DEAR DR. DONOHUE: I wish to respond to something you wrote about a man who was examined by many doctors and had a normal thallium stress test. He was told his heart was OK. Thankfully, I did not accept the results of a thallium stress test. I had an angiogram, which located seven blocked arteries. Based on my experience, I would recommend an angiogram for undiagnosed chest pain. – R.D.

DEAR DR. DONOHUE: I read about the man who had chest pain and a normal thallium stress test. I had three thallium stress tests for chest pain. I was told my pain was heartburn. I luckily saw a doctor who recommended an angiogram, and I had a blocked artery that was successfully opened. My point is, an individual should continue to seek medical advice when pain is not explained. – D.T.

ANSWER: For readers, a thallium stress test is a test done to assess the status of the heart arteries. During it, a person exercises on a treadmill. At the end of the test, a radioactive material like thallium, sestamibi or cardiolite is injected into a vein, and then pictures of the heart are taken. The pictures show any area of the heart not receiving blood. The tracer does not light up that area.

This kind of test is an excellent way to determine if heart arteries are blocked and heart muscle is not getting enough blood. An insufficient supply of blood to heart muscle brings on the chest pain of angina — pain that arises when a person is physically active.

A positive thallium stress test can detect heart artery blockage up to 90 percent of the time. It’s not 100 percent accurate. No medical test is. However, taking the evidence of this test along with a person’s history and physical examination makes a pretty strong point for the health of heart arteries.

Both writers prove that this is not always the case. The next step on the diagnostic ladder would be injection of dye into heart arteries to take pictures that are as close to 100 percent accurate as anything can be.

That’s an angiogram, and when to insist on it in the face of nonsupporting evidence is a very tough call. Angiograms are invasive procedures, and there are inherent risks anytime the body is breached.

DEAR DR. DONOHUE: My mother, who is very wise, told me I should take care in my use of over-the-counter medications because the symptoms I treat will return with greater magnitude when I stop using them. Does the rebound effect apply for short-term or one-time usage? – K.D.

ANSWER: Use beyond the recommended time limit and use in doses greater than those recommended can lead to rebound for some medicines. One glaring example is nose decongestants.

Use of medicines for the prescribed time and in the prescribed amounts ought not to lead to rebound.

Your mother is a wise woman. It’s best to keep medicine use to a minimum and not to pop a pill for every tiny symptom that arises.

DEAR DR. DONOHUE: I need more fiber in my diet. I heard that dry beans have more fiber in them than do canned beans. But who eats dry beans? Some nutrition labels are confusing. Does half a cup of canned beans have as much fiber as half a cup of cooked beans? Or should we consume dry beans like vitamins? – J.H.

ANSWER: Anyone who suggests that you eat uncooked beans for their fiber advantage should be looked at with alarm. When fiber content is given, it is given for cooked or canned beans, unless otherwise specified, and I have never seen it specified otherwise. Don’t eat dry beans.

Half a cup of canned baked beans has 9 grams of fibers; of kidney beans, 7 grams; and of lima beans, 5 grams.

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.

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