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DEAR DR. ROACH: I’m a 63-year-old male diagnosed with chronic myelogenous leukemia, Type 2 diabetes and coronary heart disease. I am 5 feet, 11 inches and weigh 240 pounds. I have two stents and take Sprycel for the CML. My levels are good, and the coronary disease is under control.
For a few years I’ve had what feels like “cotton balls” under the skin in the area of the balls of my feet. Now it feels like it’s migrating to the arch. While not too uncomfortable, it is almost impossible to walk barefooted. Some type of foot covering is needed to keep from noticing the feeling. My doctor says it’s the diabetes, and to lose weight or see a podiatrist. Other than losing the weight, do you have any opinion about this? – N.M.
ANSWER: Cotton-ball sensation is one way that many people describe the beginning of neuropathy, a general term for a variety of different conditions that affect the nerves of the body.
In a person with cancer (like CML, chronic myelogenous leukemia, a cancer of the bone marrow) and a new symptom, it is always wise to consider whether it could be due to the cancer, the treatment for the cancer or from something else. In your case, usually CML is not associated with neuropathy. However, the medicine you are taking, dasatinib (Sprycel), has been associated with a severe kind of reversible neuropathy. I read the case reports of this condition carefully, and I doubt that is what is going on with you, as the symptoms you have are different from those reported.
People with longstanding diabetes frequently develop a particular disease of the nerves, diabetic neuropathy. This almost always begins with sensation changes in the feet. I agree with your doctor that diabetes is the most likely cause.
Seeing a podiatrist is absolutely a good idea. He or she can test you for this condition (usually a careful physical exam will make the diagnosis), in addition to looking carefully for any early signs or risk factors for injury or infection. You also should learn how to do a daily inspection of your feet and recognize the signs, so you can get to medical attention promptly should any damage to your feet occur. The podiatrist will make sure you have appropriate footwear.
Many people with diabetes benefit from weight loss, but the important thing is to be sure your diabetes is under good control. This is achieved through good diet, regular exercise and medication, if needed, in addition to weight loss in people who are overweight.
DEAR DR. ROACH: Due to cancer, my prostate was removed about seven years ago. My PSA reading has increased since 2012 from 0.09 to 0.304. Should I be concerned? I am 78 years old and in relatively good health. – B.D.
ANSWER: PSA readings can go up and down, but a threefold increase could mean that the cancer is coming back, and you should see the specialist taking care of your prostate cancer to discuss getting additional testing.
Not having disease for seven years after treatment is a good sign, but the PSA test is pretty specific for cancer recurrence if two separate readings are above 0.2. You may need additional therapy, but only further investigation will show how concerned you need to be.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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