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.

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.

DEAR DR. ROACH: I am a 78-year-old female who was treated for anal 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. Can I change to a safer method of monitoring for a recurrence?

— S.H.

ANSWER: Your risk for a recurrence of anal 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.