Dear Dr. Roach: I want to know what you think about vagus nerve stimulation (VNS), both the surgically implanted type as well as the external noninvasive device for rheumatoid arthritis (RA) and other indications. What kind of doctor does this? Just reading about it gives me hope that less drugs are being used to treat these conditions.
— L.L.
Dear L.L.: VNS uses electrical impulses to trigger some of the many actions of the vagus nerve. VNS is approved by the Food and Drug Administration for some types of drug-resistant epilepsy, headache disorders, and drug-resistant depression.
For RA in particular, a recent randomized trial showed effectiveness at improving symptoms of joint pain and swelling through an implantable VNS device, compared to a “sham” device that didn’t use electrical stimulation. VNS works by inhibiting the inflammatory pathway by electrically stimulating specific receptors. The effect size is modest but statistically significant.
Other studies on noninvasive devices, most commonly one that’s used on the ear, didn’t improve the disease activity of RA. RA is a complex, multi-system disease that can cause disfiguring and disabling joint disease, and it can also affect the heart, lungs, and other internal organs. Since a VNS device hasn’t been proven to modify disease activity, it is my opinion that this device should be used in conjunction with appropriate disease-modifying treatments as recommended by an expert.
I have respect for RA as I recall the days before effective treatments, when I saw many patients with severe joint disease who nearly lost the entire use of their fingers and hands. Rheumatologists are the experts in treating RA and would likely be the person to order a VNS device from.
Dear Dr. Roach: I am a 78-year-old female who was treated for anal cancer in 2013. The cancer was discovered during a routine colonoscopy, and fortunately, it was only stage I. It was determined to be caused by human papillomavirus, and I was told that a recurrence was unlikely after the first year post-treatment. I underwent chemotherapy and radiation, and I haven’t had a recurrence.
I’ve had repeat colonoscopies every two to three years since then, and I’m now at an age where there is an increasing risk that is involved in this procedure. Since I didn’t have colon cancer, can I change to a safer method of monitoring for a recurrence?
— S.H.
Dear S.H.: Your risk for a recurrence of anal cancer is now very low, and expert guidelines don’t recommend more intensive screening for you compared to the average-risk population for colon cancer.
Modeling studies have suggested that the harm from a colonoscopy (such as perforation of the bowel) becomes equal to the benefit of finding cancer early at about age 75 in average-risk people. I’ve had very healthy patients who want to continue colonoscopy screening until age 80 or even 85, but the experts recommend against screening beyond this time. Patients with significant health issues are at a higher risk for complications and are unlikely to benefit from colon cancer screening past the age of 75.
You remain at risk for treatment-related complications, especially from radiation, which can show up years or even decades after treatment finished. So, it’s wise to continue seeing your regular doctor or cancer doctor for periodic visits and for an evaluation of your bowel and bladder function. You may also be at a higher risk for osteoporosis in the pelvis, so you should have a bone density test done as well.
A multitarget stool test such as Cologuard could be considered, but a positive test would still require a colonoscopy. Cologuard isn’t an appropriate screening test for HPV-related cancers, although, for you, this risk is now almost zero.Readers may email questions to ToYourGoodHealth@med.cornell.edu.
This article originally appeared on The Detroit News: Dr. Roach: Using a vagus nerve stimulation device for rheumatoid arthritis
Reporting by Dr. Keith Roach, To Your Health / The Detroit News
USA TODAY Network via Reuters Connect
