Qs and As on carpal tunnel; baby aspirin
Q: I get numbness and tingling in my fingers. It’s worse at night. Does that sound like carpal tunnel syndrome?
A: You probably have made the right self-diagnosis. But you should make an appointment with your doctor to confirm it.
Carpal tunnel syndrome is very common. It happens when the median nerve — which runs down your arm and into your hand — gets compressed within a narrow space in the wrist known as the carpal tunnel.
At first you might think all of your fingers feel numb. But typically the numbness and tingling of carpal tunnel syndrome affects the thumb, index finger, middle finger, and half of the ring finger. Your little finger is typically not affected because it is served by a different nerve (the ulnar nerve).
Symptoms of carpal tunnel syndrome often occur during sleep, causing people to wake up and shake their hand.
Your doctor can usually diagnose carpal tunnel syndrome based on your symptoms and a physical examination. But in some cases, you may need additional tests to ensure that those symptoms aren’t being caused by another condition, such as a pinched nerve in your neck or peripheral neuropathy.
If your symptoms or exam do not fit the classic pattern, your doctor may order a nerve conduction study and electromyogram (EMG). This test uses an electrical signal to determine how well the nerve is working.
For mild cases of carpal tunnel syndrome, wearing a splint at night and intermittently during the day may be all it takes to relieve symptoms. If symptoms persist, your doctor might recommend a corticosteroid injection to reduce inflammation and swelling.
Any hand grip weakness or symptoms that interfere with daily function, or frequently wake you up at night, mean you should strongly consider surgery to decompress the nerve.
Most often the surgery can be done using a local anesthetic. Unless you do a job that involves manual labor, you can quickly return to normal activities.
Q: I am thinking about taking a baby aspirin every day to prevent a heart attack or stroke. But it seems the recommendations keep changing. How do you decide?
A: Taking a daily aspirin isn’t something you should decide to do on your own. While it may sound like a good idea, there are risks to taking even low dose aspirin. So talk it over with your doctor before you start.
Everyone’s blood has a tendency to form clots. We need clots to stop any bleeding that may start, such as from a cut or a stomach ulcer. On the other hand, if clots form too easily, they can plug up an artery, causing a heart attack or the most common kind of stroke.
Aspirin works to lower the risk of heart attack and stroke because it reduces the tendency of blood to clot. But that means aspirin also increases the tendency to bleed.
Aspirin therapy is typically prescribed to people who have had a heart attack or stroke. Other candidates for anti-clotting therapy include people who’ve had coronary artery bypass surgery, people who’ve had a stent implanted to keep an artery open, and people with peripheral artery disease (significant plaque buildup in the leg arteries).
As a purely preventive therapy, who should take aspirin and at what dose is hotly debated. The more cardiovascular risk factors you have, the more likely you will benefit from taking aspirin. Those risk factors include diabetes, smoking, high blood pressure, a high LDL cholesterol, a family history of heart disease, obesity and physical inactivity.
But there are risks, even with low-dose aspirin. Since aspirin reduces the blood’s ability to form clots, it also increases the risk of internal bleeding. The most common form of serious bleeding is from the stomach or upper intestine. Rarely, bleeding into the brain can occur, which may result in disability or death.
That is why you should discuss whether to be on aspirin therapy with your doctor and not just start taking it on your own.
Although most doctors recommend a “baby” aspirin (81 milligrams), whether that is the best dose for prevention is debated.
Also undetermined is whether it’s best to take an aspirin with a safety coating (called an enteric coating), in order to reduce the risk of stomach bleeding. Some data suggest the coating may interfere with the body’s ability to absorb the aspirin. For people who do take aspirin, I suggest taking the uncoated form with food.
In preparation for your aspirin discussion with your doctor, check out the aspirin risk calculator at www.aspiringuide.com.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.
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