Dear Dr. Roach: We recently lost a dear relative to cholangiocarcinoma. He had served in the U.S. Navy in Vietnam. The probable cause of his cancer was from a parasite, a river fluke, common to that region. The diagnosis came way too late to save his life. How can veterans be tested or diagnosed early enough for a possible successful cure? Are there any current tests available?
J.A.E.
I am sorry to hear about your relative. Cholangiocarcinoma is cancer of the bile duct, a rare cancer. Liver flukes are a risk factor, and so is a condition called primary sclerosing cholangitis, a condition associated with ulcerative colitis. The cancer is rare but highly lethal, because by the time symptoms show up, the cancer usually is advanced.
Also because of its rarity, screening for the cancer in a general population won鈥檛 be effective. However, for people at high risk, such as those with a history of liver parasites, at least one study has shown that screening with a blood test (CA 19-9, CEA) or by endoscopy can be effective. It would be reasonable to speak with the expert taking care of this problem, usually a gastroenterologist, about screening.
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Dear Dr. Roach: My mother, 88, recently switched her medicine for hypertension from timed release, which she has been taking for 10听years, to one that is not timed release, because the timed release was too expensive. I鈥檓 worried. Has she compromised her health by doing this? Her cardiologist gave her the go-ahead. J.R.
In my opinion, timed-release versions for high blood pressure are preferable to non-timed-release because the level of the medication in the blood can go up and down to a greater degree with the regular-release formulation. However, it does depend on the medication, and her cardiologist knows more than I do about her particular situation.
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Dear Dr. Roach: My wife suffered from spinal stenosis. She had a cortisone shot, which helped for 90 days. She had regular physical therapy meetings. She was in constant pain, but insisted on playing tennis.
Then she tried a 鈥渟tretch鈥� workout while on vacation in Florida. After the first time she felt a little better. She went to several sessions, and finally asked the trainer how she could keep it up.
The trainer suggested a听stretching DVD. It takes about an hour and she now does it three times a week. She plays hard tennis five days a week, hasn鈥檛 complained about pain since 2010, and hasn鈥檛 needed physical therapy, either. I continue to be amazed.
R.M.
Spinal stenosis is caused by pressure on the nerves at the level of the spinal column. Physical therapy is one effective treatment, and one I always recommend prior to considering surgery. I thank you for taking the time to point out that gentle stretching can help, probably by opening up the spaces in between the vertebrae to allow the nerve more room.
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Dr. Roach cannot answer individual letters, but will incorporate them in the column when possible. Email [email protected].
