Dear Dr. Roach: For the past seven years, I have had an itch under my shoulder blade on my back. It stretches from the left side to the centre. There is no rash or anything visible on the skin; it just itches all the time. Neither my physician nor my dermatologist has a remedy. My physician indicated that it might be shingles, but under the skin. It that were the case, where is the pain associated with shingles? I so desperately need a solution to this problem.
J.C.
It is true that after an episode of shingles, some people have severe, prolonged itching. The fact that this is on a discrete area on one side does suggest that it might be itching related to a damaged nerve, and shingles certainly damages nerves. Some people with shingles have only mild pain, while others may have pain without a rash, but a rash and moderate to severe pain is the most common presentation, by far.
However, I think it鈥檚 much more likely that you may have the condition notalgia paresthetica, a condition of localized itching thought to be related to nerve compression in the upper back. There is no rash, apart from damage done where people scratch too much.
The most common treatment is topical capsaicin cream. Sometimes oral medications are used, and other treatments have included nerve stimulation (TENS) and nerve block.
听
Dear Dr. Roach: It will be two years in July that I had two metal plates put in my left leg at the ankle 鈥� one on each side of it, plus about 20 pins 鈥� due to an injury caused by being hit by a car. I believe they are made of titanium.
I was just recently injured by a shopping cart. My question is whether an MRI is safe for my back, which still bothers me. I have been told it is, but I would like your opinion, please.
C.M.
If you are sure that the metal is titanium, then an MRI is safe. However, you don鈥檛 sound 100 per cent sure, so what I鈥檇 recommend that you do is get a copy of the operative report from your surgery back in 2014. That should contain the exact description of the metal plates used, in order to determine whether it鈥檚 safe for use in an MRI scanner. Most plates used now are, but since the MRI can generate a great deal of heat, most MRI facilities will not perform the test without being sure.
听
Dear Dr. Roach: My husband has high triglycerides, and his HDL is always low. He has a heart condition and is under a great doctor鈥檚 care. We are wondering if you have any suggestions that might help to improve the levels for both.
L.D.
The combination of high triglycerides and low HDL is common, and often relates to a condition called 鈥渕etabolic syndrome.鈥� A large waistline and high blood pressure often go along with this condition, but the major concern is development of prediabetes or diabetes. Losing even a few pounds can really help reduce this risk.
Although there are medications for this condition, such as metformin and statins, many people can effectively treat this with a careful diet, especially avoiding excess processed carbohydrates and simple sugars, and getting regular exercise, such as a brisk 30-minute walk per day (on top of, not instead of, whatever else he might be doing).
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].
