DEAR DR. DONOHUE: I had an echocardiogram. The findings are consistent with “moderate to severe aortic stenosis with trace mitral and tricuspid regurgitation and mild pulmonic insufficiency, with left atrial enlargement and left ventricular diastolic dysfunction. The ejection fraction is greater than 65 percent.” My doctor referred me to a cardiologist, who told me I need surgery. I am 86 years old and do not feel it would be safe. Will you explain in plain English what I have, and if surgery would lengthen my life span? — M.I.
ANSWER: Forget about the mitral, tricuspid and pulmonic heart valves. These three valves have an insignificant leak. Your aortic valve, however, is your main problem. The aortic valve closes after the heart pumps blood out to the rest of the body. Your valve is so narrow (stenosis) that it creates an obstacle to emptying the heart of blood. That has given rise to “diastolic dysfunction.” Your heart can’t fill with blood normally, as it should between heartbeats (diastole). It is less stretchable. The aortic valve trouble has caused it to thicken.
Early on in aortic stenosis, all goes well. When the valve narrows to a critical size, about 1 square centimeter, symptoms arise, and heart damage progresses more rapidly. The three most important symptoms and signs of aortic stenosis are shortness of breath when up and about, chest pain with activity and fainting spells. Once these symptoms appear, a downhill course in heart health is to be expected.
Even though you’re 86, age is not a contraindication to surgery. If your health is otherwise good, you could be a candidate for it. Discuss with the doctor the surgery he has in mind. Ask if you might be able to receive a new valve inserted into the heart through a surface blood vessel by way of a catheter. No extensive incisions are made. It’s a less-traumatic procedure. Replacement of your heart valve will increase your life span and will do away with the severe symptoms that come from a narrowed aortic valve.
DEAR DR. DONOHUE: What elevates a person’s white blood cell count? What can a person do about it? Mine has been high for a while. — B.L.
ANSWER: White blood cells are the body’s warriors. They fight germs and perform other tasks to protect the body from infection. The normal white blood cell count is 5,000 to 10,000.
Infections, inflammation, trauma, some noninfectious illnesses, leukemia and stress (including emotional stress) raise the count. So do dehydration and cortisone medicines.
If no illnesses are found, it’s not unusual to ignore the higher-than-normal count. If suspicions of hidden illness are high, then further testing has to be done — like a bone marrow test. A person can do nothing on his own to lower the count.
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©2013 North America Synd.