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ASK THE NURSE
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Edema
Question: I am a 47 yo female who has experienced throbbing varicose
veins prior and during my menstrual cycle for the past three years
or so. I have yet to experience any menopausal symptoms, but am curious
why this happens to me. Would love to hear a response.
Answer: Varicose veins can be painful. Perhaps the cause of the throbbing
prior to your menses is fluid retention. Try elevating your legs (when
you have the opportunity!) and wearing support hose when you are upright.
-JRS
Question: I am a 42-year-old female. I'm 5' 4" and currently weigh
212 lb. On 12/22/01 I started taking Norvasc 10 mg. once a day for an
irregular heartbeat that's caused by anxiety and I also started taking
Arthrotec 75 mg. twice a day for arthritis. I don't have high blood pressure,
or any other known health problems other than on 1/6/02 I developed edema
in my feet. On 1/7/02 the edema had spread up to my knees. I tryed walking
on 1/8/02 and it went away for a few hours. I sleep with my feet raised
and in the mornings there is a little less swelling, but it's still noticeable.
On 1/9/01 I was unable to walk more then 2 blocks because of sever pain
in my feet. The pain is now present in my feet, though mild, even when
I don't walk. I sit at a computer as much as 16 hours a day. I've gained
4 pounds since 1/6/02. This morning I've felt a little short of breath
just walking across the room. There's a history of heart disease in the
men on both sides of my family. I haven't gone through menopause. Could
the edema and shortness of breath be the result of Norvasc or Arthrotec,
or should I be checked out for something else? I don't take any other
medicines. Up until December I took a different medicine for the arrhythmia.
Answer: Yes, the edema could be related to the Norvasc. Arthrotec may
do it also. However, other things may cause your edema. First things
first....Norvasc is new. The edema occurred after the Norvasc. Norvasc
is a drug that frequently causes edema. Discuss this with your physician.
He/she may switch your medication. Shortness of breath could be caused
by a variety of things. But with a recent onset of leg edema, pain in
your feet/legs, and shortness of breath you should be evaluated as soon
as possible. -JRS
Question: Hi. Thank you so much for taking the time to read this. My
name is Rachael. I am 18 years old...and I am desperately looking for
a way to relieve the pain in my legs. My calves are constantly tight,
although wearing orthodics in my sneakers help aleviate the pain. My
legs always appear swollen, and sometimes discolored (such as a bluish/redish
color). When I wake in the morning, after having my feet elevated all
night long, my legs feel alright. As soon as I stand up and start walking
around, my legs get really heavy and I always want to sit down and put
my legs up. My calves are the worste; they swell up until they appear
twice the size as their usual appearance. Lately, my thighs have been
hurting also....they often feel tight. In the cold, the symptoms are
worse. During the winter, my legs hurt extremely bad....and I try to
massage them and put a heating pad on them in order to aleviate some
of the pain. When I remain sitting for long periods of time (without
my feet elevated), and then I stand up, my legs hurt a lot. When I excercise...such
as walking or kickboxing, my legs feel better after I'm done. Also, they
do not appear as swollen or discolored. Please take into consideration
everything I have said and give me your opinion. I appreciate it so much.
I have done a lot of research on my situation, and I believe it may have
something to do with water retention or my circulatory system. Thank
you again.
Answer: Rachael, What you describe sounds like fluid retention, also
called edema. Localized edema due to venous (vein) or lymphatic (lymph
node) obstruction may be caused by thrombophlebitis (inflamation of a
vein), lymphangitis (inflamation of lymph nodes), pelvic/abdominal tumors,
or infection with a parasite (filiaria). These are only a few of the
causes. Some of the causes of edema are very serious and need evaluation
by a physician sooner rather than later. Please make an appointment with
your physican....today. - JRS
Fitness
Question: I am nearing my 49th birthday. My husband and I in-line skate
routinely, however during the winter months we go less often. At Christmas
my husband bought me a heart rate monitor. He uses one every time he
exercises. He is 49 1⁄2. His average heart rate during a 10-mile
skate is 136, and he finishes in 52 minutes or less routinely. My average
heart rate for an eight-mile skate completed today was 166. I took over
53 minutes to complete. My max heart rate was 180. Twenty minutes after
skating my face was still flush red. I went to my family physician when
I first got the monitor because I had similar readings after a skate
on Christmas day. After an EKG, he pronounced me fit and not to worry--
that my heart rate would be higher than my husband's. (He is also my
husband's doctor and has consulted with him over the three years my husband
has been skating concerning his exercise regime.) I play tennis regularly,
so I know that I'm not "Out of Shape" as my husband jokes,
but today's skate was hard. We live in Florida and skate outdoors. The
route we take is relatively flat. I want to skate in the Athens to Atlanta
In-Line Skate Marathon next fall with my husband but I am concerned with
my heart performance. Any suggestions or advice would be most appreciated.
