I am 75 and have had Waldenstrom macroglobulinemia for three years, which has been treated with ibrutinib (Imbruvica) and is now in remission. A side effect of Imbruvica is bleeding, and it requires the drug to be withheld before procedures. I need a colonoscopy and a prostate biopsy now. Ideally, how long before and after the procedures should Imbruvica be withheld? — T.

Answer:

Waldenstrom macroglobulinemia is a rare disease — a type of blood lymphoma and a cancer of the bone marrow. Ibrutinib is a new effective treatment for many people who have this condition and sustain remissions from the disease.

As you correctly say, bleeding can be a problem with this medicine, and it is generally held for three to seven days before and after surgery. Because a prostate biopsy is a low-risk procedure and a colonoscopy has almost no risk, most experts would hold the medication for just three days before and after.

There have been reports of the disease flaring up when withholding the drug, so as little time as possible is the best answer of how long it should be withheld. But it is your hematologist whose clinical judgment is required.

Dear Dr. Roach:

I am 85 years old and in reasonably good health. I developed neuropathy of my feet approximately seven years ago after my back surgery, but now I am to the point where I have difficulty walking. My doctor said I have persistent spinal stenosis with no cure. Is there any medical procedure to help? — W.T.

Answer:

“Neuropathy” is a term used to describe a syndrome of nerve damage, which can be from dozens of different causes.

In your case, the neuropathy may be due to pressure on the nerve roots from your spinal stenosis, which means that the bone canals the nerves go through when they leave the spinal cord are too small.

There are treatments, starting with surgery to relieve the pressure on the nerves. Physical therapy can be helpful for some people. Medications are also helpful, but they can only relieve the pain, not the numbness.