#Middlebury
DEAR DR. ROACH: Have you heard of the 64-slice test for your heart? Would you recommend it instead of a stress test? – D.F.
ANSWER: You’re asking about a CT scan of the heart. The use of multiple detectors allows the CT scan to get a very high-resolution picture of the heart very quickly. Modern 64-slice detectors can construct an entire 3-D image of the heart in five seconds under optimal conditions. The scan is excellent at detecting calcium in the arteries, which is imperfectly correlated with blockages in the arteries. However, by adding intravenous dye, blockages in the arteries can be detected with accuracy approaching that of a cardiac angiogram. Thus, for the diagnosis of coronary artery disease, a heart CT scan can provide information similar to a stress test.
However, a stress test gives information not only on anatomy, such as blockages, but on physiology as well. By measuring the amount of time someone can exercise, and the response of the heart rate to that exercise, the cardiologist can gain useful prognostic information, which is impossible to glean from an anatomic test like a CT scan or even a cardiac catheterization and angiogram. The two tests are complementary, and we often obtain both. So, it really depends on the goals of the stress test as to which is preferred.
DEAR DR. ROACH: I have breast cancer that has metastasized to my bones. I know that there have been great strides in curing cancer at the original site but there doesn’t seem to be any work done to help when it has spread. Are you aware of any? I am 87 years old. – L.L.
ANSWER: Once breast cancer – and indeed, most cancers – has spread beyond its original location (metastasized), it becomes much more difficult to cure. However, there have been significant improvements in the treatment of metastatic breast cancer. Cure might not be possible, but a good quality of life for months or years is possible (half of women with metastatic breast cancer will live longer than two years). The exact treatment depends on the pathology and receptor status of the cancer, and a plan needs to be individualized by an experienced oncologist.
DEAR DR. ROACH: I normally go to the dermatologist once a year to get a skin check and follow up on some moles I had removed. Now the office recommends that I go every three months. What gives? – F.M.
ANSWER: I’m guessing your dermatologist is keeping a close eye on something he or she doesn’t like but isn’t quite worried enough to do a biopsy. I don’t want to second-guess your dermatologist. When you go back, ask and find out. If you really dislike going so often – perhaps because of copayments, inconvenience or having to take time away from work or family – tell him or her so that you both can work toward a plan that is easiest for you but still allows the dermatologist to keep you free from skin cancer or other problems.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
© 2018 North America Synd. Inc.
All Rights Reserved
You must be logged in to post a comment.