I value your answer because I read your articles constantly. I feel confused but am an active person who still drives, cooks, and takes care of myself. I’ll wait for a reply in the paper. Thank you.

DEAR READER: I completely understand where each physician is coming from and why you have received two conflicting recommendations. Let’s address the issue of your breast tumor first. Because your doctor (I am assuming an oncologist) wants to perform a mastectomy, he has apparently determined that you have a malignant tumor. Unfortunately, you did not indicate what testing was performed in order for your doctor to make the diagnosis. Was it by palpation only, through mammography, ultrasound or MRI? Was a stereotactic biopsy performed? Is the tumor invasive or noninvasive? Invasive implies the disease has spread to surrounding tissue. Noninvasive implies the disease is confined to the lining of the milk ducts (breast cancer) or the lobules (precancerous). Has he or she been informed you have carotid-artery disease?

My guess is that you are also seeing a cardiologist who feels a more conservative approach in your case might be more beneficial. Because of your age and medical history, he or she has likely determined there are other factors that enter the big picture supporting this approach.

The Arimidex he is suggesting is designed to treat breast cancer as well as slow estrogen levels in postmenopausal woman. This, in turn, may slow the growth of specific types of tumors that require estrogen in order to grow.

Patients with a history of heart disease, circulatory problems, severe liver disease, history of stroke or blood clot, and those who have not completely gone through menopause might require testing or dosing adjustments before beginning the medication. You certainly fall into this category, so specific attention to proper dosing must be adhered to.

The best-case scenario is for you to meet with both physicians at the same time, perhaps through a conference call in one office or the other, so both specialists can work together with you to determine whether you are well enough to undergo surgery or whether a trial of the Arimidex is more appropriate. Unfortunately, without knowing all the details and without having access to your complete medical history, I cannot make any recommendations. Good luck.

DEAR READER: Fibrocystic breasts are fairly common, with more than half of all women experiencing fibrocystic changes within their lifetimes. These changes involve the development of cysts, the overgrowth of cells lining the milk ducts (hyperplasia) or the milk-producing tissues (lobules), scar-like tissue (fibrosis) and enlarged breast lobules.

These changes are normal and most often occur in women between ages 20 and 50. Postmenopausal women rarely experience these changes unless they are on hormone therapy.

Symptoms include breast lumps, pain or tenderness, areas of thickening, fluctuating lump size, increasing pain or “lumpiness” from ovulation until just before menstruation and green or dark brown non-bloody nipple discharge.

Women with absent or minor symptoms do not require treatment. Severe pain or large cysts may necessitate therapy. Aspirating cysts is beneficial. The fluid confirms that the lump is a cyst and not a tumor. It essentially removes the lesion and often reduces the pain. If a cyst continues to return after aspiration, surgical removal may be appropriate.

Pain is often treated with over-the-counter relievers such as acetaminophen or ibuprofen. Oral contraceptives can ease the pain caused by menstrual cycles. Danazol is a prescription medication that can relieve severe breast pain by mimicking a male sex hormone; however, it can cause acne, excess body hair and more, thus limiting its use.

Home remedies include a low-fat diet, avoiding caffeine, wearing a sports bra during exercise and while sleeping, and using a firm support bra (professionally fitted is best). Some women have found that taking one capsule of evening primrose oil up to three times a day can manage breast pain and other symptoms.

Fibrocystic breast changes are not a risk factor for breast cancer; however, because some of the symptoms overlap, it is important to undergo testing to ensure that the lesions caused by the cysts or thickening are not, in fact, caused by cancer or a tumor.

As you can plainly see from my answer, there are, in fact, several things you can do in an effort to relieve the pain you are experiencing. Either return to your physician and demand answers as to why he or she didn’t provide you with this information or request a referral to a gynecologist with experience in diagnosing and treating painful fibrocystic breasts.

There is no reason for you to suffer from severe and near-debilitating pain when there are treatment options available that may help. Your doctor has dropped the ball. If you would like to learn more about your condition, the Mayo Clinic has an easy-to-understand article online at www.MayoClinic.com/health/fibrocystic-breasts/DS01070.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

To date I still have a seroma which must be drained once a month and now my surgeon wants to do another surgery to see what is wrong. Have you ever heard of this problem?

DEAR READER:
A seroma is simply a build-up of fluid that usually follows surgery, especially mastectomy (breast removal). In most cases it disappears on its own. Some seromas may need to be drained, occasionally more than once.

In your case, your seroma has failed to be reabsorbed back into the body and continues to accumulate fluid which, I assume, is causing pain, discomfort or annoyance that necessitates its repeat drainage. It has been more than three years, making this a highly unusual case.

I suggest you take your surgeon’s advice and have the surgery to investigate what is causing the seroma to “stick around” for such a long period of time. He or she can then advise you what to do next to ensure that the seroma does not return.

To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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).

I’ve worked as a mammography technician since before it became a specialty, so I’ve had numerous opportunities to address issues and concerns. Recently a reader wrote concerning pain behind the breast. This is a common complaint, so common we no longer discuss it at conferences. One theory is that arthritis develops in the intercostal spaces and the pain radiates into the breast.

Many women seem to take comfort in this possibility and enjoy the peace of mind the knowledge brings when other possibilities have been ruled out.

DEAR READER:
Breast pain is common and affects as many as seven in ten women at some point in their lives. Symptoms are most common in pre-menopausal rather than in post-menopausal women. Alone, they rarely signify breast cancer, but the fear is always first and foremost on a woman’s mind, whether within the breast tissue or behind the breast.

