Q&A: Ligament Tears; Sense of Taste; Anxiety
Q. Years ago I had tears in my anterior cruciate ligament (ACL) and my medial collateral ligament (MCL). Do these knee injuries lead to early arthritis? At the time, I had some arthroscopic procedures to repair the injuries.
A. Any trauma to a joint (even surgery) can lead to a series of events in the joint that can lead to cartilage destruction and osteoarthritis (OA). OA develops within 10 to 20 years in over half of patients with ACL injuries. However, some research suggests that OA is less likely to occur when the torn ACL is reconstructed than when the patient is left with an “ACL-deficient” knee. If the menisci are intact, fewer than 10 percent of patients have signs of arthritis 10 years after surgery. And, one study found that patients who regained normal knee motion after an ACL injury were less likely to develop arthritis than those who lost knee motion. ACL reconstruction is almost always done arthroscopically or with a combination of open surgery and arthroscopy. Because arthroscopic reconstruction uses several small incisions rather than a large incision that exposes the entire knee joint, recovery is faster and less painful. Arthroscopy is not used for repair or reattachment of the MCL because it is outside the joint; surgery is performed through a small incision on the inside of the knee.
Q. My sense of taste is fading; is this considered a normal part of aging?
A. Studies examining the cause of this have shown conflicting results. Some indicate that normal aging by itself produces very little change in taste, but that the changes may be related to diseases, smoking, and environmental exposures over a lifetime. Whatever the cause, decreased taste can certainly lessen your interest in and enjoyment of eating. The National Institutes of Health says that beginning about age 40 to 50 in women, and 50 to 60 in men, the number of taste buds decreases, and the remaining taste buds begin to atrophy. Usually, salty and sweet tastes are lost first, with bitter and sour tastes lasting slightly longer. The sense of smell may also decrease, and may be related to loss of nerve endings in the nose. A majority of people with Alzheimer’s disease and Parkinson’s disease has a loss of smell, but many other conditions also can cause loss of smell (which also can affect taste). Head injury, viral infections, allergies and other nose disorders may be associated with loss of taste. Headache or behavioral disturbances may indicate that the central nervous system is the problem. Dental and mouth disease also may lead to loss of taste; tests by a specialist to assess taste and smell may be required. Other causes of “dysgeuria” (abnormal taste) include chemotherapy, zinc deficiency, and certain medications used to treat hypertension. Treatment depends on identifying the cause. For example, nasal disorders may require relief of obstruction, treatment of infection, or reduction in swelling by temporary use of steroids. For such causes as head injury or viral infection, no treatment is available, but damaged nerves may be able to regenerate. Older adults also tend to produce less saliva, which can lead to dry mouth. Drinking plenty of fluids, chewing sugarless gum, or sucking on lozenges can improve this condition.
Q. Do anxiety disorders worsen heart disease? And if so, what is the cause?
A. Yes, anxiety does appear to be associated with worse cardiovascular outcomes in people with heart problems. A study published several years ago in Archives of General Psychiatry involved 1,000 adults with stable coronary heart disease. Researchers evaluated the participants for anxiety and followed them closely for about five-and-a-half years, tracking medical events related to their heart disease. During the study, the 106 participants who had anxiety disorders had a 74 percent greater risk of having a heart attack, stroke, heart failure, or death than participants without anxiety. Researchers theorized several causes: that the greater risk was related to exposure to surges of fight-or-flight hormones in the anxious participants, or to an unknown underlying factor that increased risk for both heart events and anxiety. These findings suggest that heart patients should be assessed and treated for anxiety as part of comprehensive treatment of their disease. Anxiety disorders are usually treated with talk therapy, medication, or a combination of both.
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