Medical Tests & Procedures Archive

Q. I'd like to start monitoring my blood pressure at home, but I'm not sure when I'm supposed to do it. Is there one particular time of day that's best?

A. The best home blood pressure machines have a cuff around the upper arm, and they automatically inflate the cuff and measure the pressure. The cost of these small machines has dropped, they are easy to use, and they're accurate. To help your doctor determine if you have high blood pressure, I recommend making two measurements per day, one in the morning and one in the evening, for a week. I recommend that most people who have high blood pressure (like me) take their pressure at the end of the work day, or at a time of day when they feel most stressed (like I do). These machines are a great aid in helping you and your doctor control your blood pressure.?

Many doctors overtreat their back pain patients. Instead of following current guidelines and recommending NSAIDs and physical therapy, they are prescribing narcotics and sending patients for imaging scans and more aggressive treatment.

Each technique works for appropriate people.

Some 1.5 million Americans, most ages 75 or older, have aortic valve stenosis: a stiffening of the valve that must open to let blood surge from the heart to the body. As the valve degenerates, blood flow slows. Daily activities become difficult or impossible. Symptoms include fainting and chest pain. Unless the valve is replaced, half the people with symptoms die within two years.

Fortunately, surgeons learned decades ago how to replace the aortic valve. Modern surgical replacements use a mechanical valve or a bioprosthetic valve made with animal tissue attached to synthetic materials. Yet surgical aortic valve replacement (SAVR) still means open-heart surgery, several days in the hospital, and four to six weeks of recovery at home. Especially for older patients, this can be very risky, says Dr. Fred Welt, assistant professor of cardiology at Harvard Medical School and Brigham and Women's Hospital.

Even when it's not an emergency, it's okay to have heart catheterization in hospitals not equipped for heart surgery.

When you're having a heart attack, the best hospital is the closest hospital—even if you live in a rural area and the closest hospital isn't equipped for heart surgery. Most of these hospitals can perform emergency balloon angioplasty and stenting to restore blood flow to the heart as safely as hospitals fully prepared for cardiac surgery.

The effectiveness of abdominal sacrocolpopexy surgery to correct pelvic organ prolapse declines over time. Adding urethropexy can reduce incontinence risk, but it doesn't affect the odds of treatment failure.

Q. I used to see a cardiologist for mild high blood pressure, and she performed a cardiac ultrasound, electrocardiogram, and stress test with nuclear imaging every year. I felt reassured when my test results were normal. I had to switch to a new cardiologist, and he routinely does an electrocardiogram, but no other tests. He says I'm doing fine, and that I don't need those tests every year. Am I being neglected? I am not getting as much attention as I used to.

It's your doctor's call, but it's good to understand, and to weigh, your options.

Your heart doesn't just pump blood—it needs blood to survive. So, when blocked coronary arteries threaten the heart's blood supply, something must be done.

Vertigo is common in older adults, and it can lead to balance problems and falls, which can result in fractures, immobility, and death. The most common form of vertigo is benign paroxysmal positional vertigo (BPPV).

Inside the ear are three tiny canals that help us recognize the position of our body in space, which help us maintain balance. BPPV happens when tiny crystals in the inner ear become dislodged and bang around inside the canals. Simply looking up or rolling over in bed can dislodge crystals and cause brief bouts of extreme dizziness, including a sensation of spinning. A physical therapist can guide you through a number of exercises to reposition the loose crystals and reduce the symptoms of vertigo.

Despite recent recommendations against annual breast cancer screenings, women continue to have mammograms each year. Researchers suggest this is because providers disagree with the recommendations.

Q. An MRI of my knee shows I have a torn medial meniscus and mild osteo­arthritis. What treatment options should I consider?

A. A torn meniscus is a common cause of knee pain, and meniscal tears are especially common in people with osteoarthritis (OA). Menisci are small cartilage pads within the knee that help pad the bones in the joint and provide smooth knee motion. Meniscal tears may cause knee pain in people with OA. If you have knee pain and both conditions are detected, it is common to attribute the pain to the meniscal tear and to recommend surgical repair through an arthroscope. A surgeon inserts the scope and instruments into the knee joint through tiny incisions and trims the torn meniscus in a procedure called partial meniscectomy. Whether this approach results in better function has been debated.