Thank You.
Answer: First, you must be congratulated
on your commitment to exercise. Keep in mind that exercise is not supposed
to be a heart-rate competition!
When you exercise and your heart rate is 180, you are about 10 beats
above your aerobic threshold.... a bit uncomfortable. My suggestion is
to ENJOY the Atlanta In-Line Skating Marathon with your husband and listen
to your body. Skate at your own "comfortable" pace. Good luck.
-JRS
Question: I am an individual that exercises four times a week and works
45 hours a week. I relaxed for 12days of now exercising because I was
on vacation. Notice that my heart was beating hard and my breathing was
heard. I know it is winter here in the Northeast and it is very dry.
Is the reason my heart beat is high and breathing hard because of the
dryness or not?
Answer: If you did not exercise for 12 days while on vacation...and perhaps
gained a few pounds, you may be mildly deconditioned. This can be one
of many reasons for your symptoms. I do not think that dry air can cause
the symptoms. -JRS
Heart Surgery
Question: is quadruple bypass the highest level of bypass surgery ever
attempted?
Answer: I have patients who have up to 6 grafts. I do
not know the "record" for
the number of grafts. -JRS
Question: I am a 35 year old woman facing heart surgery (either sternotomy
or thoractomy). After the surgery, assuming I recover well and am back
to my pre-surgery good health, I would like to get pregnant. What is
the success rate for carrying a child and delivering by C-section? Based
on medical evidence, which surgery - the sternotomy or the thoracotomy
- affords the least post-operative difficulties which results in the
best physical recovery and long-term prognosis? Before heart surgery,
are there any foods or vitamins that will increase my chances for a successful
recovery, alternatively, are there any foods I should avoid? After my
sternotomy (or thoracotomy) what is the best way for me to keep the incision
clean (vitamin E, epsom salt baths, etc.) which will lead to the most
esthetic looking scar? In inches, how long is the incision in a full
sternotomy? After my sternotomy (or thoracotomy) what modifications,
equipment, helpful tools, etc. will I need to make (if any) to my bathroom
or bedroom to allow for ease of showering, bathing, getting out of bed,
etc.?
Answer: These are very interesting
questions. However, given the information I have from your questions,
I cannot give you complete answers. The type
of incision depends on what type of heart surgery you are having done.
The decision as to what type of incision, whether it is a sternotomy
or a thoracotomy, depends on the surgeon's preference (and the type of
heart surgery being performed). A full sternotomy incision is approximately
8 inches long. Since I do not know what type of heart surgery you are
having (valve replacement/repair, congenital heart defect repair or coronary
artery by-pass) I cannot give you a research-based answer. This can be
best answered by a high-risk obstetrician. The diet prior to surgery
(and for good health in general) should be a well-balanced diet based
on the U.S.D.A. Food Guide Pyramid. The "Pyramid" can be found
on this website under Nutrition and Health. The diet should be high in
fresh fruits and vegetables, whole grain products. Seafood, poultry,
and meats should be included in the diet. Fatty foods, snack foods and
desserts should be kept to a minimum. To keep an incision clean is a
much more simple task than most people think. Wash the wound with a gentle
soap & water daily while showering. Don't put any salves, ointments
or creams on the incision unless specifically prescribed by the physician.
An esthetic-appearing scar is not guaranteed by good wound care. The
amount of scaring depends on how your body heals. Some people form thickened
scars called keloids despite the "best" care of the wound.
Good luck with your surgery. I am sorry I could not be more specific
with my answers. -JRS
Question: I am am a 23 year old female having surgery to correct a 75%
coarctation of the aorta which has only just been found. I am going to
have the surgery done in five weeks and want to know what to expect from
a thoractomy incision. How long are these usually (ie where do they start
and finish) and how long do they take to heal. Also, what sort of pain
can I expect from this? I guess what I am asking is "What can I
expect?"
Answer: You sound very concerned about your upcoming surgery. I would
hope that you will have a discussion with the surgeon and your cardiologist
regarding this procedure in the very near future. The surgeon should
discuss the approach (incision) with you. Pain is managed and controlled
with a variety of medications. The choice of medications is up to your
surgeon. You should discuss pain management stategies with your surgeon.
You will probably be home within a week of your surgery. Initially you
will not do any heavy work or driving for about 6 weeks. However, specifics
will need to be discussed with your surgeon. My overriding theme here
is you need to discuss these concerns with your cardiologist and especially
your surgeon. Each surgeon has particular ways that he/she chooses to
manage patients. Therefore, I cannot/should not speak for him/her. Please
write down all of your concerns/questions and take the list with you
to your appointment with the surgeon. Good luck, -JRS
Question: About 7 weeks ago,I had bypass surgery,during this time I experience
some set backs, (collaspe lung,partial paralysis lower diaphragm,fibrillations,chest
infection.From day one I complained that the chest tubes were to tight,not
discomfort!Then I thought the chest wound or the dressing was causing
the tightness. But now I believe the tightness was from day one,not the
chest tubes. Nobody I talk to,has any history of this problem. the tightness
is more severe at night, when I try to sleep. I am told that I still
have to heal,but I feel this is more of a pain then a discomfort.I'm
wondering if this is connected to my problem with my diaphragm?
