I am a 52-year-old woman diagnosed with a mild case of trigger finger on my ring finger. Can it actually be cured or do I have to be careful using my finger for the rest of my life? Cortisone shots concern me, and after a month of soaking it twice a day, there is not much improvement. L.V., Jerusalem
Dr. Michael Chernofsky, a veteran hand surgeon at Hadassah University Medical Center on Jerusalem's Mount Scopus, replies:
This is a very common problem, an inflammatory condition involving the fingers. Four fingers on each hand have two tendons, while the thumb has only one. When you bend the finger, the tendon moves through a tunnel system that begins near the base of the palm and goes through the finger. Trigger finger is more common in the fingers with two tendons. With overuse, they can swell from inflammation, so that it's hard for them to glide through the tunnel system. This makes them get stuck, and if swollen enough, you can't move the finger until the tendon stretches and pops to reenter the tunnel. This produces the phenomenon that is called "trigger finger."
If the problem is due to overuse, you and your doctor have to find the underlying cause, such as working long hours on the computer, heavy lifting or even working in the garden. A steroid injection is the ultimate anti-inflammatory solution rather than cortisone pills that go through the whole body. However, steroid injection in one finger can be done only once, as the tunnel - composed of fibrous tissue - has a very delicate structure.
There is a variety of conservative treatments, such as heat therapy with paraffin, ultrasound, massaging the finger with Voltaren cream and oral anti-inflammatory medications. A little splint can be attached to the finger for wearing at night and letting it rest for hours in a fixed, straight position. If none of these works, the surgical option will solve it, and this is a very common procedure in hand surgery.
Why is diarrhea so common in Israel during the summer? What can be done to avoid it? J.D., Beersheba
Dr. Shmuel Bar Haim, head of the emergency medicine department at Assaf Harofeh Medical Center in Tzrifin, comments:
Diarrhea can be a seasonal problem that repeats itself every year. It is caused by a virus that spreads more easily in the heat, and its symptoms also include vomiting and a not-very-high fever. In most cases, it is not caused by food that has gone bad. Recommended treatment includes drinking a lot of water or tea - but not cola drinks, even though some people think these help; in fact, cola drinks give a feeling of satiety due to the carbon dioxide, but the person doesn't get enough liquids.
In addition, one should avoid eating or drinking milk products, fresh fruits and vegetables and fresh or artificial fruit juices when suffering from diarrhea. Instead, eat solid food such as toast and rice or chicken soup (but not vegetable soup). The virus should go away in 24 to 72 hours. Nevertheless, if one still suffers from serious diarrhea after 24 hours, go see a doctor.
Heart and kidney patients as well as those who suffer from chronic diseases or take diuretic drugs (which increase urination) should be examined by a doctor. Dehydrated diarrhea patients who reach the hospital are mostly given infusions of liquids and sent home.
Judy Siegel-Itzkovich adds:
Ann Karlin, a resident of the Beit Oved residence in Rehovot, comments on a previous question about natural means to prevent and treat constipation. She says that at Beit Oved, every morning the elderly residents are given peeled fresh tomatoes run through a blender as an applesauce-like tomato drink. This seems to do the job, she says.
Rx For Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx For Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and residence.