DEAR DR. ROACH: I am a 72-year-old woman, and I have developed painful burning and tingling in my feet over the past several months, to the point that I cannot sleep many nights. Unfortunately, I cannot tolerate gabapentin on an ongoing basis, and topical anesthetic creams only help a little.

I do not have diabetes, but I do have significant scoliosis since childhood. I was told by an orthopedic surgeon that the only way to stop the neuropathy from progressing is to have back surgery, which includes fusion, rods and spacers. He told me this is a 10-hour surgery, and although I’m not afraid of surgery, the recovery sounds horrific.

Do you think this is the best treatment for my neuropathy? I do have an appointment with a neurologist and a podiatrist next Monday. — C.R.

ANSWER: I have only very seldom referred an adult with scoliosis to surgery, and I would be very cautious in your case. While it is entirely possible that the scoliosis is causing the neuropathy, you haven’t told me enough to be sure of surgery, especially not a surgery like the one you are contemplating, which is a very major undertaking with a long recovery, as you say.

I completely agree with your planned visits. Your neurologist and podiatrist have complementary expertise to find out whether the neuropathy is really coming from your scoliosis. An MRI of the spine, as well as nerve/muscle studies like an electromyography (EMG) and nerve conduction, might be able to give more certainty on the underlying cause of the neuropathy.

Furthermore, if an alternative medication could be found to treat your symptoms (there are several other medicines), this would generally be preferable to a major surgery, in my view.

DEAR DR. ROACH: What’s the difference between atrial fibrillation and premature ventricular contractions, aka PVCs (extra heartbeats)? — M.

ANSWER: Both AFib and PVCs are rhythm disturbances of the heart. PVCs are very common early beats of the heart, which are often followed by a compensatory pause that leads to a sensation of a skipped beat. Premature beats can come from the top chambers of the heart (called premature atrial contractions, or PACs, which are also common) or the ventricle.

PVCs can be found in people with normal hearts (80% of people will have PVCs using a 24-hour monitor), but they are found with greater prevalence in people with some kinds of heart disease. This includes those who have poor blood flow to the heart (from blockages in the arteries), an enlarged heart, and congenital heart disease.

PVCs may also be found in high numbers in people with non-heart issues, such as chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea. Stimulants are more likely to cause PVCs. However, in most cases, occasional PVCs do not need to be treated, and a person can be reassured after an evaluation. Up to 500 PVCs a day are usually considered normal.

AFib is an abnormal heart rhythm and can be continuous or come and go (paroxysmal). AFib puts people at a higher risk for stroke and may cause symptoms, so it always deserves a careful workup to determine if an underlying cause can be found — and to consider treatment to reduce symptoms and stroke risk.

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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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