Patient has questions about cardiologist’s techniques

Dear Dr. Gott: I learned I had mitral-valve prolapse (MVP) about 40 years ago and have had it monitored ever since. I am now 65 and otherwise healthy. I have always had spells where my heart would start beating real fast, but they have been more recent lately, occurring almost once a month.
About four years ago, my cardiologist put me on 20 milligrams lisinopril daily. My blood pressure is 135/80. Since then, we moved from California to Arkansas. Last month, a new doctor took me off lisinopril and prescribed 60 milligrams diltiazem twice a day. He referred me to another cardiologist. The new cardiologist wants me to start taking 240 milligrams Pradaxa instead and suggested I undergo valve repair ASAP.
The surgeon he is referring me to repairs by splitting the breast and putting a ring around the valve. My research shows newer and less intrusive methods for repairing mitral valves (like the MitraClip). Can you refer me to a doctor in Arkansas that does these new procedures? What do you think about the procedure and starting the Pradaxa?

Dear Reader: The New York Daily News ran an article on this subject almost a year ago, following years of apparent successful use in Europe. Reports were the tiny medical clip might literally save millions of Americans from open-heart surgery. Mitral regurgitation affects more than 8 million people in the United States. The clip is reported to be far safer than surgery and nearly as effective. In fact, a study presented at an American College of Cardiology conference at that time found more complications (sixfold) from surgery than experienced by those who got the clip. It is important to note that the company that manufactures the MitraClip funded the study; nevertheless, doctors called it a turning point for advanced procedures.
Here’s the glitch. While the clip is commercially available in Europe, from what I can understand, it has yet to receive FDA approval in the United States, even though the procedure has been performed numerous times here under FDA protocol. Without FDA approval, insurance companies might not cover the procedure, and there might be restrictions.
The system includes a catheter-based device delivered to the heart through a blood vessel in the leg. It is designed to reduce significant regurgitation by clipping together the leaflets of the mitral valve. Repair with the clip is performed by physicians in the catheterization laboratory. Because the heart beats, there is no need for heart-lung bypass-machine involvement.
This is a highly personal decision and shouldn’t be made lightly and without the advice of your physicians. If the procedure is as good as it sounds, your recuperation will be minimal, and your body will be less traumatized; however, it may not be available to you. Ask your physician for a referral to a cardiologist for a second opinion. Reach out to a large teaching facility in your area or call your state medical society for their suggestions. I congratulate you for taking the initiative to educate yourself regarding the newest procedures for mitral-valve prolapse. Keep in mind that you may be a candidate for other, less invasive procedures to correct your MVP.
Readers who would like additional information on cardiac abnormalities should send for my Health Report “Coronary Artery Disease” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.

Dear Dr. Gott: I’m a 57-year-old man happily living with my wife of 34 years. Although I watched my diet, exercised, and have no family history of cardiovascular disease, I had a 90 percent cardiac blockage in 2009 and ended up having a heart-catheterization procedure and stent insertion. I saw the signs early and now take 40 milligrams of simvastatin.
Because I had paid my deductible and co-insurance, I saw a back surgeon about my back, which had been giving me problems for years. After X-rays, a CT and MRI, he determined that I have a vertically herniated disc between my fourth and fifth vertebrae. He said I need a spinal fusion, which would involve going through my abdomen. He gave me prescriptions for pain but didn’t prescribe physical therapy or other alternatives.
I’m hoping I can avoid surgery by exercising and watching what I do. I gave up golf and began exercising at a health club, swimming, lifting weights, and walking on an incline treadmill. I limit activities that aggravate the pain.
Recently, I met a man who had spinal fusion in the same area. I asked him what caused him to go ahead with the surgery, and he replied it was because of a drop foot on his left side. My question is, can I live with a herniated disc and not have surgery? Is there another type of doctor I can see who would have an alternative?

Dear Reader: Spinal fusion is the permanent connection of two or more vertebrae in the spine that eliminates any motion between them. This is accomplished with screws, rods or plates to hold the vertebrae in place and promote healing. Fusion is performed in a small portion of those people with recurrent herniated discs or such severe herniation of the disc that it pushes on the nerves, causing problems. The specific technique used is largely dependent on the surgeon’s experience and comfort level with a specific approach. Unfortunately, as I have said countless times, nothing is without risk. In this case, infection, bleeding, blood clots, blood-vessel injury around the site and pain at the site where the bone graft was taken can occur. Beyond this, once fusion is accomplished, stresses of the spine are shifted to adjacent areas, which can accelerate wear and tear in those joints on either side of the fusion. This, too, could result in chronic pain. There are methods of making several smaller surgical incisions as opposed to open surgery through one large incision. This procedure is rather complex, requires great skill, and is not available at all hospitals. Despite the procedure, you may have less pain following surgery, but it’s unlikely all your pain will disappear.
If you don’t want surgery, speak with your orthopedic specialist. Take your films, and get a second opinion from a highly qualified physician. Check in with a naturopath. If your original specialist has already recommended fusion, it may be that you will not experience relief without a radical procedure; however, if there are options to delay what might be inevitable, ask for recommendations for physical therapy, acupuncture, chiropractic manipulation, a pain-management clinic and/or massage therapy. Even without intervention, your condition likely will not lead to neurological deficits or result in a progressive worsening condition; however, it is a possibility. If and when you feel your quality of life has been sufficiently compromised, consider the procedure once again. Who knows, perhaps in a year or two, less invasive and more advanced techniques might be available. Research is always ongoing.
Readers who would like additional information can order my Health Reports “An Informed Approach to Surgery” and “Managing Chronic Pain” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.

