Treatment depends on risk levels
Linda Calabresi is a GP and editor of MedicalObserver. Send your queries to email@example.com MYmother is 61 years old and has had a heart attack in the past. She takes medication for hypertension, rheumatoid arthritis and high cholesterol. She has had several episodes of atrial fibrillation. She is worried she should be taking medication for this to prevent a stroke. SPEAKING generally, people who have atrial fibrillation — especially if they have a history of heart disease — should be taking anti-clotting medication, most commonly warfarin. However, every patient needs to be assessed individually as treatment will depend on factors such as the severity of the symptoms, the cause of the atrial fibrillation, the patient’s overall stroke risk and the risks associated with the treatment. Your mother really needs to discuss this with her doctor, especially as she also suffers rheumatoid arthritis, the treatment for which can sometimes mean the risks associated with taking warfarin would be greater. I AM58 years old and female. Three years ago I was diagnosed as having a segmental spinal stenosis at the L3-4 and L4-5 levels, due to some diffuse bulging of the discs with some bony overgrowth at the degenerative facet joints. I also have a broad-based leftsided paracentral disc protrusion at the L5-S1 level which appears to be compressing the left S1 nerve root. I was recommended to have physiotherapy rather than surgery, as I can still walk. The physio helps and I swim for 60-90 minutes every day, which has stopped the symptoms getting any worse. However, I still suffer pain in my lower back, and pain and numbness in my lower thigh and foot. Would I be better off having an operation? Would it be better done sooner rather than later? How long would it take to recover from the operation? THE diffuse disc bulging and degenerative facet joints are consistent with a diagnosis of osteoarthritis in your back. Generally this would mean that surgery would be of limited value. However, the fact you have limb symptoms, coupled with the finding of a nerve root compression, makes it more likely your doctor would consider surgery an option. You need to discuss the risks and benefits with your doctor, but be aware that the operation is unlikely to relieve all your pain given the extent of your arthritic changes. The leg pain and numbness should improve once that nerve root is decompressed. The timing of the operation is best left to the specialist, but it is important to have your symptoms monitored regularly as a sudden worsening of symptoms, or the development of bowel or bladder symptoms, is usually sign that treatment is more urgently required. Removing a disc is considered a major operation, although a commonly-performed one. Some people recover very quickly but it is probably more realistic to expect it to take up to three months to feel fully recovered. I HAVE started eating and drinking soy products rather than dairy, as I have found I feel better on soy. However, I am concerned I will develop a calcium deficiency. Am I right? GENERALLY, soy products are very rich in vitamins, minerals and protein, but not necessarily calcium. You need to choose calcium-fortified products that have had calcium added to them— at least 100mg of calcium per 100ml, preferably more if you are pregnant or menopausal. You can obtain calcium from sources other than dairy and calcium-fortified soy products, of course. Examples of other sources include salmon and sardines, as well as nuts, especially almonds and a variety of fruit and vegetables. However, proportionally the amount of calcium these products contain is far less than in dairy, and it isn’t absorbed by the body as well.