I am concerned about having 2 polyps – a benign at 5 mm and a 10 mm Precancerous sessile serrated adenoma polyp?



 

I am a 65 year old female who just had a colonoscopy 2 weeks ago,  They found 2 polyps, one of which is benign at 5 mm.
The concerning one is 10 mm Precancerous sessile serrated adenoma polyp which was removed.  I read that this type is very serious and is a precursor to colon cancer.  It seems to act differently than most polyps in that it has a different molecular structure that is malignant?
I understand that there is a higher chance of getting colon cancer even if the polyps are always removed.  Is this the case.
Also, when should I have the next colonoscopy?   Any preventative measures?
My dr. is out of town on vacation and I am extremely nervous and worried about this.
Any assistance you can give me is well appreciated…Truth always helps so I can be prepared and ready to monitor etc.
Thank you,

 

Doctor Answer:

The 10mm polyp is a premalignant lesion of the colon so its not the sign of
cancer but of malignancy, results of biopsy and evaluating the surgeon’s notes are important to understand the risks, whether there is cancer and more aggressive treatments, if any,  are needed. This type of polyp is a little more difficult to deal with, BUT If the polyp was COMPLETELY removed during the procedure and there are no additional elements, just regular follow up colonoscopies will be required 0 the first within a couple of months. Please follow the advice of your Doctor and Oncologist.

Below is a more comprehensive answer.

ADVICE AS PER ABOVEMENTIONED QUERIES:

A sessile serrated adenoma (SSA) is a premalignant flat (or sessile) lesion of the colon,
predominantly seen in the cecum and ascending colon.
SSAs are thought to lead to colorectal cancer through the (alternate) serrated pathway. This
differs from most colorectal cancer, which arises from mutations starting with inactivation of
the APC gene.

TREATMENT

Complete removal of a SSA is considered curative.
Several SSAs confer a higher risk of subsequently finding colorectal cancer and warrant more
frequent surveillance. The surveillance guidelines are the same as for other colonic
adenomas. The surveillance interval is dependent on ;
(1) the number of adenomas,
(2) the size of the adenomas, and
(3) the presence of high-grade microscopic features.
Prevention strategy
The usual approach to primary prevention of CRC or neoplastic colorectal polyps is to alter
modifiable risk factors as well as utilize effective nutritional or chemopreventive agents.
While tobacco use is associated with the presence of SSPs, there is relatively little else
known about the primary prevention of SSPs.
The focus of secondary prevention is on high quality surveillance colonoscopy, complete
eradication of SSPs is finally on improving our recognition and understanding of SPS.

 



 

How to get rid of chronic pain?

Hello Doctors. I am a 32 year old woman suffering from chronic back pain. I have been to several doctors as well as many specialists and there seems to be NOTHING wrong with me. This has been confirmed by numerous tests – cbc blood test, scans etc .  My question is: Please inform me as to what are my options. What can I do to get rid of this chronic pain I am suffering from? Thank you ahead of time. God bless you.

Hello. In response to your question I think it is important to underline some facts.

At times pain is not caused by anything physically. And it isn’t imagined either. It is real.

Pain can be purely psychological. It is often caused by psychogenic factors meaning pain that’s psychological in origin. It also is possible it starts from fearful thoughts…negative perceptions of ourselves.

There are 100 million Americans who suffer from chronic pain, with back pain, neck pain, fibromyalgia symptoms, or other forms of pain that have no diagnosed physical cause…none whatsoever.

It’s not that their pain is “in their heads.” The truth is much more nuanced: All pain can have both physical and psychological components. But the psychological component is often dismissed or never acknowledged.

Big pharma’s aggressive marketing of pills and the minimal training doctors get in pain medicine mean that for too long, the go-to treatment for many forms of chronic pain has been opioids. Yet opioids have proven to be not only largely ineffective for treating most chronic pain but also highly addictive and risky.

Other forms of therapy do exist for relief of chronic pain

Cognitive behavioral therapy

Cognitive behavioral therapy shows meaningful benefits on chronic pain — both for psychogenic pain, and for pain with a physical cause — according to systematic reviews of the research. There’s also promising research around mindfulness-based stress reduction and therapies inspired by it.

