Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I am 87 and have been jogging/running for 35 years. I recently had a major upper-gastrointestinal bleed after collapsing and losing consciousness. The problem was found and corrected. Following this episode, my hemoglobin level was 84 g/L, and my blood pressure dropped to 88/38 mm Hg. Since that time, my average blood pressure is now 134/46 mm Hg. Should this low diastolic blood pressure be a concern? — E.D.
ANSWER: The difference between the systolic (the first number) and diastolic blood pressures (the second number) is called the pulse pressure, and yours is quite wide. It’s this number, rather than the low diastolic number, that is a bit concerning.
Low diastolic blood pressure is most commonly caused by stiff blood vessels, especially the aorta. This tends to happen as we get older. However, a leaky aortic valve can also cause low diastolic blood pressures and wide pulse pressures. A wide pulse pressure does put people at a higher risk for heart attack. However, I don’t understand why these conditions would come after a gastrointestinal bleed.
Some blood pressure medications preferentially act on diastolic blood pressure more than systolic. If you are on medications, it is time to review them with your prescribing physician or an expert, like a cardiologist.
DEAR DR. ROACH: Does creatine enlarge the prostate, and can it lead to prostate enlargement? — A.A.
ANSWER: Creatine is a common supplement used by weightlifters and other athletes to boost physical performance. It has been shown to be useful only for young men doing intense, short bursts of activity, and not for endurance athletes. It has generally been considered safe.
One study a few years ago found that some volunteers developed high levels of dihydrotestosterone while using creatine. This substance is implicated in enlarging the prostate and also causing baldness in men. However, other studies did not find this result, and I couldn’t find studies that directly implicate creatine intake with either baldness or prostate enlargement.
Both of these conditions are very common as men age, and it can be difficult to determine whether a person who has long used creatine would have developed these conditions regardless.
DEAR DR ROACH: I am a metastatic melanoma patient on immunotherapy treatments. I am apparently allergic to COVID boosters. Two of the three boosters that I received have hospitalized me, with extreme dehydration caused by severe vomiting and diarrhea two days after the shot.
My doctors say that the benefits of vaccination do not outweigh the risks and didn’t recommend vaccination for me. Besides masking up when I leave my house, what other recommendations do you have for me? — M.O.H.
ANSWER: Since you can’t have the boosters (although you might want to ask your doctors about the recently released Novavax vaccine), then masking is your primary means of protection. I recommend an N95 or KN95 mask, which can be reused several times.
You also should stay away from large crowds as much as possible. Tracking wastewater has become a primary way of estimating COVID-19 activity. This data can be found at a statewide level through the Centers for Disease Control and Prevention (www.cdc.gov/nwss/rv/COVID19-statetrend.html) and also at a local level from many states. You should know what your local COVID activity is. During times of very high levels, you may want to stay home.
Unfortunately, the injectable antibodies that were able to protect some are no longer effective against current variants.
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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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