Dear Dr. Roach: My mother has been on anxiety medication for one year. Her anxiety level continues to increase to the extent that she is unable to rest. She currently takes 30 mg buspirone daily for anxiety. She is also on 20 mg losartan. She is in otherwise good health. Is there any additional or different medication that you would recommend for her to improve the quality of her life?
Anxiety is a condition nearly everybody has to deal with on a frequent basis. The difference in anxiety disorders is that the anxiety is difficult to control, happens more days than not and, most importantly, causes significant distress and impairment. Regular anxiety does not require medication treatment; anxiety disorders often do.
Before discussing alternative medication, I should mention that therapy, especially cognitive behavioural therapy, has been shown to be as effective as medication in treatment of generalized anxiety disorder. Unfortunately, there aren’t enough CBT practitioners in most areas of the country, and the COVID-19 pandemic has made in-person therapy challenging. Video therapy is an option for some people. Others prefer medication treatment.
Although buspirone is an effective treatment and relatively free of side effects, the most effective class of medication for generalized anxiety disorder in long-term use is the selective serotonin uptake inhibitor class. There are many SSRIs, and some of them are more calming than others. Any of them may be effective for a given person. Your mother could ask about alternate therapy and request a referral to a mental health professional who can provide it.
Dear Dr. Roach: How long do artificial heart valves last?
There are two main replacements for a heart valve: mechanical and bioprosthetic. A mechanical valve, also called artificial, is man-made of durable materials, and the bioprosthetic is typically constructed of animal tissue. Mechanical valves generally last longer than bioprosthetic valves. The durability of bioprosthetic valves depends on age. For patients in their 20s, a bioprosthetic aortic valve has a 50% chance of failure at 15 years, while in a 70-year-old, less than 10% of aortic valves will fail during the same time.
Mechanical valves are expected to last a person’s lifetime, although there have been models of mechanical valves that have developed failures of different components and had to be recalled. Since the mortality rate of the surgery to replace an artificial valve overall is somewhere between 7% and 14%, this presents a major problem.
However, durability of the valve is only one consideration. Most bioprosthetic valves do not require a person to take anticoagulation medicine, whereas those with mechanical valves absolutely need an anticoagulant to prevent clotting.
Dear Dr. Roach: I’m a 70-year-old man who fully recovered from a comparatively mild case of shingles 10 years ago. Once I was symptom free, I went ahead and got the early shingles vaccine (Zostavax). I’m now considering the Shingrix vaccine. Do you think it’s warranted in my case? I’m a little wary of possible reactions (a friend had a really nasty one). I had a triple bypass five years ago and take atorvastatin and metoprolol once a day but am otherwise in very good health, with careful diet, daily exercise, good cholesterol numbers, no smoking and no weight issue.
I do still recommend the new shingles shot, Shingrix, to people who have already had shingles. Although the risk of getting shingles is lower if you have already had it, and lower still if you had the original Zostavax, the risk of a reaction is generally less bad than the risk of developing shingles.
Reactions to Shingrix can be unpleasant. Fever, fatigue, feeling bad and a sore arm for a day are two are common. However, shingles and its complication, postherpetic neuralgia, are so bad that in my opinion the benefits outweigh the side effects.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
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