Q: I've been smoking clove cigarettes for about a year now. Are they more dangerous than regular cigarettes? What exactly is known about them?
A: Smoking clove cigarettes is risky business. Some people have died apparently as a result of smoking them, and hundreds of others have been hospitalized.
Unlike tobacco cigarettes, which take their toll after years of use, clove cigarettes seem to trigger sudden difficulty in breathing in susceptible people.
The popularity of clove cigarettes, which contain less tobacco than ordinary cigarettes, may stem from the belief that they're less harmful. Yet they frequently produce much more tar and nicotine.
Smoking in any form poses an unnecessary threat to health and is our nation's biggest preventable health danger. If you don't smoke, don't start. If you do, quit now.
Action on Smoking and Health (ASH), an organization concerned with the problems of smoking and the rights of nonsmokers, publishes an informative newsletter. Write ASH, 2013 H St. NW, Washington, D.C. 20006. Two other enlightening publications review the health effects, ethics and politics of smoking, and chronicle the course of antismoking campaigns:
"The Cigarette Underworld," edited by Alan Blum, MD, available from Lyle Stuart Inc., 120 Enterprise Ave., Secaucus, N.J. 07094 ($9.95 a copy plus postage).
The July 1985 issue of the New York State Journal of Medicine, available from Circulation Department, New York State Journal of Medicine, 420 Lakeville Rd., P.O. Box 5404, Lake Success, N.Y. 11042 ($7.50 a copy, postpaid).
Q: I've been treated for carpal tunnel syndrome with an anti-inflammatory medicine (Naprosyn) and a wrist splint at night. If the condition persists, surgery may be necessary. The first time I had this problem was during pregnancy, but it cleared shortly after delivery. This time it started after several week of heavy yard work and seems to be holding on.
What exactly is carpal tunnel syndrome? What causes it and how can it be avoided? Does medicine correct the problem or does it just treat the symptoms? Is surgery a permanent cure?
A: The carpal bones are your eight wrist bones, and the carpal tunnel is a narrow space in the middle of your wrist. Through this tunnel pass several tendons and the median nerve. This nerve controls some of the movement of your thumb and fingers and gives the sense of touch to the thumb, second, third and part of the fourth finger on the palm side of your hand.
In the narrow confines of the carpal tunnel, there is no room to expand, so any swelling there puts pressure on the median nerve, leading to the carpal tunnel syndrome. This condition most often affects women between 30 and 60.
Symptoms include numbness, tingling and a pins-and-needles feeling in the thumb and fingers reached by the median nerve. (One clue to the diagnosis is that the little finger is not affected.) The symptoms may waken you from sleep and make you shake your hand as if to shake out the tingling. Sometimes these sensations are painful and can extend up from the wrist into your arm. Hand weakness may develop at a late stage in the condition.
Your story is very typical, because the swelling that occurs during pregnancy or after overuse of your hands and wrists (especially from repetitive grasping or twisting) is a common cause of this syndrome. Less frequently, certain diseases produce wrist swelling and carpal tunnel syndrome. These include underactive thyroid gland (hypothyroidism), diabetes, rheumatoid arthritis and overactive pituitary gland (acromegaly).
Several treatments help reduce swelling and improve symptoms. Anti-inflammatory medicines and resting the wrist (which is helped by a splint, particularly during sleep) are usually tried first and often are all that's needed. If these don't work, an injection of an anti-inflammatory cortisone-like medication into the carpal tunnel may help. Vitamin B6 pills seem to work for some people, although many doctors don't accept this as standard therapy.
For persistent and very bothersome cases, a surgeon can make a small incision in the wrist to take the pressure off the nerve. This surgery usually cures the problem. Follow-Up
A few months ago I wrote about the long-term effects of Accutane, the anti-acne medication. Recently, another study linked the drug to birth defects if taken during pregnancy.
Now, new studies report a potentially worrisome side effect that doesn't go away once treatment is stopped. The adverse condition, called skeletal hyperostosis, causes thickening of bones and calcification of ligaments and tendons, something that could result in stiffness and joint pain.
At first, investigators discovered this reaction only in a few people being treated for rare and unusual skin disorders. These patients received much higher than standard doses for much longer periods of time. Now there are reports of mild cases of hyperostosis occurring in acne patients who are treated with the usual dose and duration of therapy.
I don't think this means that no one should use Accutane. What is important is that this medicine be reserved for severe cases of cystic acne -- acne causing large, pus-filled bumps -- and used only after other treatments have failed.