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DEAR DR. ROACH: Am I facing a grim fate? At the age of 25, I triumphed over testicular cancer. Fast forward 45 years, I've enjoyed a fulfilling life, raising two children and welcoming three grandchildren, and I'm in good health overall. The only medication I currently take is gabapentin to manage peripheral neuropathy, a side effect of the chemotherapy I underwent during my cancer treatment. It seems that one or more of those drugs led to the neuropathy in my feet.
A neurologist initially prescribed me 800 mg of gabapentin three times daily, and I adhered to this regimen for approximately 15 years. As I aged, the dosage increased to 800 mg four times a day, which I have been following for the last 20 years. When I share this with others, they often express disbelief that I am still alive after consuming such a high amount of gabapentin for so long.
I haven't encountered any recognized side effects from it. However, I've come across information suggesting that prolonged use of gabapentin might elevate the risk of developing dementia. Are there particular tests or evaluations my primary care physician should conduct due to my extended use of gabapentin? -- C.P.
RESPONSE: Testicular cancer is among the most treatable forms of cancer, as it responds well to radiation and chemotherapy. Nevertheless, patients may experience complications from these treatments many years after they have been successfully managed.
For several years, platinum-based chemotherapy has been a cornerstone treatment for advanced testicular cancer. A frequent side effect of this therapy is painful peripheral neuropathy, particularly affecting the hands and feet. Gabapentin is a widely prescribed medication that helps alleviate pain resulting from peripheral nerve damage, which can occur in conditions like diabetes or as a consequence of chemotherapy.
I rarely encounter doses as high as the ones you're taking, but they are definitely prescribed. In a landmark study regarding pain after shingles (post-herpetic neuralgia), the intended dose of gabapentin was 900 mg taken four times a day. It typically requires several weeks or even months to gradually reach this dosage to ensure tolerance, yet it proves to be quite effective. The primary side effect is drowsiness, but a gradual increase in dosage can help minimize this issue.
The relationship between gabapentin and dementia remains inconclusive, as two large studies involving hundreds of thousands of participants have yielded contrasting results. One of these studies indicated a potential risk of dementia associated with gabapentin use, particularly among younger individuals.
I believe that you are not without hope. Although many experts do not recommend routine screening for dementia, there are simple memory and cognitive assessments available for individuals worried about their memory or for those whose physicians may have noticed potential changes in their cognitive abilities. If any issues are identified, the individual can subsequently be directed to a specialist in memory care.
DEAR DR. ROACH: In a previous column, you addressed the topic of IBS-C (irritable bowel syndrome). I want to share my experience with IBS-D. For several years, I endured severe episodes that caused intense cramping, often leaving me confined to bed for two to three days at a time. About three years ago, these episodes began to occur more regularly, happening every three to four weeks.
I came across information suggesting that yogurt might be beneficial, so I started incorporating plain yogurt into my daily diet (with some fruit and granola mixed in). It's been two and a half years since my last episode! I'm curious why doctors don't recommend this. The difference has been incredible. -- K.V.
RESPONSE: I'm delighted to hear about your positive results! Yogurt is frequently suggested because of the live cultures it contains, which are believed to support gut health. However, my experience—similar to many studies—indicates that it doesn't seem to benefit most individuals. Additionally, the lactose in yogurt can be an issue for many people dealing with IBS.
Nonetheless, it could be worthwhile to give it a shot, and I concur with the idea of consuming plain yogurt.
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 [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2022 North America Syndicate Corporation.
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