Keith W Roach, MD

04/24/2026

DEAR DR. ROACH: I want to know what you think about vagus nerve stimulation (VNS), both the surgically implanted type as well as the external noninvasive device for rheumatoid arthritis (RA) and other indications. What kind of doctor does this? Just reading about it gives me hope that less drugs are being used to treat these conditions. -- L.L.

ANSWER: VNS uses electrical impulses to trigger some of the many actions of the vagus nerve. VNS is approved by the Food and Drug Administration for some types of drug-resistant epilepsy, headache disorders, and drug-resistant depression.

For RA in particular, a recent randomized trial showed effectiveness at improving symptoms of joint pain and swelling through an implantable VNS device, compared to a “sham” device that didn’t use electrical stimulation. VNS works by inhibiting the inflammatory pathway by electrically stimulating specific receptors. The effect size is modest but statistically significant.

Other studies on noninvasive devices, most commonly one that’s used on the ear, didn’t improve the disease activity of RA. RA is a complex, multi-system disease that can cause disfiguring and disabling joint disease, and it can also affect the heart, lungs, and other internal organs. Since a VNS device hasn’t been proven to modify disease activity, it is my opinion that this device should be used in conjunction with appropriate disease-modifying treatments as recommended by an expert.

I have respect for RA as I recall the days before effective treatments, when I saw many patients with severe joint disease who nearly lost the entire use of their fingers and hands. Rheumatologists are the experts in treating RA and would likely be the person to order a VNS device from.

VNS works by inhibiting the inflammatory pathway by electrically stimulating specific receptors.

04/24/2026

DEAR DR. ROACH: I am a 78-year-old female who was treated for a**l cancer in 2013. The cancer was discovered during a routine colonoscopy, and fortunately, it was only stage I. It was determined to be caused by human papillomavirus, and I was told that a recurrence was unlikely after the first year post-treatment. I underwent chemotherapy and radiation, and I haven’t had a recurrence.

I’ve had repeat colonoscopies every two to three years since then, and I’m now at an age where there is an increasing risk that is involved in this procedure. Since I didn’t have colon cancer, can I change to a safer method of monitoring for a recurrence? -- S.H.

ANSWER: Your risk for a recurrence of a**l cancer is now very low, and expert guidelines don’t recommend more intensive screening for you compared to the average-risk population for colon cancer.

Modeling studies have suggested that the harm from a colonoscopy (such as perforation of the bowel) becomes equal to the benefit of finding cancer early at about age 75 in average-risk people. I’ve had very healthy patients who want to continue colonoscopy screening until age 80 or even 85, but the experts recommend against screening beyond this time. Patients with significant health issues are at a higher risk for complications and are unlikely to benefit from colon cancer screening past the age of 75.

You remain at risk for treatment-related complications, especially from radiation, which can show up years or even decades after treatment finished. So, it’s wise to continue seeing your regular doctor or cancer doctor for periodic visits and for an evaluation of your bowel and bladder function. You may also be at a higher risk for osteoporosis in the pelvis, so you should have a bone density test done as well.

A multitarget stool test such as Cologuard could be considered, but a positive test would still require a colonoscopy. Cologuard isn’t an appropriate screening test for HPV-related cancers, although, for you, this risk is now almost zero.

04/23/2026

This is very good news.

https://www.facebook.com/photo.php?fbid=1370706278436989&set=a.625299199644371&type=3&mibextid=wwXIfr

After the July 2022 launch of the , su***de mortality among adolescents and young adults aged 15-34 years in the US was lower than expected based on prelaunch trends.

From July 2022 through December 2024, observed deaths were reduced compared with forecasted mortality, suggesting a population-level association between expanded crisis services and lower su***de mortality.

https://ja.ma/4vPgvCg

04/22/2026

Dear Dr. Roach: I am bedbound due to back problems. I can walk, but I have to sit often. I don't go outside, except maybe for fresh air. Do I need the shingles vaccine?

— K.G.

Dear K.G.: Yes, I absolutely recommend the shingles vaccine. You don't get shingles from being exposed to someone else. You get it when your immune system weakens over time and the chicken pox that you had when you were a child escapes your body's defenses.

