Hello, dear readers, and welcome to a bonus letters column. Our inboxes are brimming with your questions and comments, so we’ll get right down to business.
A reader from Los Angeles, who has been struggling to manage toenail fungus for several years, asked if there have been any advances in laser treatments. “I tried the pills, but they gave me a terrible headache and I had to stop,” he wrote. “I’m wondering about those ads for a laser cure that I keep seeing. Is there any indication that could work?”
Toenail fungus, as many people know, is a fungal infection that is extremely difficult to cure. This is because our toenails are so effective at protecting the nail bed, which is the area in which the fungal infection takes hold. The pills you were prescribed are a systemic medication that travels through the blood. It can be effective but, as you have experienced, can have unpleasant side effects. Topical creams, liquids and ointments can improve the appearance of affected nails, but, again, can’t penetrate the nail sufficiently to effect a cure.
That brings us to laser treatments. These use focused beams or pulses of light to stimulate, heat or destroy targeted tissues. When it comes to the use of laser on toenail fungus, the data show that results are mixed. Initially, the treatment can be effective. But as happens with systemic and topical treatments, a sustained cure has proven elusive. Even with multiple treatments, the fungus often returns. Success also appears to depend on the type of laser being used. If you decide to move forward with laser therapy for your condition, make sure it takes place in a medical setting and with someone experienced in this particular use.
- In response to a column about the health benefits of walking, a reader shared a bit of wisdom: “I saw this in the newspaper years ago,” they wrote. “‘Walking is the diet without denial, the medicine without prescription, the exercise without equipment, the vehicle without pollution and the therapy without a couch.’” That’s a great quote. Concise, and all true.
- We recently heard from a reader who says a column about cramp-fasciculation syndrome helped him receive a long-sought diagnosis. This is a rare nerve disorder caused by abnormal surges of nerve activity, which cause muscle fibers to contract spontaneously. It results in localized spasms and twitches, which can be quite painful. “I have been searching for this answer for over eight years. I have seen numerous neurologists since this began,” he wrote. “I am tested annually for ALS, as the symptoms are closely related, but have never gotten an answer. This has been a revelation.” Neurological conditions can be hard to diagnose. They often share symptoms, and unlike many diseases, may not have definitive metabolic markers. We are glad a previous reader’s question about cramp-fasciculation syndrome helped you get your own diagnosis.
As always, we thank you for taking the time to write. It’s a pleasure to get your letters, and to know so many of you are interested in the science of medicine.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
