July 17, 2018
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I’m not able to get any straight answers from the doctors about a serious issue my husband is having.
DEAR DR. ROACH: I am a 75-year-old woman who has been suffering from four to five bouts of hot flashes with night sweats (about every two hours from bedtime until morning) since I stopped taking HRT at age 62.
DEAR DR. ROACH: I am a 58-year-old healthy female. I am 6 feet tall, and weigh 130 pounds. My last blood pressure reading was 100/58. I have Raynaud's phenomenon. I exercise every day (walk, bike, snowshoe).
I have seen a couple videos and read a little about ivermectin use with COVID-19 and wondered what your thoughts were.
DEAR DR. ROACH: What are your thoughts on the COVID-19 vaccine during pregnancy?
DEAR DR. ROACH: I am 74 and in very good health. I'm active and walk twice daily.
I am over 60 and a teacher in California.
DEAR DR. ROACH: My husband developed melanoma, and had 16 of his lymph nodes removed.
DEAR DR. ROACH: In 2002, I had a severe case of Bell's palsy that lasted eight months.
Is there a cure for overactive bladder?
Are people with autism spectrum disorder normal functioning?
DEAR DR. ROACH: I will be starting a new job that requires regular, but random, drug testing.
DEAR DR. ROACH: I have had pernicious anemia for about eight years and must have an injection of vitamin B-12 every three weeks to stay alive. I am also a diabetic for over 10 years, with my A1C remaining in the 6.1-6.5 range over that time.
I have a question about medications.
I was a bit surprised that in your response to a question about coping with nighttime leg cramps some time ago, you made no mention of vitamin E.
DEAR DR. ROACH: Why do I feel sleepy for almost half the day whenever I have bread for breakfast?
DEAR DR. ROACH: I am a 52-year-old female. During my annual exam this year, my fasting cholesterol came back at 217.
I am a 50-year-old female in fair health who was recently diagnosed with gout.
DEAR DR. ROACH: I am an 88-year-old man in quite good health.
DEAR DR. ROACH: My lab results showed my potassium level was 5.4 mmol/L. My primary care doctor does not seem concerned at all with this reading.
I recently spent time with a seasoned hearing-impaired citizen.
If I have the beginnings of arthritis of the knee, is an elliptical machine better to use than a treadmill?
I am 81 years old and was diagnosed with shingles at the end of October 2020.
DEAR DR. ROACH: I am a 79-year-old woman in reasonably good health. I am very active and do everything I can for my health.
We have friends who got the measles-mumps-rubella vaccine believing it will help with exposure to COVID-19. What are your thoughts on their thinking? — P.H.
I would like to know how to treat arthritis.
In a previous column, I deferred making a recommendation about a COVID-19 vaccine until more data were available.
There is much information about the spread of COVID germs from coughing, sneezing, speaking, etc. However, I have not seen anything about two other ways that could also spread the germs.
DEAR DR. ROACH: I am almost 88 years old. All seven of my children came down with chickenpox at different times.
Two years ago, I received the high-dose flu vaccine at my doctor’s office.
Whenever I go to my local VA clinic for a checkup, I’m asked if I want the pneumonia vaccine.
DEAR DR. ROACH: Recently, you wrote about intermittent explosive disorder. I have this condition and would like your help dealing with it.
I have been using turmeric on my food for quite a while. I’ve noticed I’ve started having bouts of diarrhea. I found others’ reports of this when searching on the internet.
DEAR DR. ROACH: A recent column advised readers to wear masks. Please print a study that shows masks work. I can show you 10 studies from the CDC that say they don't. You should not encourage your readers to do something without proof.
Some months ago, you wrote that the blood flow to the penis could be reduced by blockages in the arteries.
I have had fatty liver for the past 10 years.
I am a 72-year-old man with an enlarged prostate. My PSA has varied over the past several years, between 2.8 and 3.5. I take Flomax.
DEAR DR. ROACH: I have some questions about my lab results. My doctor’s office called to say all results were good and everything is fine.
You seem to promote statins. How about statins for older people?
I would like your opinion about the need to lower blood pressure to the standard 120/80.
With all the misinformation flying around, can you comment on whether it’s a good idea to wear N95 masks if you have them on hand?
I’m an 88-year-old woman in good health except that I have had a lot of leg and back pain in the past two or so years.
