#MIDDLEBURY
By Keith Roach, M.D.
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 suggests they may be. This would be a great addition to treatment, since the only currently accepted highly effective treatments are oral medications that 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 their 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 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 ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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