In most cases, leave surgical hardware where it is
DEAR DR. ROACH: I am a 75-year-old female. In 2012, I broke my ankle and they put in a plate and six screws on one side, and one screw on the other side. I've been reading that one should not leave the screws in for the rest of their life, because it can cause problems with the bones, causing arthritis. I can touch and feel the screw heads. The only problem is buying shoes that aren't too high to rub, or when I sleep, positioning my foot.
If the screws are removed, there will be a hole where the screws were. Will they fill the hole with a filler, or does the bone grow back and fill the holes? What if I get an infection after surgery? Or should I just leave them in? -- G.B.G.
ANSWER: In general, surgical hardware should be left in, unless there is a very good reason to remove it. Probably the most common reason to remove hardware is infection, which it doesn't sound like you have. Infection is infrequent, but is most common right when the hardware is put in. Removal of hardware has its own potential for complications.
Pain and joint stiffness are possible after surgical hardware placement, although that doesn't mean the hardware is causing the problem. The ankle fracture itself can predispose to developing arthritis in that joint. When people have pain at the site that might be due to the hardware, they should discuss the option of removal with the surgeon. If there are no problems at all, the hardware should be left in. The holes in the bones from the screws are repaired by the body's own processes. The materials that are used are designed to be left in.
DEAR DR. ROACH: I am an older male (I'm nearing 90) and have suffered from acid reflux for decades on and off. As I grew older, it bothered me more chronically, and recently I have been prescribed omeprazole, which seems to have helped. My question is this: I have also been advised that after a heavy meal (which aggravates GERD), half a teaspoon of baking soda with 7 ounces of cold water is also very helpful in controlling acid reflux and can complement omeprazole. What is your opinion? Is this effective, or just another generational "hand me down" home solution? -- M.B.
ANSWER: Just because a home solution is old and passed down by family members, doesn't mean it's ineffective. Baking soda is an antacid and counteracts stomach acid. It does not prevent reflux, which is the backward movement of food and acid up the esophagus, sometimes all the way up into the throat.
Avoiding heavy meals, eating well before bedtime and going easy on caffeine and alcohol are ways to prevent reflux in the first place for many people, but others will have reflux no matter how careful they are. Omeprazole, which almost completely prevents the stomach from being able to make acid, is an effective treatment for some people, but most people do not need to be on omeprazole all the time. Omeprazole has the potential for long-term side effects, including stomach and intestinal infections and bone loss over time. Further, omeprazole really isn't a good choice for occasional use, since it takes a few days to start working. Over-the-counter antacids, baking soda or medicines like Pepcid or Zantac are better choices for occasional symptoms.
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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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