In your recent column referring to the shingles vaccine, you do not mention younger adults.
Recently I had a sudden onset of appendicitis and was operated on the following day laparoscopically.
I am a 67-year-old male who had a major heart attack 19 years ago.
I'm writing in regard to your recent column about a 56-year-old person, recommending he or she wait till 60 for the shingles shot.
Can you share as much information as you know about a procedure called Inspire that supposedly helps reduce the serious issues of sleep apnea?
I am a 77-year-old female of Hispanic heritage. For many years I have been on cholesterol medication. It has always bothered me, but in the past year, the night cramps in my legs have been intolerable. With each new prescription of a higher dosage, it has gotten worse. After I stopped taking them, all symptoms stopped as well. This was about a year ago.
I am a 65-year-old woman. As a child, I had what we called “lazy eye.” My condition was that my right eye was aligned noticeably outward. I believe this is referred to as “exotropia.” I had surgery to correct it at the age of 12, and surgery was successful -- my right eye has remained in proper alignment since then.
I have read everything I can find on Heberden’s nodes. I have one on the middle finger of my left hand, my writing hand. I have had this node for about three months, and I believe it is still growing.
My husband had a hemorrhagic stroke in 2014. He is 75 years old. His blood pressure in the past five days has gone from 123/64 with a heart rate of 50 to 142/77 with a heart rate of 45. It will be in the green for days and then read in 140s for a couple of days. He becomes very upset when he sees the yellow light come on. He walks 2 miles each morning and thinks this should keep his BP at a normal level, in addition to the metoprolol and enalapril he takes twice daily.
In a recent column, you wrote that migraine of any kind starting in a person’s 60s is uncommon. I am a 66-year-old male in relatively decent health. I have controlled blood pressure and cholesterol.
I am a male, 67 and I have difficulties urinating during the night. I get up three or four times ...
I have worked at the election polls in a school gym for years and know that presidential elections bring out close to 2,000 voters in my precinct.
I lived in England in 1985-1986, during the mad cow disease outbreak. Since then, I have been ineligible to give blood. It is one of the few questions they ask. This has been 35 years and, obviously, I don’t have and have never had the disease itself. Is this still a valid reason to rule me out as a blood donor?
I found your response to a question about shortness of breath in a recent column very interesting, since I had the problem for a couple of years before the cause was identified. I had been to an oncologist, cardiologist and family practice, and had all proper tests and X-rays with no answers. The answer was found at the eye doctor.
DEAR DR. ROACH: I have a history of cancer with an elevated CA-125 level. Recently I had a shingles shot and soon thereafter, my CA-125 level was high. A
I am a 72-year-old man in good health. I have lost about 12 pounds in the past year, with no explanation. I’m 5 feet, 9 1/2 inches tall, and my morning weight has dropped from 166-168 pounds to 154-156 pounds. It is still slowly falling.
At what age do you recommend the shingles vaccine? I’m 56 and my doc is recommending it, but I’ve heard that people frequently have negative side effects. I’m doing everything I can to stay well and out of the doctor’s office during coronavirus.
DR. ROACH WRITES: Every year around this time I write a column on the different flu vaccines that are available.
DEAR DR. ROACH: I have been diagnosed with frozen shoulder after an X-ray by an orthopedic doctor.
DEAR DR. ROACH: I hear about insulin resistance all the time. What is it and how do you prevent it?
I wear a face mask whenever I go into a store. My problem is that even wearing a mask for a short time gives me a scratchy throat the next day, causing me great anxiety because I fear that I have contracted the coronavirus.
I’m a 71-year-old male in reasonably good health. At a recent routine checkup, my primary-care physician suggested I consider taking Lipitor 10 mg. My total cholesterol is in the 150-160 mg/dL range, although my LDL is slightly elevated, and my HDL is slightly low and has been for many years.
I am a woman in my late 70s, a 1949 polio patient. For forever I have been told that because of poliomyelitis I cannot tolerate any preventive inoculations, including flu, pneumonia, shingles, etc.
I recently had a stroke, and the hospitalist started me on 40 milligrams atorvastatin per day the first day I was in the hospital.
I have seen so many articles relating to diabetic neuropathy, but my situation is different.
