Dear Dr. Roach: I was diagnosed with a minor to moderate tricuspid valve leak, as well as a minor to moderate aortic valve leak and a trace mitral valve leak. My doctor says that there is no need to worry; he says we will just watch it. He also says that I can live a lifetime and not have any changes. Is he right?


Dear Y.A.: The echocardiogram is a high-resolution type of sonogram. It uses soundwaves to take pictures of the heart. The quality of echocardiograms has dramatically improved. They are so sensitive that small amounts of leak (also called “regurgitation,” which is when blood flows the wrong way through a valve) can be found in 80 to 90 percent of healthy people. While I can’t comment on your specific echocardiogram, my experience is that the vast majority of trace or mild leaks seen in valves by echocardiogram are not concerning. They likely have been that way for many years, and are unlikely to change. In someone with no symptoms of heart disease, I agree that there almost never is a reason to worry.

Dear Dr. Roach: I am male and 66, and I have battled an acne problem for over 50 years. Dermatologists have prescribed pills and creams, but these were never totally successful. I no longer take any medications. I have always drunk a lot of water because I heard it was good for your skin. Recently I have doubled my water intake, and my acne problem has almost totally cleared up. Is large consumption of water helping?


Dear J.K.: I found many anecdotes of people finding their acne improved with increased water intake, but no scientific studies showing that it is effective. So that brings me to your next question: Is drinking large amounts of water good for you? The answer depends on how much water is considered “a large consumption.”

While your body is capable of maintaining correct water balance across a very wide range of water intake, a modest amount, one to two liters (that includes water in food), is all you are likely to need. The exceptions would be if you are in a very dry environment or if you are losing excess amounts of water through sweating or because you are taking a medication that requires water intake.

To be fair, water intake up to very high amounts (40 liters per day) can be handled by a person with normal kidneys and normal heart function, unless the person is taking a medication that affects salt and water metabolism, such as a diuretic, or has an abnormality with anti-diuretic hormone. In my world, as an internal medicine doctor, I see far more problems with water excess than with inadequate water intake.

In your case, the time course you present is strong evidence that the extra water helped your acne. But it also is possible it was something else. Testosterone levels tend to decrease normally in men in their 60s, and that may be responsible.

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