Dear Dr. Roach: My son, 55, had groin pain and was told he needed a new hip. Since the surgery, he has been in constant pain. Many doctors say it is his back, and he might not have needed the hip surgery. He sent his films to a clinic in Florida that does laser spine surgery, and they say he might be a candidate. Could you give me some information about it? He is reluctant to have another surgery. It鈥檚 very expensive, and insurance won鈥檛 cover it. H.J.
I can鈥檛 tell you if your son needs another surgery. Neither can the Florida laser spine surgery clinic. Only after a really comprehensive exam, review of the films, CT or MRI scans he may have had, and especially a long discussion with your son, should another surgery be considered.
As far as laser spine surgery goes, there certainly are people who have had great results, and some who are worse after the procedure. I don鈥檛 know of any good studies comparing one against another. But it worries me that insurance doesn鈥檛 cover it and that a neurosurgeon at the Mayo Clinic wrote that they don鈥檛 use or recommend it at their hospital (which is the case at many other teaching hospitals).
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Dear Dr. Roach: I recently heard about brown fat. I had never heard of this fat, and was especially interested that this particular fat burns regular fat. If this is true, then it might have a bearing on the serious obesity problem. R.C.
Brown fat is a metabolically active fat that was previously thought to exist mostly in babies. However, some recent studies have shown that brown fat can become active in lower temperatures, burning off calories to keep us warm. Researchers are trying to find a way to use this discovery for weight loss. Overweight people have little or no brown fat. It鈥檚 not clear to me whether the excess weight is because they don鈥檛 have brown fat, or the other way around. In any event, these findings about brown fat are interesting, but not yet of practical use against obesity.
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Dear Dr. Roach: I have been diagnosed with Holmes-Adie syndrome. I cannot find much information on this syndrome other than that it is rare, caused by a virus or bacteria and affects the autonomic nervous system. What is the autonomic nervous system? Can you provide any information on this condition, if it will progress and what to expect? What kind of doctor treats it? N.W.
The Adie pupil, also called Adie鈥檚 tonic pupil, is found when the eye loses part of its nerve supply. This causes one pupil to be bigger than the other during light exposure but smaller than the other when looking at objects close up. An Adie鈥檚 pupil usually occurs without other problems in the autonomic nervous system, but it can occur alongside other problems, such as Ross syndrome, where the Adie pupil is associated with abnormal reflexes and partial loss of sweating. Syphilis causes a similar pupil, but on both sides, in which case a test for syphilis should be done.
An eye doctor can help fit special glasses with one lens that鈥檚 different from the other to help correct the vision issues that may occur. Fortunately, most cases do not progress.
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Dear Dr. Roach: Is it still OK for me to engage in sex? Four years ago at a checkup, I was found to have three blocked arteries in my heart. I was shocked, but was told I needed surgery right away. My husband was not happy about it and moved into a guest bedroom. He said he did not want a woman with a scar on her chest. Since he doesn鈥檛 want me, I am ready to move on. L.I.O.
Safety of sexual intercourse after heart surgery or diagnosis of heart disease often is a concern for patients and their partners. For most people with heart disease, sexual activity is safe. It is generally safe after a successful heart surgery. It is unsafe within a few weeks of a heart attack, in people with heart pain (angina) that is more than mild, or for those with severe heart failure or uncontrolled blood pressure.
A stress test is sometimes used to determine what exercises are safe after a cardiac event, such as surgery. Regular exercise reduces the risk of a heart attack. A supervised exercise program, called cardiac rehab, is appropriate for people with more severe disease.
Some partners have difficulty reconciling their desire not to hurt their partner with their desire for sex. Most times it can be worked out.
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Dr. Roach regrets that he is unable to answer individual letters. Email questions to ToYourGoodHealth@ med.cornell.edu
