DEAR DR. GOTT:
I read your column faithfully and find it very helpful and interesting is so many ways for both my family and me. I am an 84-year-old female in very good health. I had stage II breast cancer followed by breast removal 16 years ago. I was on tamoxifen for five years but never had chemotherapy or radiation. I continue to have yearly mammograms and so far, everything has been good.
I used to be a competitive racewalker, competing locally and nationally with the Senior Olympics. I received numerous medals in both levels but had to give it up to take care of my husband about 10 years ago. I continue to racewalk on my own. I was treated for leg and back pain while doing this competitively.
I am writing for you opinion on two issues. The first is treatment of meralgia paresthetica. I have tried epidurals and increasing dosages of nortriptyline (25, 50 and then 100 mg). The injections did not help, the nortriptyline did not work, and the 100 mg dosage caused side effects. My doctor has now prescribed gabapentin 300 mg which I have not taken yet because I want to make sure the other medication is out of my system first.
I would like to know you thoughts on this line of treatment and if there is something else, such as chiropractic manipulation, that may be of benefit to me.
My second issue is high cholesterol. My internist doesn’t feel I need medication but I am afraid that I am at risk of heart attack and stroke. I have enclosed copies of my lab results from my last nine annual physicals.
Thank you for anything information you can give me.
DEAR READER:
I will start with the cholesterol issue. You kindly provided 9 years worth of cholesterol tests that have repeatedly shown high cholesterol levels ranging between 246 and 330. This on its own would be cause for concern but taking a further look at the breakdown numbers reveals a different story.
Your HDL, the good cholesterol, has ranged from 70.7 to 102. The LDL, or bad cholesterol, has ranged from 130 to 196. And, finally, your triglycerides went between 131 and 208. This year your cholesterol reads as total: 330, HDL: 102, LDL: 186, triglycerides: 208. Your last two cholesterol tests included a cholesterol/HDL risk ratio which basically evaluates your heart attack and stroke risk. Both 2007 and 2008 were 3.2 which puts you in the low risk category.
This all means that while your total, LDL and triglyeride levels are high, your HDL level is equally high. HDL cholesterol essentially is the street cleaner of the body aiding removal of plaque and LDL.
Judging by your LDL levels, you do not appear to be on a low fat diet. If you were to take this simple step, your cholesterol levels may drop but as long as your HDL remains high and your risk level remains low this is not necessary.
Now to the meralgia paresthetica. This is an annoying and sometimes painful but harmless condition. It is caused by compression of the lateral femoral cutaneous nerve which supplies sensation to the skin surface of the thigh. When the nerve is pinched, it can cause burning, tingling or numbness on the outside of the thigh.
Compression of the nerve can be the result of tight fitting clothing, pregnancy, obesity or weight gain, injury or trauma. Treatment is aimed at relieving the pressure by wearing looser fitting clothing or losing weight. Some individuals may need medication to relieve the discomfort. Severe, long-lasting symptoms may require surgical decompression, but this is a last resort.
Your doctor has correctly treated you thus far with steroid injections, epidurals, and tricyclic antidepressants (nortriptyline and gabapentin). However, you do not say if he or she recommended a reduced exercise program. Your condition may be the result of racewalking. One of the most important self-treatments is to avoid walking, cycling and standing for long periods of time.
I recommend you reduce your racewalking and try the gabapentin. You may also wish to try alternative treatments such as acupressure or massage therapy. If these do not work, return to your doctor and discuss whether or not you are a candidate for surgery. At 84, the risks may outweigh the benefits resulting in you having to live with the discomfort. Remember surgery is a last resort and becomes riskier as we age. With luck you will be able to control your symptoms with a non-invasive treatment.
Let me know how this works out.
To give you related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Managing Chronic Pain”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).
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