DEAR DR. ROACH — My son has been experiencing what he thinks is neuropathy in his arms and fingers. He presently feels sharp ache in his fingers. He has a tingling feeling as nicely. The orthopedic surgeon’s workplace put him on meloxicam, and he wears an arm brace in addition to a pc brace. Is meloxicam used for these issues? Or is there one other medication or take a look at that needs to be given/accomplished to alleviate the ache? It retains him from sleeping. Do you could have any recommendations?
Pricey Reader — Neuropathy is a common time period which means “one thing fallacious with a number of nerves.” Ache and numbness or tingling are frequent early signs; weak point is a late and extra severe symptom. Within the case of arm and finger ache in in any other case wholesome folks, the commonest neuropathies are compression neuropathies of the arms, happening to the fingers. Carpal tunnel syndrome causes neuropathy of the median nerve, which provides the thumb and three center fingers; whereas ulnar entrapment, additionally known as cubital tunnel syndrome, is brought on by a compressive neuropathy of the ulnar nerve, which provides the nerves to the little finger and a part of the ring finger. Much less generally, a number of nerves will be compressed within the neck or within the brachial plexus within the armpit.
Most common docs, or an knowledgeable similar to a neurologist or orthopedic surgeon, can normally make the right analysis by bodily examination. A wrist brace (for carpal tunnel) or elbow brace (for ulnar entrapment) and taking an anti-inflammatory similar to meloxicam is usually an inexpensive first-line strategy. Injections and surgical procedure could also be thought-about, and there are different drugs that may be tried for symptomatic reduction. Until there’s weak point or atrophy current, a deliberate strategy is prudent, and speeding to surgical procedure is unwise.
Earlier than surgical procedure, or if the analysis is unclear, additional testing usually consists of an EMG (electromyography) and nerve conduction research. These are the very best methods of figuring out exactly which nerves are concerned.
DEAR DR. ROACH — Your latest article on vaccinating folks on immunosuppressants hit residence. My spouse takes Rituxan each six months for rheumatoid arthritis. Twenty-one days after her final Rituxan (two required inside two weeks, each six months), she acquired her first vaccine shot. She acquired her second vaccine shot (Moderna) 28 days later. How quickly after the final vaccine shot can she safely get a booster shot? For those who wait six months from final vaccine, you’re in want of one other Rituxan infusion. It is a Catch-22.
Pricey Reader — I am unable to reply with precision, as there isn’t a proof of effectiveness of a booster shot, neither is there definitive proof that the rituximab (Rituxan) is stopping the vaccine from working.
Nevertheless, primarily based on my understanding of the vaccine and the consequences of rituximab on the antibody-producing B cells, I would counsel you ask her rheumatologist about repeating her vaccine 4 to 6 weeks earlier than her rituximab. That might give probably the most time after the earlier injection and sufficient time for the vaccine to work earlier than the following one.
Physicians are in uncharted waters for some people with particular medical circumstances and need to train their finest judgment. 5 months from now, the COVID-19 scenario in North America could also be completely completely different from how it’s now, and there could also be higher steerage on giving vaccines to immunosuppressed folks.
Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu