Dear Dr. Roach: Three months ago, I slammed the tip of my left index finger in a drawer. It is still swollen and painful. My doctor sent me for an X-ray and there is no fracture. I can bend it at the joint, but cannot put pressure on the fingertip. I looked online, and read something that said a fingertip crush injury can take six months to a year to heal and the swelling may never go away completely. Can this be true? Why does it take so long? Is there anything I can do to help it heal? I can get along OK without using the finger for everyday functioning, but I am a guitar player, and I really need to use that fingertip to play. Is there hope that I will be able to play again someday? I would be very sad to have to give it up. D.L.
Crush injuries to the fingertip often do take months to heal completely, due to the fact that there isn鈥檛 a lot of room in the fingertip and that there are many important structures in the fingertip. A little bit of inflammation can cause pain and loss of function for a long time.
Fortunately, almost everybody does regain complete use of the hand and I wouldn鈥檛 sell your guitar just yet.
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Dear Dr. Roach: My 18-year-old grandson has just been diagnosed with superior mesenteric artery syndrome. It sounds extremely serious. Would you be able to tell me more? I am very worried. G.D.
The superior mesenteric artery is one of the critical arteries that supplies blood to the intestines. Directly underneath the SMA is the duodenum, the first part of the small intestine. In SMA syndrome, loss of the normal fat around the duodenum causes the artery to constrict the duodenum, causing a compression of the duodenum and an obstruction to food going through.
Serious weight loss due to medical illness, surgery or anorexia nervosa is the most common cause of SMA syndrome. It鈥檚 a difficult diagnosis to make, and there is some controversy about what criteria are used for diagnosis.
If weight loss is the underlying cause of SMA syndrome, then nutritional support and weight gain become the primary treatment. Surgery is sometimes necessary.
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Dear Dr. Roach: I am inquiring for a friend who is experiencing erectile dysfunction. I read your column on donating blood and wondered if this might be his issue, since he donates blood as often as he is permitted. He is 66 and also has some hypertension and takes an ACE inhibitor and the diuretic HCTZ. C.L.J.
Your friend should be commended for his public service in donating blood and reassured that it is not a risk for erectile dysfunction. Erectile dysfunction is common in 66-year-olds and can be due to problems in the circulation, such as blockages to the artery serving the penis, nerve damage or low testosterone levels. Psychological issues occasionally are the cause of ED and, rarely, tumours that secrete prolactin can cause ED. However, blood-pressure medicines are a very common cause and HCTZ is the most common of all. I think it would be worthwhile for your friend to see his primary provider, get checked out and maybe try a different blood-pressure medicine. In the meantime, he can continue to donate blood.
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