Dr. Roach: Doctors are at odds over heart patient
Dear Dr. Roach: I’m in the middle of a dispute between my neurosurgeon and cardiologist, and would appreciate your opinion.
I’m a 70-year-old male with extensive cardiac issues, including a heart attack, stent, ablation and A fib. I have a pacemaker/defibrillator implanted in my chest. I recently was diagnosed with a herniated disc, and the neurologist wants to perform surgery. He insists that I stop taking my daily 81-mg aspirin seven days before surgery.
My cardiologist absolutely refuses to allow this, and states that stopping the aspirin could be life-threatening. The neurosurgeon will not operate unless the aspirin is stopped. Neither doctor will budge. Am I doomed to a life of back pain, or is there some alternative?
Dear R.G.J.: I’m sorry, but I can’t override either your cardiologist or your neurosurgeon. Both are doing their best to make sure you are safe, from their respective points of view.
When surgery is absolutely indicated, we sometimes use heparin (or one of its newer cousins) by injection for the week before surgery. It wears off much more quickly than aspirin does. So, by stopping it right before surgery, you are only without an anticoagulant for the few hours during the surgery, and you restart the aspirin as soon as the neurosurgeon allows.
This plan minimizes bleeding risk during surgery and also clotting risk in the days before surgery.
If your back is bad enough to be worth both of these risks, then I would ask both your cardiologist and your neurosurgeon whether they would consider this plan.
Dear Dr. Roach: I have a seborrheic keratosis on my face (cheek), and I was wondering what you thought was the best method for removal that would give optimal cosmetic results? Also, are there certain foods, vitamins/supplements or creams that could help?
Dear T.A.: A seborrheic keratosis is a common, benign skin condition. It appears as a raised, slightly bumpy lesion, usually brownish, and can occur anywhere on the body. They often look as though they could be peeled off, but don’t attempt to do that. They don’t need to be treated, but many people find them unsightly and want them removed.
Seb Ks, as they often are called, are treated with either liquid nitrogen or are surgically removed. Both methods usually provide very good to excellent cosmetic results, but a recent study showed that liquid nitrogen freezing generally provides better cosmetic results, and it’s easier for the patient. A dermatologist with lots of experience can make a personalized recommendation for you based on the lesion, its location and your skin.
I could not find reliable evidence that any foods or supplements can prevent or treat these. Creams can cover them up, but not get rid of them. Electricity and laser are less common treatments.
Email questions to ToYourGoodHealth@med.cornell.edu.