Lifestyle

Purpura spots appear as skin begins to get thinner

DEAR DR. ROACH: I am an 84-year-old male and have had atrial fibrillation for many years. In 2022, I had the WATCHMAN procedure. Prior to the WATCHMAN implant, I took Eliquis to help prevent strokes. During this time, I never had an issue with purpura spots. After the WATCHMAN, I took Plavix for six months and had many occurrences of purpura.I stopped taking Plavix in October 2022, but continued to have issues with purpura spots, primarily on my hands and arms when I accidentally rub too hard or bang against something solid. When I told my cardiologist about the problem, he said my skin was getting thinner. In my opinion, this was an unsatisfactory answer. I find it hard to believe that my skin suddenly got so much thinner in six months that I now have this problem. I believe the issue is related to Plavix and that it is having a permanent after-effect. What is your opinion? -- E.S.ANSWER: Plavix works by reducing the effectiveness of platelets, the blood-clotting cells. This makes bruising easier. Eliquis works on blood-clotting factors, so it doesn't really cause the type of bruising you have now.Many people in their 80s have your exact issue, called "solar purpura." The skin on the top of the hands, wrists and arms gets damaged by decades of sun exposure and can easily bruise. The Plavix you took is long gone and can't be causing problems now, and it doesn't cause permanent damage either. So, I agree with your cardiologist, but I do wonder if you are taking aspirin, which also affects platelets and would increase the risk of these superficial bruises.DEAR DR. ROACH: Have there been randomized, controlled studies about taking calcium supplements in people with osteoporosis? Do they really make a meaningful difference? -- M.A.ANSWER: That's a deceptively simple question with a complicated answer.First off, calcium is not generally given alone; it's given in combination with vitamin D. Vitamin D improves absorption of calcium and phosphate, the main mineral components of bone. In studies of people with osteoporosis who were given combination calcium and vitamin D, bone density tends to get better.However, this doesn't necessarily translate into the main goal, which is the prevention of fracture. When looking at all studies, people in nursing homes (who have a high risk of low vitamin D) received a benefit with combined calcium and vitamin D, while people who lived in the community did not have a reduced risk of fracture. Nearly all of these studies have been done on women only.A potential concern about calcium supplementation has been that some studies have shown an increased risk of heart disease, while other studies haven't. My opinion is that if there is harm to the heart from calcium supplementation, it is likely to be small. Still, there is no increase in heart risk from a high-calcium diet, so I prefer that my patients get their calcium primarily from food, if possible.It's also critical to remember that in studies using bisphosphonate drugs, like alendronate, all patients received supplemental calcium and vitamin D. These studies showed reduced fracture rates. To follow evidence-based medicine, we recommend our patients get adequate calcium and vitamin D.Murray Favus, one of my medical school professors who was part of the team that did the studies proving the benefit of bisphosphonates, told me that without adequate calcium, these medicines can cause bone pain.* * *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. (c) 2024 North America Syndicate Inc.All Rights Reserved

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Finding the best-in-class care for an iliac artery aneurysm

