Dear Dr. Roach: My 64-year-old son just returned home after cardiac bypass surgery. The surgery went well, but he has severe pain. His body won’t tolerate any oral painkiller due to nausea and vomiting.
I can’t imagine what it will be like with six to eight weeks of excruciating pain. He is emotionally drained. Is there anything that can be done?
W.G.
Open heart surgery normally requires opening the chest through the sternum, which is quite a painful procedure. Although the patient is under anesthesia, there is still pain afterward. Oral opiate drugs are used once a person no longer needs intravenous treatment, but nausea and vomiting are common.
Anesthesiologists are experts at treating nausea and vomiting, and normally the person can get through the postoperative period using both painkillers and medication to reduce nausea. Postoperatively, options include nonopioid oral medicines and epidural medication; though both of these have significant limitations.
Once a person is home, the options are more limited. Anti-inflammatory medicines like ibuprofen are generally avoided due to the risk of problems with postoperative bleeding, and they should only be given when specifically prescribed by the cardiac surgeon. Tylenol is often given, and although it may sound like it would be ineffective, most people get pretty good results. There are also medications that may be given through a patch on the skin.
Finally, most people have much better pain after six to seven days after open heart surgery, not six to eight weeks. If he is having severe pain after this time, he should get evaluated.
Wound infections, blockages in the bypass graft, instability of the sternum, and migration of sternal wires can all cause postoperative pain that will likely require intervention.
Dear Dr. Roach: My eye doctor has recommended the consumption of alcohol to treat my macular degeneration. I was recommended to consume one drink once daily. Please give me your advice on this treatment.
B.G.
There must be a miscommunication here. Large amounts of alcohol consumption have been shown in multiple trials to increase the progression of age-related macular degeneration (AMD). Although some studies have found a slight reduction in progression among those who drink moderately, this was not a universal finding in studies.
I am very reluctant to recommend alcohol use as a health benefit of any kind, since the consensus of newer studies is that alcohol consumption is more likely to cause harm than benefit. Smoking cessation is critical for smokers with any form of AMD. A Mediterranean-style diet probably improves AMD by delaying its progression.
Some people with AMD benefit from a vitamin supplement, such as the AREDS2 formulation.
Dr. Roach writes: A recent column on alpha-gal syndrome, a meat allergy that occurs in response to a tick bite, generated many letters. In particular, many people stated that fatty animal products, like lard, can cause serious reactions in people with this syndrome.
I had also written that some people have fewer (or no) symptoms with cooked meat, but some of the allergens in meat are heat-stable, meaning that cooking it will not reduce the potential for serious allergic reactions.
I appreciate the letters from those with the condition, especially the creator of AlphagalInformation.org.
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]
