Keith W Roach, MD

08/28/2025

Timely info from YLE.

https://yourlocalepidemiologist.substack.com/p/covid-19-vaccine-license-change-12

And an important note about the ousted CDC leaders

08/06/2025

DEAR DR. ROACH: My husband is 72 years old and on a waiting list for a hip replacement due to severe osteoarthritis. The surgeon he was referred to is quite young, has been performing anterior minimally invasive hip replacements for five years, and does about 250 per year.

Originally we had asked to be referred to a different surgeon who has 30 years of experience, but we were told that older surgeons, although very experienced, do not do this procedure. Instead, they tend to do what they were initially trained to do, which includes cutting through muscle and tendon to access the hip. Apparently this causes a lengthier recovery period. What are your thoughts on this? -- D.M.

ANSWER: In general, I do not recommending telling a surgeon which specific type of surgery to perform. You place yourself in the surgeon’s hands and expect to be treated to the best of their expertise. Depending on your particular issues, one type of surgery may be better than another, but only a surgeon can decide this.

I reviewed the published literature on minimally invasive versus conventional surgery. Not everyone is a candidate for the minimally invasive procedure. There are some benefits to minimally invasive surgery such as less postoperative pain, reduced hospital stay, and less blood loss.

However, there has been no consistent benefit shown for rates of infection, the need to revise the procedure, or complications such as dislocation or fracture near the prosthesis. Some studies have suggested a higher rate of nerve injury with the minimally invasive procedure.

Since there are some short-term but no proven long-term benefits to the minimally invasive procedure, I advise you to find a surgeon you trust and listen to their recommendation for the right procedure in your husband’s case.

Choose a surgeon you trust, then allow them to advise the best course of action.

08/06/2025

DEAR DR ROACH: I have a couple issues with my bladder and a sleep aid. I am an 81-year-old male in fairly good health. I have a difficult time getting back to sleep after getting up to empty my bladder. My solution for this was to take a melatonin tablet after each trip back to bed. This seemed to help.

However, I researched melatonin online and found that some people, my wife included, can get nausea and stomach cramps from using melatonin. While this does not happen with me, I’m wondering if taking 3 mg per night could be harmful to me given the reaction my wife gets. -- J.T.M.

ANSWER: Although melatonin is generally safe, it can cause some side effects. In addition to the stomach cramps, people have reported vivid dreams or nightmares, short-term depression, dizziness, and headaches. A few people find the medication helpful enough that they are willing to live with these side effects, but many people will give up and try a different treatment for sleep.

If melatonin isn’t causing you any side effects, then it is likely safe for you. Many people use melatonin, and although long-term safety has not been proven by trials, it is increasingly unlikely that any long-term adverse effects haven’t been discovered.

07/31/2025

DEAR DR. ROACH: My husband woke up with double vision about three weeks ago. It appears that his left eye is turned inward and does not move with his right eye. He’s had a prescription for prednisone that did not help. An MRI has ruled out a brain tumor, and blood tests have ruled out myasthenia gravis.

An optometrist has prescribed prism glasses, which help a little. He’s been wearing an eye patch to drive short distances. His primary care provider indicates that it can get better with time, and he should just wait to see what happens. He has not hit his head or fallen. He’s 75 and in good health.

The only new medication he’s taken is Eliquis, which was prescribed about six months ago after he had a blood clot in his leg. The prescribing doctor indicated that he would only need to take it short-term, but his primary care provider seems to be reluctant to stop it.

I’m concerned that we’re not doing enough for his double vision. Do you have thoughts about its relationship to the blood thinner? -- L.C.

ANSWER: Double vision, specifically binocular diplopia (seeing two images when both eyes are open and one image when either eye is closed), is most often caused by an inability for the eye muscles to move one eye, which seems to be the case with your husband. It sounds like the nerve that stimulates the muscle to move the left eye outward -- the abducens or sixth cranial nerve -- may not be working properly (which is called a palsy).

