Treat­ment de­pends on risk lev­els

The Weekend Australian - Travel - - Health - THE DOC­TOR LINDA CAL­ABRESI

Linda Cal­abresi is a GP and ed­i­tor of Med­i­calOb­server. Send your queries to linda.cal­abresi@medobs.com.au 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.

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