Answer: I am not sure why you are feeling pain and tightness in your
chest that has persisted since your surgery. Has the discomfort decreased
over the past few weeks or has it stayed the same? Does it hurt when
you touch the area? Do you have a fever or are you draining from your
incisions? Are you short of breath? I feel that you need to discuss your
concerns with your surgeon since you are troubled by your symptoms. I
would like to know what the explanation for you symptoms is. Please keep
in touch. -JRS
Question: How long will it take before I can really expect to be pain-free
following a full sternotomy double by-pass? It is now three months since
surgery and this reminds me of the old joke about curing a headache by
hitting your toe with a hammer - no more intermittent angina pain - it's
been replaced by constant muscular and skeletal pain. Can't turn over
in bed, lift anything very heavy, etc., ad nauseum. I think this aspect
of the surgery/recovery was seriously minimized in pre-surgery discussions
and both my physician and my pharmacist are giving me the raised eyebrow
when I ask for additional pain medication.
Answer: I am sorry that you still have discomfort from your sternotomy
incision. Keep in mind that you had your breastbone cut. This takes time
to heal...and aches for an extended period of time are common. Often
extra strength acetaminophen (tylenol) is very effective in decreasing
the pain. Sometimes over the counter non-steriodal antiinflamatory agents,
such as motrin/naprosyn are prescribed. However, if you have fever, chills,
redness, swelling, or drainage from your chest incision, you need to
call the surgeon. -JRS
Question: My mother of 78 years underwent heart surgery
to replace the aortic value(stenosis). The surgery, which would have
taken about three
hours, took close to, if not over, 10 hours. We were told that the aorta
had calcified and work was needed to correct this situation. My Question:
can the condition of the aorta be determined with any precision before
surgery? Thank you for your anticipated response.
Answer: Unfortunately, the answer is no. -JRS
Question:
What are the symptoms one looks for if they suspect their cholesterol
levels are high?
Answer: There are no true symptoms. One sign is Xanthalasma
fatty deposits on the skin especially around the eyes. -JRS
HRT
Question: I have high blood pressure, have gained about 50 pounds, had
bells palsy a year ago (steroids). I am experiencing hot flashes, which
increased this weekend. My heart feels like it is going to burst. What
can I do? I thought about making an appointment this evening for my local
doc to get HRT. What do you think? Will it help the hot flashes, the
mood swings, and stuff?
Answer: Yes, HRT will help the hot flushing and mood swings. However,
given your weight gain due to steroids with probable resultant high blood
pressure, HRT may not be the best idea now. There is some information
that soy products can help decrease menopausal symptoms. HRT may be related
to cardiovascular events, such as strokes for the first 6 months to 2
years after starting the medications.......Your high blood pressure puts
you at risk for stroke. -JRS
Question: I'm confused. I thought that HRT was cardioprotective. Now
my cardiologist is recommending discontinuation of HRT due to data from
the HERS trial showing increased risk of MI in women with know CAD. How
could the medical establishment have been so wrong on this issue for
the last decade. Five years ago every health newsletter acted as if any
post menopauasal woman who was not on HRT was committing a supreme act
of ignorance. Over and over again we heard how cardiac disease is the
biggest killer of women and we should all shelve our breast cancer concerns
vis a vis HRT given the overwhelmingly positive data showing that HRT
protects against CAD. How did that dogma just fly out the window in one
fell swoop?
Answer: Fortunately, research is
on-going. We learn new things every day through research. Somethings
we thought were "gospel" are
not......so it is with HRT. But the jury is still out.....we anxiously
await further HRT studies. Please don't feel defrauded...you are another
informed woman who seems disappointed in the results of that part of
the HERS trials. So am I. -JRS
Question: I am two years post-menopausal so I asked my doctor if I should
go on estrogen. He said that since it was only two years since my periods
stopped that I would have a higher chance of developing complications
like blood clots. Is this true?
Answer: First, I would like to ask
a question. For what reason do you wish to take hormone relacement therapy
(estrogen): prevention of osteoporosis,
prevent symptoms (hot-flushing, vaginal dryness), or to decrease risk
of heart disease? According to recent data (research studies) are not
as beneficial at preventing heart disease as was once thought. The first
18-24 months during estrogen replacement therapy a woman can be more
susceptible to clotting. This could be stroke, heart attack, and clots
the leg leading to a clot in the lung (pulmonary embolus). If you are
thinking about taking estrogen you need to consider a few other issues.
