Dear Dr. Roach: I am a 65-year-old male in fairly good health. I do a bit of running.
I鈥檝e checked my blood pressure and pulse lately and have started monitoring it. My pulse is always in the 40s or low 50s. I went to the hospital to get some blood work done and have an EKG. They almost didn鈥檛 let me go home. My pulse was reading 35, so the doctor sent me to the outpatient department. I wore an all-day heart-rate monitor. It did register in the 30s overnight.
I eat right, don鈥檛 smoke and am athletic, so my doctor couldn鈥檛 recommend anything. Is there a problem with a low pulse? When I get older, how low will it drop?
C.W.
Bradycardia (鈥渂rady鈥� for 鈥渟low鈥� and 鈥渃ardia鈥� for 鈥渉eart鈥�) usually is not a problem in people who have no symptoms. However, heart rates in the 30s make me nervous, and they make most cardiologists start thinking very seriously about pacemakers.
My colleague, Dr. Rob Campagna, a cardiologist at Weill-Cornell, tells me that at heart rates in the 30s and below, most people have symptoms, even if they are subtle. He reminded me that sleep apnea, a condition I have written about several times, is a cause of bradycardia and must be considered in people with slow rates at nighttime.
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Dear Dr. Roach: I have two grandsons that have PANDAS. Nobody knows what this disease is. We are having a very rough time. The boys are 13 and 15. Could you please tell me where they can find help?
B.L.G.
鈥淧ANDAS鈥� stands for pediatric autoimmune neuro-psychiatric disorder associated with group A streptococci.
This is a controversial subject, but the best study suggests that it is a rare but real diagnosis. It is generally agreed by experts that the neuropsychiatric disorders known as obsessive-compulsive disorder and tics (including Tourette鈥檚, which involves chronic motor or vocal tics) can be exacerbated by group A streptococci, such as the familiar 鈥渟trep throat.鈥� In PANDAS, the exacerbations are severe very quickly after strep infection.
Experts recommend that children with abrupt onset of OCD or tics should be evaluated for group A strep infection. In a study of children with new-onset OCD or tics, treatment with antibiotics resolved symptoms in a short period of time.
Neurologists and psychiatrists are the most likely specialists to help with neuropsychiatric disorders. A support group is at pandasnetwork.org.
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Dear Dr. Roach: I get a severe reaction to bee stings. The last time, my arm became swollen to the size of my leg. Is the next bee sting likely to be fatal? Do I need an EpiPen?
N.N.
Answer: Bee stings (or any of the family Hymenoptera, including wasps, yellow jackets and hornets) cause local reactions in most people. About 10 per cent of people have dramatic local reactions.
Fortunately, the risk of anaphylaxis 鈥� the severe systemic reaction that is responsible for 100 deaths per year in the U.S. 鈥� is very low in people with local reactions. However, it is still worthwhile to discuss with your doctor or an allergist, because the symptoms of anaphylaxis are sometimes missed. Anyone with a history of systemic reaction should carry (and know how to use!) an epinephrine injection.
Removing the stinger as soon as possible, preferably within seconds, is a good idea to prevent the full injection of venom.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or write him at P.O. Box 536475, Orlando, FL 32853-6475.
