Dr. Keith Roach

DEAR DR. ROACH: My mom was just admitted to the hospital with chest pressure. She had just lost her husband of 62 years last week, and she initially thought this was just stress. They said she might have a blockage because her troponin level was 142 ng/mL. Her cardiologist recommended an angiogram. Is that a good idea? — D.S.W.
ANSWER: A troponin level above 0.4 ng/mL suggests damage to the heart. A troponin I level of 142 ng/mL says that she has had significant damage, almost always from a heart attack. The vast majority of these are caused by blockages in one of the major arteries that supply the heart muscle, which causes damage and cell death to the heart.
An angiogram is usually performed in these situations, which will allow her cardiologist to identify which vessel is blocked and determine whether opening up the blood vessel with an angioplasty and a stent is appropriate. This can help prevent another heart attack, so I absolutely agree with her cardiologist.
An unusual condition called takotsubo cardiomyopathy is worth discussing. It is found more frequently in women by far, often around the time of intense emotional or physical stress, such as the death of a family member.
Chest discomfort is the most common symptom, and high levels of troponin are universal, although her level is much higher than usual. An echocardiogram can provide support for the diagnosis, but an angiogram is still essential. Fifteen percent of people with takotsubo also had blockages in their heart arteries.
DEAR DR. ROACH: I read your recent column on Mohs surgery for skin cancer, but I recently saw a commercial for a radiation-type treatment that does not leave scars. It supposedly has 99% effectiveness. What do you think? — B.T.
ANSWER: A controlled trial of surgery against radiation treatment showed that surgery led to higher cure rates (99.3% with surgery versus 92.5% with radiation after a four-year follow-up) and higher cosmetic-satisfaction rates than radiation did.
A more recent review of all trials found similar cure rates (both 96.2%) and similar cosmetic results in the Mohs surgery group and the radiation group. Newer radiation techniques may be better, but the 99% you mention is for a study where only half of the participants had a follow-up after a year. It’s not clear how many people might have recurrence after this newer type of radiation treatment. Finally, radiation treatment is considerably more expensive than Mohs surgery.
There are situations where radiation is clearly better than surgery, but this needs to be determined individually.
DEAR DR. ROACH: Years ago, I was bitten by an outdoor cat and was given the rabies vaccine, based on the theory that the cat might have shared a food dish with a raccoon. There are many feral cats where I live. Avoiding them and their feces is difficult. Do I still have protection from my old rabies shot? — F.W.
ANSWER: Bats, raccoons, skunks and foxes are the leading causes of human rabies, but cats and dogs still occasionally transmit the deadly disease. However, feces do not transmit rabies — it is the bite that does so.
If a cat or dog bites you and seems well, it can be confined by its owner for 10 days, and if the animal remains well, no treatment is needed. If the cat is unwell, get vaccinated. If it is feral or can’t be found, you need to consult local health officials. A rabies vaccine provides protection for three years, so you are no longer considered protected.
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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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