DEAR DR. ROACH: I am 58 years old and have early stage prostate cancer. My PSA is 6.5. How do you know when “wait and see” is the right approach? If I do need treatment, what are your thoughts about high intensity focused ultrasound (HIFU)? Why don’t some insurances cover the procedure?
I’ve been a vegetarian for the past few years, and I’m concerned about how to get enough protein without consuming meat from any type of animal. Until recently I was supplementing my diet with protein drinks and protein bars, but now I’ve been told that because these are processed foods, they’re not good for my health. What are the healthy sources of plant protein?
I have a question about excipients, something you discussed in a recent column about thyroid medication. Twice in my life, I took Celebrex for orthopedic pain.
DEAR DR. ROACH: I’m 86, and was finally, after a few false starts, diagnosed with two compression fractured vertebrae, which were very painful. This was followed by a diagnosis of osteoporosis.
DEAR DR. ROACH: I have been diagnosed with bursitis on my left hip, and my pain management doctor says she can give me an injection to help. I had one last year by an orthopedist.
DEAR DR. ROACH: I have been diagnosed with degenerative disc disease and spinal stenosis. A spine specialist has advised surgery to fuse vertebrae in two places. I have already had surgery to remove a herniated disk on both these vertebrae and spinal epidurals with limited success.
DEAR DR. ROACH: I am a 77-year-old woman who suffered with urinary tract infections until my gynecologist prescribed estradiol, which I currently take.
DEAR DR. ROACH: I am a 69-year-old woman developing arthritis in my fingers, especially the middle joints. I do various finger bending and straightening exercises, and I rub my hands together vigorously to warm them.
DEAR DR. ROACH: In 2017, my white blood cell count was 8.9 and my lymphocytes were 3.2. My recent blood tests showed a second increase in both numbers, with the WBC 10.2 and lymphocytes 4.8.
DEAR DR. ROACH: I’m a 58-year-old male with seasonal allergies. I often take the generic versions of Zyrtec and Claritin to deal with the symptoms.
DEAR DR. ROACH: My husband is a 50-year-old prediabetic who has recently experienced burning feet.
DEAR DR. ROACH: I had two blood transfusions in 2012 during an almost yearlong bout with an out of control infection that ended up in a fused knee.
DEAR DR. ROACH: I am a healthy 79-year-old male. My doctor tells me that my blood pressure and pulse are better than most men half my age. I feel good.
DEAR DR. ROACH: My adult son has lost over 100 pounds on an intermittent fasting diet (16 hours fasting per day) and now wants to continue fasting in the morning and just eat a heavier lunch and dinner to maintain his new weight.
The last time I saw my urologist, I asked him to check my testosterone level because it hadn’t been checked in a couple of years.
Many seniors, like myself, have received pneumonia shots within the past five years. Since the flu and coronavirus can result in a form of pneumonia in a severe case, would these shots be helpful to prevent or treat this virus even slightly?
DEAR DR. ROACH: My 18-year-old daughter has had digestive problems on and off for a few years now.
DEAR DR. ROACH: At the end of January, I had my yearly physical, and my doctor recommended that I start taking a statin drug. I am a female, 71 years old and take no prescription drugs now. At the end of the physical the doctor told me that I am “very healthy.”
Our excellent insurance allows for a yearly wellness visit at no cost. My regular copay is a very reasonable $10.
DEAR DR. ROACH: Short of amputation, what’s the best one can expect in minimizing the sporadic but harsh symptoms of restless legs?
DEAR DR. ROACH: My son had a pacemaker placed in 2013 and got it checked every four months. He developed an ulcer on his coccyx. He was being seen every two or three weeks in a wound clinic, and I was told it was 98% healed.
DEAR DR. ROACH: I am a male, 67 years old, and I am afflicted with urinary problems -- having to urinate several times a night, burning after urinating and the need to urinate often in small amounts only.
DEAR DR. ROACH: I am a very active 78-year-old woman. I had a CT scan for calcium and an aneurysm of the ascending thoracic aorta was found. In 2014 it measured 3.6 cm and in 2019 3.7.
I am an 84-year-old white male who is undergoing a procedure next week. My pre-op CAT scan results showed many "white spots" in both upper legs...
My wife went blind in her left eye suddenly last October, and a biopsy showed temporal arteritis. She was started on high-dose prednisone, and after four weeks they lowered the dosage.
Dear Dr. Roach: I am a 68-year-old male and have been very athletic my entire life.
