DEAR DR. DONOHUE: About 40 years ago, when I was in my 30s, I was examined by a famous heart doctor who went over me with great care and concluded I had mitral valve prolapse. He put me on medicine, which I have taken to this day. He also insisted I take antibiotics before dental work.
That doctor died, and my new doctor, quite young, says I don’t have mitral valve prolapse and that I don’t need medicine or antibiotics before dental work. He saw that I doubted him, so he had me get an echocardiogram. It showed no mitral valve problem. I still wonder about this. I can’t accept that my former doctor was wrong. — J.P.
ANSWER: The mitral valve regulates blood flow from the upper left heart chamber — the left atrium — to the lower left heart chamber, the ventricle. When the ventricle contracts, it pumps blood out of the heart. Simultaneously the mitral valve closes to prevent backflow of blood into the left atrium. Mitral valve prolapse means that the mitral valve balloons upward into the left atrium during heart pumping and might leak blood.
In the 1960s, around the time you were diagnosed with this condition, mitral valve prolapse was first described and became a very popular diagnosis. Many of those who were then given a diagnosis of it really didn’t have it. The condition was written about in newspapers and magazines, and dire consequences were ascribed to it.
Now, with new knowledge of how this valve works and with new equipment such as echocardiograms ( sound- wave pictures of the heart), a clearer picture of the mitral valve is obtainable. Most people who have a ballooning valve are not considered to have a serious medical condition. In only a handful of these people does a significant leak of blood occur. Those are the people who require treatment, and those are the people who take antibiotics before certain dental procedures.
Your doctor wasn’t wrong. He was a victim of the inadequate knowledge of that era.
Heart-valve disease is quite common. The booklet on it describes the more prevalent varieties. Readers can obtain a copy by writing: Dr. Donohue — No. 105W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: What is your opinion of prolotherapy? I have quite severe osteoarthritis in both thumbs and have been receiving cortisone injections for it. I was told that prolotherapy would be more effective than cortisone and that the relief would be longer-lasting. — B.N.
ANSWER: Prolotherapy involves the injection of various substances around damaged ligaments and tendon attachments. It triggers inflammation. The inflammation, in turn, promotes healing by stimulating collagen formation. Often the material injected is dextrose (sugar) mixed with lidocaine (an anesthetic).
Some reports say that it is quite successful in things like tennis and golf elbow, where the pain comes from ligament tears. Other reports question its efficacy. It won’t hurt you.
I find it hard to believe it is more effective than cortisone for the inflammation of arthritis.