April 2009

Q. Dr.Savard, Do you recommend using FEM V as a diagnostic test instead of a wet prep and a KOH slide in diagnosing vaginitis/cervicitis in a health clinic?

A. The Fem V test (i.e.especially knowing your vaginal pH) is a great resource for women who have vaginal discharge or symptoms of vaginitis but are not sure whether OTC anti-fungal drugs would be worth a try or whether an appointment with a clinician to rule out BV or trich. I don't think this product should be targeted to practitioners offices but rather as a tool to empower women to make better home choices - and sometime avoid a visit.

Q. I have been recently diagnosed with HPV. I would like to find an easy to understand book on the topic. Can you recommend an author and/or book? Do any of your books cover the topic?

A. There are no up-to-date books I know of on the topic however there are a number of great websites including: CDC's, www.ashastd.org and www.thehpvtest.com Hope that helps. Warm wishes, Dr. Marie PS am working on a book, "Ask Dr. Marie", that includes large section on HPV due out in August.

Q. I missed most of the discussion this morning onc-scors. I just had a "virtual" angogram with a resulting c-score of 8.0. I am a 58 year old women. How does that score measure up? What are the ranges and their indications?.

A. It sounds like you had a CT angiogram which is a CT scan with a venous injection of dye. This test is good for detecting blockages but does use more radiation than the ultrafast CT I talked about on GMA. I am not sure how your test was scored, but it is a similar CT scan x-ray that can get a calcium score so this should correlate with any other calcium score. 8 would mean your calcium score was very low. Perhaps your doctor who requested the test can explain more precisely what your results mean for you.

Q. My name is Haeree Chang and I am part of the Boston medical news unit. This morning we have had an influx of questions resulting from the Battle Against Heart Disease news piece. Would you mind answering a few user questions, or typing up a simple response that we could post to these individuals? Each question would be posted with a disclaimer. I have listed the questions below for you. Any help would be appreciated. Thank you!

I am a 50 year old. I'm a diabetic for 3 weeks now. My dad died of a heart attack at age 35. My mom dird at 60 of a blood clot in her main artery; my sister a heart attach at 48. I smoke for 20 yrs now. I'm having chest pains on and off. I have hot flashes, pain in both of my legs cramping in legs foot and toes. I want to know what kind of test my family doctor can do . a simple test

A. You are right to be worried about your heart. You have three important reasons why you could have heart disease: your diabetes, your strong family history with heart disease at such young ages, and your smoking. Since you are having symptoms of possible heart disease right now, I would have your family doctor check you now. I would not wait for your family doctor however but would go to an emergency room if you are having chest pains. You should have a number of tests including your blood pressure, blood cholesterol and other blood fats checked, along with an EKG. However even if all those tests are okay, you could still have worrisome heart disease with your history and a referral to a cardiologist for additional tests like a stress test and a heart ultrasound would be a good idea. I wish you the best.

Q. I watched this morning the discussion on the Ca+ test for calcifications in the heart vessels not detected on a standard stress test. My question relates to the results of this test and the relationship, if any, in taking calcium supplements and Vit D or any medication that might contain calcium. I understood that microcalcifications slowly built up over years (if you're one the individuals afflicted by this) and can be attributed to multiple co-morbidities or be a single risk factor. What is your advice for taking calcium based meds or calcium and Vit D supplements if you are shown to have calcifications on the heart calcium test? Should a patient now ask for this test before starting any additional calcium medication besides dietary?

A. You are right that chronic inflammation or irritation of the body can lead to small amounts of calcium deposits in the affected part. For example, women get calcifications in their breast tissue from infection or even from cancer and arteries that suffer from chronic inflammation from high blood pressure, cholesterol, smoking etc. also develop calcium in the walls of the artery - this thickened inflammed tissue is called plaque. The x-ray I referred to today simply measures the amount of calcium in the inflammed heart artery plaque and has nothing to do with the amount of calcium overall in our bodies. Our bodies require calcium to function well and the main source of calcium is from our diet and our bones. If our dietary calcium is low, the body will naturally keep the body in calcium balance by taking calcium from the bones. After years of calcium loss from the bones because of low diet calcium or low vitamin D levels, osteoporosis, or thin bones, can develop. Every adult requires at least 400-1000 IU of Vitamin D a day which helps calcium be absorbed from the intestine, and requires about 1000-1200 mg of Calcium as well. A high calcium score on an ultrafast CT scan of the heart does NOT mean you have high blood calcium - it means you have chronic plaque and calcium buildup in your arteries. I hope this clears things up for you.

