Sunday House Call, #790, May 16, 2021: A different clot than is in the news but no less than a novel treatment that can help thousands.

Topics today include:

An NEJM published study looked at excision of the left atrial appendage to reduce the risk of stroke in anticoagulated individuals. It did meet its end points with an absolute risk reduction of 2.2 per cent decreasing from 7.0 (control) to 4.8 percent over 3.8 year average for people of average age of 71.

Story: Surgery to prevent strokes in heart patients recommended worldwide: Canadian doctor

Your calls:

  • A call asks if he should get the second AZ vaccine in relation to the mutated variant from India
  • A caller asks about colon cancer screening for 92-year-old father. He is taking PEG for constipation and he is concerned that he might have cancer. We reviewed The common signs and symptoms of late stage colon cancer versus early stage, and the risks and benefits of the workup with respect to his age and the potential harms of intervention versus benefits.
  • Athlete’s foot not responding to topical antifungal treatments. Is the diagnosis correct?
  • A 55-year-old woman is concerned about diastolic hypertension. It is unclear whether she truly has a diagnosis as these are based on home readings called into her physician. We reviewed the importance of an ambulatory blood pressure monitor to ensure an accurate diagnosis.
  • The appropriate first line selection for the treatment of osteoporosis in a woman who is had a vertebral fracture.
  • A caller asks about an 87-year-old severely diabetic woman in Québec who has black swollen toes likely diagnosed as gangrene. The surgeons do not want to operate and have recommended that the toes be left to necrosis and detach on the room. The collar would like to know why they have chosen this management option.