Mastectomy, scoliosis likely unrelated
Dear Dr. Roach: In 2000 (at age 53), I had a mastectomy with a TRAM flap reconstruction. In 2010, I began experiencing lower back pain. X-rays at that time showed 19 degrees of left-leaning scoliosis.
My question is whether the scoliosis could be a result of the TRAM flap, where the left abdominal muscles are stronger than the right, pulling my spine to the left. My back specialist thought this unlikely.
R.D.
Answer: Scoliosis that starts in the 50s or later is most commonly degenerative, meaning something is causing the spinal bodies to degenerate. This happens in older people as a result of arthritis or due to weakening of the bone structure.
I agree with your back specialist that the TRAM flap is not likely to be providing enough stress on the spine to cause scoliosis. If your breast cancer was estrogen-receptor positive (likely, at age 53), then you probably were put on an anti-estrogen drug, which may increase the risk of osteoporosis. I would be sure you have had a recent examination to look at your bone density, especially if you were on an aromatase inhibitor, such as Arimidex. Dear Dr. Roach: My doctor told me to take calcium and vitamin D to prevent osteoporosis. However, I attended a women’s health seminar where the speaker stated that calcium, even with vitamin D, is ineffective. I am 84 years old and do not have osteoporosis, although my doctor says I have pre-osteoporosis. I have some arthritic pain in my back and hips, but am otherwise in excellent health. Should I discontinue the calcium with vitamin D?
A.D.M.
Answer: There remains considerable controversy about whether calcium and vitamin D are effective at preventing or treating osteoporosis. In absence of clear evidence, clinicians must make their own decisions based on their knowledge of their patients. Your doctor has made a common and reasonable recommendation. I generally would recommend listening to your doctor, who knows you, rather than a person at a seminar (or even a doctor writing a column). Readers may email questions to: ToYourGoodHealth@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.