If you have diabetes, smoke, have high blood pressure, a family history
of heart disease or hight cholesterol you are at increased risk for disorders
related to clotting. Then estrogen therapy may not be for you.......But
keep in mind this information may change after further research is done.
Estrogen, on the other hand, is very protective of the bones when taken
within the first 6 months after menopause. Estrogen can help prevent
fractures related to osteoporosis. Estrogen also helps the annoying symptoms
related to menopause such as vaginal dryness that causes uncomfortable
intercourse, hot flushes, insomnia, and irritability. Between you and
your doctor you need to decide if estrogen is "right" for you
given the information that is currently available. -JRS
Heart Valves
Question: Recently my 21-year-old daughter passed away. She had mitral
valve prolapse and asthma. She collapsed at school and was revived briefly
but then died. She just had a physical a few months before. The medical
examiner said the cause was myoxid degeneration of the mitral valve.
How could this have happened? Wouldn't her doctor be able to tell if
there was a heart problem and could it have been misdiagnosed as asthma.
Apparently her inhaler wasn't helping her. I would appreciate any information
you might have.
Answer: I am truly sorry about your daughter's death. It must be very
painful for you to talk to a stranger about it. You did state that your
daughter had mitral valve prolapse. Therefore I would assume that your
doctor knew she had valvular heart disease. -JRS
Question: I had mild mitral valve regurgitation diagnosed in May 1999
and had a repeat echocardiogram in June 2000. I have ongoing symptoms
i.e. palpitations, pounding heart. Does this condition need monitoring
and is it congenital?
Answer: Mitral regurgitation is evaluated by echocardiogram, usually
annually. If symptoms such as shortness of breath occur, the echo may
be done more frequently. MR may be congenital. -JRS
Question: My wife has familial cholesterol (monozygote) and had a quadruple
bypass in 1991 at the age of 28. Although her cholesterol is under control
through medication (still higher than normal) she is in good health.
Doctors are concerned about her valve and the murmuring they detect with
their Doppler equipment. Her cardiologist is hinting that a valve replacement
may be necessary, but he doesn't know if it would be feasible in five,
ten, or twenty years. Can doctors' zero in on an optimum time frame for
valve replacement?
Answer: Abnormal heart valves are observed by echocardiograms and physical
examination. When symptoms begin to occur, it is time to fix (repair
or replace) the abnormal valve. -JRS
Question: My 86-year old grandmother has been advised that she needs
valve replacement surgery. She was hospitalized last week for chest pain
and shortness of breath. They determined that she had several TIAs over
the past several months; also, that she has a leaky valve. They are performing
an angioplasty tomorrow (this will be her third in three years). She
has a pacemaker, is on Coumadin and hypertension medication. My grandmother
asked me to speak with her cardiologist tomorrow. What questions should
I be asking? I do want to ask what the risks are of having open-heart
surgery at her age. Any others? Thank you for your help
Answer: It sounds as if you and your 86-year-old grandmother have a good
relationship. I hope she will be involved with the conversation you and
the cardiologist have. Asking about the complications of surgery in an
elderly woman is a good place to start. Other questions are: What are
the risks of having the surgery versus medical therapy in of woman of
her age and other disease states? Will her quality of life be better
after the surgery, barring complications? How long is the projected recovery/rehabilitation
period? If she is going to have a valve replacement, why is angioplasty
being performed instead of bypass? However, the most important question
to ask is: What does Grandmom want? Good luck, -JRS
Question: Is it dangerous when one has been told that a valve (AZ I believe)
on the Aortic isn't closing? What can be done for this besides surgery?
Answer: You sound very concerned
about your Aortic Valve. Your aortic valve (AV) that "isn't closing" should
be monitored routinely by a cardiologist with an echocardiogram. Medicines
that lower blood
pressure may help protect the heart muscle and valve. You should take
antibiotics to prevent infections of the heart valve if you have dental
work or endoscopic procedures of your bowel, stomach or urinary bladder.
If and when you start to experience symptoms associated with your abnormal
heart valve, options - including surgery - may be discussed with you
by your doctor. -JRS
Question: Hello, Just this year, I began to have severe erratic heart
beat. I was sent to a cardiologist who ran some tests and told me that
I have Mitral Valve Prolapse along with a leaky valve. This MVP seems
to me to be a catch all term as I have heard many women saying that they
have been diagnosed with MVP also. I am wondering if I am in perimenopause.
I have all the symptoms and if I am, then is it possible that hormones
(or lack of) are wreaking havoc on my heart? Prior to this diagnoses,
I was on Inderol for high blood pressure. I am now taking a medication
called Atenolol. Atenolol has stopped the erratic heartbeat and seems
to be working well in controlling my BP. I also have Acute Intermittent
Porphyria which makes the option of HRT impossible. Thank you for any
help you may offer me.
