Ask Dr. Keith Roach M.D
Potentially infected knee replacement may need antibiotics for life
DEAR DR. ROACH: I am 68 years old. A recent column discussed a woman on antibiotics for seven years, and I was concerned about my own situation. I had a knee replacement four years ago, and I had a severe staph infection afterward. I also have an artificial mitral heart valve, which added to my fears. I had a large hematoma, and I was on a wound vacuum and had to be infused with antibiotics three times a day for 45 days.
My infectious disease doctor kept me on 500 mg Keflex four times a day for the first year following my surgery. I see my doctor and get my blood tested once a year, and my C-reactive protein is within its normal range. For the past three years, my doctor has prescribed 500 mg Keflex once a day. He has informed me that he plans to keep me on this regimen for the rest of my life.
What are the benefits and risks associated with someone like me remaining on antibiotics for the rest of my life? — Anon.
ANSWER: There are some times when long-term antibiotics are appropriate, and one is when there is a suspicion of infected prosthetic materials that are difficult or unsafe to remove. This decision requires exceptional clinical skill and experience. I can't question the infectious disease doctor who made the decision, as it sounds very reasonable to me. The issue is that there is a small risk of a catastrophic infection if you were to go off the antibiotics completely. Weighed against that are the small risks of longterm use of a generally safe antibiotic. Nobody wants to be in the situation you are in, but it sounds to me as though you and your doctor are making the best of it.
The concern I had with the previous letter writer's situation is that the reasons for the longterm antibiotics weren't clear, at least to me. I was very concerned that there was a serious infection or other problem that was not being appropriately looked for or treated.
DEAR DR. ROACH: How can I get rid of belly fat? -L.B.P.
ANSWER: There is no way of losing weight specifically in one part of your body. However, 'belly fat' — meaning visceral or omental fat, the kind that is most strongly associated with cardiovascular disease — tends to be more metabolically active and in most people is preferentially lost toward the beginning of any healthy weight-loss program. The most effective way to lose weight is to have a significant change in diet from calorierich, nutrient-poor foods like refined sugars and starches to a diet more based on vegetables and whole grains, with generous amounts of healthy fats and proteins, since these are more efficient at making us feel full than carbohydrates are.
Along with a change in diet, almost all of us in industrialized countries would benefit from increasing exercise and reducing sitting time. Exercise alone isn't enough to lose fat -abdominal or otherwise; it requires a change in diet. One can always outeat one's exercise.
Waist size is an unrecognized risk factor for heart disease, and it's the abdominal fat that is thought to represent that risk. However, it takes time and dedication to maintain the changes necessary to get rid of the waistline. But, there are many benefits to a healthier diet and increased exercise, including more energy and an increased sense of well-being. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.