DEAR DR. ROACH: Am I a doomed man? When I was 25, I survived a battle with testicular cancer. The good news is that 45 years later, after two children and three grandchildren, I am in good health. The only medication I take is gabapentin to treat peripheral neuropathy caused by the chemotherapy drugs I received during cancer treatment. One or more of these medications caused neuropathy in my feet.
A neurologist prescribed 800 mg three times a day, and I took it for about 15 years. As I got older, this dose increased to 800 mg four times a day over the past 20 years. When I talk to people, they seem shocked that I’m still alive after taking so much gabapentin.
I have never experienced any known side effects from it. I have read that long-term use of gabapentin may increase the risk of dementia. Are there any specific things I should ask my regular doctor to test me for due to long-term use of gabapentin? –PC
ANSWER: Testicular cancer is one of the most curable cancers because it is responsive to both radiation and chemotherapy. However, both of these modalities can cause problems years after successful treatment.
For many years, platinum-based chemotherapy has been one of the mainstays of advanced testicular cancer. Painful peripheral neuropathy, particularly in the hands and feet, is a common side effect. Gabapentin is a medication commonly used to relieve pain caused by peripheral nerve damage, which occurs with diabetes or chemotherapy.
I don’t often see doses as high as you are taking, but they are certainly used. In a seminal trial for pain following shingles (post-herpetic neuralgia), the target dose of gabapentin was 900 mg four times daily. It often takes weeks or months to reach this dose so people can tolerate it, but it is very effective. The most common side effect is sedation, but increasing the dose slowly reduces this effect.
The evidence for gabapentin and dementia is mixed, with two studies involving hundreds of thousands of people reaching completely different conclusions. In the study suggesting there was a risk of dementia, it was greater in younger people.
I conclude that you are not condemned. Although most authorities do not suggest screening tests for dementia, there are some easy-to-perform memory and cognitive tests for people who are concerned about their memory or for those whose doctors are concerned about a condition. possible change of function. If there are any abnormalities, then a person may be referred to a memory expert.
DEAR DR ROACH: In a recent column, you discussed IBS-C (irritable bowel syndrome). I suffer from IBS-D and have had very severe episodes for several years. The cramps were enough to keep me in bed for two to three days. The episodes started occurring more frequently three years ago and were occurring every three to four weeks.
I read that yogurt could help, so I started eating plain yogurt every day (although I added fruit and granola). I haven’t had an episode in two and a half years! Why is this not suggested by doctors? The change has been incredible. –KV
ANSWER: I am very happy that you obtained such good results. Yogurt is often recommended because of the live bacteria it contains, which are considered beneficial for the gut. Unfortunately, my experience (like most trials) has been that this does not help the majority of people. Lactose (milk sugar) is also problematic for many IBS sufferers.
Still, it might be worth a try, and I’m okay with eating plain yogurt.
Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.
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