This isn’t definitive as there are many causes. Myasthenia gravis, an autoimmune neuromuscular disorder, is one, and unfortunately the blood test is not definitive as a minority of cases of myasthenia are seronegative. This means the blood test for the antibody that is attacking the nerve/muscle junction is not present.

The MRI was an essential test and is very reassuring. Not only does it make a brain tumor very unlikely, it also means the anticoagulant Eliquis is unlikely to be the cause, since a collection of blood around the eye could potentially block the movement of the eye. Eliquis, like all anticoagulants (“blood thinners”), can increase the risk of a serious internal bleed, but this would have been apparent by a CT scan or an MRI.

If he has what I think he has, there is a very good chance he will recover spontaneously. This good prognosis may be why it seems like they aren’t doing as much as they could. Still, if I were your husband’s primary care provider, I would enlist the help of a neuro-ophthalmologist.

He's had MRIs and blood tests. Is there more they can do?

07/31/2025

DEAR DR. ROACH: I have a question about your recent column regarding kidney stones. I’m wondering if there was a typo. You said that diet is important with calcium-rich foods reducing the risk of kidney stones. You also mentioned that calcium supplements may worsen the risk of kidney stones. These two concepts seem inconsistent, and I am hoping to get clarification. -- D.E.

ANSWER: The apparent paradox is explained by the amount of calcium and the timing in relation to food. Calcium-rich foods decrease kidney stone risk, probably because they bind the oxalate in the foods that cause the kidney stones when the oxalate is still in the intestines. This means less oxalate is absorbed, so there is less oxalate in the urine to form stones.

By contrast, calcium supplements may increase kidney stone risk because they are so concentrated that they cause temporarily high levels of calcium in the urine, which lead to calcium oxalate stones.

If calcium supplements are absolutely needed, they should be small-sized and taken with meals multiple times daily. However, body calcium can be preserved by a thiazide-type diuretic that reduces calcium excretion.

07/30/2025

DEAR DR. ROACH: I am 66 years old and have had highly episodic and infrequent shooting pains in my outer right knee on and off for the past five or six years. It’s like an intense burning sensation or electric shock to the bony outer part of my tibia directly below the knee, and it only lasts for a few seconds.

But when it occurs during sleep, it wakes me up and “burns” six or eight times in half an hour, then completely stops. Sometimes it feels like someone is pointing a laser beam at this very specific spot on the outside of my lateral condyle. (I looked up the name.)

I played basketball in high school and college but not since. About three years ago, because of hip arthritis, I stopped biking two or three days a week for exercise (only modest exertion -- never long trips). I don’t currently exercise, although I do yard work and gardening. I have not had surgery or hurt my knee in the past.

I have no restriction of movement; there is never any swelling or tingling, and it had only been an annoyance until recently. It seems to be happening more frequently now. Nothing I do seems to provoke it. It just comes out of the blue. In the past, I might go six or eight months without any recurrence. My doctors have no clue what it is. Any idea what it could be and how to make it stop? -- V.F.

ANSWER: Burning pain in a specific area of the body is highly suggestive of a neuropathy. “Neuropathy” isn’t a diagnosis; it’s a general term to describe something wrong with the nerve. In this case, the nerve in the outside (lateral) knee is likely the common peroneal nerve (also called the fibular nerve) or one of its smaller branches.

This nerve is commonly damaged by trauma or injury to the knee. Pressure directly on the nerve can happen with certain items of clothing, during surgery, or even by keeping your legs crossed for a long time. I also wonder if you have some bony protruberences in your knee as a result of arthritis, which can put the nerve into a vulnerable position. (People with hip arthritis usually have knee arthritis as well.)

This isn’t a common problem for regular doctors to manage, so I suggest that you see a physiatrist or a neurologist. They can confirm (or refute, maybe) my suspected diagnosis, figure out why it may be happening, and suggest treatment. Since it can be so infrequent, I don’t recommend continuous treatment like medication, but maybe therapy could help get pressure off the nerve.

