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‘Rule of wrist’ for carpal tunnel

QUESTION: Once, you published a rule of thumb (or perhaps I should say “rule of hand”) for diagnosing carpal tunnel syndrome. My husband has started to get numbness and pain in his left hand (he is left handed) and sometimes has to hold his coffee cup in his right hand. He says he feels like the pain is everywhere from the wrist down and sometimes it goes up to his shoulder. Is there anything we can do without going to a doctor? We have no insurance and this problem is making it hard for him to work as a carpenter.

ANSWER: The rule of thumb (hand? wrist?) is that, if your little finger is involved in the pain and numbness, it probably isn’t carpal tunnel syndrome because the median nerve (the one that causes CTS) doesn’t usually serve the little finger. There are exceptions but they are rare.

The first treatment of choice for CTS is to immobilize the wrist and, surprisingly, this works pretty often. You can buy a really nifty wrist splint at the drug store but, if it does work, don’t throw it away because this condition is likely to recur.

If immobilization doesn’t work, you’re stuck with surgery but you can take comfort that this is a simple outpatient procedure and, as surgery goes, not horribly expensive.

The fact that your husband is having trouble working with his condition may make him eligible for assistance through the Vocational Rehabilitation Administration. I’m usually not enthusiastic about bureaucracy but I can tell you these guys are nice people and they’ve helped a lot of my patients stay off unemployment by paying for treatment from specialists.

Dr. Beaman has practiced in Richton for 28 years.

Octogenarian wants energy vitamin

QUESTION: Is there a vitamin I could take that would give me energy? I find anymore that after a couple of hours in the yard, I’m all in and have to take a nap. I used to be able to put in a 12-hour day without a problem. I’m 82.

ANSWER: There are very few weeks in the office that someone doesn’t ask me what vitamin to take to increase his energy level but I don’t remember ever receiving this question in writing before.

No one ever likes the answer, which is “If you are deficient in some vitamin (which is extremely unlikely) taking that vitamin will help you, otherwise your present energy level is programmed in and very difficult to change.

Not impossible, however because a mild exercise program actually can increase subjective energy levels fairly dramatically. Until about two years ago I was a study in exercise avoidance. Then on a whim I bought an exercise bike and worked up to 100 calories burned every night. It’s made a huge difference in my energy level and feeling of well-being.

I feel strongly that the reason that most exercise programs fail is not that the person does too little but that he tries to do too much.

If you assign yourself the goal of exercising 20-30 minutes a day it simply won’t happen because that degree of exercise is physical torture. You’ll find ways to avoid it.

On the other hand if you start slow with just a few minutes exercise a day and work up slowly staying below the point of physical pain you won’t dread and avoid your workout.

One of the conventional wisdoms is that if you don’t exercise for 20 minutes three times a week, you might as well not exercise at all. Like most conventional wisdom, it’s completely false. In fact exercising one minute a day is vastly better than no exercise, two minutes is twice as good as one and so on.

Dr. Beaman has practiced in Richton for 28 years.

Sweaty palms on his hard drive

QUESTION: A long time ago, you had an article in the Hattiesburg American about sweating hands. I lost the article and moved out of the state but am back now and would like to know what you have to say about my sweaty hands. It’s a problem summer and winter and it is not because I am nervous.

ANSWER: If I knew enough about sweaty hands at the time to write an article worthy of saving, apparently I’ve forgotten it because I just don’t know much about that subject now.

I can tell you for sure that the sweaty-hand phenomenon is inherited, probably as a dominant because practically everyone I’ve ever known who had it had a parent with the same problem. I often use a computer analogy for inherited problems…it’s “in your ROM” or “on your hard-drive”, meaning you can’t get to it to change your programming. To do so would be to fight Mother Nature and I can tell you from years of trying that it’s really tough trying to fight Mother Nature.

