DEAR DR. DONOHUE: Tell me what can be done to lessen the pain of trigger finger. It is really bothering me. It hinders my writing and cooking, and lots more. – L.T.

ANSWER: Trigger finger can develop in any finger, but the middle and ring fingers and the thumb are the ones most often targeted. It comes from an inflammation of the tendons that bend the fingers, along with an inflammation and narrowing of the tunnels through which the finger tendons pass. The causes are repetitive use of the fingers, diabetes, hypothyroidism, rheumatoid arthritis, trauma and the large “cause unknown” category.

Nodules form on the inflamed tendons. Those nodules rub against the “pulleys” over which the tendons run. The nodule causes the tendon to become caught in the pulley. That, in turn, causes the finger to lock in position temporarily and hurt. A popping noise is heard when the tendon finally breaks loose. The finger sounds and acts like a gun’s trigger.

Sometimes the finger locks in a bent position for a considerable amount of time.

Anti-inflammatory drugs – Aleve, Advil, aspirin – can lessen pain and reduce inflammation if there is no contraindication to using them. A cortisone injection promptly relieves inflammation and shrinks any nodule that has formed. A splint for the involved finger – one that holds it in a fully straight position and is worn at night – can sometimes alleviate trigger finger. In cases that resist all conservative treatment, surgery frees the tendon.

DEAR DR. DONOHUE: A year ago, one of my younger brothers died in his sleep. He was 43. The cause of his death, as it appeared on his death certificate, was: apparent arrhythmia and myocardial fibrosis and myocyte hypertrophy. Please tell me what all that means. – B.H.

ANSWER: Arrhythmias are irregular heartbeats. The arrhythmia most often responsible for sudden death is ventricular fibrillation (not the same as atrial fibrillation, a common heartbeat irregularity). With ventricular fibrillation, the ventricles – the two lower, pumping heart chambers — no longer beat. They quiver like a bowl of Jell-O. No blood circulates through the body. If the quivering isn’t ended quickly, death results in a matter of minutes.

Myocardial fibrosis is scar tissue in the heart.

Myocyte hypertrophy is enlargement of heart-muscle fibers. It’s often seen in a condition called idiopathic hypertrophic cardiomyopathy, a heart condition that features a greatly enlarged heart, one often disposed to dangerous heart rhythms. If you can speak with your brother’s doctor, you should ask if your brother had the kind of cardiomyopathy that runs in families. If he did, you and all your brothers and sisters should be checked for it. If you can’t get in touch with that doctor, tell your own doctor about your brother’s condition so he or she can look for it in you.

DEAR DR. DONOHUE: I have diplopia. The doctor says it’s due to a hardening of the arteries of the sixth cranial nerve, but the prognosis is very good. He is a neurological ophthalmologist and said I would see regularly again.

I would like to hear your explanation regarding diplopia. – S.W.

ANSWER: Diplopia is double vision, and seeing two of everything makes it hard to get around.

The brain gets two images from the two eyes, which are situated apart and have a different viewpoints of everything that’s seen. For the brain to integrate those two images, the eyes have to be aligned perfectly. If one is just a little off, then the brain sees double.

Eye muscles that hook onto the outsides of the eyeball keep the eyes in sync. In addition, the nerves that control those muscles have to function perfectly. The sixth cranial nerve (cranial nerves come directly from the brain; there are 12 of them) governs the eye muscle that moves the eyeball to the side, away from the nose. If that eye muscle isn’t functioning properly, the affected eye drifts inward, toward the nose, and two images reach the brain. Diabetes can interrupt the blood supply to that nerve. The eye muscle, in turn, weakens and causes the eye’s inward drift. Time often clears up the blood-supply problem.

Patching the deviating eye gets rid of the two images. Prisms can fuse the two images in the brain.

DEAR DR. DONOHUE: My baby, just 1 year old, came close to dying, and I think it was my fault. He began to cry and fret. My husband and I thought it was colic, and we tried burping him and holding him. The crying got worse, and we got worried and brought him to the emergency room. The emergency doctor made a diagnosis of intussusception. Our pediatrician arrived and ordered a barium enema, which corrected the situation. I can’t stop feeling guilty about neglecting the baby for so long. Should we have known sooner? – R.K.

ANSWER: How could you or your husband have diagnosed intussusception (IN-tuh-suh-SEP-shun)? Most young (or old) parents have never heard of it. Stop beating yourself up about this. It’s not uncommon, but it’s not an everyday occurrence either. It happens to anywhere from 1 in 250 to 1 in 1,000 infants, usually in the first two years of life. A section of intestine is drawn into an adjacent section like a long telescope that can be pushed together to form a compact unit.

The typical story is a well child who suddenly begins to cry in spells and draws its knees up to the chest. Between spells, the baby is quiet until the next wave of pain strikes. As time passes, crying becomes nonstop, and that’s the baby’s alarm alerting parents that something truly bad is happening.

A plain X-ray of the abdomen can often furnish clues that make a diagnosis possible. A barium enema, with thick barium introduced into the colon through the rectum, frequently frees the entrapped intestinal segment. If it doesn’t, a surgeon has to operate quickly.

You reacted in a timely manner and in a way that any sensible parent would.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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