Medical Tests & Procedures Archive

Ask the doctor

Q. Should I make my kids get tested for COVID-19 before they come to visit me?

A. As we go to press, in most communities in the United States and Europe, the virus still is widespread — particularly among young adults. Many young adults who become infected do not develop symptoms, and therefore may not suspect they are infected. Worse, they may be shedding the virus and able to infect others. Older people are more vulnerable to becoming severely ill from the virus than young adults (although some young adults and even children can become very ill). So if my kids had symptoms that might indicate they had COVID-19, I'd ask them not to come. If they had no symptoms but were living in a "hot spot," I'd ask them to get tested before they traveled — and not to visit if they tested positive. I would hate not to see the kids, but it's a sacrifice we have to make until we control the virus.

For people recently diagnosed, taming the heart's rhythm rather than slowing it down may be a better approach.

The heart rhythm disorder known as atrial fibrillation (afib) occurs when the heart's electrical system goes awry. Instead of the heart's natural pacemaker creating a steady beat, the heart's upper chambers (atria) pulsate rapidly — up to hundreds of times per minute. Most of the electrical impulses telling the lower chambers (ventricles) to contract don't get through but many do, triggering a racing, irregular heartbeat that can leave people dizzy, breathless, or fatigued.

Therapies to tackle this common arrhythmia have improved over the years. Now, new findings suggest it may be time to rethink the treatment for people newly diagnosed with afib (see "Afib: Rhythm vs. rate control").

Spontaneous coronary artery dissection is an underrecognized but important cause of heart attack, especially in younger women.

Most heart attacks happen when a blood clot blocks an artery feeding the heart. But a small percentage result from a tear in the inner wall of one of the heart's arteries. The resulting flap or swelling inside the artery wall obstructs normal blood flow. Known as a spontaneous coronary artery dissection, or SCAD, the condition strikes both sexes but is more common in women.

In women who are under 50, SCAD is the most common reason for acute coronary syndrome. This medical emergency refers to inadequate blood flow to the heart; it includes both heart attacks and unstable angina (sudden chest pain that occurs at rest).

New calculators can estimate the chance your cancer might — or might not — become more aggressive.

Active surveillance is a popular option for men with low-risk prostate cancer, defined as a tumor that is confined to the prostate gland and unlikely to grow or spread. It involves monitoring prostate-specific antigen (PSA) levels in the blood for changes and having regular digital rectal exams to look for abnormal areas on your prostate.

During active surveillance, you have a PSA test and a digital rectal exam every six months and prostate biopsies approximately every other year. If your PSA level rises, your doctor will likely recommend a prostate MRI or an immediate prostate biopsy to see if the cancer has become more aggressive. If so, you and your doctor can decide whether to continue with active surveillance and have another biopsy six months or a year later, or move ahead to treatment, such as radiation, hormonal therapy, or surgery.

In the journals

Colon cancer prevention involves following a healthy lifestyle — for instance, exercising and not smoking — and periodically getting a screening test such as a colonoscopy. But what impact do diet and medications have? A recent review of 80 statistical analyses published over the last 40 years explored this question. The review was published online Oct. 1, 2020, by the journal Gut.

Over all, the results were disappointing in that no specific drug, food, or supplement stood out in the body of evidence. Yet some of the reviewed studies did show a link between a lower risk of colon cancer and use of nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) —and a higher intake of fruits, vegetables, and fiber. But other studies did not.

In the journals

Many men with prostate cancer who have a radical prostatectomy (prostate removal) receive radiation therapy afterward to wipe out any residual cancer cells. Alternatively, men can choose to delay radiotherapy and be monitored for evidence of prostate cancer activity, such as a rising blood level of prostate-specific antigen (PSA). If PSA testing or an imaging test like an MRI shows cancer, these men can then consider radiation therapy.

According to the findings of an analysis published online Sept. 28, 2020, by The Lancet, there is no clear benefit of immediate radiation over monitoring with later radiation therapy as necessary. Since some men will never need radiotherapy, this means that by forgoing immediate treatment, they can avoid potential side effects like incontinence and bowel problems.

On call

Q. I would occasionally get some swelling in my legs. But now I notice it by late afternoon every day. I otherwise feel fine. Should I be worried?

A. It sounds like you have edema, swelling in your legs due to fluid in the soft tissues beneath your skin. This usually occurs when pressure from the fluid inside your veins is high, which forces water out of the blood vessels and into the surrounding tissues.

The condition is an all-too-real problem for men, and one of the more difficult to treat.

After age 50, men often have periods of discomfort "down there." It could be a cramping, aching, or throbbing pain in and around your pelvis and genitals. You also may have issues in the bedroom and bathroom. While the problems are real, the cause is often difficult to pinpoint.

It's called chronic pelvic pain syndrome (CPPS) — also known as chronic prostatitis — and it's one of the most puzzling and difficult-to-manage conditions for older men.

A small amount of leakage (regurgitation) from the mitral or tricuspid valve is normal. People with either condition do not need to modify their activity levels, but they should stay alert to symptoms that suggest the problem is worsening.

New imaging techniques that use light or sound waves to create images of the inside of coronary arteries have helped researchers better understand the fat-laden plaque that builds up inside artery walls (atherosclerosis). Most heart attacks happen when small, inflamed areas of fatty plaque rupture suddenly, causing a clot that blocks blood flow. This may explain why treating large, obstructive plaques with stents or bypass surgery does not seem to prevent heart attacks or help people live longer.