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‘Skipped heartbeat’ cause for concern — sometimes By Peter H. Gott M. D. Dear Dr. Gott: For the past two years, I have experienced a skipped heartbeat. Sometimes, it gets so bad that I will get a headache. I underwent an ultrasound after an EKG showed the defect, but the results were negative for any substantial blockage of arteries and valves. The doctor said it could be some damaged tissue. A nurse told me it could be stress. I am 6 feet 5 inches tall, weigh 400 pounds, am 40 years old and haven’t had a cigarette in three years. My vision is blurred during the time my heart skips. I’m on clonidine, verapamil and simvastatin to control my blood pressure and my (sometimes) escalated heart rate. Dear Reader: I can only interpret you are referring to palpitations — irregular beats of the heart. Fortunately, most people who experience the sensation do not suffer from cardiac disease or abnormal heart rhythms. If this is not the case and your physician has told you otherwise, you should request a referral to a cardiologist and have a complete workup done. In many instances, palpitations can be relieved by reducing stress, caffeine and alcohol, and discontinuing smoking. With that in mind, I must say your weight is of concern to me. While you are quite tall, you should incorporate exercise or a weight-reduction program into your schedule. Perhaps your place of employment has a gym or you have a community center in your area that will allow you to stop by after work. If diet modifications are appropriate, a referral to the dietician at your local hospital or health care center might be just the ticket. While you don’t mention stress, a coordinated program of exercise should relieve that and might even bring the palpitations under control. I am confident that if you can bring your weight down, your blood pressure will drop accordingly and you might be able to discontinue some or all of the medication you are on. While this might sound like a monumental task, you are a young man with a lot of hopefully healthful years ahead. Simple steps taken now might certainly head off bigger problems down the road. I also urge you, if you have not done so already, to limit your salt and fat intake. You do not say whether you have a high cholesterol level, but you are on a cholesterol-lowering drug. This may simply be precautionary for your abnormal heart rhythm. If, on the other hand, your cholesterol is high, reducing your fat intake could lead to a reduction or even discontinuation of the statin drug. Dear Dr. Gott: I’m 86 years old and pass black stool. I went to several doctors. One told me to go to the local emergency room, which I did. They took X-rays and blood tests but couldn’t find the cause. I’m on enalapril, HCTZ, Requip, simvastatin, terazosin, temazepam, propoxyphene, aspirin, fish oil and calcium daily. What is causing the problem? Dear Reader: Whew, that’s a lot of medication. There are numerous causes for black stool. The condition often indicates a disorder or bleeding in the digestive tract. As a rule of thumb, black stool comes from the upper digestive tract, while red or maroon stool comes from lower gastrointestinal bleeding. Stomach ulcers caused by aspirin and ibuprofen are common causes of a GI bleed. Unless there is a reason for taking aspirin every day, you should probably discontinue it, at least for a trial period. Other causes of dark stool can include the consumption of black licorice, blueberries, iron pills, Pepto-Bismol and similar medicines. Gastritis, trauma, hemorrhoids, intestinal infection, polyps and other conditions will also cause stool to darken. You need to be seen by your primary-care physician. He or she can do a simple examination and a fecal blood test in the office. If the history given is suspicious or the fecal blood test results are positive, referral to a gastroenterologist would be appropriate. The specialist might choose to order blood work, stool culture, colonoscopy, tests for H. pylori infection and more. Treatment will depend on the cause and severity of the bleed. Make an appointment with your doctor and get to the bottom of the matter. You have several medical conditions on your plate already and certainly don’t need one more. While you are there, ask whether any of your medications might be causing the problem, and, if so, whether they can be eliminated. Dear Dr. Gott: My city in Nebraska will vote soon on whether our city water should be fluoridated. What is your opinion on this matter? Dear Reader: Fluoride is found at varying levels in all drinking water. Because it is known to prevent tooth decay safely and effectively, an amount is added to many supplies across the country so levels can reach 1 part per million (ppm). Countless studies done over the years have shown favorable effects from supplements in drinking water for all children between the ages of 6 months and 16 years as a means of preventing decay. While there is always controversy, numerous studies in humans and animals have failed to reveal an association between fluoridated water and an increased risk of cancer. Therefore, I recommend you put your fears to rest and vote in in favor of the bill. Dear Dr. Gott: This is pertaining to one of your recent columns where a lady suffered from halitosis and could not discern the cause. She mentioned she was a gum chewer. In an attempt to stop smoking, I chewed gum all day and had exactly the same experience some years ago. I went to dentists and doctors to no avail. My family and colleagues at work learned to keep their distance. It was very embarrassing! Eventually, I discovered it was the aspartame in the chewing gum and many cups of coffee I devoured each day. Once I switched to another sweetener, the halitosis disappeared and has never returned. I hope this helps the lady and any others suffering from this very embarrassing situation. Dear Reader: Aspartame is an artificial sweetener used in diet soft drinks, coffee, gums, sugar-free candies and a host of other products. Some people can include it within their regular diets and never be affected. In your case, you developed a mild but unwanted side effect from it. More severe cases, such as allergic reactions, are well documented. In any event, you were lucky to have found the source of your halitosis. I am passing the information along through my column so others with a similar problem might be helped. Anyone who has suffered with halitosis and successfully treated it, please let me know what you have done. I will print a follow-up article with reader suggestions to pass on to others who suffer from this harmless but embarrassing problem. Thank you for sharing your experience.
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