DEAR DR. ROACH: I am a 68-year-old male in excellent health. I had an exam that incidentally noticed a relatively small, internal iliac artery aneurysm. Since then, I have had annual CT scans to monitor the size. As of January, it had grown to 3.2 cm.As we get closer to surgical intervention, my vascular surgeon only sees an "open" procedure as an option, as opposed to the stent option. The "open" procedure is much more involved and concerning, especially since it appears to be a 10% chance of mortality, which is a high risk compared to most surgeries. If I go the "open" route, I want a best-in-class surgeon to perform the procedure.I find it very difficult to not only learn of the specific, best-in-class surgeons, but also the best-in-class vascular surgical doctor groups or hospitals. I really would like to find other highly regarded vascular surgeons, if nothing more than to get a second opinion. Ideally, I would want one in my area, but I will travel, if necessary. -- G.C.ANSWER: I agree with your vascular surgeon that at 3.2 cm, your aneurysm has grown to the point where operating on it is safer than waiting, but I only defer my patients to surgical expertise as to which procedure is best. It depends on the exact characteristics of the aneurysm.I am often asked about finding the best surgeon or hospital, and it's a question that I find difficult to answer. There are different types of rating systems for doctors and hospitals. One commonly used rating is by the U.S. News and World Report. I looked at their ratings for the best hospitals for vascular surgery, and from my knowledge, the top hospitals really deserve to be there. I feel comfortable referring a family member to any of the top hospitals. However, they don't look at individual surgeons. Still, if you were willing to travel, any of these top hospitals would likely have an extremely skilled and experienced surgeon.There are proprietary systems for getting individual-level details on surgeons and hospitals for specific procedures. Unfortunately, they often disagree with each other. Surgeons who only take the "easiest" cases tend to do very well on objective measurements, like mortality and readmission, and they may not actually have as much expertise as the surgeon who is willing to attempt more difficult surgeries. This is one reason for disagreement.I often look to see who is publishing the results on this surgery, which usually indicates high familiarity and expertise on this subject, but this strategy may unfairly neglect surgeons who don't publish their results. I also call a colleague at one of the top-rated institutions and ask who is considered the local expert for this particular surgery. Sometimes the hospital website will identify the surgeon's area of expertise and interest, even within the field of vascular surgery.For your issue in particular, I found four vascular surgeons listed at the best-in-class hospital closest to your area who identify themselves as having expertise at aneurysm repair. This is where I would start.* * *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. (c) 2024 North America Syndicate Inc.All Rights Reserved

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Introducing CKM Syndrome; make intermittent fasting more effective

My doctor says that I'm at risk for some newly named condition -- CKM Syndrome -- and I have to aggressively protect myself from developing it by changing how I do things day-to-day. OK! But what is it? -- Clarence D., Wayne, IllinoisA: Your doctor is referring to the newly described "cardiovascular-kidney-metabolic syndrome" or CKM that can develop if you are overweight or obese and/or have elevated blood pressure, LDL cholesterol, blood glucose and triglycerides -- all risk factors for heart and kidney disease and metabolic disorders like Type 2 diabetes. About a third of U.S. adults are candidates for the syndrome.CKM was developed by the American Heart Association (AHA) to help doctors treat metabolic problems and heart and kidney risk factors as interconnected conditions. The AHA says this is important because Type 2 diabetes increases your risk of dying over the next 10 years by around 8% and kidney disease ups it by 11%, but if you have both conditions, your risk rises by 31%. The syndrome is divided into four stages: Stage 1 is being overweight or having obesity. Stage 2 is when you have elevated triglycerides and blood pressure and Type 2 diabetes. In Stage 3, you're at high risk for cardiovascular disease or a very high risk for kidney disease. Stage 4 is when you're diagnosed with cardiovascular disease. Fortunately, eating a plant-based, whole-food diet free of added sugars and red meats, getting at least 150 minutes of physical activity weekly, sleeping well and cultivating a posse and a purpose, can dramatically reduce your risk factors. In addition, weight loss/diabetes drugs reduce CVD deaths; drugs that help prevent kidney failure also protect against heart failure; and some antihypertensives benefit the kidneys. Supplement may also help. Check out iHerb.com's blog "8 Essential Nutrients That Support Longevity."So, talk to your doc about an Rx for physical activity, consult a nutritionist, and get coordinated care for kidney, heart and metabolic risks. LongevityPlaybook.com's free newsletter can provide support.* * *Q: I'm overweight and I don't have much luck shedding pounds. I wanted to try intermittent fasting, but I keep hearing contradictory info on whether it works. I will gladly try any ideas you have. -- Monica B., Greenport, New YorkA: Intermittent fasting (restricting your eating to between, say, the hours of 11 a.m. and 7 p.m.) works for some folks and not so much for others. Two keys to success are making sure you do it right by eating more food at 11 a.m. and less later in the day and by following the Mediterranean diet. Success is also influenced by your basic metabolism, sleep habits, and other conditions you might have. If you do intermittent fasting and have diabetes, keep good tabs on your blood sugar, so it doesn't go too low while you fast or spike quickly when you eat. But if your doctor says it's OK to try, then do we have news for you!A study in PLOS One looked at how time-restricted eating, when combined with high-intensity exercise three days a week, affected body composition (amount of fat and muscle) as well as LDL cholesterol, other blood lipids, and blood glucose levels in women with obesity. The researchers compared that to the effects of "intermittent fasting diet only" or "high-intensity exercise only." Turns out that women who combined the time-restricted eating with the high-intensity workouts saw the greatest improvements in body composition, blood pressure, blood glucose and lean muscle mass.For exercise, work with your doctor to identify the best options for you: Walking outside or on a treadmill or using a stationary bicycle to incorporate repeated periods of intense activity with extended slower stretches is effective. And remember: Be patient. You're in this for the long haul -- to permanently improve your health and extend your longevity. Plus, check out "Ultimate Beginner's Guide to Intermittent Fasting" at iHerb.com and Dr. Mike's book "What to Eat When." Enjoy the journey and you'll reap the rewards!* * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