Shingles in an older person can be horrifically painful and predisposes them to strokes and dementia. A sore arm for a day or two is worth the high protection that you get from the vaccine. This isn't just my opinion; it's the consensus of the experts.

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04/22/2026

DEAR DR. ROACH: About eight months ago, I was diagnosed with a torn meniscus in my right knee. Over the course of six months, I received physical therapy and two cortisone shots and had fluid drained from my knee, but I still have pain when I walk. The pain level is about a 2 on scale of 1-10. But it’s discomforting, and I walk with a limp.

The sports medicine doctor I saw didn’t recommend surgery and said to come back if the pain becomes unbearable, at around a 5 or 6. Should I get a second opinion on whether surgery will correct this? I’m 66 years old, and the pain/discomfort while walking restricts what I can do. -- R.L.

ANSWER: The menisci are cartilage structures inside the knee that provide support and shock absorption. They can be damaged by trauma and can also deteriorate over time. Most meniscal tears in people over 50 are degenerative. I am assuming that yours is a degenerative tear.

Years ago, a person with a symptomatic degenerative meniscal tear would have been taken to surgery right away, and most of them would have done very well. However, a very powerful study challenged our understanding of what happens to degenerative meniscal tears. Patients who were referred to surgery either got the recommended arthroscopic surgery, or they underwent a “sham” procedure where the arthroscope was placed into the knee (but no actual repair took place). The patients didn’t know if they had gotten surgical repair or not.

At the end of the study, there were no significant differences between the “sham” surgery subjects and “real” surgery subjects in terms of pain or function. After this study was published back in 2013, there has been significantly less interest in performing surgery for nontraumatic meniscal tears.

This doesn’t mean, however, that surgery is useless. If conservative management (including anti-inflammatories and physical therapy) isn’t effective, and a person has symptoms that are severe enough to restrict their daily activities, I certainly recommend the consideration of surgical treatment.

I do understand a surgeon not rushing to operate, but this has been going on for a long time. Waiting too long to operate can be a problem, too; it’s faster and easier to return to your previous level of function if you have surgery within six months, and you are already past this point. I definitely recommend a second surgical opinion.

Also: should a house-bound person consider getting the shingles vaccine?

04/21/2026

DEAR DR. ROACH: My husband is considering a hyperbaric chamber to see if it can possibly help him for possible post-COVID symptoms. He contracted COVID this past July, and his atrial fibrillation also started to act up at this time. He spent a week in the hospital and was so weak that he had to use a wheelchair to get home.

Two days after arriving home, my husband spent a week or so in a local hospital with continued pneumonia symptoms and sepsis. Then he went to rehab for three weeks to get his strength back. He is now in a research study following the replacement of his aortic valve this past spring and has fainted twice after completing the exercises that they ask him to do.

He says that his head is foggy and swirly, and he feels as if he is going to fall over almost constantly. He has been told by various doctors that he may be oxygen-deficient and that a hyperbaric chamber may possibly help him. Can you tell us what you know about these chambers? -- J.W.

ANSWER: Hyperbaric oxygen uses extremely high oxygen pressures to dissolve oxygen into the blood plasma. (The red blood cells get nearly 100% saturated in people with normal lungs, but high oxygen, which is way above atmospheric pressure, can force more oxygen into the fluid component of the blood.) The extra oxygen is useful for a limited number of indications, including air embolism, decompression sickness, gangrene as well as some other severe infections, carbon monoxide poisoning, and some types of nonhealing ulcers.

The experimental evidence on using hyperbaric oxygen in people with persistent COVID symptoms appeared to be promising, with one initial study of 40 sessions showing a benefit. Unfortunately, a more-recent larger trial (of only 10 sessions) showed no improvement in symptoms compared to a placebo group. (The placebo group went into the chamber but didn’t get hyperbaric oxygen, and neither the subjects nor the investigators knew who got which treatment.) Even the placebo group improved significantly. This may represent the natural history of long COVID, or it may represent the expectation that people will get better. It could also be that more than 10 sessions are needed to receive a benefit.

