Leaky heart valve raises question: How much?

Dear Dr. Roach: During a pre-op exam before minor surgery, I was told that I have a leaky heart valve (my heart has always been strong). I was told, “Everybody has one” and “not to worry.” I am elderly. What does this mean for me?

M.C.

The heart has four valves: the aortic and mitral on the left side, and the pul- monic and tricuspid on the right.

Any of these can leak, but it’s the valve involved and how extensively it is leaking that are the key issues for determining how problematic the leak is.

It is true that many, or even most, people have a small degree of leak (“leak” in this context is when the blood flows in the wrong direction across the valve when it is supposed to be closed, not that it comes out of the heart and blood vessels entirely, which is a lifethreatening emergency). The tricuspid valve in particular usually has a small amount of regurgitation (one of the technical terms for leak; the other is “insufficiency”) that can be seen on an echocardiogram. If your doctor could hear it, that implies a more significant leak.

Large amounts of leak, especially aortic valve insufficiency, need medical and sometimes surgical treatment.

Based on what you were told, it sounds like this is a very small issue, possibly tricuspid regurgitation, and if you are feeling well, it’s unlikely that you need any treatment. The next time you see your doctor, though, get the details, and ask questions until you have all the information you need to feel comfortable.

Dear Dr. Roach: I have a very dry mouth after surgery and radiation treatment for tongue and throat cancer. I have thrush in the middle of my tongue, caused by a very dry mouth. I brush my mouth and tongue three times a day and gargle every night, yet it comes back the next day, and I start all over again. I’m used to it, but my lady friend is concerned.

We are both seniors and are thinking about a serious relationship. She was told that I could pass on the yeast infection or something worse to her. I don’t know how to answer her. Is it possible the thrush is contagious? R.C.K.

Thrush is caused by the overgrowth of yeast, normally in a warm, moist environment, such as the mouth, vagina or areas where the skin overlaps, such as under the arm. Yeast normally live in the area, so thrush typically is caused by something different in the host — that is to say, the person affected. People with diabetes mellitus or with damaged immune systems due to steroids, infection or chemotherapy are at a higher risk for thrush. Dry mouth, a common complication after head and neck cancer, predisposes one to thrush also.

Thrush is not normally considered contagious. Your lady friend likely has yeast already (most of us do, as part of the normal array of organisms that live on us), and her body’s system keeps it in check.

However, if she has a very weakened immune system, as described above, it is possible, but unlikely, to transmit infection.

Although good oral hygiene is important for getting rid of thrush, I am surprised that you aren’t on some other kind of medication.

Oral solutions, lozenges and pills all show high rates of curing infection. Some people do need ongoing treatment to prevent recurrences, and you might because of your severe dry mouth.

Talk with your doctor about a lozenge (called a troche). If you wear dentures or another oral appliance, these need to be thoroughly cleaned and disinfected nightly.