Dr. Roach: Woman with spina bifida should seek expert
Dear Dr. Roach: My sister has spina bifida. She is 72, on heavy-duty pain meds and is very discouraged, as no doctors have been able to help her. Some have even hurt her in their efforts to assist. My inquiries online have been useless, as they only refer to infants with the disease. She tries to go for walks, as that seems to help; however, I am guessing her mobility has decreased substantially. She has been blessed with a wonderful husband who takes care of her and is able to “adjust” her back to alleviate the pain.
Dear N.A: “Spina bifida” is a term used for several defects in the neural tube that can affect the skull or back. There are many different subtypes, and they are primarily described by what part of the anatomy is affected. If the skin fails to close, this is spina bifida aperta, and would be treated surgically at birth. I suspect your sister has spina bifida occulta, also called closed spinal dysraphism, where some of the structures that support and protect the spinal cord (especially the spinal vertebra) fail to properly fuse together. The lining of the spinal cord (the meninges) can go through the resulting opening, causing a meningocele. The spinal cord itself also can go through, in which case it is called a meningomyelocele. The best type of treatment for your sister depends on the precise anatomy, and it is beyond the scope of a column to go over in detail.
What I can do is help you find an expert in treating older adults with these kinds of problems. The Spina Bifida Association maintains a list of clinics that specialize in spina bifida, often affiliated with teaching hospitals, with notes about whether it takes care of adults as well as children; the website is www.spinabifidaassociation.org. I would be surprised if surgery would be considered at age 72, but based on what you are telling me, a team of experienced clinicians, including neurosurgeons, physical therapists, orthopedic surgeons and others should be able to design a treatment regimen that could reduce her pain, improve her function, reduce her medication needs and make sure her husband is safely treating her.
Dear Dr. Roach: I would like to know about warts. I know they are common in both children and adults. I have one on my thumb. I am 50 years old. Where can the warts spread to? I heard you can only find them on your hands and feet. Is that true?
Dear J.L: Warts are raised round or oval growths, caused by the human papilloma virus. Although they most commonly occur on the hands and feet, some strains of HPV are more likely to cause warts in the genital region. Warts can appear on any part of your body, and you can spread them from one part of your body to another, as well as from person to person. Warts are more likely to occur in areas of skin that are irritated, such as cuts, scrapes and even areas that are shaved. For this reason, it’s a good idea to treat the wart quickly, preferably before it gets bigger and harder to treat.
Over-the-counter wart treatments are most commonly salicylic acid. A nail file or pumice stone to get rid of dead skin first increases effectiveness. Liquid medicine is used for thinner warts, and a plaster is more effective for thicker warts.
One home remedy is as follows: Apply silver duct tape to the wart and leave it on for six days. Follow up by soaking the wart and removing any dead skin, then leave the tape off overnight. Repeat the process by applying duct tape for another six days. This is effective in some people. You should see your doctor if these home remedies don’t work.
Dear Dr. Roach: Have you heard of Boswellia? Would you recommend it for arthritic pain?
Dear F.P: Boswellia, also called Indian frankincense, is an herb that has been used for millennia in India as an anti-inflammatory for relief of arthritis pain. I was able to find a well-done study from 2011 that showed significant benefit in reducing pain and improving function in people with osteoarthritis of the knee. The only side effects seen were minor headache and nausea. Other studies, all small and relatively short, confirmed these results.
Based on these small studies, it appears that Boswellia extract may have benefit in improving pain and function in people with osteoarthritis of the knee.
I found products that are labeled as having what the study medicine did (most commonly 100 mg once daily, containing at least 20 percent AKBA, the active ingredient).
However, let me emphasize that supplements are not subject to oversight by the U.S. Food and Drug Administration. In February 2015, the New York state attorney general’s office accused four major retailers of selling fraudulent and potentially dangerous herbal supplements under their store brands.
Of the products they tested, 78 percent did not contain any of the herbs on their labels, and some contained substances potentially dangerous to those with allergies (including wheat in products labeled “wheat- and gluten-free,” and powdered legumes, a potential risk for those with peanut allergies). These products were labeled “standardized” and “guaranteed.”
There may be good manufacturers, but with no way of independently testing their products, I cannot give a recommendation for a particular brand.
Email questions to ToYourGoodHealth@med.cornell.edu