Dear Dr. Gott: At one time, somebody suggested eating a berry for a urinary-tract infection, but I don’t remember the name of the berry.

Dear Reader: It’s the cranberry. At the first sign of a urinary-tract infection, drink at least 16 ounces of 100 percent cranberry juice each day until symptoms disappear. The properties in cranberry juice will interfere with the ability of bacteria to adhere to the bladder tissue. Be sure to read labels to avoid purchasing cranberry-juice cocktail, which has other juices or ingredients in the blend.

Dear Dr. Gott: I’ve heard a lot of mixed things about vitamins D and E. Can you tell me the good and the bad about them? Thank you.

Dear Reader: Vitamin D is fat-soluble, meaning that it is stored by the body for future use. It can be produced within the body during exposure to sunlight and is also available in some foods and through supplements. Before the body can use it, however, it must undergo two changes. The first occurs in the liver, the second in the kidneys. At this point, it is now active and ready for use in the body.
Vitamin D is widely known to aid calcium absorption. It also maintains appropriate blood-calcium and phosphate levels, which are necessary for normal bone mineralization. It is necessary for bone growth and remodeling (repair). The body also uses Vitamin D for reducing inflammation, modulation of cell growth and normal functioning of the immune and neuromuscular systems.
Because Vitamin D is not naturally found in many foods, it is commonly added to cereals, milk and other dairy products. Some foods that naturally contain D include cod-liver oil, salmon, tuna, mackerel, sardines, liver and eggs.
The recommended dietary allowance (RDA) varies with age. Infants from birth to 12 months should receive 400 IU daily. Children and adults from 1 to 70 years of age should obtain 600 IU daily. For those over 70, the RDA is 800 IU daily.
Deficiency can cause rickets and osteomalacia. Rickets is the softening and weakening of bones in children. It may also cause bone deformities. Osteomalacia is the softening of the bones in adults. It is not the same as osteoporosis. Osteomalacia is the result of an abnormality during the making of bone, whereas osteoporosis occurs in otherwise healthy, normal bone.
Excessive intake (toxicity) can result in loss of appetite, weight loss, heart-rhythm abnormalities and elevated blood-calcium levels with subsequence heart, kidney and blood-vessel damage. Toxicity does not occur from excessive sun exposure. High intake of enriched vitamin D foods is also unlikely to cause toxicity so the problem lies in the overconsumption of supplements.
Vitamin E is the name given to a group of fat-soluble compounds with distinctive antioxidant activities. There are eight chemical forms but only one (alpha-tocopherol) is recognized to meet human requirements. It is responsible for protecting cells from free-radical damage and is involved in immune function, cell signaling, regulation of gene expression and various other metabolic processes. It also inhibits protein kinase C activity (an enzyme) and indirectly dilates blood vessels and inhibits platelet aggregation (clumping).
Most dietary sources of vitamin E come from nuts and oils. These include wheat-germ oil; almonds and hazelnuts; soybean oil; sunflower seeds and sunflower oil; peanuts, peanut butter and peanut oil; safflower oil; and corn oil. It can also be found in spinach, broccoli, kiwis, tomatoes and mangoes.
The RDA is 6 IU (4 milligrams) for those up to age 6 months, 7.5 IU (5 milligrams) for those from 6 to 12 months, 9 IU (6 milligrams) for ages 1 to 3, 10.4 IU (7 milligrams) for ages 4 to 8, 16.4 IU (11 milligrams) for those 9 to 13, and 22.4 (15 milligrams) for those over age 14. Lactating women should consume 28.4 IU (19 milligrams) daily.
Deficiency is rare, and symptoms have not been found in otherwise healthy people who fail to get adequate amounts from their diets. Deficiency is most common in individuals with an underlying condition that causes fat malabsorption. Symptoms include peripheral neuropathy, immune impairment, retinopathy and more.
Research has not shown that vitamin E obtained from a healthful diet can cause toxicity; however, supplements can cause problems to include poor clotting and hemorrhage.
Readers who are interested in learning more can order my Health Report “Vitamins and Minerals” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.

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