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Woman feels intense side effects with anti-seizure medications

DEAR DR. ROACH: My 22-year-old granddaughter had her first seizure less than a year ago. She had a few tests done, which showed that everything looked normal. She did an MRI, a CT scan and two electroencephalograms (EEGs). She was told that the seizures she had are non-epileptic ones and are much safer than epileptic ones.She was put on Keppra, but she didn't like the side effects of it. It made her feel loopy, tired and weak. Her doctor switched her to lacosamide twice a day. Side effects of this drug are similar. She's had double vision and drowsiness, and she can no longer drive, which causes problems for her with getting to her job.What are your thoughts on these drugs? She talks about discontinuing the medication. Can you suggest a different drug without as many side effects that could help her? Is there a different solution to her issue? -- C.G.ANSWER: An epileptic seizure is caused by uncontrolled electrical activity in the cerebral cortex. Seizures are common, with 8% to 10% of people having one in their lifetime. Not all seizures need to be treated, and the decision of whom to treat is sometimes complicated. But most people with recurrent seizures (i.e., epilepsy) are generally treated with anti-seizure medicines, such as lacosamide or Keppra. As your granddaughter has found, seizure medicines sometimes have significant side effects.Psychogenic non-epileptic seizures (PNES) are involuntary responses to triggers such as emotional stress and menstruation, and can occur especially upon awakening. They do not have the abnormal electrical activity of a seizure and are not treated with anti-seizure drugs. However, they can look very similar to an epileptic seizure or may more closely resemble a faint.If the diagnosis on PNES is certain (which usually requires a video EEG during a seizure), then seizure medicines are slowly withdrawn, as they are unhelpful for PNES. The most effective treatments for PNES include eye movement desensitization as well as reprocessing therapy and cognitive behavioral therapy. Medication is not a standard way to treat PNES.It's very important to recognize that non-epileptic seizures are not under someone's conscious control, but treatment can help people control them. It is true that people with PNES may have high levels of anxiety, but people with PNES are not "crazy" or "insane." PNES may often be a response to psychological trauma.More information about PNES can be found at tinyurl.com/PNESinfo.DEAR DR. ROACH: I have osteoarthritis in my thumb. I have now had two steroid injections six months apart. The injections provided great relief. Your recent column stated that regular steroid injections can damage the cartilage. How often is regular? My doctor has not advised me of the damage that injections can cause. Tylenol gave me little relief. Do you suggest I stop all steroid injections? -- M.W.ANSWER: In the studies that evaluated steroid injections compared to a placebo injections (both also included an anesthetic agent), most found that steroid injections every three months led to radiologically proven loss of cartilage by two years. I can't answer which level is safe, but I do feel comfortable doing an injection every 12 months in my patients that benefit from it. Every six months might be OK, but without study data, I can't say.The data come mostly from knee injections, and it's not clear that thumb cartilage will react the same way. In these cases, the clinical judgment of your doctor is really the key to balancing the risk and benefit.* * *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. (c) 2024 North America Syndicate Inc.All Rights Reserved

Read MoreWoman feels intense side effects with anti-seizure medications