Answer: MVP is a diagnosis that has been overused. However, now there
are much stricter criteria for the diagnosis of MVP. MVP with mitral
regurgitation (leaky valve) is the problem that is of greater concern.
Many women, especially during menopause and premenstrually, complain
of erratic heartbeats (palpitations). This is common (and not dangerous).
The mechanism is not well understood. Beta-blockers, such as atenolol,
are excellent drugs used in the management of palpitations and high blood
pressure (hypertension). I am pleased to hear that atenolol is controlling
both your BP and palpitations. Hormone replacement therapy is not an
option for you as you stated. However, some women have used soy products,
such as tofu, to help manage annoying menopausal symptoms. -JRS
Question: My mother-in-law is 84-years-old and they just found out that
she has a leaky infected valve and spleen problems. She received 2 pints
of blood 2 weeks ago. What has caused all these problems and are they
connected? She is being given high doses of antibiotics 6 times a day
they put the camera down and had a good look at this leaky heart valve.
Answer: What caused your mother-in-law's
bacterial endocarditis (leaky, infected heart valve) can only be determined
by the doctor who is taking
care of her. A leaky valve can be due to having rheumatic fever in the
past...but there are many other causes. Heart valves that leak are prone
to infection. Infection can be caused by dental work, infected teeth
and colon or bladder "scoping". That is why antibiotics are
given to patients with leaky heart valves before those types of procedures.
A blood transfusion does not cause a leaky, infected heart valve. I am
not sure what "spleen problem" she has. So, I cannot comment
on it. I hope your mother-in-law's condition is improving. -JRS
Medication Concerns
Question: I have a question I hope you can help. My mother is 75 years
old her doctor put her on Coumadin. She apparently has a blood clot in
her neck. Is this stuff safe? what if any are the side effects? should
this help? what are the dangers? who makes this stuff? Please help!!
THANK YOU!!
Answer: Coumadin® is a safe drug if it is taken appropriately and
monitored frequently. However, if taken improperly or it is not monitored
properly it can cause serious bleeding (too much medicine) or allow clotting
events (such as a stroke) to occur (too little medicine). When your mother
received the prescription for Coumadin® (also known as "warfarin")
she should have received a pamphlet from the pharmacy describing the
drug, its purpose, dosing regimen, dietary issues, drug interactions,
and monitoring. I highly recommend that you or your mother go to the
pharmacy or the prescribing physicians office and get a copy of this
pamphlet. There is also an audiotape that addresses these issues. -JRS
Question: At age 12 I had valve replacement surgery following an infection
of the heart. I have been on Coumadin therapy since that time. I am currently
suffering from extremely heaving bleeding during my current menstruation.
This has happened about twice a year over the past few years, but seems
to be getting more frequent. Three months ago my period lasted for 5
days of very heavy bleeding of bright red blood. I also pass very large
blood clots ( about the size of an old Eisenhauer Silver Dollar) as often
as 10 times in a day. Is this a normal side affect of Coumadin therapy?
Can it be triggered by my using Aspirin for cramping at the beginning
of my period? Would Job stress cause it to be worse? I feel very weak
after a day or two and can hardly leave home because I bleed through
everything suddenly.
Answer: Coumadin® is absolutely
necessary for you to take. It may be advisable for you to avoid aspirin
or motrin-like drugs during your
period. Please check with your gynecologist regarding your heavy periods.
Perhaps he/she may have more useful information or suggestions. But,
keep in mind that menstrual periods are not similar to bleeding from
a cut. Menstruation is the sloughing (removal) of uterine lining that
is not needed when pregnancy does not occur. -JRS 122
Question: How do
decongestants affect the heart rate?
Answer: They can speed up the heart
rate. -JRS
Question: What are some of the side effects of Triamter?
Answer: Are you referring to Tiamterene (Dyazide)? This medication is
an anti-hypertensive/diuretic. The side effects are infrequent but include
allergic reaction, erratic heart beats, dizziness, weakness, fatigue,
increased blood sugar, anemias, muscle cramps, abnormal kidney function
and impotence. Have I answered your question? -JRS
Question: Does pravachol effect a man's libido? I've noticed since my
husband started taking this medication his sexual desire seems markedly
decreased. He also takes synthroid for hypothyroidism.
Answer: I do not think that the Pravachol would have an effect on your
husband's libido. However the hypothyroidism may if the doseage of synthroid
is not adequate. -JRS
Question: Should you avoid eating grapefruits when taking lipitor for
high cholestrol?
