Ask the Experts: Bed Sores; Valve Replacement Surgery; GERD Medications

Q. I developed a painful pressure sore while recovering from surgery in hospital a few years ago. I’m due to have surgery again soon—can you offer any tips for avoiding a recurrence?

A. Your pressure sore was likely caused by staying in one position for too long—this reduces the blood supply to the skin and underlying tissues, and if the blood supply isn’t restored, a sore may develop. Unfortunately, older adults are especially vulnerable to sores because their skin is thinner and can sustain damage even from fairly light pressure.

Sores are most likely to develop over bony areas of the body that have less fat to pad them—for example, the heels, hips, base of the spine, and shoulder blades—so try to avoid prolonged pressure on these areas. Use pillows or supportive foam wedges as extra padding, and place a pillow under your calves to raise your heels off the mattress. Change your resting position at least every two hours (ask for help to do so if necessary), and ensure that the bed sheets remain smooth under your body. Also check (or ask a nurse or relative to check) vulnerable areas each day for signs that a sore may be developing.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine

Q. My husband has been referred to a surgeon to discuss options for aortic valve replacement. Can you give us a primer on what’s involved?

A. If your husband decides to proceed, the failing aortic valve will be replaced with either a mechanical or biological valve. Mechanical valves are long lasting, but have a greater risk for blood clots (recipients need to take blood thinners for the rest of their lives). Biological valves are made from animal tissue or other non-metallic materials, or may be taken from a donated heart. These valves are less likely to raise the risk for blood clots, but may not last as long as mechanical valves.

A replacement valve can be situated via surgical aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR). SAVR is open surgery, during which the patient is put on a heart-lung bypass machine that oxygenates the blood and pumps it to the organs. TAVR is performed using “keyhole surgery”—a catheter with the replacement valve at its tip is inserted through a small incision in the chest or the femoral artery, and guided up and into the heart to position the new valve within the existing valve. Because TAVR is still a new procedure, and has a higher risk for post-operative stroke, it may not be considered appropriate for some patients.
Aortic valve replacement surgery has a high rate of success, but it is important that your husband discusses with his surgeon the benefits and risks of each surgical approach before making his decision. 
Bruce Darrow, MD, PhD 

Q. I have gastroesophageal reflux disease (GERD), and take an over-the-counter H2 blocker to ease my heartburn—but would a proton-pump inhibitor be more effective?

A. H2 blockers—which include famotidine (Pepcid®, Pepcid AC®), cimetidine (Tagamet®), and ranitidine (Zantac®)—inhibit the action of histamine2, a naturally occurring chemical that signals cells in the lining of the stomach to produce acid. This makes the stomach juices less irritating to the esophagus if they flow back up from the stomach, as happens in GERD. Proton-pump inhibitors (PPIs) reduce acid by blocking an enzyme needed for producing acid in the stomach. You also may be able to manage your heartburn by avoiding foods that tend to trigger it (for example, greasy or spicy foods, citrus fruits, chocolate, and alcohol), and refraining from eating within two to three hours of bedtime.

H2 blockers work faster than PPIs, but the effects don’t last as long. If you are taking your over-the-counter H2 blocker more than three times a week, tell your doctor—it’s possible you may need a prescription-strength H2 blocker or a PPI.
Judith Beizer, PharmD
Geriatric Pharmacology

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