Ask Dr. Etingin: Calcium scoring test; Lyme Disease

I have a family history of fatal heart attacks, hypertension, and high cholesterol. My cardiologist recommended a cardiac calcium scoring test. My insurance provider doesn’t cover the test, so I want to be sure I really need it given that I’ll have to pay for it out of pocket. What exactly is a calcium scoring test?

A calcium scoring test is a diagnostic imaging procedure used to assess the amount of calcium deposits in the walls of the coronary arteries. These deposits, known as calcifications, are a marker of atherosclerosis, a condition that can lead to coronary artery disease, carotid artery disease, peripheral artery disease, and aneurysm. During the test, a computed tomography (CT) scanner takes detailed images of the heart, and this provides your doctor with measurements that describe the extent of calcium buildup—or its absence.

There are several reasons why a doctor might recommend a calcium scoring test, and the primary one is it can help assess an individual’s risk of developing coronary artery disease, which is a leading cause of heart attacks. In your case, the test was probably recommended to get a clearer picture of the extent of your heart disease because of your risk factors and family history. Depending on the results, your doctor will either confirm that your current blood pressure and cholesterol treatment regimen is sufficient or modify your medications and implement a plan for lifestyle modifications, such as weight loss and regular exercise.

If you are still on the fence about scheduling the test, discuss this with your cardiologist. If you are concerned about the cost, discuss that with someone in the business office at the imaging center. They may offer to set up a payment plan that breaks down the fee into affordable monthly payments.

I am going camping, and I’m concerned about Lyme disease. I’ll be sleeping in a cabin, but will spend most of my time outdoors. What can I do to minimize my risk?

Lyme disease is caused by bacteria transmitted by ticks, which are most often found in wooded or brushy areas with high grass or leaf litter, so it’s natural to have concerns about Lyme disease when planning a camping trip. To minimize your risk, take preventive measures such as wearing long sleeves and pants, using insect repellents that contain 20 to 30 percent DEET on exposed skin and clothing, and using products that contain permethrin on gear such as your backpack and hat. DEET repels ticks, and permethrin can immobilize them on contact. They are both safe, but permethrin should not be used on skin. Perform regular tick checks during and after outdoor activities using a handheld and/or full-length mirror, and shower as soon as you return from a hike. If you find a tick attached to your body, you can remove it with tweezers; or you can use rubbing alcohol on a cotton ball to smother the tick.

Symptoms of Lyme diseaseinclude a bull’s-eye-pattern rash, along with flu-like symptoms such as fever, headache, fatigue, and muscle aches. If left untreated, Lyme disease can progress to more serious complications affecting the joints, heart, and nervous system.

Most cases of Lyme disease respond well to antibiotics, especially when diagnosed and treated promptly. However, if the infection is not detected early or if treatment is delayed, it can sometimes lead to persistent symptoms known as post-treatment Lyme disease syndrome. Prognosis is generally good with early diagnosis and treatment, but it’s essential to seek medical attention if you develop symptoms suggestive of Lyme disease.

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