Dear Dr. Roach: I have a patent foramen ovale (hole in the heart). Recently, I heard on a radio show that people with a hole in the heart are more susceptible to strokes. Is this true? If so, how can I prevent it? E.
Answer: There are several types of defects in the heart muscle that are called holes in the heart, and the most common one is the patent foramen ovale (which is Latin for open oval-shaped window). It occurs when the normal opening between the left and right atrium necessary in a developing fetus because the oxygen to a fetus comes from the mother through the placenta, not from the lungs fails to close after birth like it should. A PFO is very common: 25 to 30 percent of the population has one. Most people with them never develop problems.
It is true that people with a PFO are at higher risk for stroke. It is thought that a blood clot, which would otherwise go into the lung (and surprisingly not cause much trouble most of the time), can go through the patent foramen ovale and then into the brain, causing a stroke. This is not a common finding, though, and the increased risk of a stroke in people who havent had one is so small that treatment, such as surgical repair, often is riskier than leaving it alone. People with a PFO and no history of stroke do not need repair or further evaluation. Prevention of stroke is the same as it is in everybody else: careful control of high blood pressure if necessary; avoid smoking; eat a healthy diet; and get regular moderate exercise.
People with a stroke for no identifiable reason and a PFO may benefit from surgical closure.
Dear Dr. Roach: Should people with Lyme disease avoid the flu shot? L.A.
Answer: Lyme disease is a potentially serious infection caused by the bacteria Borrellia burgorferi, passed on by a tick bite. Lyme disease can go unrecognized for a period of time, especially when the classic rash is not present, which is not uncommon. Without prompt treatment, Lyme disease can progress to affect the brain, nerves, joints and heart.
In general, people with a moderate to severe illness should not get the flu vaccine while ill. It is safe to give the flu shot to a person with mild illness, such as cold without a fever. In the case of Lyme disease, I would recommend withholding the flu shot from someone with active symptoms (which can sometimes get worse in the first few days of treatment with antibiotics). After finishing antibiotics, it would be safe to take the flu vaccine.
Some people have symptoms (such as fatigue, numbness, pain and impaired cognitive function) after treatment for Lyme disease, a condition called post-treatment Lyme disease syndrome. It is not clear why some people treated for Lyme develop PTLDS. However, there is no reason I could find nor evidence to support withholding the influenza vaccine for people with post-treatment Lyme disease syndrome.
