Dear Doctor: I'm a 75-year-old man who's done hard physical farm labor since I was a young boy. Now I have painful tingling, burning and numbness in my right palm and fingers. It disrupts my sleep and makes it difficult to hold a pencil. A hand brace doesn't help. Is it carpal tunnel syndrome? What can I do?

Dear Reader: Of course, I can't make a diagnosis without a proper examination -- and I would encourage you to seek one from your physician -- but your symptoms have all the hallmarks of carpal tunnel syndrome. This syndrome occurs because of compression of the median nerve at the wrist. As you look at the wrist with the palm side up, feel the multiple tendons in this portion of the wrist. The median nerve has to share space in the area called the carpal tunnel with nine of these tendons. When the wrist or the tendons within the carpal tunnel become inflamed, the median nerve gets compressed.

Because the median nerve supplies sensation to the thumb, index and middle fingers, compression of it can cause abnormal sensations, such as tingling, burning or even a loss of sensation. The median nerve also helps control the muscles of the thumb and, to some degree, the index and middle finger, so compression can lead to a loss of coordination and difficulty holding objects with the hand. This is most evident when using the thumb to hold an object such as a pencil or a cup. Many people with carpal tunnel syndrome have reported dropping cups.

The burning/tingling sensation in the hand is often noted upon waking -- sometimes causing the waking -- because the hands tend to flex at the wrist during sleep, leading to compression of the median nerve.

Repetitive and forceful use of the hand and wrist is a primary risk factor for carpal tunnel syndrome, as is working with tools that vibrate or that keep the hands in a fixed posture. Lifelong work in farm labor does have physical benefits, but it can take a toll as well.

Additional risk factors include diabetes, low thyroid hormone levels and rheumatoid arthritis, all of which can lead to carpal tunnel syndrome.

A wrist brace is a good first treatment for carpal tunnel syndrome because it stops the hand from flexing at the wrist, further compressing the median nerve. The next step would be physical therapy, though you should continue to use the brace at night. Treatments such as acupuncture and ultrasound therapy have shown some benefit in easing the symptoms of carpal tunnel syndrome, but more study is needed.

Steroid injections into the wrist can decrease swelling around the median nerve, usually providing a short-term benefit of one to three months. Physical therapy can enhance the benefit, but truly lasting improvement will generally occur with surgery that opens up the space around the median nerve.

Follow up with your doctor regarding these symptoms. He or she may suggest nerve-conduction studies to verify carpal tunnel syndrome and recommend a specific therapy that meets your needs.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm hearing a lot about the health benefits of a ketogenic diet, that it's great for weight loss and can even reverse diabetes. What is the diet, exactly? Are the claims true?

Dear Reader: The ketogenic diet, widely known as "keto," is an eating plan that switches an individual's main energy source from carbohydrates to fat. In its strictest form, 80 percent of calories come from fat, 15 percent from protein, and carbohydrates are limited to 5 percent of the total daily food intake. Considering that most Americans get about half of their daily calories from carbohydrates, 15 percent from protein, and about one-third from fat, keto basically flips the typical American diet on its head.

The name comes from the word "ketosis," the metabolic state that arises from this particular distribution of nutrients. When adequate carbohydrates are available, the body turns them into glucose, which it uses for energy. With carbs missing in action, the body switches to Plan B -- its stored fat. Burning that fat creates an energy source known as ketones. This shift takes place over the course of the first few days of limiting carbs to the 20- to 50-gram range. (Some dieters opt to jump-start the process with a 24- or 36-hour fast.)

People on a ketogenic diet eat mainly meat, fish, eggs, full-fat dairy, oils and low-carb vegetables, like leafy greens. Because of their high carb count, fruit, root vegetables, corn, grains, cereals and legumes don't make it onto the plate. Needless to say, pasta, rice, bread, and sweets become a thing of the past. In fact, with carbs restricted to about 20 grams per day, a single apple or banana will blow your carbohydrate budget.

