DEAR DOCTOR K: I survived cancer, only to be told that the treatments that saved my life may have increased my risk for cardiovascular disease. What are the risks? And can I minimize them?
DEAR READER: As more people are living longer after a cancer diagnosis, more people are coping with the long-term effects of cancer treatment. Many cancer-suppressing treatments can have undesirable effects, for example, on the heart and blood vessels.
DEAR DOCTOR K: I'm in my third year of menopause, and my doctor won't prescribe hormone therapy. He says it increases the risk of heart disease. I think I recall that you told another reader that this is not true. Is my doctor right, or are you?
DEAR READER: You won't be surprised to learn that I think I'm right. But in the previous column you refer to, I didn't say exactly what you remember. I said that the effect of hormone therapy (HT) on heart disease depends on a woman's age and how recently she entered menopause. In younger women, in their first six to 10 years after menopause, HT protects against heart disease. In contrast, in older women, HT increases the risk of heart disease. It's called the "age effect."
DEAR DOCTOR K: I've been under the weather for a few days. This morning I blew my nose and saw greenish mucus, so I called my doctor and requested antibiotics. He refused. Why?
DEAR READER: Your doctor is correct not to prescribe antibiotics based on the color of your mucus alone. Despite what many people think, you cannot rely on the color or consistency of nasal discharge to distinguish viral from bacterial sinus infections. That's an important distinction because only bacterial infections respond to antibiotics.
DEAR DOCTOR K: Vaginal estrogen cream cures my vaginal dryness. But I hear estrogen is risky for the heart. Should I be concerned?
DEAR READER: Basically, I wouldn't worry. Here's why. Vaginal estrogen cream is one form of hormone therapy (HT). HT is estrogen taken alone or with other female hormones to treat the symptoms of menopause. "Systemic" HT involves hormones that enter the blood and travel throughout the body. It is the most effective treatment for postmenopausal hot flashes and vaginal symptoms, including vaginal dryness.
DEAR DOCTOR K: I've heard that some people dump their unused medicines into the sink or toilet, which then gets into our drinking water. Is this true, and could it affect my health?
DEAR READER: Unfortunately, it's true. There is increasing concern about chemicals from unused medications making their way into our drinking water.
DEAR DOCTOR K: I suffer from sciatica, which has caused a lot of pain over the past six month. My doctor has recommended epidural injections, but I hear that they have been disproven. Can you help me sort this out?
DEAR READER: Here's an answer I'm sure you'll find satisfying: It depends! It depends on what's causing the sciatica, and on which studies you believe.
DEAR DOCTOR K: My doctor switched me from several brand-name drugs to generic versions of those drugs. It has saved me a lot of money -- but are they really as good for me?
DEAR READER: The vast majority of generic drugs have been shown to be equally effective as brand-name drugs, and no more likely to cause side effects. There have been a few exceptions, which I'll mention. But that is my bottom line -- and I vote with my feet: I take generic drugs. They work as well as the brand-name drugs they replaced, they haven't caused side effects and they save me money. What's not to like?
DEAR DOCTOR K: I had angioplasty with a stent recently. I need to take aspirin and Plavix every day. I used to take ibuprofen for pain, but a neighbor said I shouldn't take it if I'm on aspirin and Plavix. Is that right?
DEAR READER: Taking aspirin and Plavix after angioplasty and stent placement is standard care. Both aspirin and clopidogrel (Plavix) attach to blood cells called platelets to make them less sticky. You need these drugs to prevent the formation of a blood clot inside the stent. If a clot forms in the stent, it can suddenly cut off the blood supply and cause a major heart attack.
DEAR DOCTOR K: A generic drug that I've been taking for years suddenly became much more expensive. I can't afford the new price. What can I do?
DEAR READER: Prices of generic versions of some commonly prescribed drugs have been skyrocketing. Like you, many of my patients have been affected.
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Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of the Harvard Health Letter. Learn more »
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