Dear Dr. Roach: I am a 70-year-old man in good health. I have had regular colonoscopies since my 50s, but I wonder about the wisdom of a colonoscopy at my age. My doctor has sent repeated requests for me to schedule the procedure. Is this a valid exam at my age, or is the clinic taking advantage of my excellent medical insurance?
The guidelines and the clinical studies are clear: Screening for colon cancer saves lives. A colonoscopy (or other screening test) is recommended beginning at age 45, and continuing, on average, until age 75, so long as a person is in good health. Some people want to continue colon cancer screening even after 75, but there are no good studies to support use after age 75. I would not recommend a test past age 85, since the benefits are lower and the risks are higher in patients who are that old.
Although there are unfortunately exceptions, I really believe most doctors recommend treatments to help their patients, not enrich themselves. Our code of ethics instructs us to put our patients’ needs above our own.
Dear Dr. Roach: In 2018, I had a stroke followed by an extreme itch across my back where a bra strap would be. In the beginning of the pandemic, I wore the N95 mask with the rubber across the back of my neck for just a short time, now my neck itches, too. I must wash my back and neck each morning and evening and put Cetaphil on it to stop the itch. I was told recently during a home visit that I should try gabapentin, so I am wondering about using it. Do you think that gabapentin would work to help stop my itch?
Neuropathic itching is the term used for an itch after nerve damage, such as after a stroke, but it can also occur after localized nerve damage such as shingles. The process is similar to pain that follows nerve damage.
Readers might dismiss this as a minor symptom, but the itch can be unbearable, and there are many reports of people doing terrible damage to themselves by trying to scratch the itch. Unfortunately, scratching doesn’t help, and will almost always make things worse by damaging the skin. Learning not to scratch is an admittedly difficult part of the treatment.
Your itching on the neck may simply be an allergic or irritative response to the elastic in the mask strap. A mild steroid cream may help the neck, but unfortunately, most anti-itch remedies are not helpful for neuropathic itching.
The most effective treatment has been local anesthetics. For a distinct or defined area, a lidocaine patch can be extraordinarily effective. Lidocaine can also be injected.
There are reports of effectiveness from gabapentin and its closely related “cousin,” pregabalin, so it may be worth a try if the lidocaine patch doesn’t work for you. A neurologist or pain management expert should have expertise in managing neuropathic pain and itching.
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 ToYourGoodHealth@med.cornell.edu