While the extreme nature of the keto diet makes it sound like a fad, it was actually introduced in the 1920s to help children with medication-resistant epilepsy. Ongoing research suggests the diet may be neuroprotective, and scientists are looking into its potential to help patients with neurodegenerative diseases like Parkinson's and Alzheimer's disease.

You're right that the keto diet has been shown to improve glycemic control in people with Type 2 diabetes. Some patients do go on to reduce or even discontinue their medication. However, the diet's effect on blood chemistry can be extreme enough to require rapid adjustments in medication levels. People with Type 2 diabetes should not attempt it without a doctor's supervision. The diet is not recommended for people with Type 1 diabetes.

And while those on the keto diet experience rapid weight loss, they're also subject to constipation, electrolyte imbalances, nutritional deficiencies, poor mood and just plain boredom. Our main concern is the high fat content. Despite a dieter's best intentions to stick to good fats, the focus on high fat inevitably leads to excessive bad fat consumption. One of our patients wound up with LDL levels that doubled, which is never a good thing.

You've heard this from us before, but seriously, please check with your doctor before going keto. And if you do decide to give it a try, it would be wise to work with a nutritionist to craft the most well-rounded version of the diet possible.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm a 76-year-old woman who had a complete hysterectomy when I was 50. My daughters insist that I should still be seeing a gynecologist for cervical cancer screenings, including pelvic exams. Is this really necessary? I already see my family physician every six months for a checkup and blood work.

Dear Reader: Your daughters' confidence in this screening is understandable. Pap smears are an important part of primary care medicine, proven to decrease the rates of cervical cancer and related deaths. Years ago, physicians recommended annual Pap smears for every woman over the age of 21. Now, with the knowledge that cervical cancer is directly linked to HPV infection, doctors understand that screening intervals for Pap smears no longer have to be yearly. The U.S. Preventive Services Task Force now recommends Pap smears every three years for women ages 21 to 30, and both Pap smears and HPV tests every five years for those ages 30 to 65. These recommendations include shorter intervals if the Pap smear shows abnormalities or if the HPV test is positive.

Women who haven't had an abnormal Pap smear and whose HPV tests have been negative have a very low risk of developing cervical cancer after the age of 65. One reason for this is the low likelihood of acquiring a new HPV infection past that age. Many doctors -- including myself -- don't normally recommend Pap smears for women over age 65.

Women who have had a total hysterectomy, in which the cervix is removed, are even less likely to need a Pap smear. Some hysterectomies remove the uterus and leave the cervix, but that would have been highly unlikely 26 years ago. For that reason, I'm assuming that your cervix was removed. If so, you cannot develop a new cervical cancer. If your cervix showed cervical cancer before it was removed, then a Pap smear is reasonable to assess whether the cancer may have returned.

True, other cancers can sometimes be found on a pelvic exam, such as ovarian cancers, uterine and vaginal cancers, but not very reliably -- meaning pelvic exams yield little benefit. For instance, although the only good screening test for vaginal cancer is a visual exam of the area, because the incidence is low (1 in 100,000 women), the yield for screening is also low. Ovarian cancer is much more common, but has no good screening tests. A pelvic exam can sometimes detect an ovarian cancer, but not easily; the tumors are generally small and the ovaries' location makes finding them difficult. As for uterine cancers, they're typically found when a woman notes abnormal bleeding from the uterus.

When I started medical school, many physicians did yearly Pap smears and pelvic exams on women over age 65. As the science became clearer, the medical community has altered its thinking. Although some physicians still recommend yearly Pap smears and pelvic exams regardless of a woman's age, the practice is becoming increasingly less prevalent.

Unless you have one of the signs of cancer in the pelvic region, such as vaginal/uterine bleeding, abdominal bloating or pain or vaginal pain, you're correct: There's little use for a routine pelvic exam.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)