DEAR DR. ROACH: Two years ago, my grandfather (a 90-years-young Navy veteran) had a nasty fall and, in an attempt to break his fall, fractured a bone in his hand. He was taken by ambulance to the hospital, where he was dismissed with the suggestion of a sprain, without any diagnostic imaging. Cut to months of constant pain before an X-ray was ordered, indicating a poorly healed, dramatic fracture that likely led to nerve damage. His intense pain is constant and ongoing. An orthopedist inexplicably recommended carpal tunnel surgery. The pain hasn’t improved at all, and recovery from surgery made his pain worse, leading to a Dilaudid prescription. Though he has an attentive and thoughtful primary care physician, nothing seems to have been able to reduce his pain. Whenever I see him, he tries to mask the pain he is in, and is trying a variety of hot and cold compresses. The family is at a loss. Do you have any suggestions as to possible medications or exercises we could try? — N.I.

ANSWER: It hurts me to hear stories like this. I don’t know if I can help. The longer the pain lasts, the harder it is to treat, in general. However, if he were my patient, I probably would try some medications that reduce pain from damaged nerves, such as amitriptyline and gabapentin, and I certainly would find another hand surgeon. I also might consult with a neurologist, who might be able to precisely identify the source of the pain, which might help the hand surgeon decide how to act.

Please let me know if he finds relief.

DEAR DR. ROACH: Do all nuts cause constipation? — J.R.

ANSWER: Nuts do not cause constipation in most people. Most nuts have modest amounts of fiber, along with protein and fat. Almonds have more than others, so these would be least likely to cause constipation. The effect on the body of specific foods may differ greatly from one person to another. Some substances are highly variable. Coffee, for example, promotes bowel activity in most, but constipation in others.

DEAR DR. ROACH: My father had dementia before he passed away from bladder cancer in September. I would like to know if dementia is hereditary. — G.B.

ANSWER: There are several types of dementia, the most common being Alzheimer’s disease. Although there is a hereditary predisposition to both early-onset (less than 1 percent) and late-onset Alzheimer’s disease, the genetics of AD is complex. Several genes confer risk, but we do not have a reliable test to predict who will develop it.

Having a parent or sibling with AD increases your risk, but it certainly does not guarantee that you will get AD. Having more than one family member means a higher degree of risk.

If you do have an increased risk because of your family history, you can reduce that risk somewhat just by taking good overall care of your health. Keep a careful eye on your blood pressure and cholesterol. Regular exercise and a healthy diet, such as the DASH and Mediterranean-style diets, might reduce risk as well.

The booklet on Alzheimer’s disease gives a detailed presentation of this common illness. Readers can obtain a copy by writing: Dr. Roach — No. 903, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.