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Tuesday, April 2, 2013
Q: I am an 85-year-old woman, and I’ve been incredibly healthy all my life, until a couple of years ago. Recently, my complaints of breathlessness and fatigue took me to a pulmonologist, who diagnosed pulmonary hypertension. What can you tell me about this condition? How is it diagnosed? What treatment can be prescribed? I understand that it is incurable, but is it likely to get worse?
A: “Hypertension” just means “high blood pressure,” and we use it in general to talk about high blood pressure in the body — the one measured in your arm that reflects the blood pressure to most of your organs. This kind of hypertension can cause damage to the left side of your heart if untreated.
Pulmonary hypertension is high blood pressure within the blood vessels of the lungs. There are many causes, including blood clots in the lungs, autoimmune diseases like scleroderma, COPD and sleep apnea. However, much of the time, no specific cause can be found. This is called primary pulmonary hypertension. Pulmonary hypertension causes damage to the right side of your heart. After years, however, damage to the right side of the heart can affect the left, and vice versa.
Pulmonary hypertension is diagnosed by a combination of tests, including a thorough history and physical exam, an echocardiogram and often a lung scan and cardiac catheterization. Both pulmonologists and cardiologists diagnose and treat pulmonary hypertension.
If there is a specific cause for pulmonary hypertension, treatment is directed against that. For example, if blood clots in the lung are found, then treatment likely would include medication to treat and prevent blood clots.
For primary pulmonary hypertension, there are several new treatments, such as ambrisentan, bosentan and sildenafil. They are promising but haven’t really been around long enough to know how much they will improve symptoms and outcomes for people with pulmonary hypertension. There also are inhaled and injection therapies available. Unfortunately, almost all of these medications are very expensive. A few people with pulmonary hypertension are appropriate candidates for lung transplantation, usually those who are under 60 years old but with very severe disease.
There are several advocacy groups for your condition —one that I found very helpful is the Pulmonary Hypertension Association. Its website is www.phassociation.org. It has much more detailed information to help patients and their families. I found several doctors near you who identify themselves as having special expertise in pulmonary hypertension.
Q: There is a lot of talk about toxins today. Many people talk of the need to “sweat out the toxins.” This does not make sense to me. Aren’t toxins stored in body organs other than the skin? Could you please address this? Additionally, what is the true best way to remove toxins from the body, and are there some that will never be able to be removed?
A: You are quite right: Very little, if any, toxins are released by sweating. Our body has two main ways of getting rid of toxins — the liver and the kidneys. Keeping these organs in the best shape is your best bet for getting rid of toxins. Sweating excessively without replacing fluid loss actually harms your kidney function.
Having normal bowel function also may be important, since some potential toxins we eat don’t get absorbed, and are best sent out of the body with regular bowel movements.
Very rarely, ingestion of true toxins like arsenic or mercury can be removed by chelating agents like DMSA. This is only for treatment of poisoning.
Dr. Keith Roach’s column runs in Tuesday’s Extra.
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