Dear Dr. Roach: I鈥檓 in the middle of a dispute between my neurosurgeon and cardiologist, and would appreciate your opinion. I鈥檓 a 70-year-old male with extensive cardiac issues, including a heart attack, stent, ablation and A fib. I have a pacemaker/defibrillator implanted in my chest. I recently was diagnosed with a herniated disc and the neurologist wants to perform surgery. He insists that I stop taking my daily 81-mg Aspirin seven days before surgery. My cardiologist absolutely refuses to allow this, and says stopping the Aspirin could be life-threatening. The neurosurgeon will not operate unless the Aspirin is stopped. Neither doctor will budge. Am I doomed to a life of back pain, or is there some alternative?
R.G.J.
When surgery is absolutely indicated, we sometimes use heparin (or one of its newer cousins) by injection for the week before surgery. It wears off much more quickly than aspirin. So, by stopping it right before surgery, you are only without an anticoagulant for the few hours during the surgery, and you restart the Aspirin as soon as the neurosurgeon allows. This plan minimizes bleeding risk during surgery and also clotting risk in the days before surgery.
If your back is bad enough to be worth both of these risks, then I would ask both your cardiologist and your neurosurgeon whether they would consider this plan.
听
Dear Dr. Roach: I read a lot about research for cancer and HIV, and nothing about money spent on arthritis. Is there research on a substance that can be sprayed on joints that have lost cartilage to make them slippery?
E.M.
Funding for research in a particular disease is decided by a large number of factors 鈥� from the public-health burden of a disease to the effectiveness of the lobby by a particular group of supporters. An interesting paper looking at the U.S. National Institutes of Health research was done a few years ago, showing that, adjusted for the amount of disability attributable to a particular condition, there are two conditions 鈥� HIV and breast cancer 鈥� that have much higher funding.
The basic scientific understanding gained from researching these important conditions is applicable to many illnesses. However, there are other diseases that have much less funding given the amount of disability they cause in the population. Arthritis gets relatively little funding compared with HIV and cancer. Interestingly, the two conditions that get the least amount of funding considering the amount of suffering caused by them are depression and chronic obstructive pulmonary disease.