Initial discomfort might be treated with a non-steroidal anti-inflammatory over-the-counter drug, 1000 mg capsules of evening primrose three times a day, 400 IU of vitamin E up to three times a day, or hot or cold compresses. Any discomfort or unusual symptoms should always be brought to the attention of a physician or gynecologist who can perform an exam, schedule a mammogram, ultrasound, or biopsy and rule out abnormalities. While not to be taken lightly, the fact that the discomfort could be arthritis is extremely reassuring to most women.

Keep up the good work and thank you for your articulate letter and the information it contained.

To give you related information, I am sending you a copy of my Health Report “Breast Cancer and Disorders”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The only problem she has had since her treatment is burning and numbness in her feet and legs. I might add she is on her feet eight hours a day as a cashier. She never had these problems prior to her cancer. Her doctors don’t think it is neuropathy. We do have a couple of nerve centers in our area, but would like your recommendation as to the right physician to see for pain relief.

DEAR READER:
Unfortunately, breast cancer is the most common form of cancer among women. The good news is that it can be curable if discovered in its early stages.

Warning signs include breast lumps, thickening or swelling, skin dimpling, nipple retraction, or discharge. Any changes in an otherwise normal breast should be reported to a primary care physician or gynecologist for prompt follow-up.

Chemotherapy is often coupled with radiation for treatment of breast cancer. Chemo refers to the use of a number of anti-cancer drugs used to kill cancer cells, while radiation therapy is an extremely effective, targeted means of destroying cancer cells that can linger after surgery. Radiation can reduce the incidence of recurrence by more than 65%.

Side effects of chemo can include nausea, vomiting, hair loss, weight gain, a reduced resistance to infection, loss of appetite, and more depending on the type used. Radiation side effects include armpit discomfort, heart and lung problems, fatigue, and skin sensitivity. On the bright side, the effects of radiation typically vanish within a few weeks following final treatment. Each form of therapy will affect women differently, so it will not be easy for a physician to state precisely what a woman with breast cancer will experience.

This brings me to some unanswered questions. When did your wife complete her chemo/radiation therapy? If it has been within a couple of months, her symptoms of numb feet and legs could improve. If, however, she had treatment two years ago, we will have to look elsewhere.

If your wife’s doctor doesn’t feel the pain is neuropathy, it will do no harm to visit a pain clinic for an opinion. It might be just the answer you are seeking. Ask her physician for a referral.

I am a 75-year-old male in fairly good health. For the last three months, my right nipple has been very sore. Some days are worse than others. When I told my doctor about it, he said it is from the beer I drink. When I asked about the possibility of cancer, he said I didn’t have cancer because I didn’t have a lump.

Dr. Gott, I don’t think this is caused by beer. I drink about three days a week when I go to the local VFW and I only consume light beer. I don’t drink alcohol at home. My doctor claims it’s only caused by the beer and hasn’t given me any other possible cause.

I’m worried about this since it is only on one side and (to me) doesn’t appear to be related to alcohol.

DEAR READER:
As I have written before, men can develop breast cancer, especially if there is a strong family history of breast cancer, such as in your mother, sister, grandmother or aunt. It is especially worrisome if you have another male relative who was diagnosed with breast cancer. Because you do not give a family history, I do not know if there may be a genetic relation. Symptoms can include nipple discharge, a lump, swelling, tenderness and pain. Just because you do not have a palpable lump does not rule out cancer. I urge you to make an appointment with an internist (a diagnostic specialist) who can perform a breast exam and order appropriate testing such as a chest X-ray, mammogram or breast ultrasound. He or she may choose to order a CT scan or MRI which can provide more detailed images.

If your doctor is dismissing your fears without proper testing and examination, you should find another physician. I hope, for both your and your doctor’s sakes, that the cause of your breast pain is benign. The time wasted by your current physician in getting you proper testing could make the difference in detecting disease in its early stages and necessitating minor treatment and finding advanced disease that needs extensive and powerful medications and possibly surgery.

It is ALWAYS important to follow-up on a patient’s health concerns, even if they are something the doctor feels are minor. It is the doctor’s job to make the patient feel comfortable and that includes answering any questions. Your doctor has completely failed you in this respect. You need to find a physician who is kind, respectful and willing to sit down to discuss health concerns with you. Good luck. Don’t delay any longer in getting the testing you need.

To give you related information, I am sending you copies of my Health Reports “Breast Cancer and Disorders” and “Choosing a Physician”. 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).

I have a strong family history of cancer so the specialist suggested I have a biopsy. He said it would be a painful process. He also gave me the option of wait-and-see.

I have not done anything yet but wonder if I should. The surgeon told me he thought the drainage was from a milk duct abnormality. What is your opinion?

DEAR READER:
Any breast drainage is a red flag warning of possible cancer. Your breast surgeon is, in my view, somewhat correct that a biopsy is an appropriate step, however I suggest you first explore non-invasive techniques, such as mammogram and breast ultrasound. In this way, the surgeon would be able to visualize the mammary glands (milk ducts) as well as the rest of the breast. These procedures should show any abnormalities.

I would just like to mention that I am unsure how your breast surgeon would know where to do a biopsy unless he has already done imaging studies. This would be like throwing a dart at a target but only knowing what wall the target is on. Chances are, if something is present, it would be missed.

Because you have a strong family history of cancer, the drainage is persistent and you have delayed for nearly a year, I urge you to have the imaging studies. Further testing and possible treatment can then be based on those findings. Don’t delay any longer. Breast cancer can be cured if caught in the early stages. There is always a likely chance that the drainage is benign but without evaluation, there is no way to tell.

To give you related information, I am sending you a copy of my Health Report “Breast Cancer and Disorders”. Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.