Dear Dr. Roach: How can I find the most successful, experienced kidney doctor? Would I be better off with a doctor who has his or her own practice, or one who works in a hospital? My kidney function is at 32 percent, down from 44 percent four years ago due to hypertension.
Dear J.A.: I often have tried to point out when a teaching hospital or special expertise is critical to having the best chance for a good outcome.
For chronic kidney disease, the expertise of the kidney specialist is seldom at issue, because virtually all kidney doctors are very experienced and are expert at taking care of this condition. The main goal will be to slow down the decline of kidney function, but many people in your situation eventually will need dialysis.
In my opinion, what you want to look at carefully is the dialysis facility, which vary greatly in quality.
I found a watchdog group with an interesting look at dialysis centers at projects.propublica.org/dialysis/. This uses Medicare data to evaluate hospitalization, infection and even mortality.
It’s not a perfect tool, but it gives you some information on which to base your decision. Find a doctor affiliated with the best dialysis facility around.
Dear Dr. Roach: I have had stomach pain on my lower left side for several months. Other symptoms include occasional heartburn, bloating and almost constant burping. My doctor is treating it with metronidazole, clarithromycin and omeprazole. Could these be symptoms of stomach cancer?
Dear D.W.: Abdominal pain, heartburn and belching are nonspecific symptoms that can be associated with many conditions.
The most common would be GERD (gastro-esophageal reflux disease), gastritis and stomach ulcer. The combination of medications your doctor is treating you with is for the bacteria H. pylori, which can cause gastritis and ulcers.
Eradication of the infection, which is very common, can heal ulcers and relieve symptoms. H. pylori can be diagnosed definitively by a breath test or a stool test, or by biopsy of the stomach. A blood test shows evidence of old infection, but it isn’t completely accurate.
Stomach cancer has vague symptoms as well, and requires a high degree of suspicion.
Stomach symptoms that don’t improve with treatment, or that have worrisome features like weight loss, early satiety (the feeling of being full after eating only a small amount of food) or bleeding should cause the doctor to consider an endoscopy to look at the stomach.
New onset of symptoms in someone over 55 also should be considered for endoscopy.
Email questions to ToYourGoodHealth@med.cornell.edu.