Most people find exercise like bike riding helps symptoms of hip arthritis.

There is also a hip injury. Could that be the culprit?

07/30/2025

DEAR DR. ROACH: I was interested in the letter from the woman who kept getting bladder infections. I have found that avoiding pants that are slightly too tight stopped my bladder infections. There may be no scientific studies to back this up, but it worked for me. With whatever mechanism might be at play, your reader should see if this is a consideration for her. -- P.G.

ANSWER: I appreciate your writing. There aren’t any studies I could find to back this up, but it’s possible that too-tight clothing changed the living bacteria on your skin. It may not help everybody, but it will not hurt to try.

07/29/2025

DEAR DR. ROACH: I want to point out a serious health concern. My daughter turned 40 last year and got her mammogram, which came back with a shocking diagnosis of stage 3 microinvasive carcinoma. She underwent three surgeries, the last of which was a double mastectomy.

I read that cancer incidence increases with hormone usage greater than five years in a row. My daughter’s doctor prescribed “the pill” to her for much greater than five years and never even warned her of the risk.

How many other women are unaware of the risks? These women are in many cases busy, young professionals as my daughter is. They are using the pill because it is so easy. Please warn them and their parents. -- M.R.

ANSWER: The association of combined oral contraceptives with breast cancer is controversial. Many large studies, such as the Nurses’ Health Study, found no association of “the pill” with breast cancer, either while a woman is using it or after she stops.

There have been some studies that have shown an increase in risk, but the magnitude of the risk is small. In a large Danish study, the overall increase in risk was about one additional case of breast cancer in 8,000 women taking the pill for a year. For women under 35, the risk was one case in 50,000 women per year. The studies that showed a risk for breast cancer did not show an increased risk when women are taking them longer.

Oral contraceptives certainly have risks. Blood clots are more common among users. They have side effects that can be very bothersome and sometimes prevent women from using them. However, there is an overall improvement in mortality risk among users because even in 2025, having a baby puts a mother’s life at risk, and oral contraceptives are effective at preventing pregnancy.

The most common oral contraceptives risk is blood clots.

07/29/2025

DEAR DR. ROACH: I am a healthy male, age 65. I get 7-8 hours of sleep most nights, but during the night, I typically wake up three or four times with a very full bladder. So, I use the bathroom, then return to bed.

My question is, where do my kidneys get all the water to make so much urine? I’m not drinking during the night, and I don’t drink anything before I go to sleep. Where is it coming from? This does not happen during my waking hours. -- B.F.

ANSWER: When you drink or even eat food with high water content, this fluid will be absorbed into your blood, but this takes time. Once it’s in your blood, it will be filtered by your kidneys to make urine, but this, too, takes time. In general, I tell my patients to stop drinking 4 hours or more before bedtime. People with kidneys that don’t work 100% may need an even longer time from when they stop drinking fluid so that they can urinate all the fluid out.

There are other considerations. Many men and women over 60 develop swollen legs during the day due to leaky blood vessels and valves in the veins. Taking in excess salt worsens this problem. This fluid will go back into the blood overnight, and it can easily be enough fluid to fill the bladder. Compression stockings can reduce the amount of fluid in the legs.

Finally, the body has a system for reducing urine output at night (the anti-diuretic hormone is secreted at night to prevent you from having to get up), and in some people, this system fails. The hormone can be given nasally in these cases, but since it can affect blood sodium levels, it needs to be used very judiciously.

07/28/2025

DEAR DR. ROACH: I am a 75-year-old woman in reasonably good health. Two months ago, I had a seizure in my doctor’s office during my annual checkup. I woke up in an emergency room in a large metropolitan hospital.

I take ramipril for high blood pressure, which is controlled. I am now taking levetiracetam for seizures. I have never had a seizure before and know of no one in my family who has had one.

