Is my heart too weak to cope with surgery?

Every week Dr Martin Scurr, a top GP, answers your questions

I’VE been advised to see a consultant about having a cholecystectomy (gallbladder removal) and am unsure whether to go ahead.

I’ve heard it would make it difficult to eat certain foods. I also have a mitral valve prolapse and wonder how my heart would cope. I have a fear of heart problems after the death of my husband 20 years ago, in his sleep at 47, from an undetected heart problem.

My son, 29, had a cardiac arrest two years ago and has an implanted cardioverter defibrillator. Can you advise? I’m 68.

June Smith, birmingham.

PLEASE accept my condolences for your bereavement. sudden cardiac death in a man of 47 may be due to coronary heart disease, but in about 10 per cent of cases the patient’s heart seems normal.

We know there are a number of disorders of the heart’s electrical function that can cause sudden cardiac death — for example the long QT syndrome. Many of these disorders are inherited, which may explain your son’s experience.

There seems to be a genetic trait on that side of the family, yet you have quite understandably developed some anxiety about your own heart, not least as you have a mitral valve prolapse.

This is where the mitral valve — one of the heart’s four valves — doesn’t close properly. In most people it causes no symptoms, and millions may have it without knowing. It’s typically spotted when a skilled doctor hears a ‘click’ or a quiet murmur when listening to the heart.

An echocardiogram, a type of ultrasound, will confirm the diagnosis. It’s usually mild and complications are rare, but patients should have an annual check by a cardiologist in case the problem worsens and the valve becomes leaky or affects heart rhythm.

YOU SAY in your longer letter that your recent check-up did not raise any issues, which is reassuring, as some action should be taken with regard to your gallstones. They form in the gallbladder, the organ that stores bile, which is secreted by the liver and helps digest fatty foods.

Gallstones affect more than 12 per cent of us and are twice as common in women. They develop when the gallbladder starts to malfunction; genetics and diet play a part in this. Most people have no symptoms, but gallstones can cause severe upper abdominal pain or ‘biliary colic’. This usually occurs when the gallbladder contracts to empty out bile in response to a fatty meal.

In your longer letter, you tell me you’ve had an ERCP — an endoscopic retrograde cholangiopancreatography. This is normally performed if doctors suspect gallstones have been pushed out of the gallbladder into the bile duct (which transfers bile to the duodenum, the start of the small intestine).

Blockage of this duct may lead to a build-up of bile in the bloodstream and cause jaundice.

During an ERCP, a viewing instrument called an endoscope is entered into the duodenum via the mouth to identify the point where the bile duct joins the intestine (the ampulla).

If stones are found, the ampulla can be stretched or opened to allow them to pass.

However, once stones form, it’s likely they will continue to do so; 50 per cent of patients will have more within five years. To avoid this, and further complications, a cholecystectomy is recommended; it is the most commonly performed elective surgery in the uK.

once the gallbladder is removed, bile will drain straight from the liver into the intestine. The body adapts, though about half of people will develop loose stools, gas and bloating. This improves with time.

your best option would be to accept the referral to a consultant surgeon with a view to having the surgery. And with your history, you can be sure the anaesthetist will pay special attention to your heart concerns. FOR three years I had recurring mouth ulcers. I’d get four or five at a time and they were very painful. My GP gave me a steroid inhaler called Clenil Modulite 50. I used it every day and the ulcers have stopped, but my doctor wants me to cut down. I’m at my wits’ end. I’m 39.

Mrs Lindsay burns, Co. Armagh, N. Ireland. AnyonE who’s had aphthous ulcers, the painful lesions you describe, will know just how much misery they cause. Typically the ulcers are round, acutely painful and come in crops that heal within ten to 14 days. Larger, more severe ulcers may occasionally appear, lasting up to five weeks.

The term for the condition is recurrent aphthous stomatitis. It often runs in families.

one theory is that recurrent ulcers are down to a fault in the immune defences lining the mouth. Hormonal factors, emotional stress and injury, such as from brushing teeth, may also play a part.

Mouth ulcers are sometimes a problem for patients with coeliac disease or inflammatory bowel disease. But I understand you’ve been investigated in detail, and those potential associations will have been considered and ruled out.

usually the condition goes into remission eventually. The mainstay of treatment is with topical steroids in the form of ointment, gel, or a tablet placed over the ulcer that slowly dissolves.

your specialist has prescribed a steroid asthma pump at the lowest dose. As a treatment for ulcers, it is sprayed into the mouth, rather than breathed deeply into the lungs as for asthma.

It is impressive that this novel way of using the inhaler has been so effective in your case.

As you know, there are potential side-effects, such as oral thrush, a yeast infection in the mouth and throat. As the steroid suppresses the local immune defences, it allows yeast, which we carry in our bodies, to proliferate.

THE GREATER concern is absorption of the steroid into your system, which can suppress the function of the adrenal glands (which produce hormones). Fortunately you are only on the smallest dose, so it’s not a major worry.

numerous other medications have been tried for severely affected patients, such as sodium cromoglycate, dapsone and colchicine, yet none has been fully evaluated.

one drug, thalidomide, has been studied in a trial with more than 80 per cent of patients experiencing complete remission within two weeks. However, the drug has potentially serious side-effects — it can cause birth defects and nerve damage — so its use is limited.

Talk to your GP and specialist about using the steroid spray for one month on and one month off, to protect against adrenal suppression. There’s every chance this strange but common condition will eventually resolve.