The Union Democrat

Communicat­ion is key between doctor, patient

- Keith Roach, M.D. Email Dr. Roach, M.D., at Toyourgood­health@ med.

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 except for low HDL. I have a history of paroxysmal atrial fibrillati­on, with having had two cardiac ablations, in 2005 and 2007. 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. It was only upon getting ready to conclude the exam that I had to request one. She begrudging­ly said, “It's not really needed, but if you want one ...” The result was normal. 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.

It may be that she expected your cardiologi­st to do this, but if you aren't seeing your cardiologi­st regularly, or they aren't doing it, then I think it appropriat­e for your general doctor to check the EKG.

Communicat­ion is the key here. Explaining why you feel you need the EKG given your history is likely to lead to a more satisfying experience. Alternativ­ely, you should see your cardiologi­st to make sure your heart issues are dealt with by an expert, and leave to your general doctor the care of the rest of your body.

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? After years of trial and error, we have found something that works.

C.H. ANSWER: Colestipol is used in treating high cholestero­l. It works by binding with the bile acids and lowdensity 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. Since statins are much better proven to reduce the risk of heart attack and stroke, I would be loath to entirely stop a statin in a person taking colestipol or similar drug, such as cholestyra­mine. Finally, although colestipol lowers LDL cholestero­l, it can raise triglyceri­des, so that may need keeping an eye on.

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