STRUCK NUMB

STRUCK NUMB

Several years ago, I went to my GP complaining of pains in my feet. He diagnosed Morton's neuroma, and got me to a surgeon with great speed. The operation was apparently a common one, and was a success, but the after-effects are a total disaster. I am a trained dancer and, before the operation, still did class every day with great pleasure, as I was generally fit and supple. Since the operation, I cannot feel anything in my feet. I have lost my balance, and my ability to jump, move quickly across the floor, or do anything gracefully or easily. The numbness was supposed to go away but it has not. This has robbed me not only of one of the great pleasures of my life, but also of a professional skill (I am an actress). What can I do about this? Is it a hopeless situation? Is there a remedy or an alternative treatment? Why was I not informed of the possible after-effects and given some kind of choice? It has all been a great shock and has seriously diminished my quality of life. I have a high pain threshold and it is possible that if I had known what I now know, I might have preferred the pain.

A Morton's neuroma is sometimes known as an interdigital neuroma. It is a thickening of the tissues around the nerve that runs between the bones of the foot where they meet up with the toes. No one knows exactly what causes the tissues to thicken. It may be because of pressure caused by overuse or tight- fitting shoes. I suppose it is possible that your dancing in some way contributed to the development of the neuroma, but you will never know for sure. The main symptom of a Morton's neuroma is pain, between the toes and in the ball of the foot. There are three ways of treating neuromas. Your surgeon chose the most radical treatment first, by simply removing the thickened tissues and cutting the affected nerve. Numbness of the toes - usually permanent - is the inevitable result of this treatment, and if you were not warned of this you should have been. Less aggressive treatment, such as adjustments to shoes, or less radical surgery, are often suggested before surgery that cuts the nerve. It is going to be difficult for you to regain all of the function you have lost. I think you should consult a specialist physiotherapist who has some experience of helping dancers. With exercise and training you should be able to improve your balance and jumping ability. The numbness, however, is unlikely to disappear. Your predicament highlights the importance of fully discussing the pros and cons of surgery before deciding to proceed.

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AUTOANTIBODY ACTION

I am a 60-year-old woman with a low white blood-cell count and also low platelets. This has been ascribed to prolonged radiotherapy many years ago. Recently I have been diagnosed as having an antilymphocyte antibody. Could you tell me the implications of this, as I am experiencing a host of symptoms including further allergies, a sore larynx, periodic hoarseness, and temporary swelling of veins in fingers and arms.

Your low white blood-cell count and low platelet could show that your bone marrow is now working well. White blood cells and platelets are two constituents of the blood that are made in the bone marrow. The white blood cells fight off infection and the platelets help to prevent bleeding and bruising. Radiation therapy is known to damage the bone marrow and yours was probably irreparably damaged many years ago. A low white-cell count may make you more susceptible to infections, but I think it is unlikely to be the cause of allergies or swelling of veins. An antilymphocyte antibody is a substance produced by your own body that attacks your lymphocytes. Lymphocytes are a type of white blood cells. People who have one type of autoantibody sometimes develop other autoantibodies that are directed against other types of tissue or cells. It may well be that some of your other symptoms are related to this.

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ALCOHOLIC SECRETS

I am trying to moderate my alcohol intake as part of a weight-loss programme. Unfortunately, bottles of wine and beer do not reveal how many calories they contain and pub staff just laugh when I ask them how many calories their drinks have. Can you give me some guidance on how many calories I might be consuming in typical glasses of wine, beer and spirits?

I entirely agree that some nutritional information on alcoholic drinks would be helpful. A half-pint of draught beer or lager contains about 90 calories. A standard glass of dry red or white wine (125ml or one-sixth of a bottle) contains about 85 calories. A whole bottle of wine contains 500 calories. Sweet wine has 120 calories per glass. A single pub measure (25ml) of spirits contains 55 calories. The calories in alcoholic drinks come mostly from the alcohol itself. This means that stronger drinks contain more calories than weaker ones. One millilitre of pure alcohol contains about 5.5 calories.

HAVE YOUR SAY

JJ from Glasgow is puzzled by the link between dyslexia and eyesight:

When I was 10 I had a lazy eye. I assume this caused some loss of vision in one eye, which can't be corrected. But I don't have any problem with dyslexia. I am surprised that eyesight is related to dyslexia. How does this work?

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions

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