Give doctor all your info for the best advice

DEAR DR. ROACH: About three years ago, I was walking from the parking lot to church (not a long distance) and was overcome with a feeling of warmth and weakness throughout my body. I almost dropped my purse, but it stopped almost immediately. About three weeks ago, the same thing happened. I did not feel ill, and it passed almost as fast as it came on me. I am 65 years old, exercise regularly and eat a healthy diet. I have yearly checkups and blood tests.

After looking over my yearly blood work, which we do at work, my white blood cell count is usually low, according to my hematologist. He had me do a total body X-ray and several blood tests over a threemonth period and found nothing wrong with me. I did not mention the above to him. Can you tell me what can possibly be going on in my body? — A.N.

Since it has happened only twice in three years, and since you have had an evaluation without finding anything, it may just be one of those things that happens that we don’t get an answer to. In fact, I think that is the most likely outcome. However, whenever I hear about warmth all over the body, I worry about condi- tions that cause a release of substances that act on the blood vessels of the body. Carcinoid syndrome and pheochromocytomas are two rare conditions that can cause a temporary flushing sensation, and you certainly should mention this to your doctor. Neither of them is likely, but you don’t want to miss either possibility.

Sudden onset of weakness is a warning sign of a TIA or stroke, but your situation doesn’t really sound like that. Still, giving your doctor the most information will help him decide whether this needs to be looked into further.

DEAR DR. ROACH: I had mitral valve prolapse for many years. In 2005, I got an infection, and it ended up as endocarditis. My mitral valve was not able to be repaired. I got a porcine valve. I am starting to have a little problem with my heart. Have you heard of a doctor doing a second replacement? My cardiologist says it is a really big deal. — J.L.F.

Endocarditis is an exceedingly serious infection of the heart valves. It is much more likely in people who have damaged heart valves, such as from rheumatic fever, but it also can happen in people with normal heart valves. Endocarditis is treated with antibiotics, almost always intravenously to begin with, but complications such as an abscess or heart failure may require surgery, either repair or a valve replacement.

I have seen many cases of replacement of a damaged prosthetic valve. As your cardiologist suggests, the risk of the operation is high. However, if the valve is very damaged, you don’t really have any other options. It is clear that the decision to replace a prosthetic valve is difficult and should be undertaken only if other treatments have failed. An experienced cardiac surgeon, hospital and entire team is critical.

You didn’t say what the new problem with your heart is. A recurrence of infection is fairly common, since artificial valves, both bioprosthetic (like your porcine valve) and mechanical, are at higher risk of becoming infected. Consultation with an infectious disease expert certainly would be appropriate, if that were the case.

Keith Roach, M.D. To Your Good Health