Practicing family physicians from the UNC Department of Family Medicine have teamed up with The Carrboro Citizen to bring you a weekly feature responding to your questions about health and medicine. Send your questions or comments to yourhealth@unc.edu
This week we respond to questions about stress tests and fingernails.
Dear HOUSE Calls, My cardiologist scheduled me for a nuclear stress test. What is the difference between this and a regular stress test?
There are two different components to a stress test: the stress and the heart evaluation of response to the stress. We prefer to use exercise for stress. This might be on a treadmill or a bicycle and is usually done according to a protocol or until development of symptoms, EKG changes, blood pressure changes or near-maximal exercise capacity. If a patient cannot exercise, we can use a medicine to increase the heart rate and workload of the heart. This might be an important option for someone with severe arthritis, deconditioning or underlying heart or lung disease. The evaluation part of the test requires gauging how the heart is responding to the stress. This can be done with EKG monitoring, nuclear images or ultrasound images, which each have pluses and minuses. The nuclear images and the ultrasound are somewhat more accurate but a lot more expensive than EKG monitoring. In the end, none of these studies is perfect, and they are used to risk stratify a patient and determine if a cardiac catheterization is warranted. Your doctor will recommend which test is best for you based on your symptoms and your risk of coronary disease. During the nuclear test, the patient receives an injection of a nuclear tracer that will be attracted to heart muscle during exercise. Images are taken of the heart at rest, then the heart is stressed (either by exercise or medicine) and the images are taken again. Areas showing poor blood flow may be affected by coronary disease.
Dear HOUSE Calls, My nails are brittle and they tend to get white spots. Does this mean that I am vitamin deficient? Is there something I can do to make my nails stronger?
That is tough to determine without touching and feeling your nails and skin. We would also like to know more about your general health. White spots are often a sign of minor trauma or hitting your nails. Both white spots and brittle nails can be caused by deficiency in trace minerals. There are a variety of other issues that may cause these nail changes, including genetic conditions, metabolic conditions, fungal nail infections and picking at your nails. Psoriasis can also cause similar symptoms. If this is new, see your doctor sooner rather than later. If it has been going on for a while, you can probably ask at your next yearly exam.
House Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page and Dr. Adam Zolotor on behalf of Your Health and the UNC Department of Family Medicine.