A therapist can help cane users with proper technique

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I have Parkinson’s disease, and balance is an issue. I have been using a cane on the right side, my weak leg side. I have seen videos that say a cane should be used on a person’s uninjured side. I tilt to the right and catch my balance without cane support in most cases. Which side do you suggest I use for better and faster movement? — J.C.A. ANSWER: A cane is normally used on the “good” side, the side opposite of the one that needs support. However, I refer every patient with a cane to a physical or occupational therapist, since the cane should be the proper type, the proper height and used in the correct hand. Also, people need to be instructed on how to use it properly. Up to 70% of people with canes don’t use them properly, and as such won’t get the help they could be getting. Almost half of people will abandon them. A skilled therapist can help you get the most benefit from the cane. I have read that canes with built-in laser lights can be particularly helpful for people with Parkinson’s. This might be something to look into as well. These are valuable for people with “freezing” of gait. *** DEAR DR. ROACH: You put my life into disarray as I read your column on the risk of recurrence with respect to breast cancer! I promptly grabbed my retired pathologist husband, and he was floored also. He accessed respected medical sites online, and we cannot find any stating that “women with estrogen receptor positive, progesterone receptor positive and HER2 negative tumors are more likely to experience recurrence.” What research are you looking at? I was told by my breast surgeon, oncologist and radiologist that I am in the best possible position with breast cancer. If this is an actual error, you’ll have a whole nation of readers and breast cancer survivors in an anxious state and the phones of providers ringing off the hook! Please tell me that this was a misprint. — T.W. ANSWER: It is not a misprint. The issue is that risk factors for late recurrences are different from overall prognostic findings. Because fortunately late recurrences are relatively rare, they don’t have a major effect on overall prognosis, which is where I think you and your husband may be looking. Specifically, triple-negative tumors (ER negative, PR negative, HER-2 negative) have a worse overall prognosis, but survivors have a low risk of recurrence if they get through the first five years. I am putting some of the original research onto my page at facebook.com/keithroachmd1.

I must note that there are more sophisticated genetic markers that can help predict recurrence. My column lacks space to go into those, but your oncologist can speak to you about them.

I am sorry your life is in disarray. I don’t mean to increase your anxiety. Perhaps it would help if I noted that according to one of the studies I am posting, recurrence rate in the 20 years after diagnosis is only 1.4% per year for ER+ women with no lymph nodes positive for cancer. *** 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 ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.