The Shadow
DEAR DR. DONOHUE: I had an echocardiogram. The findings are consistent with “moderate to severe aortic stenosis with trace mitral and tricuspid regurgitation and mild pulmonic insufficiency, with left atrial enlargement and left ventricular diastolic dysfunction. The ejection fraction is greater than 65 percent.” My doctor referred me to a cardiologist, who told me I need surgery. I am 86 years old and do not feel it would be safe. Will you explain in plain English what I have, and if surgery would lengthen my life span? — M.I.
ANSWER: Forget about the mitral, tricuspid and pulmonic heart valves. These three valves have an insignificant leak. Your aortic valve, however, is your main problem. The aortic valve closes after the heart pumps blood out to the rest of the body. Your valve is so narrow (stenosis) that it creates an obstacle to emptying the heart of blood. That has given rise to “diastolic dysfunction.” Your heart can’t fill with blood normally, as it should between heartbeats (diastole). It is less stretchable. The aortic valve trouble has caused it to thicken.
Early on in aortic stenosis, all goes well. When the valve narrows to a critical size, about 1 square centimeter, symptoms arise, and heart damage progresses more rapidly.
The three most important symptoms and signs of aortic stenosis are shortness of breath when up and about, chest pain with activity and fainting spells. Once these symptoms appear, a downhill course in heart health is to be expected.
Even though you’re 85, age is not a contraindication to surgery. If your health is otherwise good, you could be a candidate for it. Discuss with the doctor the surgery he has in mind. Ask if you might be able to receive a new valve inserted into the heart through a surface blood vessel by way of a catheter. No extensive incisions are made. It’s a less-traumatic procedure. Replacement of your heart valve will increase your life span and will do away with the severe symptoms that come from a narrowed aortic valve.
The booklet on heart-valve disorders describes the more common causes of heart-valve problems and how they are treated. Readers can obtain a copy by writing: Dr. Donohue — No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I had a wonderful physician back in the 1950s who had a simple name for illnesses that we now give long names to. The doctor, a rather direct and simple diagnostician, said we suffer from “Americanitis,” an illness indigenous to the United States. We complain about stress where none exists until we stress ourselves over “situations” we encounter. They then become “problems.”
Most of all, he said the roots of this illness were in our own minds.
For the past 60 years I have attempted to remember my doctor’s claims, and I have done pretty well.
How much validity do you find in my doctor’s claims? — M.B.
ANSWER: I think we do suffer from worry about many things that never come to pass. I also believe that worry wasted on events and news over which we have no control is unhealthy. I believe that some people delight in causing panic over many issues that don’t deserve such overblown reactions.
DEAR DR. DONOHUE: I am 71 years old and have been told I have DISH, diffuse idiopathic skeletal hyperostosis. I am told there is no cure. Will you give me your opinion and advice? — R.B.
ANSWER: DISH is something that happens in middle and older ages. It’s calcification and bone formation in the ligaments of the back. Bone spurs are part of the picture.
Any part of the spine can be affected, from neck to lower back. For many, it causes no symptoms but accidentally is discovered on an X-ray. For others, it’s a source of pain and stiffness.
Osteoarthritis, the most common kind of arthritis, has no cure either. Many therapies exist to dull its pain and preserve joint motion. The same goes for DISH. Heat, stretching exercises, Tylenol and the many nonsteroidal anti-inflammatory drugs (Aleve, Advil, Motrin, etc.) can make life livable for those with DISH.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
(c) 2011 North America Syndicate Inc.
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