Since hyperbaric oxygen hasn’t shown a consistent benefit for long COVID, it remains unreimbursed by insurance. There are centers where a person can get treated, but there have been recent reports of fires and explosions in hyperbaric facilities. Despite this, the overall safety record is very good for hyperbaric oxygen.

I’ve had many patients with persistent symptoms after COVID, especially those who had very severe COVID. More research needs to be done to find new ways to help.

Dr. Roach: The experimental evidence on using hyperbaric oxygen in people with persistent COVID symptoms appeared to be promising,

04/21/2026

DEAR DR. ROACH: I read your recent column about human papillomavirus (HPV) vaccinations. Two questions: If an older man were to test positive for the virus, would it be factored into the cost/benefit a**lysis of receiving the vaccination? If so, why not voluntarily have the test? -- J.B.

ANSWER: You are right that if a man had already been exposed to HPV, especially the most dangerous types of HPV, it would make the vaccine less effective at preventing future infections. However, the question is moot because there aren’t any approved tests by the Food and Drug Administration for HPV in men. The existing tests aren’t very accurate, which is why none are approved.

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04/20/2026

DEAR DR. ROACH: Please write about the correct amount of water that people should drink. There’s so much misinformation! -- E.N., MD

ANSWER: There is so much misinformation since a simple answer, like “more is always better,” is easier than a nuanced answer. It depends on your age, activity level, the temperature and humidity, any medications you might be taking, and whether your kidneys have any issues. However, the simplest answer, which is true for most people, is that your body has a built-in system, called the thirst reflex, to make sure that you are getting enough fluid. There are only a few times when you should override this system.

The most important exception is in older people, who sometimes have a decreased thirst mechanism. This is particularly the case in people who live in long-term care facilities or those who have physical or cognitive disabilities. As such, reminders to drink a reasonable amount (1.6 liters or about seven 8-ounce glasses for women; 2 liters or eight 8-ounce glasses for men) of all liquids during the day can be helpful. (Alcohol, of course, isn’t helpful and can be harmful to a person’s fluid status.)

People who are taking diuretics do not need more water. In fact, excess water drinking while on most diuretics can lead to abnormally low sodium levels. Another way to tell if you are getting enough water is the volume and concentration of your urine. People should generally void every few hours, and the color of the urine shouldn’t be dark. Needing to urinate less frequently or having concentrated urine should be an indication for a person to drink a few glasses of water.

Age, health status, level of activity and more determine how much water a body needs.

04/20/2026

DEAR DR. ROACH: What’s a good general wellness supplement to take? I’m a 47-year-old female, and I have always taken a multivitamin, collagen with biotin, probiotics, decaffeinated green tea pills, and my usual prescriptions (losartan, levothyroxine and metformin). I’m looking for more natural ways to lower my weight and cholesterol. Sometimes I take oregano oil and apple cider vinegar. Any good suggestions? -- C.A.

ANSWER: I don’t know of any over-the-counter supplements to lower weight or cholesterol that are both effective and safe, so I don’t recommend any supplements specifically for these purposes. You might be taking decaffeinated green tea extract for this, but a clinical trial showed no significant changes in weight or waist size (although green tea extract with caffeine did show a small benefit).

Metformin, which is normally used for diabetes, has much larger effects in promoting weight loss, but it does have a higher potential for side effects, particularly gastrointestinal ones.

I am concerned about the combination of biotin and levothyroxine. My concern isn’t an interaction between them, it’s that the blood tests to check thyroid levels can be misleading in people who take biotin. I hope your doctor has advised you to stop taking biotin at least a couple of days before receiving your blood tests.

A recent study on multivitamins did show an improvement in “global cognition,” but there was no reduction in the incidence of mild cognitive impairment or dementia during the time period of the study. Previous trials haven’t shown an improvement in cognition.

A mostly plant-based diet and moderate exercise has larger effects on the body than any supplement, and most people would benefit more from a diet change over a supplement.

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04/16/2026

DEAR DR. ROACH: I recently underwent skin scratch testing for food allergies. I was shocked that among the positive findings was peanuts. I have eaten peanuts all of my life (I’m 55) and have never had any type of reaction to peanuts. I was given an EpiPen and was told to avoid peanuts.

