Dear Dr. Roach: I am an 82-year-old male. In my younger years, I participated vigorously in sports. As a result, I ended up with a degenerated joint in the big toe of my right foot. Forty years ago, the doctors gave me an artificial joint. Prior to the joint installation, I was in severe pain. After the procedure, I had no pain or problems of any kind with the joint. My oldest daughter has a bad joint in her big toe that gives her a lot of pain, plus problems walking. Her doctors tell her that they will not replace that joint anymore. Instead they propose to fuse the joint. She would be off her feet for six weeks, and she would have to undergo eight weeks of intensive therapy and learn to walk differently.
Why would they not do the procedure for her, when my procedure was so successful? A.E.C.
Not everyone with a 鈥渂ad joint鈥� in the big toe 鈥� usually a bunion 鈥� needs surgery. Many people get relief from conservative measures, such as shoe modification, orthotics, night splinting and stretching. If pain or difficulty walking persists despite conservative measures, then referral to a foot surgeon is appropriate.
There are more than 150 surgeries described for treatment of bunion deformities. Joint replacement (arthroplasty) is still being done, but a 2005 trial comparing a fusion procedure (arthrodesis) to joint replacement found arthrodesis to have superior pain control. Other studies have found the two procedures to have very similar outcomes.
While I am glad you had such a good outcome, one has to be very careful when comparing one鈥檚 own treatment with someone else鈥檚. There may be subtle differences between you and the other person that you aren鈥檛 aware of. Or, as may be in this case, surgery techniques may have changed over time.
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Dear Dr. Roach: I am 72, and for the past few weeks I have been fighting a case of hives. The dermatologist has taken me off nearly all meds, as a biopsy shows I have a chemical allergy. The itching is severe. Is there anything other than triamcinolone cream that can calm things down? The hives are large, most of them flat, and most ringed with red. The only meds I take are for diabetes and a thyroid condition, and I鈥檝e taken them for ages. F.L.
I am surprised you aren鈥檛 taking an antihistamine, like Benadryl or a prescription equivalent. But the issue here is why are you having hives? There are many causes, and the biopsy report, while consistent with chemical allergy, might not be definitive. If the hives last more than six weeks, normally you鈥檇 get a series of blood tests, with perhaps additional follow-up testing if necessary. Sometimes the cause is never found.
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Dear Dr. Roach: I am 75-plus-year-old healthy female. My doctor鈥檚 comment on my most recent annual physical test results was: 鈥淕reat results on all tests. Excellent report.鈥� My question: Is it necessary to have another colonoscopy at my age and with my good health. My mother died of colon/rectal cancer at age 85 in 2002, and all family members were advised to have this procedure. My initial results were two or three polyps removed that were not the type that would recur and were not cancerous. The recommended followup was five years. The results of that exam showed no polyps, slight indication of diverticulosis and no recommendation for future followup.
My previous doctor has retired, and I just received a letter from his replacement that I am due for another procedure. I am not inclined to do this at my age, and considering the 鈥渁ll clear鈥� reports of the previous exams and my general good health. I would appreciate your thoughts and recommendation. B.J.M.
The odds are low that the colonoscopy would find something there, but there is still a small chance, especially with your mother having had colon cancer. Not having it is reasonable. But since you seem to be otherwise healthy and can expect a longer life than average, I would encourage you to have it.
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Dr. Roach Writes: Many readers wrote in about chronic cough. Several mentioned the possibility of cough due to medication side effect, which is common with ACE inhibitors, used for high blood pressure or heart failure. Chronic sinusitis, postnasal drip due to an infected tooth and food allergies were mentioned. An additional one is ear wax 鈥� this can affect the nerve in the ear canal that goes to the lung, causing a cough reflex. It鈥檚 rare but it does happen.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
