To Your Good Health
DEAR DR. ROACH: My husband had a quadruple heart bypass in 2012. He continually experiences discomfort, numbness and pain along the area of the scar on both sides. He also is bothered wearing his shirt when it touches this area. He is in good health otherwise. Is there anything you could suggest for relief? — S.K.
ANSWER: The description of his symptoms tells me that this is very likely to be pain from neuropathy — damage to one or more nerves. This is not uncommon after bypass surgery. In one study, 15% had neuropathy with persistent pain and numbness. It seems to be more common when the surgeon uses the internal mammary artery, which provides excellent, long-lasting results for the heart in most people.
Neuropathy is frustrating to treat, because the options are limited. Nerves can recover after trauma, but if they do, they usually do so within a year. Since he has had symptoms so long, your husband's symptoms are likely to continue without treatment.
The most common treatment would be medication. Tricyclic antidepressant drugs, such as amitriptyline, are often the first used, but newer drugs like gabapentin and pregabalin may also be used as first-line treatment. Due to side effects, it's best to start at a low dose and gradually build up. Most people get significant, but not complete, relief from neuropathic pain with medication treatment. TENS units, nerve blocks and even acupuncture have been tried as well for this complication.
DEAR DR. ROACH: I’m quite overweight, with some physical mobility and fatigue issues because of autoimmune-related inflammatory arthritis. Some days, I can get about a block at a fairly brisk pace but I have to stop for a few minutes because of the pain in my legs, pelvis and back or I will fall down. Other days, I can get two or three blocks at a brisker than usual pace without needing to stop.
When it comes to burning calories, is it better for me to walk slower and take less breaks or to walk faster and take more breaks to get my pain under control? Must I reach a certain heart rate and keep it there for a certain period of time in order to being doing anything meaningful for weight loss? Unfortunately, because of the pandemic restrictions, walking around is the only kind of exercise I’m able to do right now. The pools, gyms and yoga studios are closed. — F.B.C.
ANSWER: For most people, longer and more intense workouts are generally more effective for weight loss. In your case, overly intense workouts are not a good idea. Overdoing it can lead to pain in the joints (and muscles and soft tissue). I recommend a slower, steadier exercise regimen, which I hope will help build up your stamina and reduce your risk of falls and injuries.
High-intensity exercise is needed to gain a high degree of cardiac fitness, and for maximal performance. However, for weight loss and overall longevity, moderate exercise is very nearly as good.