Mastectomy, scoliosis not likely related
DEAR DR. ROACH: In 2000 (at age 53), I had a mastectomy with a TRAM flap reconstruction. In 2010, I began experiencing lower back pain. I did physical therapy and have continued those exercises since then, but the back pain worsened last year. I began also doing low-impact aerobics classes and water therapy. X-rays at that time showed 19 degrees of left-leaning scoliosis, compared with 9 degrees back in 2010, but I don’t recall being told about any scoliosis at the time. In fact, I was never diagnosed with scoliosis before 2010.
My question is whether the scoliosis could be a result of the TRAM flap, where the left abdominal muscles are stronger than the right, pulling my spine to the left. My back specialist thought this unlikely. — R.D.
ANSWER: Scoliosis is a condition where the spine is pulled to one side. The most common form is adolescent scoliosis, which is caused by asymmetrical growth of the spine. In truth, nobody knows what makes this type happen. In contrast, scoliosis that starts in the 50s or later is most commonly degenerative, meaning something is causing the spinal bodies to degenerate. This happens in older people as a result of arthritis or due to weakening of the bone structure (osteoporosis).
I agree with your back specialist that the TRAM flap (where a portion of the abdominal muscle is used in the mastectomy and reconstruction to provide a result that looks more natural) is not likely to be providing enough stress on the spine to cause scoliosis. If your breast cancer was estrogen-receptor positive (likely, at age 53), then you probably were put on an anti-estrogen drug, which may increase the risk of osteoporosis. I would be sure you have had a recent examination to look at your bone density, especially if you were on an aromatase inhibitor, such as Arimidex.
DEAR DR. ROACH: My doctor told me to take calcium and vitamin D to prevent osteoporosis. However, I attended a women’s health seminar where the speaker stated that calcium, even with vitamin D, is ineffective. I am 84 years old and do not have osteoporosis, although my doctor says I have pre-osteoporosis. I have some arthritic pain in my back and hips, but am otherwise in excellent health. Should I discontinue the calcium with vitamin D? — A.D.M.
ANSWER: There remains considerable controversy about whether calcium and vitamin D are effective at preventing or treating osteoporosis. There have been at least 11 trials — some have shown benefit, others have not. The U.S. Preventive Services Task Force has determined that there is still not enough evidence to estimate the benefits of calcium and vitamin D in post-menopausal women without osteoporosis or vitamin D deficiency (although low doses, less than 400 IU of vitamin D or 1,000 mg of calcium, are likely to be ineffective).
In absence of clear evidence, clinicians must make their own decisions based on their knowledge of their patients. Your doctor has made a common and reasonable recommendation (a typical dose in a woman your age is 1,200 mg calcium and 1,000-2,000 IU of vitamin D daily). I personally recommend getting calcium through diet if possible. However, since it’s almost impossible to get vitamin D through diet, for people at high risk of vitamin D deficiency (especially those who are indoors most of the time) or those with proven deficiency by blood levels, I do recommend supplementation.
I generally would recommend listening to your doctor, who knows you, rather than a person at a seminar (or even a doctor writing a column).
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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.