Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: My pulmonary specialist has recently suggested that I go on oxygen due to my low oxygen levels. He says that in order to diagnose a pulmonary blood pressure problem, I need to have this highly specialized test done called a cardiac catheterization.
After reading about it online, I am wondering if there isn’t another less intrusive test available to determine the cause of high blood pressure in the lung area. — J.E.
ANSWER: Everyone knows that regular high blood pressure can be measured through the arm. However, there is an entire other side to the heart and a separate circulation from the right atrium and ventricle into the lungs. The pulmonary circulation doesn’t develop high pressure problems as often as the left (systemic) side does, but it is increasingly recognized as a problem. Unlike systemic hypertension, where we rarely identify an exact cause, it is critical to know the underlying cause of pulmonary hypertension so it can be properly treated. It is possible to have many contributory causes.
Pulmonary hypertension is complex. There are five different groups of underlying causes. If, after all the noninvasive tests (like an echocardiogram), you are suspected of being in group two (those who have pulmonary hypertension due to left heart disease, including heart failure, valvular disease or congenital disease), a cardiac catheterization is recommended.
There may be other reasons why your pulmonologist recommends a cardiac catheterization. This is most commonly done to look for blockages in the coronary arteries, but can also provide other information, especially about the oxygen levels and pressures inside the chambers of the heart.
Without more information, I can’t tell you exactly what your pulmonologist expects to find, but I will say that the risks of a cardiac catheterization are low. They do exist, but your pulmonologist wouldn’t have recommended a cardiac catheterization if the less invasive tests were giving the answer.
DEAR DR. ROACH: Please provide information about this “miraculous” solution to diabetes and obesity that Big Pharma has supposedly hushed up research about. Usually something that seems too good to be true is exactly that. — L.O.
ANSWER: If there were miracle solutions that you could buy to two of the most prevalent medical issues in the industrialized world, everyone would be using it. Unfortunately, there aren’t such miracles. Most people with Type 2 diabetes will dramatically improve their weight and blood sugar levels through a combination of regular moderate to vigorous exercise and a prudent diet, as recommended by doctors, diabetic nurse educators or registered nutritionists.
In people for whom diet and exercise are inadequate, medications can provide a great deal of help. Newer medications, such as the glucagon-like peptide-1 agonists, help with weight, improve blood sugar, and reduce risk of heart disease and death.
When you read an advertisement that says “Big Pharma” wants something hushed up because it is so effective, you are wise to be skeptical. “Big Pharma” has its faults, but they are smart enough to buy and market any new miracles.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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