DEAR DR. ROACH: I have had hot flashes, similar to those experienced by post-menopausal women, ever since my coronary bypass in 1990. I can be sitting quietly in a chair reading or at my computer, and suddenly I find myself dripping with perspiration. I also have had panic attacks, with increased heart rate and other physical symptoms. A few years ago, a 24-hour EKG showed heart-rhythm irregularities and that my heart stopped briefly while asleep.
If these idiosyncrasies of my autonomic nervous system are a consequence of my time on the heart-lung machine for the bypass, I’m not complaining — just curious. You said that studies have been done on almost everything. Is this one? — W.S.B.
ANSWER: I found that a lot of people complain of similar symptoms. I also found that indeed, the autonomic nervous system (the part of the nervous system that regulates temperature, sweat, blood pressure and many other critical aspects of body function without our being consciously aware of it) can be adversely affected by cardiac surgery. Some authors have suggested that the autonomic nervous system changes are one mechanism by which people are more likely to have depression after cardiac surgery. I found several possible explanations why the ANS changes with bypass surgery, but no clear consensus.
I would want to be sure that there are no other causes of these symptoms. It sounds like you have had an extensive evaluation, but I certainly would be concerned about a sudden fast heart rhythm, such as atrial fibrillation.
The booklet on abnormal heart rhythms explains atrial fibrillation and the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing: Dr. Roach — No. 107W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: I suffered a long time with GERD. I was diagnosed with Barrett’s esophagus, a precancerous disease. My doctor recommended a procedure called a Nissen fund oplication. Since the procedure, I have not had heartburn again. I would do it again, after what I went through. I get an endoscopy every two years to keep an eye on my disease. — G.D.B.
ANSWER: Barrett’s esophagus is a complication of longstanding reflux. It is diagnosed when the lining of the esophagus starts to look like the lining of the stomach. Barrett’s esophagus can progress to cancer of the esophagus. About 0.2 percent of those with Barrett’s per year will develop cancer, which sounds low, but if you live with the condition for 25 years, that’s about a 5 percent risk.
Surgery for reflux disease is done only rarely. However, it is very effective (85 percent to 90 percent). The most common reason to consider surgery is inadequate relief from medications and lifestyle changes. However, severe erosions from acid in the esophagus, inability to take medications, a stricture (partial closure) of the esophagus and Barrett’s esophagus are all reasons to consider surgery. Surgery appears to reduce the risk of cancer more than other treatments.
Dr. Roach regrets that 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. ©2016 North America Synd.