Q. Will health insurance pay for the "fast CAT scan calcium test"? I am 57, normotensive, no meds, borderline cholesterol level, with good levels of HDL, LDL and moderate risk CRP, nonsmoker, moderate alcohol, 3x week exerciser, with strong family hx (mom died of MI at 51, two older brothers had MI's and bypass surgery in late 40's.

A. You do have a strong family history of premature heart disease which means heart disease occurring at a young age. I too would suggest you talk to your doctor about controlling all of your risk factors as best you can. Your blood pressure should be under 120/80, your LDL under 100, blood glucose under 100 and your CRP under 1.0. Diet and exercise (and possibly adding aspirin, especially for men) can go a long way to make this happen but with your history, I think talking to your doctor about an additional heart test to gauge whether you have heart plaque build up would make sense. Unfortunately insurance companies are not yet paying for most ultrafast CAT scans to check calcium score although this may change soon. Some radiologists will discount the fee is you are paying out of pocket but this can still be expensive. Your insurance would almost certainly pay for a stress test however this is not always reassuring, even if normal, when the history of heart disease is so strong. A heart ultrasound during a stress test can also be of help. I would agree with your concern for further testing and would suggest you let your doctor know your history and concerns and desire for additional tests.

Q. I saw the show this morning about calcium scoring. 2 years ago at age 38 had single vessel bypass surgery. My blockage was 90% righ LAD. My calcium score was a zero. Why would I have a blockage and such a low calcium score.

A. Thank you for sharing your unusual story. Most 38 year old men (or women) would not normally undergo a calcium score test as you did. Normally it takes 10-20 years or more for plaque to build in the arteries and for the test to be helpful. You had a serious heart blockage which is almost always caused by atherosclerosis - which is a chronic build up of plaque. On the other hand, rarely people can have a blockage from a peculiar anatomic variant in your blood vessels, from a tear in the blood vessel wall, or from a blood clot without plaque. Your message is important however - no single test is ever perfect and can only be a guide to help patients get the treatment they need.

Q. Healthy female, 70, walk 3 miles 5 - 7 days a week. Diet is a blend of healthy & junk. Take vitamins & supplements. No problem sleeping. Both parents had heart disease as do both brothers, Mother & brother diabetic. I have no symptoms except borderline bloodpressure, cholesterol and sugar. My Primary doesn't see any problem but I am concerned since alot of heart conditions have no symptoms until the big one. I think I need to have a stress test (never had one), a carotid artery ultrasound, and the new calcium test discussed this am on GMA. I don't need referrals, should I contact a cardiologist for an appointment & just ask for these tests, should I see my primary first for blood work - what tests do you recommend?

A. You have a number of reasons to be concerned about heart disease and I would agree you should have a thorough checkup to be sure your heart is okay. I would let your family doctor know how concerned you are about your many risk factors and that you need the peace of mind of additional testing. Your doctor could refer you to a cardiologist and of course you could see one on your own. I always suggest first including your family doctor whenever possible. You sound like you may have a condition called metabolic syndrome that would place you at higher than average risk of heart disease. Your family history adds to your risk of heart disease as well. You should be proactive about asking about daily baby aspirin, controlling your blood sugar, cholesterol and blood pressure because even if you have some evidence of plaque, there is so much you can do to prevent a heart attack.

Q. I take medication for HBP and a former Viral Cardiomyopathy (1993), supposedly resolved according to my last stress test. One of the meds I take is a calcium channel blocker. I was also told that I am on a borderline to having osteoporosis, so I take calcium of 1500mg a day. My question is "does the calcium I take have any effect on the blocker ?" Am I likely to build up too much calcium?

A. No, your calcium blocker has nothing to do with the calcium level in your body or how much calcium supplement you take. However you are not alone to be confused by the name "calcium channel blocker" - I wish the pill was called something to make it clearer to everyone. The heart pill relaxes the arteries, lowers your blood pressure and takes the strain off your heart. Calcium along with 600-1000 IU of vitamin D is important both for your bones and for your heart health.

Q. My daughter was just diagnosed with Breast Cancer(IDC). What are her chances of when they take the mass out of them getting it all. She is 41 yrs old. It is in the stage 3. Thank You Very Much. I am not familiar with Breast Cancer, so maybe you can shed some light on this subject.

A. I have attached the link below to the most comprehensive website for women on breast cancer. The information is accurate, up to date, and should help you understand all the confusing information. As you can see, there are so many factors that a doctor considers before telling your daughter her prognosis. The good news overall however is that as long as she is getting the best care, treatments are now so much better and targeted to each individual patient. I would first make sure she is comfortable that she is seeing the best doctors in your area and that if there are any questions, she consider a second opinion. The most important information will come after they look at the tumor under the microscope following surgery to find out more about the best treatments and her prognosis. http://www.breastcancer.org/symptoms/diagnosis/staging.jsp