DEAR DR. ROACH: I just celebrated the one-year anniversary of my heart valve replacement surgery. The operation consisted of replacing my bicuspid aortic valve with a bovine valve. All went swimmingly, and I was back to work in two weeks. I recently ran a 5-mile road race. 

My problem is with my medications. I am 55 years old and do not like taking pills. My cardiologist prescribed a daily 25-mg metoprolol tablet, along with a baby aspirin. I skip the pills occasionally, without noticeable side effects, and often go to my checkups with a false report of either saying I am taking the pills when I actually have skipped a few days, or saying I’m off the meds when I actually was taking them. Each time, the cardiologist says I need to get back on or stay on the pills.

Are these pills just a placebo? Is my doctor in the back pocket of the pharmaceutical companies? Or is he just afraid of lawsuits? Thanks. — J.D.

ANSWER: Medical care after valve replacement includes reducing the risk of blood clots, assessing function of the valve and preventing endocarditis (valve infection). The aspirin you are taking is standard for a bioprosthetic valve (if you had a mechanical valve, you would need warfarin). Your cardiologist will do an exam and probably obtain an echocardiogram to look at valve function. Hopefully he has spoken with you about taking antibiotics appropriately before high-risk procedures in order to prevent your valve from getting infected.

Metoprolol, a beta blocker, has many roles in cardiology, but I don’t have enough information about you to say exactly why you are on it. It could be that your blood pressure is higher than he’d like, or it may be that the left ventricle of your heart is thick or stiff due to working hard against a bicuspid valve for 54 years. It may be some other reason I don’t know.

What I can say is that your doctor is prescribing metoprolol for your benefit, and not for the benefit of pharmaceutical companies. It is against our ethics and illegal to receive any kind of compensation for prescribing a particular medication, and metoprolol is a very inexpensive medication. It is a powerful medicine. Even at the low dose you are taking, it has significant effects on heart and blood vessel physiology, and it may have beneficial effects on your heart rhythm.

I would strongly recommend that you be completely honest with your cardiologist about how often you are taking the medication, and you should find out exactly why he recommends you take it. I even would have him tell you, in detail, about the consequences of not taking it. It’s your body and your decision whether to take the recommended treatment, but you should know the consequences of not doing so.

Finally, all doctors are at least a little afraid of lawsuits. That fear is harmful, because it sometimes makes us order tests that we don’t think are necessary. Unfortunately, that often backfires and leads to different kinds of harms. Most successful doctors do their best to forget about lawsuits. The doctors least likely to be sued are the ones who are best at communicating.

READERS: The booklet on herpes and genital warts explains these two common infections in detail. Readers can obtain a copy by writing: Dr. Roach — No. 1202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.

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