DEAR DR. DONOHUE: I’d like you to provide information on defibrillators, the devices implanted for heart failure. Does this device have to be replaced, and how often? How bad is the heart when it’s used? — D.B.

ANSWER: Defibrillators are used for more than one heart condition. Their chief purpose is to deliver an electric shock to a heart that has developed a dangerous heartbeat, one responsible for sudden death. The defibrillator detects the abnormal heart rhythm and then gives the heart a shock to restore a normal beat. The defibrillator device is much like a pacemaker. It is placed under the skin of the chest, and its wires are threaded through blood vessels to reach the heart. The battery for an internal defibrillator has to be replaced about every five years and is done quite easily.

A second reason for a defibrillator is to get the two lower heart chambers, the ventricles, to pump in sequence, like they should. This is why a defibrillator is used in some cases of heart failure. When the ventricles are out of step, they don’t pump enough blood. Restoring the normal pumping sequence can improve heart failure. The heart’s output is quite low when this kind of defibrillator is used as a remedy, but it’s an effective remedy. Most cases of heart failure respond to medicines.

A third use of defibrillators is to jolt a nonfunctioning heart back to work. Automated external defibrillators are found in many public places, like airports. These defibrillators can be used by people with very little training. The device comes with voice information on how to place the paddles that deliver a shock. The machine interprets the heart rhythm and decides if a shock would restore a normal beat. If it would, it automatically provides it. This is like the internal defibrillator device in the first paragraph.

DEAR DR. DONOHUE: I am an 81-year-old woman, and I have osteoporosis. A physician’s assistant prescribed Evista for me, along with calcium pills containing vitamin D. I developed very swollen ankles, and my family physician changed me to Actonel. She prescribed a multivitamin that contains 400 IU of vitamin D. In addition, I take a calcium pill twice a day that has 400 IU of vitamin D. Am I taking too much vitamin D? I would like to know if Actonel is a risk for me. I had a heart attack 20 years ago and have high blood pressure. — A.P.

ANSWER: The current recommendation of daily vitamin D for people between the ages of 51 and 70 is 400 IU, and for those 71 and older, 600 IU. Most authorities feel these limits are too low, and advise a dose of 1,000 IU to 1,200 IU a day. The official recommendation is likely to follow that amount. If I have done the arithmetic correctly, you take 1,200 IU of vitamin D a day (I didn’t add the amount in the pill the physician assistant gave you. You have to add that in if you’re still taking it). Twelve hundred IU is a safe amount. In fact, the upper limit for vitamin D is set at 2,000 IU. Experts believe that it isn’t dangerous to take three or four times that quantity.

Actonel is an excellent osteoporosis drug. I can’t find any information that bans its use in people who have had a prior heart attack. It can cause a rise in blood pressure for a very small number of people. If it does that to you, stopping the medicine brings pressure back down.

DEAR DR. DONOHUE: I am a 60-year-old woman with recurring back pain. I had X-rays (enclosed report) taken after I fell from a pickup truck. Imagine my dismay to learn I have scoliosis and degeneration. I am active and walk two miles a day, four or five times a week. Where do I go for help, and how can I prevent further degeneration? — K.S.

ANSWER: The report says, “moderate levoscoliosis.” Scoliosis is a bend of the spine to the right or the left. “Levo” indicates “left.” The degree of scoliosis found on your X-ray should not cause back pain and, at your age, isn’t likely to increase. Degenerative joint disease is osteoarthritis, and the extent of osteoarthritis found on the X-ray is what would be expected for a woman of your age. It probably is not causing your back pain, either. Do just as you are doing, as far as exercise goes. It is the best treatment for your back.

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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