Yet pain psychologists are hard to find and hard to pay for, and most patients don’t even know they exist. “At the moment, they tend to be seen as a route of no hope for the hopeless, for people who have gone through everything else,” says Amanda Williams, a psychological researcher who conducted one of the reviews of studies on the effectiveness of psychological therapy for pain.

Doctors have long known that pain can exist in the absence of any physical harm.

Likewise, doctors have known that pain can be suppressed without any real medical intervention.

“Pain can be ‘real’ pain — and it can be caused by brain circuits,” says Tor Wager, a neuroscientist who studies pain at the University of Colorado Boulder. “We have to get over this concept that either the pain is real or it’s all in my head and I’m making it up.” It’s both. Pain, explained

Chronic pain may start off as an acute injury and then never go away. It could also be the result of nerve problems, or degenerative diseases like arthritis. Some people might be more susceptible to acute pain turning into chronic pain due in part to genetics. And there’s some evidence that differences in brain structure can predict who goes on to develop chronic pain and who does not.

Our thoughts, personalities, and learned behaviors can also influence whether our pain alarms get tripped. So do our emotions.

Overall, the takeaway is that “pain isn’t just something that happens to us,” says Beth Darnall, a professor of anesthesiology at Stanford University. “We are participating with pain by how much attention we give to it, by the contents of our thoughts, and our appraisal. How awful and negative is it? How helpless and hopeless do you feel about it? Do you feel as a victim; do you feel at the mercy of your pain?”

The power of the mind to self-heal.

You might be thinking: Isn’t this all a placebo response? Well, maybe. But don’t dismiss placebos’ healing power. Even powerful painkillers like morphine are much less effective when people don’t know they’ve taken them.

It could be that psychological therapy is kind of like a strong placebo, or that placebo is a weak form of therapy –

the power of healers to cure disease may in fact stem form the psychological effects healers exert on people’s own inner mental placebo effect.

The best evidence base for this is for cognitive behavioral therapy

Considering how dangerous and damaging the past decades of treating chronic pain with addicting opioids has been, and how risky and expensive surgery can be, they’re a worthy option, one that’s never sold to doctors by pharmaceutical representatives or advertised directly to consumers on TV.

The most common psychological treatment for pain, and the most well-studied, is cognitive behavioral therapy, or CBT. Overall, it’s one of the most rigorously tested and effective tools psychology has to offer. More typically, it’s used to treat anxiety, phobias, and mood disorders like depression. But it can also help some people manage their pain.

CBT “helps people change ways of processing their beliefs and their experiences when they are overly negative,” she says.

Alternative treatment therapies have also shown to help with chronic pain… one of which Reiki healing being presently used in hundreds of American hospitals as well as thousands of hospitals throughout the world.

In the brain, emotional pain and physical pain interact. Just as people sometimes turn to opioids to mask their emotional problems, psychological therapy and other healing techniques can help physical pain. “It’s time to recognize that there is so much overlap that we almost can’t treat one without addressing the other,” Darnall, the Stanford professor of anesthesiology, says.

Psychological therapies can get better — and so can access to them

On the bright side, psychological therapies for pain are low-risk. The same cannot be said of medical treatments for chronic pain. Back surgery for lower back pain often backfires. Doctors literally call this “failed back surgery syndrome” — around 20 percent of back surgery patients will still have chronic pain despite successful procedures, which can cost $50,000 or more.

So the best advice to chronic pain sufferers is to explore ALL avenues even those that seem out of the ordinary.

Dr. D. Zluf

Answer by: Dr. D Zluf, Consultant Physician

4 Medical Cannabis – Marijuana Questions To Ask Your Doctor


 
Medical marijuana is increasingly being introduced as an additional treatment for some conditions but unfortunately your Doctor may not yet be familiar nor perhaps sympathetic to the idea, so before you head out to see your doctor make sure you have done your research.

If you can find documentation that medical cannabis may have helped other people with your condition or is actually being used as a potential treatment, make a copy of the study, article or video and bring it to your appointment.

A reputable source, scholarly journal or academic study is the best way to inform your Doctor and will be your best evidence, but you may also bring along patient testimonials, blog posts or general articles.

Since medical cannabis – marijuana is being used as an additional or alternative treatment, you need to feel confident that your symptoms can be better managed through the use of medical cannabis – marijuana and you need to be able to convey this to your Doctor in terms that she/he can understand.

