TO YOUR GOOD HEALTH
By Keith Roach, M.D.
DEAR DR. ROACH: I am a 77-year-old male. I had to stop playing golf about two years ago due to joint pain. I had psoriasis from age 15 until I was 40. I am retired from the Navy and had to be hospitalized twice during my time in service due to my skin. Why it disappeared at age 40, I don’t know. Is it possible that I could have psoriatic arthritis? One doctor I saw said that I had to have psoriasis in order to get it. I saw that you said that sometimes the arthritis shows up before the skin lesions. Can it show up after you have quit having the lesions? – Anon.
ANSWER: Indeed, psoriatic arthritis can show up years after psoriasis starts and when there are no skin lesions. Often, pits in the nails or other nail changes are seen in those with psoriatic arthritis.
However, having psoriasis doesn’t protect you from other types of arthritis, such as osteoarthritis or rheumatoid arthritis. Since psoriatic arthritis is so destructive, you should see an expert, perhaps a rheumatologist.
The arthritis booklet discusses rheumatoid arthritis, osteoarthritis and lupus. Readers can order a copy by writing: Dr. Roach — No. 301W, 628 Virginia Drive Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: Do varicose veins in the leg still return blood? Does circulation diminish if they are removed? Should the elderly avoid removal? What if a vena cava filter exists for a one-time DVT 25 years ago? – S.S.
ANSWER: Varicose veins are dilated veins. They are very common, especially as we get older, and they seem to run in families. They often come because of leaky valves inside the veins. A previous blood clot is a risk factor, and a filter may make varicose veins and clots somewhat more likely.
They do continue to function, returning blood. They should be treated conservatively, with leg elevation, exercise and compression, such as using pressure stockings. I seldom recommend more aggressive therapy, but if they are symptomatic (pain, tightness, skin irritation) despite a good trial of conservative treatment, they can be treated with laser or radiofrequency ablation, by injecting medication into or around them, or by vein stripping. A vascular surgeon is the expert on these treatments.
DEAR DR. ROACH: I am a 63-year-old male who had a subarachnoid hemorrhage in 2008. The source of the bleed could not be found, and fortunately I came out of it in good shape, with no adverse effects. My doctor prescribed diclofenac [an NSAID] for joint and muscle pain, and it does help. Do you see a problem with this, considering that it thins the blood? – T.O.M.
ANSWER: Since the aneurism wasn’t repaired, I would not recommend taking the NSAID unless your consulting neurosurgeon has specifically told you that it is safe to do so. I wouldn’t be brave enough to prescribe it without that OK, even though there is some evidence saying it may be safe.
Dr. Roach regrets that 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. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive Orlando, FL 32803.
(c) 2015 North America Synd., Inc.
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