EKG no longer conducted at physical
Dear Dr. Roach: It has been almost a year now that I had my physical with my general doctor, and I’m mulling over whether to return to her for this year’s physical. I am a 73-year-old man with usually unremarkable physical exams. I have a history of paroxysmal atrial fibrillation, with having had two cardiac ablations. I still have intermittent ventricular contractions. I am still reeling from the fact that during my last physical exam my doctor never gave me an EKG. She begrudgingly said, “It’s not really needed, but if you want one ...” What is your take on this?
J.S.
Answer: There is no good evidence that getting an EKG on an otherwise healthy person leads to any good outcome, and I suspect that’s why your doctor did not order it. However, you aren’t an otherwise healthy person: You have had a cardiac ablation that has failed, presumably, since you needed a second ablation. Checking periodically to make sure you are still in normal rhythm (not atrial fibrillation) seems to be a very good idea to me.
Dear Dr. Roach: My gastroenterologist has prescribed colestipol for irritable bowel syndrome with diarrhea. It is working great with only one dose a day (he prescribed two doses, but I could not tolerate the constipation).
Is this medicine OK for long-term use? Should I continue my cholesterol meds with it?
C.H.
Answer: Colestipol is used in treating high cholesterol. It works by binding with the bile acids and low-density lipoprotein cholesterol. It is moderately effective for treating cholesterol and is considered very safe.
A dose-limiting side effect for many people is the constipation. Your gastroenterologist is taking advantage of this to treat your irritable bowel syndrome with diarrhea. I approve completely: It’s a less-wellknown treatment but in the right situation is both safe and effective, especially at the lower dose. Some people need much higher doses for effectiveness.
The doctor who prescribes your other cholesterol medicine should definitely check your levels. It’s possible you may need less of whatever other medication you are taking.