DR. ROACH: Several treatments available for carpal tunnel symptoms
DEAR DR. ROACH: I have symptoms of carpal tunnel syndrome. I read that a hand brace can help with this. Does it really work? Does anything else (besides rest)? -- K.R.
ANSWER: The carpal tunnel is an anatomic space inside the wrist. The median nerve runs through this space, and provides sensation to the thumb, index finger, middle finger and half of the ring finger. In carpal tunnel syndrome, the nerve is compressed. This can happen during pregnancy, with thyroid disease and with overuse, especially high trauma cases, such as in a jackhammer operator. Many times there are no particular risk factors.
The symptoms of carpal tunnel syndrome include pain and numbness in the affected fingers. Sometimes the sensations feel like they are going up the hand, but do not usually rise above the elbow. If symptoms progress to the point of weakness, then it's time to visit the hand surgeon in order to avoid permanent weakness and atrophy of the hand muscles.
For people with numbness or tingling but not weakness, there are several treatments, some of which can be effective for a given person. If there is a medical cause, such as thyroid disease, treatment of the underlying issue can make carpal tunnel syndrome go away. For those who are overusing the hand and wrist, reducing activity can make a big difference. Anti-inflammatories are modestly helpful at best, but yoga was shown to be effective. Injection of steroids is helpful, but it last only a few months in most people. A brace that keeps the wrist in a neutral position (straight, not bent up or down), especially at nighttime, is effective in some people, and may delay or eliminate the need for surgery. Some people wear the braces continuously.
DEAR DR. ROACH: My brother, who will be 70 in October, was diagnosed with LGL leukemia. I would appreciate any information on this cancer that you can give. -- L.R.
ANSWER: Large granulocyte lymphocytic leukemia is a rare form of leukemia. It illustrates a paradox of liquid cancers: It isn't curable, but it is indolent, with almost 90 percent of people being alive five years after diagnosis, and more than half of people alive after 10 years. Other more-aggressive leukemias are more likely curable, since many of our treatments are directed against very active cells.
Not everybody with LGL leukemia needs treatment at the time of diagnosis. Treatment is given when the blood cell lines become low, whether they are red blood cells, white blood cells or platelets. Chemotherapy is the standard treatment.
DR. ROACH WRITES: I have written several columns about C. difficile infection. Numerous people wrote, including a few pharmacists, to remind me that the IV form of vancomycin can be compounded for oral use for a fraction of the cost (one writer said his out-of-pocket cost for oral tablets was $1,100, and for compounded, $80). Not every pharmacy can or will do this. Another writer wanted me to mention fidaxomycin (Dificid), a new and very expensive treatment for C. diff. Its website had a "$200 off" coupon when I accessed it. Many people wrote to tell me that fecal transplant is considered experimental and not covered by their insurance.
Another very helpful comment I received told me about a resource, NeedyMeds, which helps people who meet certain income criteria with expensive medications, including oral vancomycin but many others as well. It can be found at www.needymeds.org.