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Dear Dr. Roach: I'm a 78-year-old male with a history of high blood pressure, and I had a bovine aortic valve replacement in 2009. I had a negative colonoscopy in 2003, but in 2013, my colonoscopy required a polypectomy of a 3-mm tubular adenoma. In 2019, my colonoscopy was negative again. I'm concerned with the risks involved in repeat colonoscopies. What is your opinion? — J.G.
Answer: The usual recommendation would be to consider a repeat colonoscopy in 2029, when you would be about 82. This is an age where you could decide to stop having colonoscopies, but if you were my patient, I would probably advise you to consider another colonoscopy again, given your history of a tubular adenoma. This is a condition that can progress to colon cancer over the years.
You are right that there are risks of a colonoscopy, but high blood pressure and a valve replacement are not high-risk conditions that would make a colonoscopy too dangerous, in my opinion. If the next colonoscopy were negative again, you could then safely discontinue the colonoscopies as the risk of progressing to colon cancer in your expected lifetime, even if you lived to be over 100, would be very small.
I would respect your decision not to have any more colonoscopies, but in my opinion, the benefit outweighs the risk for most healthy 82-year-olds with a history of premalignant polyps, even if your most recent one didn't show any polyps.
Dear Dr. Roach: I have a "trigger thumb." My thumb no longer bends at the middle joint and hurts. Exercise doesn't seem to work. I tried physical therapy, too, without results. — A.M.
Answer: Stenosing flexor tenosynovitis, aka trigger finger, is a common issue I see very frequently in my clinical practice. Symptoms usually start with some "catching" or locking of the fingers while flexing and extending one or more of them. This may progress to discomfort or pain and can progress to the point where a finger or thumb is locked in place and needs to be bent by the other hand.
Initial treatment includes rest and anti-inflammatories. Some experts use a splint to reduce the trauma from repetitive movement in the pulley system of the hand. If conservative treatment isn't effective, most hand experts will try an injection of a steroid into the area of the pulley and tendon. Surgery is an option if two or three injections haven't solved the problem.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.