DEAR DR. ROACH: I was diagnosed with shingles after a few days of a painful rash. The doctor recommended acyclovir, gabapentin and prednisone. Do these really help? — M.F.
DEAR DR. ROACH: My father was recently diagnosed with a type 4 hiatal hernia
DEAR DR. ROACH: What do you know about copper killing the cold virus?
DEAR DR. ROACH: Does eating strictly organic food and drinking only bottled water help in a meaningful way to prevent diseases and contribute to a long and healthy life? — M.T.
DEAR DR. ROACH: I am an 83-year-old African American female who is contemplating having a neurostimulator implanted in my back.
There are a lot of flu cases in my state, and people are very worried.
I am having a serious, lengthy battle with cellulitis on my lower leg.
In a recent column, you wrote: “The acid reflux you have been treating might be something more concerning.” What else could it be?
DEAR DR. ROACH: What tests check for emphysema? Are they the same tests for COPD? My age is 80. —P.T. ANSWER: There are two main forms of chronic obstructive pulmonary disease: chronic bronchitis and emphysema. The main risk factor is cigarette smoking, but there are other risk factors, including a genetic condition, alpha-1-antitrypsin deficiency.
Is mumps as prevalent and as serious as measles? Can I be a carrier and not know it?
DEAR DR. ROACH: Are you aware of the possibility of pancreatitis resulting from long-term vitamin D2 supplementation?
DEAR DR. ROACH: I have two boys diagnosed with limb girdle muscular dystrophy.
My 77-year-old aunt, who is in good health, had an endoscopy and was told that her stomach biopsy was positive for H. pylori.
At 64, I was in very good health except for moderate hypertension, which was treated with lisinopril.
DEAR DR. ROACH: Are there any benefits to taking omega-3? — B.H.
I have fought high cholesterol and triglycerides for many years and have taken various statins for a long time
DEAR DR. ROACH: I am battling depression and have a question about psilocybin
Five years ago, I developed a blood clot in my left leg after fracturing my ankle and being immobilized for several months.
DEAR DR. ROACH: Could you give some additional information about H. pylori infection? I was diagnosed with it recently, via biopsies taken during an endoscopic procedure.
DEAR DR. ROACH: I am a nursing student in my 30s and originally from the Philippines. As part of my testing, I had a skin test for tuberculosis, which was positive. I had a friend in the hospital recently with tuberculosis. My doctor has recommended that I get treated for latent tuberculosis. What does this mean? — A.C.S.
DEAR DR. ROACH: I am a very healthy 74-year-old male. I am not on any medications and enjoy normal blood pressure and great stats from my regular bloodwork. I weigh 140 pounds and have been exercising every day faithfully for decades.
DEAR DR. ROACH: Is it possible for X-rays and a CT scan to miss advanced lung cancer? My brother worked two days before he died. He went to the hospital, was admitted to hospice and died the next day. I wonder if he knew at least a year ago, but didn’t tell anyone.
DEAR DR. ROACH: I ran across a recent article of yours about carotid artery stenosis. In this article you state that “there is no miracle food, drink or supplement that can clear out arteries.” This is actually not true.
DEAR DR. ROACH: I am in my mid-50s and in good health (I don’t take any medications). I rarely get sick with colds or flu. I have been vaccinated with all the common vaccinations for our childhood.
DEAR DR. ROACH: I was having lots of arthritis pain in my neck and feet last summer. Someone recommended turmeric supplements to help. I started taking 600 mg twice a day. The pain slowly subsided.
I have been a pretty regular blood donor for decades. At times, I’m rejected because I just miss the minimum iron count necessary. My question at this time is if I should continue to be a blood donor, as I am 84 years of age.
DEAR DR. ROACH: I am a 75-year-old man with an arthritic back, urinary tract problems and, worst of all, highly sensitive skin!
DEAR DR. ROACH: I am a 63-year-old female in very good health. Admittedly, I smoked for 22 pack-years, but that is pretty far in the past. I have had two CT lung scans as a result of a pneumonia diagnosis last fall.
DEAR DR. ROACH: I’m a 65-year-old male. I’ve had scoliosis since childhood. I experience stiffness, discomfort and some soreness. What is the best treatment for my scoliosis? Chiropractic was not helpful, and although I had only mixed results with physical therapy, I still do those exercises.