Curing or controlling your palm problem would be like trying to dry up the runny nose I inherited from Mom. Lots of things help a little but nothing for very long. I suspect it would be the same for you. There are medications (some blood pressure pills, for instance) that might help a little but your body would learn to compensate within days or weeks.

Sorry, but I suspect you are destined to go through life with sweaty hands. The one treatment possibility, though it’s a long shot, would be a prescription antiperspirant named “Drysol”. This stuff works like gangbusters under arms and it might work on hands but, even if it did, you would want to save it for special occasions and not use it every day or your body would find a way to restore normalcy (for you) even in the presence of the medicine.

Dr. Beaman has practiced in Richton for 28 years.

Better choices than Metamucil

for elevated cholesterol

Click to add text, images, and other contentQUESTION: What is your opinion of the use of products containing psyllium such as Metamucil to control cholesterol? My levels are around 250 total (LDL 160 and HDL 50). I am 45 and enjoy reading your column every week.

ANSWER: About 15 years ago, there was a flurry of interest in Metamucil (and the other psyllium products) to control elevated cholesterol. At the time, we didn’t have any good alternatives because the “statin” drugs (Zocor, Lipitor and others) hadn’t been invented.

I jumped on the bandwagon and had hundred of patients drinking that yucky stuff that ranks just below paper mache on the palatability scale. Not a single one is still taking it. Not only was it unpleasant and inconvenient, it just didn’t work worth a flip. The most I ever documented was about a 10% drop in total cholesterol and most of that came from HDL (the good cholesterol) which is the one you’d like to keep high. I’m sure there are some benefits to the use of Metamucil (regularity, for instance) but low cholesterol isn’t one of them.

With an LDL of 160, you are in a moderate- to high-risk category and you really need to take a modern drug. People with LDL’s of 160 often live to see the insides of Coronary Care Units.

Dr. Beaman has practiced in Richton for 28 years.

Son inherited tendency

toward getting warts

QUESTION: Please help with a frustrating problem. My son has been to 3 doctors several times to have a large wart on his hand removed. One of those doctors is a dermatologist whom he saw twice for that purpose. The cost has now run into several hundred dollars and not only is the wart getting bigger but now others are appearing. No one has indicated that this is some kind of serious problem with no solution. Their methods of removal are just not effective.

Many years ago, I had the same problem and our family doctor burned the large one and several smaller ones with an electric needle. They all dried up immediately.

ANSWER: You had warts and now your son has them also. It’s interesting how those genes work, isn’t it? Don’t get me wrong…I’m not saying warts are a genetic defect. They are caused by a virus but the susceptibility to that virus is inherited just as surely as hair color is inherited (but we won’t get on THAT subject, today).

I’ve never seen anything written about inheritance patterns of wart susceptibility but my experience tells me it’s a fact. Practically every time I treat warts in the office, the mom will tell me another family member has had them.

The electric needle you remember was called a “Hyfrecator” and there’s no doubt it worked like a charm but there were problems. You had to numb up the area because no one could stand to be burned like that and the shot to do the numbing was painful in itself. The whole process was rather gory with the smoke and the smell of human flesh burning and, usually, it left a big white scar. Not a pretty process on the whole. Still, the burning seemed to stimulate the immune response and speed up the development of antibodies to the wart virus, which is really the only way you can heal viruses anyway. It worked but now we have a better solution.

That solution is called “cryosurgery”, which is just a fancy way of saying we kill the wart (or skin cancer or any number of other growths) by freezing the ever-loving life out of it. There’s no wart on the face of the earth that can survive cryosurgery if you do it hard enough. When warts survive the freezing, it is because there wasn’t enough freezing but that isn’t to say the doctor is at fault. Like the hyfrecator, some patients just can’t tolerate a freeze that’s deep enough to do the job. Sometimes, I provide a prescription for elixer of Demerol to put the patient in lahlahland and that allows you to do the job without inflicting too much pain. Sometimes, even that doesn’t work.

