In this issue of Better Health, Bumrungrad cardiology and orthopedic specialists answer questions about cholesterol levels and coronary thrombosis, weight and bone mass, and how a person’s age may impact the decision of having bypass surgery.
 

Q: Does losing weight have any effect on bone mass loss? If so, how to avoid it?

A: Although losing weight can reduce bone mass, the method determines whether or not it’s a problem. If the loss results from exercise, the beneficial effects make up for the lost bone mass. For example, impact exercise such as brisk walking or running creates bone mass and strengthens bones. Even if the bones lose a slight amount of density, the benefits are that body weight decreases and muscle is built, as well as there being relief of knee and back pain.
 

If the person diets to lose weight, the body will bear a lesser load and the bones will also reduce in mass, which is not an expected effect. Thus, the right way to lose weight will not have much effect on the reduced bone mass. We recommended exercising and reducing weight rather than staying overweight out of fear of reduced bone mass. Dr. Sumroeng Neti, Surgeon, specializing in Orthopedics

Q: My 87-year-old grandfather has coronary heart disease with chest pain, but he doesn’t feel he can handle surgery due to his age. What risks does such surgery pose for him?

 

A: There are several risk factors for coronary bypass surgery. All surgeries for older patients have higher risks if they have any underlying diseases – whether known or unknown – such as diabetes or hypertension, and whether the patient has had a heart attack or heart failure. If the patient takes steroid medications, has any infection or any chronic lung disease, especially due to smoking or emphysema, or needs a respirator at all times, the risks associated with surgery increase. Compromised renal function or chronic renal failure requiring kidney dialysis poses the likelihood of a difficult post-surgery recovery.
 

The anatomy of the blood vessels significantly affects the level of difficulty in surgery. If a blood vessel is uneven or constricted throughout, and small in size, surgically reconnecting them is very difficult. The patient’s age is only one of multiple risk factors in surgery. Therefore, we must consider the risk factors individually.
 

I performed a successful valve replacement surgery on an 86-year-old patient. This individual did not have any diseases other than a stenosis. Renal function was normal. The patient was not a diabetic or a smoker, and did not have lung disease. Thus, the risk was low and post-operative recovery was quick. This patient continues to enjoy a long life. Dr. Thanyalak Chaiseri, Physician, specializing in Cardiology

  

Q: One of my relatives has a cholesterol level of only 155, but acute myocardial infarction appears with 90 percent of coronary thrombosis. Why?

 

A: Excessive cholesterol is the primary cause of coronary thrombosis, but many other factors may play a part, such as diabetes, family history of early heart disease, smoking, and stress, among several others. For this reason, normal cholesterol levels do not guarantee that someone will not get coronary thrombosis.
 

To find the cause of coronary thrombosis, a physician must review the patient’s medical and family history and do a detailed physical check-up, including laboratory tests. Dr. Pitsanu Kerdsinchai, Physician, specializing in Cardiology