DEAR DR. ROACH: I have had hot flashes, similar to those experienced by post-menopausal women, ever since my coronary bypass in 1990. I can be sitting quietly in a chair reading or at my computer, and suddenly I find myself dripping with perspiration. I also have had panic attacks, with increased heart rate and other physical symptoms. A few years ago, a 24-hour EKG showed heart-rhythm irregularities and that my heart stopped briefly while asleep.
If these idiosyncrasies of my autonomic nervous system are a consequence of my time on the heart-lung machine for the bypass, I'm not complaining – just curious. You said that studies have been done on almost everything. Is this one? – W.S.B.
ANSWER: I found that a lot of people complain of similar symptoms. I also found that indeed, the autonomic nervous system (the part of the nervous system that regulates temperature, sweat, blood pressure and many other critical aspects of body function without our being consciously aware of it) can be adversely affected by cardiac surgery. Some authors have suggested that the autonomic nervous system changes are one mechanism by which people are more likely to have depression after cardiac surgery. I found several possible explanations why the ANS changes with bypass surgery, but no clear consensus.
I would want to be sure that there are no other causes of these symptoms. It sounds like you have had an extensive evaluation, but I certainly would be concerned about a sudden fast heart rhythm, such as atrial fibrillation.
The booklet on abnormal heart rhythms explains atrial fibrillation and the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing: Dr. Roach – No. 107W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: I suffered a long time with GERD. I was diagnosed with Barrett's esophagus, a precancerous disease. My doctor recommended a procedure called a Nissen fundoplication. Since the procedure, I have not had heartburn again. I would do it again, after what I went through. I get an endoscopy every two years to keep an eye on my disease. – G.D.B.
ANSWER: Barrett's esophagus is a complication of longstanding reflux. It is diagnosed when the lining of the esophagus starts to look like the lining of the stomach. Barrett's esophagus can progress to cancer of the esophagus. About 0.2 percent of those with Barrett's per year will develop cancer, which sounds low, but if you live with the condition for 25 years, that's about a 5 percent risk.
Surgery for reflux disease is done only rarely. However, it is very effective (85 percent to 90 percent). The most common reason to consider surgery is inadequate relief from medications and lifestyle changes. However, severe erosions from acid in the esophagus, inability to take medications, a stricture (partial closure) of the esophagus and Barrett's esophagus are all reasons to consider surgery. Surgery appears to reduce the risk of cancer more than other treatments.
DEAR DR. ROACH: My father is an 84-year-old diabetic. He has had a wound on his foot (on the inner side of his right foot, near his big toe) for about five months. He has been treated by a podiatrist, who has debrided the wound every week. He prescribed antibiotics when the wound has looked infected. A visiting nurse and my mother have changed and dressed the wound regularly during these months.
This week, the podiatrist said he could see the bone in my dad's foot, and recommended hyperbaric treatment. Could you tell me what your opinion is of this treatment in my father's case? Do you know if it has a high percentage of success? – C.O.
ANSWER: Foot ulcers in diabetes are common and feared. Diabetes damages blood vessels, both large and small. Also, longstanding diabetes decreases the effectiveness of the inflammatory response and immune system. Finally, poor nerve function in people with diabetes combines with these other factors to predispose one to developing breakdown of the skin and development of ulcers. These ulcers can get large and deep, and when the bone is visible (and sometimes even when it's not), the bone is infected. In this case, there is a high risk of the need for amputation.
By far, the best way to deal with diabetic foot ulcers is to not get them in the first place. Good control of diabetes, proper footwear, regular checks by a professional and daily self-checks of the feet for people at high risk can reduce the likelihood of developing ulcers. Early and aggressive treatment of precursor lesions, even mild redness of the skin, ingrown toenails or fungal infection of the feet, should prompt urgent evaluation by a podiatrist.
Once the ulcer has progressed to the point where your dad's is now, aggressive measures are called for. In addition to care by a podiatrist or orthopedic surgeon, evaluation by a vascular surgeon and a wound-management specialist may be limb- and even life-saving.
While hyperbaric oxygen has indeed been shown to be beneficial in several studies (reducing amputation rate from 33 percent to 9 percent in one study), only an expert with detailed knowledge of your dad's case can decide whether this is appropriate treatment. If you trust your podiatrist, I think it may well be a useful treatment. However, I would be sure that he, or a vascular surgeon, has looked at the quality of blood flow to the foot.
DEAR DR. ROACH: What is your position on the shingles vaccine for people in their 70s? We have been told that some doctors do not approve of it. Yet we know of so many people who suffered terribly from shingles. Thank you. – J.T.
ANSWER: I've written about the vaccine lots of times. I am a strong believer in it and think anyone over 60 should get it unless they have a medical reason not to. The older you are, the more important it is to get the shot, since the complication of pain (postherpetic neuralgia) is so devastating and tends to lasts longer the older you are.
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 [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved