Ask Dr. Keith Roach M.D
DEAR DR. ROACH: I am a 73-year-old male. I see my doctor on a regular basis and am taking various meds for age-related ills. I had gout in one foot and then the other about two years ago, but I now have a burning sensation in the toes of both feet. It is not painful to walk, but it feels as if I have a second-degree burn.
My doctor says it's probably a neuropathy, so I asked for a referral to a neurologist, which he said I don't need. He seemed to fight my idea of a specialist. Could there be a reason for his hesitation? Should I insist on going? -M.B.
ANSWER: I agree that it does sound like a neuropathy, but there are many causes for neuropathy. Although the diagnosis is sometimes never made with certainty, it is important to get an evaluation. There are specific treatments for a few neuropathies, and nonspecific treatments for most. If your regular doctor is comfortable performing the evaluation and is working with you toward getting you treated, great. If not, then I would think a referral to a neurologist would be appropriate.
DEAR DR. ROACH: While the standard is seven to eight hours of sleep for adults, is four hours of sleep and three to four hours of lying awake acceptable, in terms of proper rest? Some of us older folks can't get a solid seven to eight hours of sleep. Any suggestions to beat the four-hour problem? — N.R.
ANSWER: Eight hours per night is often quoted as the correct or even optimal amount of sleep, but the amount of sleep necessary for someone to feel refreshed and have normal alertness varies greatly from person to person and across the lifespan, with gradually decreasing sleep needs as we get older.
Less than four hours is too little for most people, but if you feel refreshed in the morning and don't get sleepy during the day, even in a monotonous setting, then that's probably enough for you. However, I don't recommend lying awake in bed. It doesn't provide the benefits of sleep and tends to make people associate the bed with lying in bed awake rather than sleeping.
For many people who aren't sleeping enough (the term 'sleep insufficiency' is preferred), allowing more sleep time, either by choosing an earlier bedtime or a later waking time, is adequate to address sleep duration. For people with difficulty sleeping (insomnia), this may require evaluation, since insomnia can be related to many medical conditions and medications, both prescribed and over-thecounter.
DR. ROACH WRITES: I recently wrote a column on Pap smear screening after cervical cancer, but I was asked specifically about uterine (also called endometrial) cancer in a woman who'd had a hysterectomy. In this situation, it is recommended to have an examination every three to six months for two years, then every six months or annually. The provider will ask about symptoms of recurrence of disease and perform a careful physical exam. The use of the Pap smear (in addition to the history and physical exam) in this situation is controversial, with one group (the United States National Comprehensive Cancer Network) recommending a Pap smear and the other (the Society for Gynecologic Oncologists) recommending against it. In my opinion, the careful exam and history are the important part of the follow- up, and the decision to perform a Pap smear during the exam ought to be left up to the treating provider. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cor nell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.