Popping sounds can be normal
DEAR DR. ROACH: I have been diagnosed with multiple myeloma in the smoldering stage, based on a bone marrow biopsy and blood tests. Every three months, my hematologist checks my blood tests and tells me that when I feel bone pain, it will be time to begin chemo. While I am in the smoldering stage, is there anything I can do to prolong the shift to the full-blown stage? I am 79 and otherwise in good health. My only symptoms are some fatigue and lack of energy. – W.K.
ANSWER: Multiple myeloma is a type of cancer of blood cells – the plasma cells, which are responsible for making antibodies. Most, if not all, cases of myeloma have a precursor stage called MGUS, monoclonal gammopathy of uncertain significance. About 3 percent of all people over 50 have MGUS, and about 1 percent of people with MGUS will develop MM per year. "Smoldering" MM is the diagnosis when the bone marrow biopsy shows evidence of MM, but there are no other signs of MM. Signs of MM include myeloma in the bones (on X-ray or CT, called lytic lesions, since they cause holes in the bones), anemia, high calcium, poor kidney function and high viscosity of the blood, which predisposes a person to strokes.
In addition to looking for physical symptoms, your hematologist is searching for any of these findings. In addition, the amount of immunoglobulin in the blood predicts risk for developing overt MM (the higher the immunoglobulin, the higher the risk). A level over 1.5 g/dL puts you at high risk. Although trials are ongoing, there are no generally accepted treatments to prevent progression to MM for people with MGUS or smoldering myeloma.
DEAR DR. ROACH: I had colon cancer nine years ago and had 12 inches of my colon removed. Quite a few times since then, I have lost control of my bowels, or have had a large movement that I couldn't stop. Last night, I had one in my sleep. This is the first time that has happened. I take Metamucil, which was recommended by my internist, but it doesn't seem to work. What kind of doctor should I see to help it? – J.W.
ANSWER: Fecal incontinence is a common problem, but one that is so embarrassing for some people that they won't bring it up with their doctor. It can lead to social isolation, and is the No. 2 cause listed for nursing-home placement. Incontinence has many possible causes and, therefore, many types of treatments.
Your internist is probably right about fiber, as it is very helpful in people with liquid stool, but it can make things worse in people with a stricture, such as from radiation, a common cause of incontinence. If you do try fiber, adjust amount so that you are having one or two soft but formed bowel movements daily.
Other types of treatments depend on the underlying problem. Biofeedback, medications, surgery and nerve stimulation are all treatments that have been useful in some people. A gastroenterologist, the specialist in this area, or your cancer surgeon would be the right person to start with.
DEAR DR. ROACH: In discussing treatment of nail fungus, you did not mention newer laser treatments that I see advertised by podiatrists in my area. Are they effective? – J.F.
ANSWER: We don't really know if they are effective, since well-done studies haven't yet proven it; however, preliminary evidence is suggestive. This would be a great addition to treatment, since the only currently accepted highly effective treatments are oral medications, which have risk of liver damage. Even more exciting is the idea of combining a topical antifungal agent, amorolfine, with laser. This medication is not available in the U.S., but a study in Korea showed a 50 percent effectiveness rate (which is pretty good for this difficult-to-treat condition).
Since I last wrote about this condition, I heard from a lot of readers. Some mentioned cures from Vicks Vapo-Rub, but the only study I found on that showed a 22 percent cure rate. One person asked about surgery, but since the fungus gets into the nail bed, the infection often recurs after removing the nail. Listerine and white vinegar mixed half and half cured one couple, and several people had success with Dr. Paul's Piggy Paste, which also is vinegar-based. None of these has good data to support its use, but all likely are safe.
DEAR DR. ROACH: I am 70 years old and have been dealing with a problem for about a month now that I've never read about in your column. The upper joint in my left thumb pops every time I bend it. The lower thumb joint is tender, and it is becoming increasingly difficult to grasp things. The thumb never gets stuck. My right thumb pops only occasionally, and there is no pain there. Can you please tell me the cause of such an anomaly, and the type of doctor that I should be seen by? I am very active, and this has become a bit bothersome. – C.G.
ANSWER: If it's not getting stuck, then the popping sound can be made by one of the tendons snapping over a bony protuberance, or it can be from nitrogen bubbles coming out of solution. Neither of these usually causes much trouble, but the fact that you are having pain suggests that you may have some arthritis in the thumb joint. A rheumatologist is the expert in all joint matters, but your regular doctor probably has a fair bit of experience with this as well.
DEAR DR. ROACH: I am a 74-year-old male with a breast issue. When I press on the nipple or around it, I feel pain. It has been seven weeks, and no change. I can't say I feel a lump, but it does seem harder under the nipple compared with my other breast. I did not bump or bruise it, and I see no marks or discoloration. – R.F.C.
ANSWER: You should go and get it checked out right away. While breast cancer in men is uncommon, it does happen, and the sooner it is evaluated, the better. Odds are it's nothing to worry about, but get seen.
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]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved