In a health advice column, Dr. Keith Roach answers two reader questions about vaccination and nerve damage. In the first, a grandfather asks whether his 23-year-old grandson, who has severe mental illness, addictions, and may become homeless, needs a shingles vaccine. Dr. Roach says the shingles shot is not recommended for the grandson at this age unless he has a qualifying immune system disease. For someone young and at risk of homelessness or shelter living, he says the most important immunizations are hepatitis A and hepatitis B, assuming childhood vaccines were already completed. He also recommends an annual flu shot because of the increased risk of influenza in shelters and crowded settings. He notes that shingles vaccination is generally advised at age 50 or older, or for younger people with certain immune disorders such as HIV.
In the second letter, a patient with multiple myeloma describes life-changing neuropathy after years of treatment, including Velcade (bortezomib) injections. The writer says the condition causes numbness in the feet, a feeling of swelling, and uncertainty while walking. The patient has already tried gabapentin without benefit and had ultrasound treatments that helped somewhat before the provider closed. The patient also asks whether pink Himalayan salt might help.
Dr. Roach responds that reaching minimal residual disease-negative status is an excellent sign for prognosis, including a better chance of remaining progression-free and having improved overall survival. However, he says this success has come with the known side effect of chemotherapy-related neuropathy. He explains that bortezomib is a useful myeloma drug but is well known to damage small nerve fibers and can cause peripheral neuropathy, often with pain or burning. He says pregabalin may help some patients, especially when gabapentin has not worked. For numbness, he says treatment is much more difficult than for pain, and some studies suggest duloxetine may help in certain cases, though his own experience has been limited.
He strongly dismisses Himalayan salt as a treatment, saying it is essentially ordinary salt with trace minerals and no evidence that it improves neuropathy. Instead, he recommends practical steps to reduce injury and improve stability: wearing protective shoes, checking the feet every day for cuts or sores, and working with physical therapy to improve balance, coordination, and strength.
The column closes with a reminder that Dr. Roach cannot answer individual letters directly but may use them in future columns.