Interestingly, there is a medicine (simple over-the-counter Tagamet) that seems to stimulate antibody formation and allow warts to heal more quickly. I have no idea how it works and the data is all just observational but it seems to be effective in some cases.

Of the thousand-and-one colloquial folk remedies for warts, not one is worth a flip. I’m guessing they originated because all warts eventually go away by themselves and whichever treatment is tried last always gets the credit for the cure.

Yes, it’s true…even if you do nothing at all, eventually your son will be blissfully wart-free. Trouble is that might take until he graduates from college and going through high school looking like you own a frog farm could be a humiliating experience.

Take him back to a dermatologist

Dr. Beaman has practiced in Richton for 28 years.

Mom’s moaning drives kids crazy

QUESTION: My mother has started to do something that drives us all crazy. I have been assigned to the task of mentioning it to her but first I wanted to make sure this wasn’t a sign of disease that she didn’t have any control over.

Her problem (OUR problem, really) is that she moans loudly with almost every breath. I don’t think she’s in any pain or she would mention it. The moaning, frankly is so annoying and, in public, so embarrassing that we find ourselves avoiding her and I know she is hurt by this.

Do you think she could actually be in pain and hiding it from us? We would all appreciate your advice.

ANSWER: I doubt if pain is the source of Mom’s moaning. It’s more likely she doesn’t hear well and can’t hear the sound she’s generating or has concluded (wrongly) that it’s too soft for anyone to hear but her. At this point, it’s probably become such an engrained habit it will be tough to break. Tough but not impossible.

Have you ever noticed that it feels good to moan? When you think about it, it would be an easy habit to get into, especially if you couldn’t hear it yourself.

I like to think of myself as completely free from such annoying quirks but Sandra tells me that, when I’m uncomfortable or being forced to do something I don’t want to do, I growl like a bear. I’ll think I’m being quiet and attentive when she will elbow me and whisper, “Stop making your bear noises”. I’m sure she’s just making it up to embarrass me but it works every time.

I’m guessing your mom would die a thousand deaths before she knowingly did anything to embarrass her children or limit her contact with them. She probably will welcome your input but don’t expect the behavior to stop abruptly. You’ll have to remind her again and again (kindly) but be patient. There really is some wisdom to that “old dog – new tricks” analogy.

Dr. Beaman has practiced in Richton for 28 years.

No test ever cured anybody

QUESTION: I have been going to Dr. (deleted) with my (deleted) and I am about to decide all he is interested in is tests and money. I go in to his office, his nurse does everything and then he breezes in and says I need such-and-such test. He never even tells me what the LAST test showed and he sure never explains why I need the test. In fact, he never explains ANYTHING. If I question the need for the test, he gets mad and walks out of the room.

Would you keep going to a doctor like this?

ANSWER: I purposely deleted the name and specialty but I can tell you I know the doctor you’ve been using and I couldn’t agree more. My impression is that tests are everything to him and patients are a necessary evil so that he can have somebody to run tests on. If this isn’t the case, it’s certainly the impression he leaves. I seldom go a week without someone coming to me to get them away from that doctor and in to another one in that specialty. Sad but true.

Regardless, you are under no obligation to go to ANY doctor…particularly one you feel uncomfortable with. Go to your regular family doctor to get his recommendation and referral.

Dr. Beaman has practiced in Richton for 28 years.

Smokeless tobacco a killer

QUESTION: I would like your opinion on the use of “smoke-less” tobacco. I have had a blocked coronary artery that has been reopened. I have continued to use smokeless tobacco since that time. My children and grandchildren constantly stay on me about this. Is this really harmful or would a small amount occasionally be OK? I am a man in my late fifties.

ANSWER: If you want to be around to watch those grandchildren graduate and get married, you need to avoid tobacco in any form. It doesn’t matter whether you roll it up and smoke it, stick it into your cheek or bake it into brownies, the net effect is the same…your arteries narrow down and the blood supply to your organs (heart included) is reduced.

