A Question of Health

Should my late partner have had more heart tests? And are my moles risky?
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Anger at treatment

Anger at treatment

Q. My partner recently died of a heart attack. He had been experiencing chest pains and had seen a specialist who, after giving him tests, found nothing. He got the all-clear, and six weeks later was dead. I feel angry, confused and helpless. We are asking for records of what tests were performed, but in the meantime several friends report that they know of many such instances: chest pains, a visit to the GP, tests which indicate a normal heart, followed by death soon afterwards. Are there any specific tests one can ask for to double check preliminary results? In my partner's case, he was 56 and extremely fit (cycling 50 or so miles a day) and "not a suitable candidate" for further tests, even though he was a smoker. The coroner found furred arteries, a clot in the heart and hypertension.

A. Anyone who reads your account will sympathise with your anger, confusion and feeling of helplessness. How can it happen that a specialist gives someone the "all-clear", and six weeks later he drops dead from a heart attack? The tests that are used to assess the heart and the coronary arteries (the blood vessels that bring blood to the heart muscle) are imperfect. An electrocardiogram (ECG) performed while someone is lying on a couch only tells you how well the heart is performing when it is "resting". A more sophisticated test is an exercise ECG, which measures the heart's activity when the patient is walking on a moving treadmill. This assesses the heart's ability to respond to physical activity. But even an exercise ECG will miss about one-third of people who have furred-up coronary arteries. Another test that is sometimes used to assess the heart is a thallium scan. This, too, can fail to diagnose about one-sixth of people who have heart disease. If your partner was seen by a cardiologist and had all of these tests, and they were all negative, his doctors probably did as much as they could for him. But the sad reality is that all medical tests are imperfect in one way or another.

Skin cancer signs

Q. I have about a dozen dark moles on my arms and back. I'm careful to stay out of the sun, and I always use sunscreens. But how can I tell if a mole is turning cancerous?

A. Sun exposure is an important risk factor for skin cancer, although it is not the only risk factor. Your natural complexion is also important. People who have fair skin and blond or ginger hair, are more likely to develop skin cancer than those with darker complexions. Melanomas are the most unusual type of skin cancer, but also the most serious. American dermatologists have developed a helpful ABCD guide to melanomas. A stands for asymmetry. A mole that is oval or round is less likely to be turning cancerous than one that is asymmetrical or irregular in shape. B stands for border. If the border of the mole is poorly defined, it is more likely to be cancerous. C stands for colour. Moles that are uniformly coloured are less likely to be cancerous than moles that contain different colours. D stands for diameter. Moles more than half-an-inch across (12mm) are at greater risk of turning into cancer. Also look out for bleeding from moles, itchy moles, moles that seem to be spreading into the surrounding skin, and moles that turn hard and lumpy. Melanomas that are picked up early are usually cured, so it's worthwhile keeping an eye on any suspicious moles.

Does jab work?

Q. Both my sons have had all the childhood immunisations, including two doses of MMR. But they have both had measles, and now my 15-year-old has developed mumps. Having the jab hasn't prevented two of the diseases - was it worth having?

A. There are two possibilities: either the MMR jabs didn't work, or the diagnosis of measles and/or mumps was wrong. One dose of MMR will protect more than 90 per cent of children. After two doses, the level of protection goes even higher. I suspect that your sons may have had some other viral illness that caused a rash similar to measles. I have frequently come across children who have been "diagnosed" with measles who clearly did not have it. One reason for a wrong diagnosis is that many young doctors in the UK have never seen a child with measles. The MMR is definitely worth having, for the sake of your own children and for the sake of other children in the community.

Have your say: readers write

A non-surgical treatment for frozen shoulder, from RB:

I had a frozen shoulder for a good couple of years, and despite cortisone injections from a specialist was in severe pain and stuck with a pretty useless arm. The specialist was all set to operate, but I really dislike the idea of anaesthetics unless they are essential. The description of the operation on the internet suggested the main thing was to knock you out so the arm and shoulder could be wrenched about until they were freed up, so I went to a very good osteopath, and he did the job for me over two sessions. It did hurt, but it certainly worked! Although my arm was very weak after such disuse, it worked properly again, and within days of the second treatment was functioning reasonably as the soreness subsided.

Send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax: 020-7005 2182; or e-mail: health@independent.co.uk. Dr Kavalier regrets he is unable to respond personally