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Thu, Feb. 20

Dr. Roach: Growth hormone or no? Grandmother asks the question

DEAR DR. ROACH: My grandson, who will be 14 in a month and weighs 75 pounds, is about to start growth hormone therapy. His parents have taken him to an endocrinologist, and he has had tests done and an MRI. The endocrinologist recommends this therapy, but I and other family members do not feel good about it. His father was small until his junior year in high school, at which time he went through a real growth spurt. He is over 6 feet tall now. His mother is probably about 5 feet 9 inches tall. However, his grandmothers are short. I realize this therapy is relatively new, since the 1980s, but I would like reassurance that it is a good thing. – B.S.

ANSWER: Treatment with growth hormone of children with no known medical reason for short stature is controversial. There are several things that should make the parents pause before proceeding. One is that, as was the case with your grandson’s father, many adolescents will have catch-up growth without treatment. His father having done so makes this scenario somewhat more likely. Being a bit shorter than average does not significantly affect most people’s sense of well-being, physically or psychologically. The benefit of growth hormone treatment is modest (2 inches taller is the average), which has to be considered, as the expense and time commitment of the treatment can be considerable.

On the other hand, growth hormone treatment is generally safe, but there may still be rare side effects. It works best when started earlier.

Without knowing how tall he is now, the average height for a man born to parents 5 feet 9 inches tall and 6 feet tall would be close to 6 feet. I understand the reasons for your unenthusiastic support of this treatment.

DEAR DR. ROACH: I had carpal tunnel surgery a month ago, and now one finger is mostly all numb and weak. Is this normal? Will it go away? – G.F.

ANSWER: The carpal tunnel is a structure in the wrist, through which passes the median nerve. In cases where there is not enough room in the tunnel, the nerve can be compressed, leading to pain, which can be felt in the wrist or even the forearm, but is most commonly felt in the thumb and the index and middle fingers and half of the ring finger. Numbness can be felt in the same areas. In severe cases, there can be weakness and even atrophy of the hand muscles.

Surgery reduces the pressure in the carpal tunnel, and usually relieves the pain and numbness within six weeks. Improvement in weakness takes longer.

About 75 to 85 percent of people have excellent results with surgery. I would say that it’s likely the numbness should improve with time. However, if it isn’t better by six weeks after surgery, I definitely would recommend a repeat visit to the surgeon. When I see someone who didn’t get better with carpal tunnel surgery, I worry that the problem wasn’t that the surgery was inadequate (although that does happen, especially with less-experienced surgeons); rather, I worry that the initial diagnosis of carpal tunnel syndrome might not have been correct.

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