DEAR DR. DONOHUE: I am a 79-year-old woman with peripheral neuropathy. I have a numb left foot and pain extending the length of my leg and occasionally into the hip. Early in the mornings, as I begin to move about, my leg seizes up, and the pain is intense. I use a heating pad, which eventually eases the pain. I have had diabetes for 30-plus years. It is well-controlled. Any help would be appreciated. — J.H.

ANSWER: Simplifying peripheral neuropathy invites egregious errors, but I hope it adds to people’s understanding of this condition. “Peripheral” here refers to the arms and legs, mainly the legs. Neuropathy is nerve injury. Nerves that bring messages from the brain to muscles, instructing them to move, are motor nerves. Nerves that bring sensations from the body and body surface to the brain are sensory nerves. And some nerves combine both functions. Neuropathy can affect either kind. Motor nerve impairment leads to muscle weakness, even to the point where muscles no longer work. Sensory nerve impairment brings numbness, peculiar sensations or outright pain. You have predominantly sensory nerve involvement. The “seizing up” you describe is a muscle cramp, and that sometimes is part of the neuropathy picture.

Diabetes, deficiencies of some of the B vitamins, an autoimmune attack on nerves, excessive intake of alcohol and some inherited conditions lead to neuropathies.

Antidepressants can alleviate neuropathic pain. Amitriptyline and Cymbalta are two that are often prescribed. Seizure-control drugs like Lyrica and Tegretol also suppress it. Capsaicin cream (Zostrix, no prescription needed) applied to the painful area can bring relief. Lidoderm patches and lidocaine gel, products related to Novocain, offer easing of pain. If routine pain medicines are ineffective and the pain is severe and disruptive, drugs like oxycodone and tramadol (morphinelike drugs) can be prescribed and should not be feared.

Get in touch with the Neuropathy Association. It provides you with more-extensive explanations and guides you in treatments. The phone number is 800-247-6968 and the website is www.neuropathy.org.

DEAR DR. DONOHUE: I am writing about two recent columns. One was from a woman diagnosed with trichomonas. I find it disturbing that you did not take advantage of the opportunity to educate your readers. She said she knew all her male partners pretty well, and they held responsible positions in the business world. She took for granted that they would not pass along a sexually transmitted disease.

I am an HIV-positive woman and a national HIV educator. I am middle-class and am constantly faced with people who think they can make these assumptions and have unprotected sex. As a result of this obliviousness, many contract sexually transmitted diseases, including HIV.

I understand that you cannot print this entire letter, but I hope you will address the serious issue of unprotected sex, especially in those who think they can choose partners based on how someone looks. — V.W.

ANSWER: I believed the woman’s plight was self-explanatory. Your message comes through clearly. It is a good one. Many, both male and female, think their chances of coming down with a sexually transmitted disease are remote. STDs are very prevalent and do not distinguish the well-dressed from the poorly dressed, the educated from the uneducated, the rich from the poor or the young from the old. Casual sex without protection is an invitation to trouble.

DEAR DR. DONOHUE: My granddaughter was just diagnosed with gonorrhea. She has been treated.

She often visits us and uses our bathroom. Do I have to be concerned that this infection could be transmitted to other family members? — A.

ANSWER: Gonorrhea is a sexually transmitted disease. That means that sexual activity is the way it is passed from one person to another. You have no worry that anyone in your family will come down with this illness because of your granddaughter’s visit.

Toilet-seat transmission of gonorrhea does not occur.

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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