Answer: If I recall correctly, you can eat grapefruit or drink grapefruit
juice but not at the same time you are taking Lipitor. -JRS
Question: My question doesn't have anything to do with my heart. I just
wanted to know if someone was taking Lipitor and got pregnant and didnt
know it, what could happen to the fetus and that person? Thanks
Answer: Safety in pregnancy has not been established. If you are taking
the drug and become pregnant...stop the drug. Rare reports of congentintal
abnormalities have reported. -JRS
Question: Can you tell me the pros and cons of Zocor, the cholesteral
lowering drug. I have just had it prescribed to lower my LDL cholesteral.
Answer: Zocor is a drug which is
classified as a "statin".
It has been shown to lower cholesterol and prevent heart attacks. However,
a 3-fold program is needed to lower your cholesterol. Drugs help but
you also need to exercise and follow a heart-healthy diet which includes
fresh fruit and vegetables, grilled poultry, fish and lean meat. You
should also avoid pastries, cake and candy and other "junk foods".
While you are taking the drug your liver funtion should be monitored
with a blood test. This should be done in approximately one month after
you start the medication. The drug can cause liver function abnormalities,
which are not usually dangerous. The changes in liver function usually
return to normal after the drug is stopped. If you develop severe muscle
pain during the first few weeks you are taking the drug it should probably
be stopped. But first call your doctor so blood tests can be done. -JRS
Question: My mother has emphysema, and she was at a cardiology appointment
yesterday, and they were talking about her being on potassium while taking
the water pill Lasix. Then nothing more was said. I am curious about
the symptoms of low potassium, and what can happen because of this. Thank
you.
Answer: Low potassium can lead to muscle weakness, EKG abnormalities,
and irregular heart beats. -JRS
Question: Hello, I have heard from a few different people that taking
grapefruit juice along with Sudafed is dangerous. Could you tell me if
this is just another myth? Thanks a bunch
Answer: There are a few medications which should not be taken with grapefruit
juice. However, I am not aware of Sudafed being one of them. A pharmacist
can give you a list of food-drug interactions. -JRS
Menopause
Question: I am 47 y/o female. I have hypertension, heart murmur, leaky
valve, GERD, hypothyroid, hypoglycemia and am 50 lbs overweight. I take
on a daily basis, Synthroid, Hyzaar, Prilosec, VitE 800mg., Vit B6 100mg,
Calcium 600mg., and 1 baby aspirin. Over the past couple of weeks I have
began experiencing hot flashes. Every time this happens I check my temp
and I am usually running a low grade temp (99.3-6). I take a couple of
Tylenol and after a while I cool down. Is this the beginning of menopause?
And do women sometimes run a low grade temp with the hot flashes? I feel
fine other than just my face is hot. I have also noticed that I have
mood swings and sometimes get a bit depressed and will get tearful even
over happy events. I do see my doctor on a fairly regular basis and have
my thyroid in check, my BP under control. I was planning an appt with
my doc after the Christmas holidays. I was just curious about the low
grade temp.
Answer: Welcome to menopause! I am not aware that fever accompanies a
hot flash. However, if you feel better after taking Tylenol, that's great.
Perhaps you would care to share your finding with the McNeill Company,
the makers of Tylenol. -JRS
Question: Hi I am 47 and was told by my doctor that I am perimenapause.
What exactly does that mean- and when should I expect to start to enter
into menapause. thanks
Answer: Perimenopause means that you are starting menopause. Menstrual
periods do not usually abruptly stop...it takes months to years to complete
the process. -JRS
Question: I am 45 years old and am just starting to
enter into menopause. Should I be taking an aspirin a day? Both my parents
died from heart
disease so I wondered if aspirin might help reduce my risk.
Answer: Aspirin should not be taken routinely. You need to have a complete
physical with cardiac risk assessment to make a determination. Just because
you are entering menopause, it doesn't mean that your risk changes suddenly.
Usually it takes about 7 to 10 years post menopause for a woman's risk
for heart disease to catch up to a man's. Ask your doctor or practitioner
about the risks and benefits of taking aspirin. -JRS
Symptoms - Probably Not Heart Disease
Question: Are these early signs of a heart attack? I am 47-years-ld and
I am about 20 lbs overweight. I have never smoked or drank. For the past
2 days, I have had a headache and nausea, I am very tired and my body
is very achy I want to wait until February to go see a doctor, as that
is when I will have insurance.
Answer: Sounds as if you have a viral infection. -JRS
Question: I am 51-years-old and female. My concern is that I have pain
in two fingers on my right hand that feels like electrical pain shooting
up my right arm. The nails on this had has a blueish red color to them
they hurt this electrical pain runs up my arm and under my arm pit stopping
their for a moment the I get this severe pain under my right breast.
It is so sharp and electrical not tingling. Then I tight up my hand like
a fist till this pain pass. Sometimes I cry I feel dizziness and nausea.
I guess this is not a heart attack but what is it. What should I do because
the pain under my right breast seems to be getting worse. When I left
my right arm above my head to sleep it gets numb. I can't sleep I am
so tired. I hope you can understand what I am trying to say this is hard
for me to put in words.
