Question: My problem is pain in my right hand. It is in the thumb, just at the wrist. It doesn't hurt unless I grasp something. I have great pain writing this letter. Is it some form of arthritis? I have some joint stiffness in other points of my body, but when I get up and move around that disappears. The thumb pain is there all the time. You mention cortisone a lot. Would cortisone shots help me?
Answer: Quite a few things can go wrong to cause pain at the base of a thumb.
Under ordinary circumstances, arthritis would be a good possibility. If it's arthritis, it should react positively to the anti-inflammation drugs such as aspirin, indomethacin or ibuprofen. Successful treatment of symptoms often leads back to a presumed diagnosis.
Cortisone shots are always a possibility. You need a bit more than a guessed-at diagnosis, though, since cortisone is strong medicine.
In an edited portion of your letter you say your doctor referred to "bracing." I don't know what he meant; my guess is that he would like to fit you with a kind of brace that would be slipped over the thumb to allow healing. I have seen small braces work for just such a hand problem.
L.F., who writes with similar symptoms, asks about surgery. When medicine and bracing fail, then you look to surgery. In one procedure, the arthritic bone can be fused together. Loss of some degree of motion is a price paid for control of pain.
You also should rule out navicular fracture, a wrist-bone break near the thumb. X-rays would show it.
Question: A chest X-ray revealed that my heart is slightly enlarged. My doctor said it is nothing to worry about. What might cause such an enlargement, and how will it affect me?
- Mrs. J.
Answer: I trust that in all other matters, you check out fine.
No such finding is ever dismissed out of hand. But if, as I assume, your doctor has ruled out ominous causes, you can dismiss it as a simple finding worth noting.
Had your exam not gone well, your doctor probably would have wanted more pictures, etc.
If it continues to concern you, ask your doctor to explain further.
Your heart-failure pamphlet is on the way. Others can order the report by sending $3 and a self-addressed, stamped (55 cents) No. 10 envelope to: Dr. Donohue - SR138, Box 5539, Riverton, NJ 08077-5539.
Question: I read a response to the question about the effects of cocaine. Could you please answer the same question with regard the effects on the whole body. Also, what about crack cocaine?
Answer: Cocaine stimulates the brain into a short intense euphoria. After that brief effect, the headache, anxiety, depression and loss of reality take over.
The whole body feels the effects. Blood vessels constrict, and blood pressure rises. Body temperature rises as well. Cocaine has led to strokes, even among young users.
Snorted, it can ulcerate and deteriorate the cartilage that separates the nostrils.
Crack is purified cocaine that, when smoked, acts like the inhaled type. Crack's effects are far more rapid in intensity, more immediate in effect and more stubborn in addicting quality.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 5539, Riverton, NJ 08077-5539.