Dear Dr. Roach: I am 82 years old, and for the past several months, I have been experiencing numbness in the fingers of my left hand. The fingers on my right hand have some numbness, but not to the extent of the left hand. I am concerned that perhaps it might be heart-related, because it is on my left side.
D.D.
Angina pectoris (literally 鈥渃hest pain鈥�) is the classic sign of poor blood flow (ischemia) to the heart. However, despite its name, the sign usually isn鈥檛 pain, and it doesn鈥檛 have to be felt in the chest. Most people with ischemia complain of chest discomfort or chest pressure, usually after exertion but sometimes at rest. The discomfort often feels as though it is coming from other locations, including the left arm, but most commonly that is the inside of the left upper arm. Frequently, the sensation is nausea, shortness of breath, abdominal pain, shoulder pain or back pain. Any of these sensations upon exertion is worth a discussion with your doctor, as they can be the most important signs of blockages in the arteries to the heart, which may lead to a heart attack.
Numbness is only rarely a sign of heart problems. Far more likely, this is a neuropathy, a symptom of damage to a nerve. The most common neuropathy of the hand is carpal tunnel syndrome, compression of the median nerve in the wrist, but cubital tunnel syndrome (compression of the ulnar nerve in the elbow) and compression of the nerves of the neck (cervical radiculopathy) can look very similar, though your regular doctor or a neurologist usually can tell them apart on exam or with a study such as an EMG (electromyogram, an electrical study of the nerves).
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Dear Dr. Roach: My 57-year-old husband had a checkup with his urologist. His PSA level measured 4.2, and he was told to have a prostate biopsy. I am wondering about false-positive tests. Please explain what this is: Does stress make the number higher? Is it affected by diet? What is the prostate, and what should he expect with a biopsy?
A.V.R.
The prostate is a gland that only men have; it鈥檚 located behind the penis and testicles and in front of the rectum. The urethra carries urine from the bladder and flows right through the prostate. The prostate makes prostatic fluid, which makes up the majority of the fluid a man ejaculates. The PSA test looks at the amount of PSA, an enzyme normally found in the prostate, in the blood. The higher the number, the higher the risk of prostate cancer 鈥� although, the test is not perfect. Some men with prostate cancer have very low PSA levels (this would be a 鈥渇alse negative鈥� result), and others have high PSA and no cancer (a 鈥渇alse positive鈥� result). Prostate infection and inflammation, and benign growth of the gland, are common causes for a high PSA level without cancer.
About 25 per cent of men with a PSA level above four but less than 10 have prostate cancer. The biopsy is usually performed by a urologist using an ultrasound probe to guide the biopsy site, and usually five to seven samples are taken. A local anesthetic is used. The major complication is bleeding, which is usually minor.
There remains a great deal of controversy about PSA testing, and it is best to have a discussion about the risks and benefits in an individual prior to getting the PSA.
