Answer: Your DePuy ASR prosthetic hip is defective, breaking down its alloy components into tiny flakes of cobalt and chromium, which have entered the surrounding tissues and your bloodstream. A normal cobalt blood level should be below 5 mcg/l; a level of 12 is considered toxic.
I agree that the itchy rash you've had for the past year is likely due to cobalt toxicity. While we need a trace amount of cobalt to aid in the formation of the insulating (myelin) sheath for peripheral nerves as well as to aid in red blood cell production, too much can cause peripheral neuropathy, visual impairment, heart muscle damage (cardiomyopathy), hearing loss, cognitive (brain) impairment and hypothyroidism. Chromium is needed in trace amounts to help regulate blood sugar. Chromium toxicity from the defective prosthesis has not been an issue thus far.
What an awful situation to be in! I have to concur with your orthopedist that the best course of action is to replace your defective and toxic hip with a safe one.
Left-sided breast cancer is slightly more common Q:
It may just be coincidence, but I was diagnosed in 1999 with cancer in my left breast, and two of my friends also had breast cancer on the left side. At my last checkup, I asked the nurse and she also thinks that breast cancer occurs much more often in the left breast. Is that so? What might be the cause?
A: Actually, left-sided breast cancer occurs only 5 percent more often than right-sided breast cancer. For your nurse and me, it would appear that left-sided breast cancer is much more common than that because the left arm is generally used to take one's blood pressure. In the case of a left-sided mastectomy with lymph node removal, it's advisable to avoid use of the left arm. This deviation from the blood pressure routine likely makes us more aware of left-sided breast cancer.
The U.S. Surveillance, Epidemiology and End Results Program (SEER) looked at 250,000 cases of breast cancer from 1973-1992. They confirmed the results from numerous other studies that there is a 5 percent excess of left-sided breast cancer in women. This excess occurs for all races and stages of disease. The reason for this is unknown. One possible explanation is that the left breast tends to be, on average, slightly larger than the right; more breast tissue might explain a slightly greater than 50-50 chance of left-sided breast cancer. Why that's the case is another enigma.
Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076.