ArcaMax

DEAR DR. ROACH: Am I a doomed man? When I was 25, I survived a battle with testicular cancer. The good news is that 45 years later, after two kids and three grandkids, I'm in good health. The only medicine I take is gabapentin for peripheral neuropathy that was caused by the chemotherapy drugs I received during the cancer treatment. One or more of these drugs caused neuropathy in my feet.

A neurologist prescribed 800 mg three times a day, and I took this for about 15 years. As I got older, it became 800 mg four times a day for the past 20 years. As I talk to people, they seem shocked that I'm still alive after taking so much gabapentin.

I've never experienced any known side effects from it. I have read that long-term use of gabapentin can increase the chances of dementia. Are there specific things that I should have my regular doctor test me for because of the long-term use of gabapentin? -- C.P.

ANSWER: Testicular cancer is one of the most curable cancers because it is sensitive to both radiation and chemotherapy. However, both of these modalities can lead to problems years after the successful treatment.

For many years, platinum-based chemotherapy has been one of the mainstays for advanced testicular cancer. Painful peripheral neuropathy, especially in the hands and feet, is a common side effect. Gabapentin is a commonly used medication to relieve pain from damage to the peripheral nerves, which occurs in diabetes or with chemotherapy.

I don't often see doses as high as you are taking, but they are certainly used. In a seminal trial on pain following shingles (post-herpetic neuralgia), the target dose of gabapentin was 900 mg four times daily. It often takes weeks or months to build up to this dose so that people can tolerate it, but it is very effective. The most common side effect is sedation, but increasing the dose slowly reduces this effect.

The evidence of gabapentin and dementia is mixed, with two studies looking at hundreds of thousands of people and coming to completely different conclusions. In the study suggesting that there was a dementia risk, it was strongest in younger people.

I conclude that you aren't doomed. While most authorities don't suggest screening tests for dementia, there are some memory and cognitive tests that are easy to do for people who have concerns about their memory or those whose doctors are concerned about a possible change in function. If there are abnormalities, a person can then be referred to a memory expert.

DEAR DR ROACH: In a recent column, you discussed IBS-C (irritable bowel syndrome). I have IBS-D and had very serious episodes for several years. The cramping was enough to keep me in bed for two to three days. The episodes started happening more frequently three years ago and occurred every three to four weeks.

I read that yogurt could help, so I began to eat plain yogurt every day (although I added fruit and granola). I haven't had an episode in two-and-a-half years! Why isn't this suggested by doctors? The change has been amazing. -- K.V.

ANSWER: I am very pleased that you had such great results. Yogurt is often recommended due to the live bacteria in it, which is thought to be beneficial for the gut. Unfortunately, my experience (like most trials) has shown that it doesn't help the majority of people. The lactose (milk sugar) is problematic for many IBS sufferers as well.

Still, it may be worth a try, and I agree with eating plain yogurt.

========

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.

(c) 2025 North America Syndicate Inc.

All Rights Reserved