Dear Dr. Roach: We always hear about the negative prospects and effects of various diseases, but never hear about the effective benefits and longevity of medical control of them. I am a 76-year-old male in otherwise good health who was diagnosed with atrial fibrillation more than 15 years ago. I have religiously taken medicine (propafenone) for the problem, and have had only a few instances of rapid and irregular heartbeats since.
Do you feel that as long as I keep taking my medicine, my heart鈥檚 condition is as good as someone who has never had a problem, or will I always be subject to the negative consequences and associated problems of a condition that is supposedly under control? I have very low cholesterol, never had high blood pressure and have never been overweight. I do have a history of heart problems in my family. D.T.
That鈥檚 a great question, but it鈥檚 hard to answer, because it depends on the disease and its treatment. In your case, atrial fibrillation successfully treated with a medication for rhythm control, the risk of heart problems and stroke is very nearly reduced to the risk of someone with no history of atrial fibrillation.
In hypertension, reduction of risk has to do with the type of medication used, how high the blood pressure was before treatment and how long it went untreated, as well as how well-controlled the blood pressure is while on treatment. Most studies show that with well-controlled blood pressure, most of the excess risk of heart attack and stroke eventually goes away, but never quite completely.
In diabetes, long-term prognosis also is dependent on how well the diabetes has been controlled and for how long. Interestingly, very 鈥渢ight鈥� control of blood sugar (A1c level) did not reduce risk further, and actually increased heart disease somewhat, compared with 鈥済ood鈥� control.
听
Dear Dr. Roach: About 10 years ago, I had a tooth implant installed in my lower left gum. It took only a few days to realize that something was wrong, so I went back to the oral surgeon, and he removed the implant. The nerve had been damaged, and the result was neuropathy in my lower left lip. It tingles constantly, but it also causes dry lips. I asked the dermatologist about the dry lips, and he said to get a certain brand of lip balm from the local pharmacy. That didn鈥檛 work, so I am constantly using regular Chapstick. Is there anything I can do to stop the dry lip and/or is there anything I can do about the nerve damage? W.M.
It sounds like you have a form of complex regional pain syndrome, formerly called reflex sympathetic dystrophy. CRPS occurs after a traumatic event 鈥� in your case, the tooth implant. There are several phases of CRPS, but pain, sensitivity to touch and changes to overlying skin, muscle and bone are hallmarks of the condition.
After 10 years, it鈥檚 very unlikely the nerve damage will repair itself. However, the symptoms, such as the tingling sensation, can be treated, if necessary. In some cases, the degree of pain can be catastrophic and disabling.
I suspect the dry lip is the mouth鈥檚 equivalent of the skin changes common in CRPS. Some lip balms have ingredients that actually strip the skin of its protective layers. I strongly recommend avoiding products with phenol, menthol, camphor or salicylic acid. Plain petrolatum may work well.
There is a great website with support information at www.rsds.org.
听
Dear Dr. Roach: I have statin myopathy. I am in pure agony. I am taking muscle relaxants and pain relievers. The muscles all over my body ache. I have had pain for two months. Do you have any advice or remedies? B.A.
Statin drugs are used to reduce risk for people with an increased chance for heart attack, depending on cholesterol levels, blood pressure, family history and other risk factors for coronary heart disease. As many as nine per cent of people treated with statins have muscle aches, which can be severe.
The treatment is stopping the statin. After stopping, the average time for symptoms to get better is two months. Only seven per cent have symptoms after six months.
Coenzyme Q-10 has shown promise as a treatment for statin myopathy, in the dose of 200 mg a day, once daily or divided. It doesn鈥檛 work for everybody.
听
Dear Dr. Roach: Despite an ample supply of lubricant, intercourse for my wife is painful, and all activity has ceased. She is 70. T.F.
There are many possible causes for painful intercourse, and these include infection, interstitial cystitis and endometriosis. Only a careful history and physical exam by a gynecologist or other provider trained in women鈥檚 issues can sort it out. However, the most common cause in post-menopausal women is atrophic vaginitis, which can be effectively treated with vaginal estrogen creams. These are safe and have few side effects for most women. Have your wife start by speaking frankly with her family doctor.
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.