A person whose heart muscle has already been starved for blood doesn’t need any more constriction of his coronary arteries than already exists.

I get the impression from your letter that you were hoping for something in the way of affirmation from me…something you could point to triumphantly but I can’t provide it. Sorry.

Dr. Beaman has practiced in Richton for 28 years.

Artificial sweeteners perfectly safe

QUESTION: My son who works at the shipyard showed me the enclosed sheet telling about the dangers of an artificial sweetener. If half of this is true, this stuff should be pulled off the market and everyone who ever took it should be compensated. What do you think?

ANSWER: The sheet you sent has been making the rounds at large industrial complexes for several years now. I’ve gotten a half-a-dozen or so copies and I still haven’t figured out why anyone would go to the trouble to cook up such a litany of bogus gobbledegook unless they were trying to get a class-action lawsuit rolling.

Nothing on that sheet makes the slightest sense medically or statistically. It’s just meant to inflame the reader and it does that pretty effectively. You have to hand it to the author…he knew how to whip up a frenzy without any hard evidence to point to.

There is one tiny shred of truth among the malarkey and that’s the fact that the Air Force and Navy have discouraged their pilots from consuming this product before they fly for fear their short-term memory would be affected. The studies are conflicting on this but at least one appears to show mild, temporary memory impairment in people who use the stuff regularly.

If you’re wondering what product all the fuss is about, you’ll just have to keep on wondering because I have no desire to fan the flames of litigation or get sued by a major manufacturer. I can say it is a sweetener whose name you would recognize.

My advice to people who use a lot of any sweetening product and who feel their short-term memory (what you had for breakfast this morning rather than what you used to eat for breakfast as a child) has declined, is to change sweeteners and see if things improve.

Not likely but it’s worth a shot.

Dr. Beaman has practiced in Richton for 28 years.

‘Stay in bed and drink plenty of

fluids’ advice really works

QUESTION: When I get a cold, I’m usually not sick enough to bother the doctor but I would appreciate if you would mention in your newspaper column the things a person can do to shorten a cold and minimize the symptoms. I’m not talking about the flu, just the stopped-up head, coughing, sneezing rotten cold that feels like it will never go away.

ANSWER: Things you can do to make a cold go away quicker? The list is very short…you can get as much rest as possible and drink plenty of liquids. I know this sounds like “little house on the prairie” medicine but it really does work….you really DO get over a cold more quickly if you stay in bed. That was demonstrated in a study in Helsinki Finland decades ago but we all really knew it all along.

The “drink plenty of fluids” thing has to do with the fact that water is a cofactor in the production of antibodies and, when your nose is dripping like a faucet, water is leaving your body at a prodigious rate. When you think about it, a runny nose is like an IV drip in reverse. You’ve got to replace that water and a glass of juice or Gatorade at the bedside is about the only way to do it.

That takes care of the “things a person can do to shorten a cold”-part of your question. Now, moving on to the “minimizing the symptoms”-part which is an entirely different question.

As far as I can tell, there is no role for antihistamines in the treatment of viral colds. Despite the fact that every “(blank)-Cold and Sinus” remedy under the sun has an antihistamine in it, they probably do more harm than good because they thicken and dry the very secretions you’d like NOT to be thickened and dried…the bronchial and sinus secretions. Some of them give you one medicine to thicken and another to loosen secretions…bizarre. I give them all a wide berth.

The DECONGESTANT medications (like pure pseudoephedrine) work fine to open up the head of a cold sufferer but there are a lot of precautions you have to observe like the high blood pressure that can make your head explode (don’t you hate it when that happens?).

The BEST way to deal with colds is to avoid them entirely. The Chinese showed in a careful study that, to do that, all you have to do is walk around all the time with cotton balls stuck up your nose.

I don’t expect that approach to catch on.

Dr. Beaman has practiced in Richton for 28 years.

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