Here are a few points:

  • Draw up an exhaustive list of all of your symptoms.
  • Indicate which ones can be managed through the use of medical cannabis.
  • Provide a list of all medication and treatments or therapies you have used.
  • Indicate how you responded to each medication, treatment or therapy.
  • Here are 4 questions that you should ask your Doctor:

    1. Given my condition, could medical cannabis be a valid treatment for me?

    2. Is medical cannabis safe for me to use?

    3. Will taking medical cannabis affect my other medications?

    4. What are the side effects?

    As new studies roll out and more jurisdictions legalize the use of medical marijuana, the medical professional will
    be more and more inclined to integrate medical cannabis – marijuana as a treatment option.

    Medical Marijuana and Cancer Treatments: The New Miracle?

    Many people believe that marijuana can help control or relieve some of the symptoms of cancer or the side effects of cancer treatments. But research shows that taking marijuana is not a clear cut solution to minimizing the effects of cancer treatment side effects or pain. However there are studies that show that taking cannabinoids may help.

    Marijuana is not all the same:

    Strains are developed to intensify specific characteristics of the plant, or to differentiate the strain for the purposes of marketing or to make it more effective as a drug or treatment.

    Marijuana contains THC which is a type of cannabinoid but there are many different types of cannaboids. There are at least 113 different cannabinoids isolated from cannabis. Phytocannabinoid tetrahydrocannabinol (THC) and Cannabidiol (CBD) being the two major cannabinoids constituents of the cannabis plant.

    According to cannabis experts, there are at least 779 known cannabis strains in the world. Some strains have been around for a long time. New strains are developed on a regular basis. Many come and go every day. Most strains can be found at a dispensary somewhere in the world. But the sheer volume of strains also increases the difficulty for researchers to properly study the effects of marijuana. With new strains being developed and new claims being made constantly yet never quite actually confirmed through clinical studies.

    Research studies are few and far between. And many are still ongoing.

    What we know about Medical Marijuana so far:

    1. Using medical marijuana, drugs containing cannabinoids or both may help you relax and give you a sense of well-being.

    2. Several studies have shown that some cannabinoids can relieve nausea, vomiting or both. These are side effects of some cancer treatments, including chemotherapy and radiation therapy.

    3. Some people find that medical marijuana can increase their appetite.

    4. Some people claim that medical marijuana can help relieve long-term (chronic) or severe pain.

    Drugs derived from marijuana:

    There are a number of cannabis derived medications available today through prescriptions by your doctor. Some are still in the legal approval process. Others are still in development and clinical tests.

    1. Sativex

    Mouth spray whose chemical compound is derived from natural extracts of the cannabis plant. Sativex contains two cannabinoids: THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol).

    Used for the treatment of neuropathic pain and spasticity in patients with Multiple Sclerosis (MS); Analgesic treatment in adult patients with advanced cancer who experience moderate to severe pain.

    2. Dronabinol / Marinol

    Synthetic Delta-9 THC.

    Used for the treatment of nausea and vomiting for patients in cancer treatment; appetite stimulant for AIDS patients; analgesic to ease neuropathic pain in multiple sclerosis patients.

    3. Nabilone / Cesamet

    Synthetic cannabinoid similar to THC.

    Used for the treatment of nausea and vomiting in patients undergoing cancer treatment.

    4. Dexanabinol

    Synthetic non-psychotropic cannabinoid that blocks NMDA receptors and COX-2 cytokines and chemokines.

    Is a neuroprotective (protects brain from damage) for use after cardiac surgery; regain memory and other high-level function following Traumatic Brain Injury (TBI); possible future use as an anti-cancer drug.

    5. CT-3 (ajulemic acid)

    Synthetic, more potent analog of THC metabolite THC-11-oic acid.

    Used for the treatment of spasticity and neuropathic pain in MS patients; anti-inflammatory properties may help relieve pain from arthritis.

    6. Cannabinor (formerly PRS-211,375)

    Synthetic chemical that specifically binds to the brain’s secondary cannabinoid receptor (CB2).

    Used as an anti-inflammatory; treatment of chronic pain with an emphasis on neuropathic (nerve) pain; bladder control.

    7. HU 308

    Synthetic chemical that specifically binds to the brain’s secondary cannabinoid receptor (CB2).

    Used for the treatment of hypertension; anti-inflammatory.

    8. HU 331

    Synthetic chemical compound composed of central cannabinoid (CB1), peripheral cannabinoid (CB2), and non-CB receptor-mediated pharmacology.

    Used for the treatment of memory, weight loss, appetite, neurodegeneration, tumor surveillance, analgesia, and inflammation.

    9. Rimonabant / Acomplia

    Synthetic chemical that blocks endocannabinoids from being received in the brain, and, as a result, suppresses appetite.

    Used for anti-obesity (appetite reducer).

    10. Taranabant / MK-0364

    Targets receptors in the brain linked to appetite; acts as a Cannabinoid receptor type 1 (CB1R) inverse agonist, blocking cannabinoid receptors in the brain, which suppresses appetite.

    Used for anti-obesity.

    So is Marijuana the new miracle drug?

    The answer is not simple. With the bulk of research still ongoing and new strains and products in development, we still need to wait to know for sure. But what we know so far is that, yes, marijuana can help in some way. We also know that – like all new products being promoted- it is hard today to differentiate fact from hype.

    Buyer beware!

    How important is your sleeping posture?

    dr jean claude

    How important is your sleeping posture?

    Sleeping postures can have an important effect on your health:

    For such a simple thing, sleeping is not an easy thing to master. From obesity to heart-related issues, multiple things can be associated if your sleeping is disturbed. It turns out that it is not just the quantity of speed but also what posture you sleep in that matters. Your sleeping posture matters a lot so it needs a definite check!

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    Some of the sleeping postures and their pros, as well as cons, are described below:

    Back sleepers:

    The good:
    You may be surprised but this is not the most popular sleeping position. Only eight out of every hundred people prefer sleeping on the back. This is although the best position to sleep in. Sleeping on the back allows the neck spine and head to be in a relaxed position. This will lead to minimal pressure on these vital areas. It is also good for patients suffering from gastric acid reflux. Make sure you also add a pillow so that your esophagus always lies higher (superior) than the stomach.

    The bad:
    But this sleeping posture has its cons as well, especially for people who suffer from sleep apnea and snoring. This can lead to an increased incidence of apneic episodes and worsen snoring as well.

    Sleeping on the side:

    The good:
    In this position, the torso and legs are relatively straight but sideways. This is also a good position to sleep as the body is relatively stretched and spine is supported. It helps decrease any acid reflux, neck pain, and back pain. The benefit of this position oversleeping on the back is that it does not cause or worsen snoring. It is the posture of choice for patients with sleep apnea and loud snoring.

    The bad:
    Sleeping on your side can lead to nerve compression and joint pain. This is worse if you are suffering from nerve impingement or rotator cuff injury.

    Fetal position:

    The good:
    Fetal position is one of the most popular sleeping postures. Around 40 percent of all adults prefer sleeping in fetal posture. This includes a person being on side with knees in a bent position. This position is especially good for sleep if the person is pregnant. In pregnancy left lateral fetal position is recommended to increase blood flow to the maternal heart as well as fetal tissues.

    The bad:
    This position is however not good if you have joint problems as it can lead to joint soreness. It also restricts bleeding by not allowing a person’s diaphragm to move properly.

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    Stomach position:

    Seven out of every one hundred people sleep on their stomachs. This posture unsurprisingly is one of the worse sleeping postures for your health. It leads to back pain and neck pain. It also leads to unnecessary pressure on your joints, muscles tingling and aches. It is especially recommended to change your habit of sleeping on your stomach if you have spine problems.

    So how exactly should you sleep?
    People mostly try to sleep whatever posture they feel comfortable in. You can experiment with whatever position you feel comfortable with. Each position has its benefits and flaws. It could be difficult to switch from one posture to another suddenly. Always try to consult your doctor first if you feel any changes in your body after you wake up so they may guide you more about your sleeping posture.

    Written by: Dr. Jean Claude, Consultant Physician

    How to have safe sex without protection?

    Hi Doctors, I am a 21 year woman and asking what is the best way to have sex without protections.

    Female
    Age: 21
    Medications: None

    SEXUALLY TRANSMITTED DISEASES – DO’S AND DONT’S ABOUT STDs :

    STDs are sexually transmitted diseases that are very commonly seen in both the sexes
    especially in sexually active candidates. They are also called as Venereal diseases (VD).
    They spread most commonly by vaginal discharge, semen, blood, body fluids etc. STDs can
    be caused by both virus and bacteria.

