be­ing Alzheimer’s dis­ease. Although there is a hered­i­tary pre­dis­po­si­tion to both early-on­set (less than 1 per­cent) and late-on­set Alzheimer’s dis­ease, the ge­net­ics of AD is com­plex. Sev­eral genes con­fer risk, but we do not have a re­li­able test to pre­dict who will de­velop it.

Hav­ing a par­ent or sib­ling with AD in­creases your risk, but it cer­tainly does not guar­an­tee that you will get AD. Hav­ing more than one fam­ily mem­ber means a higher de­gree of risk.

If you do have an in­creased risk be­cause of your fam­ily history, you can re­duce that risk some­what just by tak­ing good over­all care of your health. Keep a care­ful eye on your blood pres­sure and choles­terol. Reg­u­lar ex­er­cise and a healthy diet, such as the DASH and Mediter­raneanstyle di­ets, might re­duce risk as well.

The book­let on Alzheimer’s dis­ease gives a de­tailed pre­sen­ta­tion of this com­mon ill­ness. Read­ers can ob­tain a copy by writ­ing: Dr. Roach — No. 903, Box 536475, Or­lando, FL 328536475. En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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