Answer: The pain you have sounds more like neurologic (nerve) pain than
heart pain. You should see a doctor to have it evaluated. -JRS
Question: I recently had an "episode" while at work, I became
very light headed, my hands were shaking, I was having hot flashes, my
ears were hot, my heart was beating very fast and felt as if I was going
to literally die, I felt very scared, but didn't really know what do
and just very unattached to reality, it scared me enough to go immediately
to my doctor just to have my blood pressure checked, it ended up being
normal, my pulse was normal and I didn't have a temperature and they
said it was probably nerves. It all lasted about one hour and then I
felt fine just tired. I blew it off as being a panic attack, however,
the more I think about it could it have been early signs of a heart attack.
I'm 30 years old female and have been smoking for four years and have
been trying to quit and I'm down to about 4 or 5 a day. I didn't have
any chest pains with this episode. Another thing I was wondering if you
are having a heart attack does your blood pressure go up?
Answer: A 30-year-old woman is unlikely to experience a heart attack.
However if you have risk factors for heart disease such as diabetes,
high blood pressure, high cholesterol, smoking, or a family history of
premature heart attacks it is not impossible. Blood pressure can either
go up or down during the initial stages of a heart attack. -JRS
Symptoms of Stroke
Question: I was wondering if medication could give me a mini stroke,
or bell palsy (Spelling is wrong I think. I woke up this morning and
the left side of my face is slack. I can't feel it and my eye is not
blinking like normal. I was wondering if you could tell me what I should
do. Thank you.
Answer: First, if your face was drooping/slack and your eye is not closing,
you should be evaluated by a physician as soon as possible. Preferably,
you should see a neurologist (a physician who deals with problems such
as strokes or Bell's palsy). Please go to the emergency room if your
doctor cannot see you immediately. Since I do not know which medications
you are taking I cannot address which ones may be associated with a stroke.
An illegal drug that can be associated with stroke or heart attack is
cocaine. I cannot impress on you enough that you need to see a doctor
NOW. Good luck. -JRS
Weight Management
Question: Is ephedra safe? I am considering taking it to help me lose
weight.
Answer: Although ephedra is natural, it is not necessarily
without risk. Ephedra is a stimulant so it speeds metabolism and has
an affect on the
cardiovascular system (vasoconstriction, rise in blood pressure and pulse
rate). The U.S. Food and Drug Administration have issued a warning about
ephedra as many deaths have been associated with its use. There are other
ways to increase metabolic rate - like regular exercise. Use caution
with herbal products. Unlike a pharmaceutical product with dosage and
a predictable effect, "dosages" of herbs vary, depending upon
when what time of year the product was harvested and other factors. Check
with your healthcare practitioner before starting ephedra.-JRS
Question: I have tried for several years to lose weight and have been
successful at times. I had my first baby 9 months ago and haven't been
able to lose the weight I gained. I have a friend who is going to a doctor
to lose weight. She takes some kind of natural diet pills plus a vitamin
B 12 twice a month. Is this dangerous?
Answer: Weight loss is difficult. However, diet pills are not the answer
to losing weight. Some diet pills have stimulants in them (ephedra).
These substances can be very dangerous, especially if you have high blood
pressure. In order to lose weight and keep it off you should increase
the amount of calories you expend / burn. You can do that very easily
by taking a walk every day for at least 20-30 minutes. Initially you
will not notice your weight decreasing...but you will notice muscle toning
and firmness. Diets don't work in the long run. Avoiding snack / junk
foods, eating a healthy BALANCED diet and exercising are key to the maintenance
of a healthy toned body. Good luck. -JRS
Miscellaneous
Question: I am a Leader in the Boy Scouts and we are trying to teach
them First Aid for someone who is suffering from a heart attack in the
field and what are the first forms of care that can be given before trained
techs arrive. Can you help? Thank you.
Answer: I am pleased to read that you are taking an interest in the Scouts'
education. Please refer to the basic cardiac life support guidelines
in the HEART SAVER MANUAL published by the American Heart Association.
This is the student handbook for cardio-pulmonary resuscitation and first
aid for choking. - JRS
Question: The past couple days I have had some pain in the fingers on
my left hand. Today I noticed pain in the left forearm as well. I don't
recall doing anything strenuous to cause the pain. I am 38 years old
and have smoked since I was 18. I have had pain occassionally in my left
shoulder and was told by a physician it was an inflamed pectural muscal.
Answer: Many things can cause pain in the arm, hand, and shoulder. I
do not have enough information to comment on your statement. One thing
I could suggest is quit smoking NOW. The incidence of heart disease is
significantly higher in people who smoke. So, if you are concerned about
heart disease, stop smoking. -JRS
Question: I was diagnosed with viral cardiomyopathy in 1988,am on Atenolol
100m.g. and Cozaar 50mg. Hydroclorothyazide 25mg. daily. I am experiencing
angina and clamminess upon exertion as well as tightness in my calves.