    Most common bacteria- associated STDs.

    -Chlamydia : Chlamydia trachomatis is very commonly involved in risk of STDs among the
    bacteria.
    -Gonorrhea : affects male and female genitourinary tract.
    -Syphilis / lues : The second stage of syphilis is highly infective followed by the first stage
    which is associated with the chancre on the penis.

    Most common virus – associated STDs.

    -Herpes virus II (HSV II) : Usually involves lower parts and genitals.
    -Human Immunodeficiency Virus (HIV) : AIDS.
    -HPV (Human Papilloma virus)
    -Hepatitis : Most commonly Hepatitis type B

    Signs and symptoms :

    Irritation and rashes in the genitals
    Genital sores
    Discharge from the penis and vagina associated with color change and strong odor
    Severe itching with painful urination
    Genital warts
    Painful intercourse

     

    HOW TO PREVENT STDs ?

    DO’s to prevent STDs :

    The best way to prevent STDs is to use protection for every sexual intercourse.
    Although they are not 100% guaranteed to prevent STDs. Earlier it was thought that
    condoms with nonoxynol- 9 are effective in preventing STDs as they are bactericial
    (kills the bacterial organisms) but it was associated with irritation in vagina which
    caused secondary infections.

    Talk freely and honestly with your partner about your health and sexual history and
    get to know theirs as well before any sexual activity. But remember that it is not
    completely reliable as the symptoms may take some time to appear clinically . Also your
    partner may not share and may miss few informations.

    You and your partner can get the tests for HIV done before any activity.

    Timely blood investigations potentially reduces the risk of STDs and also if present it
    can be cured without any complications at an early stage.

    In case of active course of a disease, choosing sexual activities which are less risky is
    wise. It includes masturbation, dry humping, cuddling etc.

    Practicing safer intercourse with the use of female condoms and also gloves for manual
    exploration and penetration. Proper use of new sealed packaged condoms including its
    proper placement without tearing . Read the instructions and manual provided along
    with it for proper use.

    Use of dental dams during oral sex is also helpful.

    If the condoms accidentally breaks during the intercourse due to friction, it is advised
    to take oral contraceptives. And also prophylaxis may be needed if there is a previous
    history of STD. For such incidence, consult your doctors as soon as possible.

    Store condoms at room temperature.

    Keep condoms away from sharp objects.

    Using sterile biocompatible lubricant which does not cause allergy or irritation. Prefer
    water based lubricant as oil based may weaken the latex resulting in tearing during the
    intercourse.

    Sex toys and prostheses may serve as a vehicle for STI transmission and should be used
    with a condom or properly cleansed between each use.

    Urination after the activity for females is beneficial as it removes the infectious
    materials reducing the risk of urinary tract infections (UTI).

    Pre-exposure prophylaxis (Pr-EP) and post-exposure prophylaxis (PEP) are effective in
    preventing the transmission of infections such as HIV in patients who are at risk for
    exposure or who have been exposed.

    General hygiene maintenance : This includes proper use of sterile razors, use of clean
    underclothing for intimate hygiene , use of clean sterile towel for cleaning the private
    parts and washing it before and after the intercourse. Other measures includes- daily
    clean bath with use of intimate hygiene wash which helps in maintaining the pH of the
    genital area which maintains normal immunity functions to kill the bacteria and
    viruses.

    Vaccination : They are most commonly recommended for Hepatitis B and human
    papilloma virus. This increases the resistance power against HBV and HPV. Also
    vaccinations for hepatitis A and Herpes are available.

    DONT’s to prevent STDs :

    It is better to avoid love making if any of the symptoms (mentioned above ) are
    encountered . They should be examined by a doctor and investigated. Once cured or
    subsides, it becomes comparatively safer to proceed for intercourse.

    If the disease is already under progress, it is always better to completely avoid until
    the treatment is completed and your doctor gives you an approval.

    Avoid multiple sex partners and avoid contact with sex workers.

    Having any type of unprotected sexual contact with an infected person posses a very
    high risk and chances of getting STD.

    Intercourse must be avoided under the influence of alcohol or drug abuse. Alcohol,
    and some prescription and illegal drugs can interfere with your ability to have a
    conversation and make decisions to have safer sex.

    Anal sex poses a high risk because tissues in the rectum tear easily. Fluids from the body can
    also carry the viruses and bacteria.

    During menstruation, intercourse should be delayed until the cycle gets over. As
    there are higher risks due to direct contact with the blood.

    Avoid sharing same razors , towels and under clothing.

    Female and male condoms should not be used at the same time. Using 2 condoms
    together may result in a condom breaking and tearing.

    Avoid using old expired and broken packaging protections.

    While unpackaging the condoms avoid using scissor or teeth to prevent damage or
    accidental tearing or micro- cuts.

    Do not reuse condoms.

    Avoid oil based lubricants like petroleum jelly.

     

    Overall to sum up

    Measures can be taken to prevent STDs without the use of protection. But this does not
    significantly reduce the risk .

    Use of protection along with other measures greatly reduces the risk but it is not 100%
    effective especially during the active course of the disease.

    Over-all immunity markedly varies from person to person. It plays a primary role in
    prevention and cause of any disease.

    If the partner feels unsafe for love making. It is necessary to respect them and accept it. After
    all proper healthcare and healthy practices plays a huge role in healthy and happy life.!!!

    Dr. D. Zluf

    Answer by: Dr. D Zluf, Consultant Physician

    My wife had a cervical stitch procedure done. What to do now?

    My wife had a cervical stitch procedure done in the 19th week of pregnancy. She is now almost 37 weeks old and doctors oppose the removal of the suture. The last time the cervical length measured in week 23 was 36 mm. We suspect that he did this to encourage the delivery of a caesarean section. Do we have to get a second opinion in this case? My wife does not like going to cesarean section unless absolutely necessary. What to do now?

    Female
    Age: 37
    Medications: NA

    I was not sure whether I am pregnant or not?

    I am a 22 year old girl who has had an unplanned pregnancy. have gone the way of an abortion. I was not sure whether I am pregnant or not because I did not take a pregnancy test. No pregnancy test but I did do abortion kit, called Mifegest kit, on the third week. On day 2, I had heavy bleeding and I saw some kind of ejection of meat or flesh looking material. I wanted to make sure that whether I was pregnant or not. It has been a week after taking the abortion pills, I am still having bleeding. Did I do something wrong….what should I do next?

    Female
    Age: 22
    Medications: Na

    Is back pain, discomfort or soreness a common sign that shows lung cancer?

    Hello there doctors, I am a 31 year old woman, and I experience pain in my back. I need to find out know about the possible connection of back pain to lung cancer and if it is a cause of lung cancer. My family history has zero signs of cancer.I do not smoke and have not done so for over 16 years. No real vices – no alcohol – tobacco gum – no drugs, weed or any thing else!!! Rarely eat junk food. rarely go out to restaurants and when I do its good expensive ones. Veggies and fruit and fish is my thing . No meat Little fatty stuff. I am slightly overweight but do exercise every so often. I have been suffering from mostly upper back pain for awhile and do suffer from Vitamin D deficiency which I am now addressing with D supplements Lately the pain has become more severe in the last few days Most often it arises near the center slightly to the right side of the back. There is no coughing symptoms no breathing problems no loss of appetite no fatigue or lack of energy. No pain while breathing or at night when sleeping or lying down. I do have sinus issues which were examined by an Otorhinolaryngology specialist who said it was just drip problems. Is back discomfort a common symptom associated with lung cancer? And what stage does that} usually happen? Exactly what are the probabilities my getting lung cancer if I have back pain?

    Female
    Age 31
    Medications: Vit D

    I have developed problems to sleep with medication, why can’t I sleep?

    I have developed problems to sleep with medication, why can’t I sleep? My doctor prescribed me zoloft after I was diagnosed with depression. I have been taking zoloft before going to bed for about 2 weeks now and I now have big problems sleeping for the past 2 days. Just don’t seem to be able to get to sleep..it takes a long time and I don’t sleep well during the night. Can the meds me the reason why? What should I do?

    Male
    Age: 36
    Medications: Zoloft 150 mg

    I have lost some sensation in my feet, feeling numbness and tingling sensation?

    I have had severe problems with tingling in my feet. It began in my right foot and later moved on to my left foot. I also have a little numbness sensation. Feels very painful especially during the evening. It seems to get worse then. Feels like pins and needles, tingling, and some slight burning pain. What can it be?

    Female
    Age: 33
    Medications: Advil