Question: My daughter has been diagnosed as having RSD from a knee injury she had in a fall three years ago. An orthopedic doctor told her it would be useless to operate on her until the nerve problem is taken care of. Her leg is cold from the knee down. What do you know about RSD? Is it real? She's now on crutches.
- L.N.
Answer: RSD (reflex sympathetic dystrophy) is real. It can happen after a fracture, sprain, even a bruise, and it progresses through three stages. The first is a burning pain onset, about three months after the injury. Skin in the area sweats and becomes sensitive to touch. Three months later, pain may abate a bit, replaced by a stiffness. Then three months later still, muscle wasting starts.
The sympathetic nerves regulate certain automatic functions. One is the regulation of blood vessel caliber, which in turn dictates blood flow. Disruption of this system occurred in your daughter's lower leg.
I can't overstate the difficulty of RSD. Some need a team approach, including a physiatrist (a rehab specialist) and physical therapist to tailor a program of vigorous exercise.
You must avoid immobility, which can accelerate the muscle wasting. You may even need an anesthesiologist for a program of pain relief to allow her physical therapy. Massage and whirlpools, nerve blocks, even medication "pumps" to deliver metered pain relievers to the lower back nerves.
I can understand reluctance to operate right now. Premature surgery might worsen things.
Question: I have degeneration in my right eye. Can zinc help retard it? Can it affect the other eye?
- F.S.
Answer: The macula is a small circular area of the center of the retina, the retina being the specialized sheet of light sensitive cells at the back of the eye. To the retina falls the task of focusing light signals for relay to the brain's image formation function.
The sensitive macula delivers the sharp, clear central vision, the kind you need for reading or sewing.
Macula degeneration is pretty common. Yet we know little of its cause except as a part of aging.
Ultraviolet light and light in the blue spectrum may contribute to the degeneration, so wearing glasses that filter out both kinds of light makes sense.
Smoking may put a person at greater risk for having degeneration. A diet rich in spinach, collard greens, kale and other green leafy vegetables appears to afford some protection against it. Similar claims have been made for foods rich in carotenoids - like carrots and tomatoes. Zinc benefit has not been resolved.
Yes, the other eye may become affected.
Question: Can you list some of the new medicines that you can use against osteoporosis?
- Mrs. L.G.J.
Answer: There are at least three new medicines for osteoporosis treatment, and especially useful for women who cannot take hormone therapy. Calcitonin nasal spray is one. Up to now, it has been available by injection. It also comes in pill form. Another medicine is slow-release fluoride, which recently became available for osteoporosis. It is taken orally. Another oral medicine is alendronate.