DEAR DR. ROACH: I have read everything I can find on Heberden’s nodes. I have one on the middle finger of my left hand, my writing hand. I have had this node for about three months, and I believe it is still growing. For sure, it is not diminishing in size. I saw a physician, and he said it should grow smaller over time. He suggested Voltaren for the occasional aches. The only treatment I have found is surgery, and I watched a video of an operation. That did not look too appealing. It is pretty unsightly to me, although others do not notice it. Do you have any other suggestions? — A.S.

ANSWER: Heberden’s and Bouchard’s nodes are manifestations of osteoarthritis in the hand. A quick anatomy lesson: Your second, third, fourth and fifth fingers all have three phalanges, the small bones of the finger, while the thumb has only two. There are then two joints connecting one bone to another: the proximal one, that’s closer to the hand, and the distal one, that’s closer to the fingernails. The thumb only has one interphalangeal joint.

Heberden’s nodes form in the distal joints, while Bouchard’s nodes form in the proximal joint. The nodes are bony and feel firm or hard. Most people have pain, stiffness or soreness for years before they develop the nodes, but by the time the nodes develop, there is less pain. My experience is that once they are set, they neither grow nor shrink.

I would not recommend surgical treatment for cosmetic appearance. Surgery is reserved for people with severe symptoms that affect their quality of life, especially when it limits function.

DEAR DR. ROACH: Years ago, I was told that people with very little earwax have low cholesterol and generally live very long lives. Doctors and nurses that I mention this to have either never heard it before or doubted it was true. Your comments, please! — W.D.M.

ANSWER: There have been reports that the type (not amount) of earwax you have correlates to risk for heart disease. “Wet” earwax has more fat and less protein, while “dry” earwax has more protein and less fat. A Japanese study from the 1960s identified “dry” earwax as protective against heart disease, but no further studies have confirmed this apparent risk. Wet earwax correlates to high levels of apolipoprotein B more than it does to overall cholesterol levels.

Wet earwax has also been proposed as a risk factor for developing breast cancer. I recall, as a medical student, asking a prominent breast surgeon whether this was real, but she said it was of no clinical value whatsoever.

The earlobe crease, a horizontal crease going across the earlobe, has been also associated with heart disease, but again, there remains controversy about its usefulness.
Although the ear may have some clues about cardiac health, the magnitude of the effect is small, and it rarely changes clinical recommendations.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.


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