DEAR DR. ROACH: My grandson, age 26, was diagnosed with aortic stenosis at birth. He has had two surgeries to temporarily fix the problem.
DEAR DR. ROACH: Recently I was in the hospital. I had a CT scan and was told that I have a “mass” on my kidney (unrelated to my hospital stay). One doctor said they would probably do an aspiration to determine what was in it, and another doctor told me not to worry, that it was just a cyst.
DEAR DR. ROACH: I’ve heard that there are issues with the enzymes, proteins and chemicals that are found in animal meat and plant matter. Somehow, I’m told, it affects a woman’s brain and makes her go crazy when they’re mixed together.
DEAR DR. ROACH: My neighbor is battling cancer for the third time. The medical personnel she sees when she goes for her chemotherapy treatments are urging her to get rid of her two cats. They claim the cats are a danger to her health. Wearing gloves and a mask while cleaning litter boxes will not help. Why? What do the cats have that can hurt someone going through chemotherapy? — S.C.
After many years of various treatments, including allergy shots, food studies and an ear tube, I was recently diagnosed with “semicircular canal dehiscence.”
I am a faithful reader of your column, but I don’t read many questions about brain tumors. I am 53 years old, diagnosed almost four years ago...
DEAR DR. ROACH: I am a 60-year-old woman who has been taking a 200-mg tablet of acyclovir (Zovirax) every day for HSV-2 suppression.
DEAR DR. ROACH: I am a faithful reader of your column, but I don’t read many questions about brain tumors. I am 53 years old, diagnosed almost four years ago with multiple meningiomas.
DEAR DR. ROACH: I am a 60-year-old woman who has been taking a 200-mg tablet of acyclovir (Zovirax) every day for HSV-2 suppression.
DEAR DR. ROACH: I started going through natural menopause in my late 50s. I will be 65 in September. Should I still be having hot flashes? — B.G.
I’m an 88-year-old woman whose platelets went into the 500,000 range. I was sent to a hematologist/oncologist, who said it was a bone marrow disease.
DEAR DR. ROACH: I am 77 years old. When I go to a new doctor, there is always that past history form to fill out. I know to include current medications, including OTC and allergies, but how far back should I go?
DEAR DR. ROACH: Would you please comment on common or uncommon issues that might be expected in a pregnancy at age 57?
DEAR DR. ROACH: My boyfriend recently was diagnosed with an aneurysm. The report says the abdominal aorta is 3.02 cm in largest dimension and recommends screening every six months. Do we need to see a cardiologist for a second opinion? Is there medication to help? -- B.S.
DEAR DR. ROACH: My husband’s doctor is telling him to have his gallbladder removed because sometimes he has pain in his right side.
I have seen numerous articles extolling the advantages of eating nuts because they are a good fat. I often have wondered if it matters whether the nuts are raw or roasted.
DEAR DR. ROACH: Recently I was diagnosed with FCS (familial chylomicronemia syndrome) by my primary physician.
DEAR DR. ROACH: After treatment for prostate cancer (with brachytherapy) at age 69 my husband started self-medicating for pain with alcohol.
DEAR DR. ROACH: Is there such a thing as male menopause, with the associated hot flashes?
DEAR DR. ROACH: I am 69 and take medications for blood pressure and cholesterol, as well as plenty of vitamins.
My teens keep smoking all these flavored, ethereal wand vapors. They claim it tastes good and even try tricks with the vapor....
DEAR DR. ROACH: I received the first dose of Shingrix this week and had pretty severe side effects, though in the range of what can be expected: high fever (101.5), intense shivering, a severe headache and 12 hours of extreme fatigue.
I recently was diagnosed with kidney cancer, and my wife is now getting treatment for breast cancer. Would cooking on a nonstick skillet have caused the cancers?
DEAR DR. ROACH: I had polio when I was 11 years old, many years ago, and miraculously, recovered enough to live a normal life.
DEAR DR. ROACH: I recently have been diagnosed with early prostate cancer.
DEAR DR. ROACH: I have allergies and am congested a lot at night. I have read about over-the-counter clips and adhesive tapes. Would they help me breathe better? Are they safe for the long term? — M.V.M.
DEAR DR. ROACH: In a recent column, you described symptoms of malabsorption as weight loss, diarrhea and abdominal discomfort.
