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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


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


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


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

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


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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1999-2000; updates: 2002, 2004, 2005, 2007 Women's Heart Foundation, Inc. All rights reserved. Unauthorized use prohibited. The information contained in this Women's Heart Foundation (WHF) Web site is not a substitute for medical advice or treatment, and WHF recommends consultation with your doctor or health care professional.