Should I be concerned?
Answer: Yes, you should be concerned. These symptoms need to be addressed
with your cardiologist ASAP. -JRS
Question: My son is the longest living bone marrow transplant recipient.
It was done 24 years ago when it was refused by over 98 percent of the
people in the out-patient department at Dana Farber in Boston. He is
left with a cholesterol count that is off the charts because of this.(over
600.) I know he has to be on medication for the rest of his life and
his diet probably won't make a dent in the cholesterol count, but it
is worth trying as a life style. Why make matters worse!! The only problem
is that he is already small for an adult and loses weight too easily.
Can you recommend a dietician that is expert in this area? Do you know
how much cholesterol is good for a person in his situation each day?
Do you know a good cookbook for low/no cholesterol? Do you know good
and tasty recipes for low/no cholesterol? Thank you so much.
Answer: I think you have already answered your own question. Your ARE
between a rock and a hard place with your son's cholesterol. Medication
is a MUST. However, too severe of a dietary restriction could make him
lose weight which could be harmful. I would suggest that you get a copy
of the American Heart Association cook book. It could be helpful in finding
foods which are high in protein and not too high in fat. Does your son
belong to a transplant support group? He could find a connection with
people who have similar cholesterol issues to deal with. I am sure there
are many dieticians connected with transplant services. -JRS
Question: I have been diagnosed with congestive heart failure. I am on
prescription Atenelol, Zestril and Isosorbide Mononitrate. I'm 58 years
old. Need to get a tooth extracted with the possibility of installation
of an implant. Should I worry about possible (if any) impacts to my health
caused by the dental work?
Answer: Not unless you have valvular heart disease (leaky heart valves)......then
you would need to take antibiotics prior to the dental work. Your cardiologist
would determine that need, if any. -JRS
Question: I'm a female 50 years old. Two years ago I had a stroke. A
hematologist 4 months ago said I had Cardiolipin Syndrome and put me
on Coumadin. I started at 5mg a day that was too much. Then 4 mg has
been too little. I was having a lot of stroke like symptoms so they increased
my dosage back to 5mg. That didn't thin my blood. So I went to 6mg. That
didn't thin my blood also. Now I just started taking 7mg. This has all
been over a 4-month period of time. I'm afraid to take 7mg when 5mg use
to be too much. What is the limit on Coumadin dosage? And is it usually
this difficult to stabilize? They need to get my PT to 3.0 to 3.5.
Answer: You are fortunate to have been
diagnosed with anticardiolipin antibody syndrome BEFORE you had a stroke
/ vascular
event. Sometimes
Coumadin is difficult to regulate. If you eat a lot of green, leafy vegetables
which contain Vitamin K (the Coumadin "antidote") it is difficult
to get and keep the INR (the international normalizing ratio for PT)
in the desired range. Alcoholic beverages and antibiotics can increase
the INR level. The dose of Coumadin you need is the amount of drug necessary
to maintain your INR between 3-3.5. This is not an easy task. Good luck,
-JRS
Question: What do the initials PAC stand for Physician Assistant?
Answer: PA.C. (Physician assistant, certified) This means that the PA
took a certification/qualifying exam...and he/she passed it. -JRS
Question: What could cause my 11-year-old daughter to have an abnormal
EKG?
Answer: I cannot answer that question unless I have an idea of the abnormality
that was detected on the EKG. Perhaps you should ask the doctor who requested
the EKG. You sound concerned. -JRS
Migraine (misc)
Question: My 17 year old daughter suffers from Migraine headaches. She
gets them often and has had them for quite a few years. Our Dr. has prescribed
Propranolol. I've heard of Beta Blockers but don't know much about them.
She takes Imitrix and that seems to work. But, how often is it ok to
take them. Sometimes she gets headaches everyday for a week. But, please
tell me more about the drug Propranolol. I'm concerned about the drug
and its affect on her blood pressure. But, if its something she needs
to take to stop these headaches then we need to have her take it. Thanks
so much.
Answer: There are many drugs and
combination of drugs used for migraine headaches. Beta-blockers and Calcium
Channel Blockers are often used
in conjunction with Imitrex. Both beta-blockers and calcium channel blockers
are used for a variety of medical problems, not only for blood pressure
management and migraines. So, if your daughter's physician prescribed
the beta-blocker (probably a low-dose) it is a reasonable choice. It
may have minimal, if any, effect on her blood pressure. Unfortunately
there is no "cook-book" remedy for migraines. It is trial and
error until the right combination of drugs and other therapies are found.
I hope your daughter's headaches decrease in intensity and frequency. –JRS
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