DEAR DR. ROACH: I am a 70-year-old woman in good health. I recently saw a neurologist about my almost daily migraines.
DEAR DR. ROACH: I’m female, 68 years old with hypothyroidism but no other medical problems. I exercise about 10 hours a week and try to eat healthy. During one of my physical checkups, my TSH was 0.002, so I saw an endocrinologist. After three months of blood tests, everything became normal even without medicine.
DEAR DR. ROACH: My son had an ultrasound the other day for a hernia. I have had six hernias. His results showed an inguinal hernia, 2.2 centimeters and “reducible.” Will he need surgery? Can he wear a truss? What does “reducible” mean? Is this a risk for strangulation of the bowel? — B.E.
DEAR DR. ROACH: My fiancee wants to have her breasts lifted, as they are starting to sag.
DEAR DR. ROACH: I hope you can shed some light on an issue that I have not seen you address: the dawn phenomenon.
DEAR DR. ROACH: I read that a new drug, Xofluza, has been approved to treat flu.
DEAR DR. ROACH: For the past four weeks now, I wake up during the night because both of my hands have gone numb.
I have dealt with irritable bowel syndrome for over 40 years. I have had less cramping and loose stools when I quit drinking milk.
My daughter’s iron level has been dangerously low for several years.
DEAR DR. ROACH: I hope you can help elderly folks (like myself, age 83) who have a very embarrassing situation wherein their stool seeps out of them. The problem is only noted when I sit down and find that my underwear sticks to me. The problem appears to happen anytime, and sometimes AFTER a bowel movement. -- R.C.
DEAR DR. ROACH: Could you please address the benefits and safety of taking an oral collagen supplement.
DEAR DR. ROACH: My son is a kidney transplant recipient. Is it safe for transplant recipients to get the new Shingrix vaccine? -- J.O.
I have found that it takes months, not weeks, to schedule an appointment with primary care physicians in my area.
DEAR DR. ROACH: My 45-year-old daughter was diagnosed with multiple sclerosis about a year ago following alarming bladder problems and numbness.
I am a 66-year-old female in good health. In May 2017, my Pap smear showed that I had an infection of Candida glabrata and an itchy fungal infection in my rear-end area.
I am an 83-year-old male and have been in excellent health. My vital signs all are normal, my heart function is normal, MRI of my brain and a full-body X-ray of my bones are normal, but a CT scan of my abdomen showed organs with “fuzzy” material around the exterior.
My son-in-law recently was diagnosed with pancreatitis. He used to drink more often, but in the past year he has imbibed only on weekends, socially.
DEAR DR. ROACH: What are your thoughts about the security and integrity of patient portals?
DEAR DR. ROACH: My whole family has heart problems. I’m 74 years old.
Surgery shouldn’t be undertaken lightly at any age, and especially not for people who are among our oldest. However, cataract surgery is one that has a very good record, even among quite elderly people.
Dear Dr. Roach: My husband suffers from systemic pain; sometimes it is worse than others.
DEAR DR. ROACH: I’m writing about atrial fibrillation. In April I had a one-time 17-hour stint of it. I was not aware of anything happening at the time. When I had a device check (heart pacemaker), I was told of this occurrence, and it was recommended that I see my heart specialist.
My dad recently passed away as a result of cirrhosis of the liver. He also had Parkinson’s disease for 10 years. Several other people we know who have Parkinson’s also have cirrhosis. Is it possible that his Parkinson’s medication could have caused the cirrhosis?
I am a 78-year-old woman who was diagnosed just one year ago with primary biliary cirrhosis, which is an autoimmune liver disease.
DEAR DR. ROACH: I am absolutely convinced that marijuana is a serious health hazard.
In 2000 (at age 53), I had a mastectomy with a TRAM flap reconstruction.
DEAR DR. ROACH: I was diagnosed with atrial fibrillation in July 2017. A week after that, I had an MRI that showed I’d had a ministroke and probably several others in the past.
I am a 70-year-old woman in good health. I recently saw a neurologist about my almost daily migraines.
DEAR DR. ROACH: My son had an ultrasound the other day for a hernia. I have had six hernias.
DEAR DR. ROACH: Please discuss Brugada syndrome. Three members of my family died from it before we finally got a diagnosis. Where does it come from? — V.K.