Age not a conflict for valve repair

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DEAR DR. DONOHUE: I am 72. For the past two years, my aortic valve has given me trouble. Now I am at the point of becoming very short of breath when I walk less than one block. My heart doctor suggests surgery to replace my valve. Do you think I’m too old for this kind of operation? – J.A.

ANSWER: You’re not too old for an operation to replace a heart valve. Your doctor wouldn’t have suggested it if he thought you weren’t fit enough to tolerate surgery. My mother had it done when she was much older than you.

The aortic valve closes when the heart pumps blood into the aorta, the body’s main artery. Two things can happen to make the aortic valve function poorly. It can become too narrow – aortic stenosis – or it can spring a leak – aortic regurgitation.

When the heart has to pump blood through a narrow valve, it has to do so with greater-than-usual force. That extra effort wears the heart out. When one or more of a triad of symptoms appears, then you know that surgery is the best way to help the heart out. Those symptoms are breathlessness during activity, chest pain when moving about and frequently being on the verge of or actually fainting. You have one symptom. It’s time to act if your valve problem is aortic stenosis.

Breathlessness when active is also a symptom of aortic regurgitation, and it, too, indicates that the valve should be replaced.

Medicines can tide over people with either valve problem for many years. However, once severe symptoms occur, then medicines must yield to surgery as being the optimum treatment.

Heart valve disorders are discussed at length in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue – No. 105, Box 546475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have traded one illness for another. A month ago I had bronchitis and coughed day and night. I was put on antibiotics, and the coughing pretty much stopped. After stopping the medicine, I began to have loose stools and then nonstop diarrhea. Apparently, the antibiotic gave it to me. Now I’m on a different antibiotic. Does this ever stop? – K.H.

ANSWER: What happened is the occasional result of antibiotic treatment. You had the bad luck of having your first antibiotic kill off your colon’s normal bacteria. A few hostile bacteria had been living in your colon. Their numbers were kept to a minimum by the good bacteria. When those good bacteria bit the dust, hostile ones – which go by the name C. difficile – took over. These bacteria make a toxin that irritates the digestive tract and brings on diarrhea. The condition is called antibiotic-associated colitis.

Stopping the antibiotic often cures the diarrhea. This isn’t the hand of cards dealt you. Your diarrhea began after you had stopped taking the medicine. That can happen. The treatment in your case involves killing the C. difficile germs with special antibiotics not familiar to most people. Those drugs are metronidazole or vancomycin. Both have good cure rates, but relapses can occur with either. If diarrhea recurs, then a second round of treatment with the same drug usually puts an end to the diarrhea.

DEAR DR. DONOHUE: What’s a “no-scalpel” vasectomy? My wife wants me to have a vasectomy, and my friends have told me that this kind is not painful. How’s it done? Does it hurt? – B.B.

ANSWER: The name tells the story. With a no-scalpel vasectomy, the doctor makes no cuts.

Vasectomies sever the vas, the duct through which sperm pass out of the testes. In this procedure, the doctor snares the vas with a forceps on the scrotal skin. Then, with an instrument that makes tiny holes in the skin, the doctor encircles the vas and snips it into two separate parts. The holes are so small that no sutures are needed to close them. They heal on their own.

The procedure is not terribly painful. It’s done in a very short time.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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