Antibiotics before teeth cleaning not recommended for most
DEAR DR. ROACH: I have had two angioplasty procedures completed, one in 1999 and the second in 2014. Stents were inserted during each procedure. As a preventive measure, my dentist wants me to take four antibiotic pills (amoxicillin) before I see the hygienist. What is the reason for this? Do you feel it is necessary to take antibiotics before each visit to the hygienist? -- E.L.S.
ANSWER: Antibiotic prophylaxis is not routinely recommended for people with cardiac stents. The risk of infection is very low, probably lower than the small risk of an adverse event from the antibiotics. It's not clear that taking antibiotics would even reduce this already small risk.
People with some cardiac problems, such as a prosthetic heart valve, some types of congenital heart disease or a prior history of infection of the heart valve should take antibiotics. But, in general, antibiotics for a low-risk person is not recommended.
Of course, I would get assurance from your cardiologist that there is not something distinct about your case, but from what you have told me, I wouldn't recommend antibiotics.
DEAR DR. ROACH: I am 59 years old and in good health. For several years now I have had tingling and a slight numb feeling in mostly the ball of my left foot and sometimes the right. Sometimes it is like the feel of a sock rumpled up in my shoe, which is somewhat uncomfortable but not painful. I feel the sensation mostly at night while lying in bed. I am not diabetic. I have worked out all my adult life. I used to run up to 25 miles per week for many years but stopped, as I could sense this was not good for my knees as I got older. For exercise now, I ride my bike and work with weights. I like to take walks and hikes.
Could this be just compression of the nerves over the years, with literally thousands of miles on my feet and bike rides? It has never really worsened. -- T.B.
ANSWER: I found a study looking at 25 long-distance runners (average lifetime distance was 20,000 miles), which found evidence for damage to nerves, but which did not lead to symptoms. I think it's possible that the exercise alone could have caused your symptoms; however, I would still recommend at least a focused evaluation for other causes of neuropathy. In addition to the diabetes you mention, vitamin B-12 deficiency, Lyme disease and celiac disease are on my short list of conditions to consider in people with peripheral neuropathy, which is a general term used when the nerves don't work properly and it's not a function of the brain or spinal column. There are many others.
DEAR DR. ROACH: I have grandchildren who are very allergic to cats. Could they develop COPD from being around cats? -- Anon.
ANSWER: The vast majority of cases of chronic obstructive pulmonary disease are caused by tobacco. A much smaller but still substantial number of cases are in people with an enzyme defect, alpha-1 antitrypsin deficiency, but many people with this get symptoms only when they smoke or are exposed to lung irritants (including occupational exposures).
People with cat allergies may develop asthma, an obstructive lung disease that is distinct from COPD, and have worsened symptoms around cats. In that case, the most important treatment is to avoid cats. Cleaning a home of cat allergens is very difficult, and professional services can be beneficial.
There is an overlap syndrome of COPD with asthma, but I don't believe that cat allergy is a likely cause.
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