Initially I had a CT scan that showed nothing. Two weeks later, I had an electroencephalogram (EEG) that was clear and an MRI. No tumors or aneurysms were found. I am waiting to have a follow-up consultation with the neurology department. All my blood work was fine.

My own general physician said that there might be an age-related disease in the small blood vessels of my brain. What does this mean? She would offer no more information. I suppose she thinks that I should see the assigned neurologist.

I am in shock about this latest development in my health. I had low to normal blood pressure until I turned 70. In January, I had the worst case of the flu (worse than COVID). I was tested for COVID and was negative. Could this flu have been a factor in my having the seizure?

Is there anything that you can suggest to prevent further seizures? I’ve had no symptoms since and seem to be tolerating the medication well. -- D.M.

ANSWER: A new onset of a seizure in a person aged 75 is very concerning, and a thorough evaluation is mandatory. There are many possible causes, and one of them is a tumor, which is one reason they did the MRI. It’s very good news that there was no tumor.

Age-related changes in an MRI are common, and if there has been damage to the brain due to blood vessel changes, this can be a source of seizures. (Between 30% and 50% of new seizures in older adults are due to blood vessel disease.)

COVID, especially severe COVID, can cause damage to the blood vessels. Most cases of the flu are less inflammatory than COVID, but I suppose it is possible that the flu affected the small blood vessels in your brain. However, if the small blood vessels in your brain really are damaged, I think it more likely that the high blood pressure caused the damage to the blood vessels from when your blood pressure wasn’t as well-controlled than it being due to COVID.

However, many times we cannot find an answer as to why a person has a seizure. As far as treatment, I, too, would await the decision of the epilepsy-trained neurologist, but most recommendations I read would defer long-term treatment in a person with only one seizure when no cause can be identified.

A normal EEG also tends to make me think that the expert would recommend that you hold off on immediate treatment unless you have a second seizure. Still, the neurologist will look at all your data, especially the brain and blood vessel imaging, then give you a recommendation.

She had never had a seizure before and has no family history of them.

07/28/2025

CORRECTION: In the July 10 column, we stated that vitamin D “may help people with high-risk prediabetes develop overt diabetes.” It should have read “prevent” rather than “develop.”

07/25/2025

Dear Dr. Roach: I am a 74-year-old man. I have a DEXA score of -3.3. I take 1,200 mg of calcium with vitamin D daily. I lift weights and swim two to three times a week. My doctor put me on Prolia, and I had six months of infections. He switched me to Fosamax, and my blood pressure was 201/121 mmHg.

I found a Phase 4 clinical trial showing that Fosamax can cause high blood pressure, but my doctor says that Fosamax "doesn't cause high blood pressure." I'm reluctant to try the other bisphosphonates for fear that they will do the same as Fosamax. Do I try the other drugs one at a time, or do you have a recommendation?

— D.S.

Dear D.S.: Your doctor should have said that people taking alendronate (Fosamax) have the same rate of developing high blood pressure as people who are put on a placebo pill, which would have been a more accurate statement.

In the 12 months when subjects in a trial took alendronate, 1.9% developed high blood pressure — about the same rate seen in a placebo group over the same time period. It's unlikely that Fosamax caused your high blood pressure levels, but it is certainly possible that you are having a rare reaction, which happens to few enough people that it hasn't yet been recognized. I hope your physician reported this as a possible adverse event.

A T-score of -3.3 by a DEXA represents quite severe osteoporosis. When I see levels this low, I tend not to use denosumab (Prolia) or bisphosphonates, both of which work by preventing the osteoclast cells from reabsorbing bone.

Prolia also has a theoretical risk of increased infections, and it seems that this might have been the case with you. Instead, I would consider a medicine that promotes bone growth, such as teriparatide.

Finally, I test all men with osteoporosis for low testosterone since it is a major risk factor.

https://www.detroitnews.com/story/life/advice/2025/07/25/dr-roach-low-dexa-score-in-man-calls-for-a-bone-growth-medicine/85210925007/ #

I lift weights and swim two to three times a week.