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Dr. Roach: Supplements and a precancer scan wrack up large bills

Keith Roach
To Your Health

Dear Dr. Roach: I’m 65 and in good health. I’m only on a low-dose cholesterol medication and a blood pressure medication. I also have laryngopharyngeal (LPR) reflux.

I went to a functional doctor and was sold $350 worth of supplements to do a 21-day cleanse/clean-eating/vegan-type diet. She said I would then need to go get a full blood panel afterward. She also wants me to get a whole body precancer scan, which is $750 and isn’t covered by insurance. Insurance doesn’t cover all the supplements either.

Also: Pathologists can determine if cancer is due to outside exposure

What do you know about these methods, and are they really going to get me off my big pharma meds? Or is this a money grab? I’m just confused about these methods. I don’t eat badly. I drink alcohol occasionally, and I work out every day (using an exercise bike, strength training, stretching and tennis).

— S.T.

Dear S.T.: There are some parts of your story that concern me.

Most North Americans probably could eat in such a way as to improve their health, but I don’t like the term “clean,” as I don’t think it has any specific meaning. Vegan diets are generally healthier than typical Western diets, but there are healthy and unhealthy vegan diets. There is no evidence to suggest a “cleanse” is necessary or helpful.

A (mostly) plant-based diet, in combination with a regular moderate-to-vigorous exercise program, helps most people reduce (and sometimes eliminate) their need for cholesterol and blood pressure medications. Diet and lifestyle modification are also the first-line treatments for LPR reflux in adults.

However, $350 in supplements sounds excessive, and there are no supplements that effectively replace cholesterol medication or treat high blood pressure. If your diet is about to improve, I’m not sure which dietary supplements are indicated. If they sold the supplements to you, I would call this unethical behavior.

I also do not recommend whole body imaging scans to diagnose cancer, as the evidence is clear that these are more likely to diagnose incidental findings that will never bother you, rather than diagnosing a problem early. It may take much time, worry and expense to prove this. I don’t know which blood tests she is recommending, but it may be completely appropriate to reexamine cholesterol and other blood tests after a major change in diet and lifestyle.

I can’t tell you what she’s thinking, but let’s give her the benefit of the doubt and say she is really trying to help you. Still, I disagree with the need for expensive supplements and extensive testing that aren’t based on identified problems and aren’t studied, approved preventive care maneuvers.

Dear Dr. Roach: I understand there are multiple kinds of anesthetic, and I was wondering which would be best for my husband who is 85 and getting a shoulder replacement?

— P.A.

Dear P.A.: Choice of anesthetic is firmly in the realm of the anesthesiologist whose expertise is in this very issue. Because older adults tend to metabolize many anesthetic agents slower than young adults, anesthesiologists adjust the agents they use and their doses based on a person’s age and many other medical characteristics.

It is absolutely worth a discussion with the anesthesiologist prior to surgery. For a shoulder replacement surgery in particular, a nerve block is often done, in addition to general anesthesia, which allows better pain control and the possibility of a faster discharge from the hospital.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.