The same skin testing results were confirmed by a second allergist. I’m afraid that avoiding peanuts will sensitize me to them when I feel that I’m currently desensitized. I do have chronic inflammation and rheumatoid arthritis, so I don’t want to ingest something that may cause an inflammatory response. Prior to the skin testing, blood tests showed a very low sensitivity to peanuts. What is your opinion on this? -- L.E.

ANSWER: Most patients and many physicians have trouble with understanding false-positive and false-negative results. Very few (if any) medical tests are perfect, and there is an exception to nearly every rule. Some tests are very far from perfect, and scratch testing for allergies are one of these tests.

Scratch testing is sensitive; it will rarely miss a true case of a peanut allergy. But it isn’t especially specific, meaning that when it says you are positive, it might be wrong. For people in whom a peanut allergy isn’t suspected, the chance of this being a false positive becomes higher.

About 1.5% of the population has a peanut allergy. Since you have eaten peanuts your whole life and haven’t had problems, you have a lower risk than the general population. When putting the numbers into the equation (Bayes’ theorem) by using the published test characteristics for scratch testing, you have less than a 1% chance of a peanut allergy. The test is over 99% likely to be a false positive.

I wouldn’t have told you to stop eating peanuts based on the skin test results. While it is true that avoiding peanuts can lead to sensitization, this is only true in infants and young children; there’s no concern in adults.

Peanuts are not considered a pro-inflammatory food. People who frequently eat peanuts tend to have lower levels of inflammatory markers. I wouldn’t tell you to avoid peanuts from the standpoint of your RA.

The doctor said to stop eating peanuts. Was this a false-positive test?

04/16/2026

DEAR DR. ROACH: I just found out I have mild tricuspid valvular regurgitation, and I’m really scared. I’m a single mom of four kids. Two of them have autism, and I am the only parent they have. I just sent you my echocardiogram results. Should I worry or be scared? -- L.Z.

ANSWER: I looked at your echocardiogram results. Although it does sound scary that one of your valves is regurgitant (leaking, meaning that the valve allows some blood to flow backward from the right ventricle into the right atrium), this is extremely common. Over 80% of healthy people will have some degree of tricuspid regurgitation. When the echocardiogram says that the regurgitation is “trivial” or “mild,” you can relax and know that this has no significance and doesn’t increase your risk of any kind of heart disease.

Single parents always have my respect. To raise four children alone (two with autism) surely qualifies you for something close to sainthood.

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04/15/2026

DEAR DR. ROACH: I am 57 years old and love Pepsi, Coke, and unsweetened iced tea for the caffeine, which greatly improves my mood and gives me more energy. Unfortunately, I am borderline diabetic and get horrible kidney stones. I need a caffeine replacement source.

Drinking more water does not do the trick. I gag trying to drink coffee. I have no interest in gas-station energy drinks or shots. Chocolate has too much sugar. Anything with sucralose or artificial sweeteners leaves a horrible aftertaste. I’ve gone months without caffeine, and I feel rundown. Are there any natural supplements or foods that might help me? The difference of being with and without caffeine is very noticeable for me. -- M.D.

ANSWER: I’m guessing you have calcium oxalate stones (the most common type) and that you have been warned because tea has oxalate in it. However, there are two competing factors in tea: One is the fluid, which is very good for people who want to avoid stones, while the other is oxalate, which you don’t want.

It turns out that drinking tea reduces the overall risk of kidney stones. However, the stronger the tea, the more oxalate, so you do want to drink tea that hasn’t been steeped for too long. Furthermore, green tea has less oxalate than oolong or black, so this would be a preferred choice for you. Of course, I recommend unsweetened tea for everyone but especially for a person who is diabetic or prediabetic.

There are other options. It’s not hard to find caffeinated water now, and there are also caffeine tablets for people who really need it. The amount of caffeine in tea is much less than in coffee, on the order of 30-50 mg per cup of green tea and 40-70 mg in black tea, compared to 100 mg in coffee on average. (Specialty coffees can be much higher when brewed.) Caffeine tablets are typically 100-200 mg and might be a lot more than you need or want.

Also: Was doctor off base telling a 100-year-old they need to eat less sugar?