Dear Dr. Roach: How can I find the most successful, experienced kidney doctor? Would I be better off with a doctor who has his or her own practice, or one who works in a hospital? My kidney function is at 32 per cent, down from 44 per cent four years ago due to hypertension. J.A.
I often have tried to point out when a teaching hospital or special expertise is critical to having the best chance for a good outcome. For chronic kidney disease, the expertise of the kidney specialist is seldom at issue, because virtually all kidney doctors are very experienced and are expert at taking care of this condition.
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Dear Dr. Roach: You have written responses about being on omeprazole or similar medicine for prolonged periods of time, and indicated to stay on these medicines for a limited time. If a person is diagnosed by throat scope and biopsy to have Barrett鈥檚 esophagus, do you still recommend staying on the medicine only for a limited time? Also, I鈥檝e heard of someone who was diagnosed with Barrett鈥檚 esophagus and after taking the medicine for a prolonged time, the condition reversed itself to normal. Do you think this is possible? G.D.B.
I have indeed often said that I feel too many people are taking proton pump inhibitors such as omeprazole, and that you should have a very good reason for being on it long term. Barrett鈥檚 esophagus, however, is a good reason to be on treatment long term. In Barrett鈥檚 esophagus, the lining of the esophagus, frequently exposed to acid due to reflux, becomes similar to the lining of the stomach. This predisposes the person to dysplasia, which can lead to cancer of the esophagus. Treatment of Barrett鈥檚 esophagus is intended to treat the reflux, look for dysplasia and prevent or treat dysplasia and transformation to cancer.
PPIs are not definitively proven to reduce dysplasia and cancer, but many experts say it is likely that they do, so most people with Barrett鈥檚 are treated with PPIs long term. Studies show some people do reverse Barrett鈥檚 esophagus on treatment.
Similarly, treatment with surgery to reduce the risk of progression to esophageal cancer has been debated, with no consensus. Consequently, the recommendation is to periodically look at the esophagus to detect early signs of progression toward cancer, and treat the condition then. In people with Barrett鈥檚 but no sign of dysplasia, an endoscopy is recommended every three to five years, but every six to 12 months if there is early dysplasia, and every three months for high-grade dysplasia. High-grade dysplasia can be treated with several types of treatments, including radio waves, light therapy, freezing and removal of affected tissue through an endoscope.
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Dear Dr. Roach: It was recommended I get my blood cobalt and chromium levels checked, because I have several joint replacements. Why do I need these? Are high levels dangerous? O.G.
Joint replacements that involve metal-on-metal surfaces will cause higher-than-normal levels of chromium and cobalt in the blood. The blood levels correlate with the degree of wear within the artificial joint, in a person with symptoms of joint wear, such as joint pain. Once blood levels reach a certain point, they indicate a high likelihood of wear and can influence a surgeon鈥檚 decision to revise the joint.
There remains debate about whether these elevated levels of metals in the blood are toxic. There is no definitive proof, although most authors have suggested a low likelihood of toxicity.
