Is there a cure for numb feet?
DEAR DR. ROACH: I have seen so many articles relating to diabetic neuropathy, but my situation is different.
I have been dealing with neuropathy in both my feet for two years now as a result of the chemotherapy I received to fight breast cancer. I have tried everything, including acupuncture, and am currently on gabapentin, which doesn’t help either.
The creams I rub on my feet work for about 20 minutes, which allows me to get to sleep. I find my feet are better whenever I elevate them. But I can’t sit around all day.
Is there anything I can do to alleviate the numbness I feel? I have balance issues too and sometimes I have to use a cane. I’m 73 and would love to get back to traveling, but I feel insecure on my feet.
— K.D.
ANSWER: Although chemotherapy is often effective in fighting cancer, most cancer chemotherapy has side effects, and some, such as the platinum-based chemotherapy often used in breast and other cancers, may cause damage to the peripheral nerves.
“Neuropathy” is a term used for any kind of nerve damage, and while sometimes the cause is apparent — neuropathy from diabetes or chemotherapy, as in your case — sometimes there is no apparent cause even after a careful evaluation. I get many letters about unexplained neuropathy.
The literature on chemotherapyinduced neuropathy recommends exercise and physical therapy as first line treatments. This is less to reduce numbness as it is to increase function and reduce fall risk, which help to improve the quality of life. Given your feeling insecure on your feet, physical therapy may be the most important treatment for you. A therapist can also check whether your cane is properly fitted and appropriate.
I have often tried gabapentin (Neurontin) or a similar drug, pregabalin (Lyrica), but have not had much success. Duloxetine (Cymbalta) has evidence showing effectiveness at reducing pain and improving numbness, and those treated with duloxetine had a better quality of life than those on placebo. Finally, a preliminary trial showed a compounded cream containing baclofen, amitriptyline and ketamine showed some benefit.
DEAR DR. ROACH: An ear, nose and throat specialist told me not to use nasal sprays that contain oxymetazoline, such as Afrin, since over time they will damage and erode the tissues of the septum and inner nose. He said to use simple salt solution instead. Is this true? I used two shots of this nasal spray, and it cleared my sinuses and nose but was very uncomfortable. I have to be careful since I have had a constructive rhinoplasty and a septoplasty with reduced tissues. — S.L.
ANSWER: I agree with your ENT doctor that long-term use of oxymetazoline nasal sprays, such as Afrin, can cause problems with the lining of your nasal passages. However, there are some times when Afrin or similar sprays are helpful. I have recommended it for people with colds or sinus infections before going on a plane, for example, since it is very effective in short-term use (no more than three days).
Saline spray is a good long-term solution for many people.
For people who haven’t had surgery, or at the direction of your ENT doctor, you could consider a trial of a nasal steroid, for example fluticasone (Flonase) if the saline alone is inadequate.