San Antonio Express-News (Sunday)
Rabies vaccine protection lasts three years
Q: Years ago, I was bitten by an outdoor cat and was given the rabies vaccine, based on the theory that the cat might have shared a food dish with a raccoon. There are many feral cats where I live. Avoiding them and their feces is difficult. Do I still have protection from my old rabies shot?
A: Bats, raccoons, skunks and foxes are the leading causes of human rabies, but cats and dogs still occasionally transmit the deadly disease. However, feces do not transmit rabies — it is the bite that does so.
If a cat or dog bites you and seems well, it can be confined by its owner for 10 days, and if the animal remains well, no treatment is needed. If the cat is unwell, get vaccinated. If it is feral or can’t be found, you need to consult local health officials. A rabies vaccine provides protection for three years, so you are no longer considered protected.
Q: My mom was just admitted to the hospital with chest pressure. She had just lost her husband of 62 years, and she initially thought this was just stress. They said she might have a blockage because her troponin level was 142 ng/mL.
Her cardiologist recommended an angiogram. Is that a good idea?
A: A troponin level above 0.4 ng/mL suggests damage to the heart. A troponin I level of 142 ng/mL says that she has had significant damage, almost always from a heart attack. The vast majority of these are caused by blockages in one of the major arteries that supply the heart muscle, which causes damage and cell death to the heart.
An angiogram is usually performed in these situations, which will allow her cardiologist to identify which vessel is blocked and determine whether opening up the blood vessel with an angioplasty and a stent is appropriate. This can help prevent another heart attack, so I absolutely agree with her cardiologist.
An unusual condition called takotsubo cardiomyopathy is
worth discussing. It is found more frequently in women by far, often around the time of intense emotional or physical stress, such as the death of a family member.
Chest discomfort is the most common symptom, and high levels of troponin are universal, although her level is much higher than usual. An echocardiogram can provide support for the diagnosis, but an angiogram is still essential. Of people with takotsubo, 15% also had blockages in their heart arteries.
Q: I read your recent column on Mohs surgery for skin cancer, but I recently saw a commercial for a radiation-type treatment that does not leave scars. It supposedly has 99% effectiveness. What do you think?
A: A controlled trial of surgery against radiation treatment showed that surgery led to higher cure rates (99.3% with surgery versus 92.5% with radiation after a fouryear follow-up) and higher cosmetic-satisfaction rates than radiation did.
A more recent review of all trials found similar cure rates
(both 96.2%) and similar cosmetic results in the Mohs surgery group and the radiation group. Newer radiation techniques may be better, but the 99% you mention is for a study where only half of the participants had a follow-up after a year. It’s not clear how many people might have recurrence after this newer type of radiation treatment. Finally, radiation treatment is considerably more expensive than Mohs surgery.
There are situations where radiation is clearly better than surgery, but this needs to be determined individually.
Q: I recently contracted a rather severe case of bacterial pneumonia, requiring 10 days of amoxicillin. It has left me with a problem — I have an enlarged prostate. Prior to getting pneumonia, I had to go to the bathroom three times a night, which I could handle. Now I have to urinate every hour on average, which is keeping me from getting a good night’s sleep. Why the change, and can anything be done about it?
A: A sudden change in urinary frequency leads me to
suspect that something has happened other than just an enlarged prostate. The first thing I would consider would be medication. Amoxicillin doesn’t worsen the prostate, so you should ask your doctor or pharmacist if you were given another medicine at the time you had pneumonia. Antihistamines are common causes.
I would also be concerned that you might have a urine infection. Some bacterial pneumonias can be complicated by bacteria in the blood, which can then go into the urinary system. Amoxicillin, however, is a pretty good antibiotic for the urinary system, so unless the bacteria is highly resistant, this doesn’t seem likely. Still, a urine test would be appropriate.
If you had a urinary catheter (Foley) placed, this can exacerbate prostate problems after it is removed due to trauma and inflammation. A stone can also cause these symptoms.
If none of these are the issue, then it is time to visit a urologist, who can do some flow studies and look at how much urine is in your bladder after you finish urinating. If it’s just the enlarged prostate, medicines like tamsulosin help immediately, while finasteride and similar medications shrink the prostate slowly over a span of months.
Finally, an overactive bladder and prostate enlargement sometimes go together, causing worse symptoms and requiring two different types of treatment.
Q: Every morning, after drinking one-two cups of coffee, I spend a few hours having to clear my throat. It’s like having a chest cold. I’ve tried avoiding milk, using powdered creamer and drinking it black. Nothing helps. Any ideas?
A: You might be getting gastroesophageal reflux, which is when stomach contents go backward from the stomach up into the esophagus. There is a muscular valve, the lower esophageal sphincter, that is supposed to prevent this, but caffeine in coffee weakens the muscle and can allow acid to go backward where it doesn’t belong. Most people notice heartburn (a burning sensation), while others have a cough. But throat-clearing is not an uncommon symptom for gastroesophageal reflux disease (GERD). The timing of the symptoms (after the coffee) is very suspicious.
Although there are medicines to promote movement of food and acid the correct way, we seldom use them due to their long-term side effects. Avoiding the offending foods (or beverages, in your case) is effective.
At least one study showed that switching to decaffeinated coffee improved symptoms; however, there seem to be substances even in decaf coffee that also promote reflux.
Medicines to reduce acid production by the stomach, like famotidine, are effective at improving symptoms. It would be a useful diagnostic test to see if the medicine can stop the throat-clearing after you have your coffee.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.