Q. I'm 50 years old and have already had coronary bypass surgery. I still have angina occasionally but with medication am able to lead a normal life. My question concerns my choice of hospitals in the event I have a heart attack.
My doctor says I should go to the nearest hospital -- about 5 minutes away. But I would prefer going to the hospital where I had my bypass surgery -- about 45 minutes away -- because it's better equipped. For example, they do emergency coronary angioplasty at my preferred hospital but not at the one close by.
What are the trade-offs between going to a larger hospital farther away versus the smaller one nearby?
A. For heart attacks, how quickly you get medical attention can make all the difference in the world.
Of all the people who die of a heart attack, about half die within the first hour. So prompt medical care is important, whether it be by a rescue squad, a hospital emergency room staff or even a family member trained in CPR (cardiopulmonary resuscitation) -- a potentially life-saving skill that more people should learn. In fact, cities like Seattle that emphasize CPR training have been able to significantly reduce deaths from heart attacks that occur before the victim reaches a hospital.
I agree with your doctor that you should go to the nearest hospital if you think you're having a heart attack. Even if you called an ambulance and asked to be taken to the hospital where you had bypass surgery, they would routinely take you to the nearest emergency room for the reasons I've mentioned.
Most people having a heart attack do not need emergency coronary angioplasty (opening up blocked arteries around the heart with a balloon-tipped wire inserted through an artery in the groin). Other emergency methods include clot-dissolving medications injected into a vein in the arm or coronary artery. But it's by no means certain that most people having a heart attack should have one of these emergency treatments.
However, if you're concerned about the possibility of needing an emergency procedure, you can be transferred from a hospital where it's not available to one where it is. Transfers should take place within an hour or so because emergency coronary procedures usually need to be done within four hours of the time your symptoms start. Hospitals in the Washington area that offer these special heart procedures are able to do them 24 hours a day, so you shouldn't worry that you'll miss out on a necessary medical treatment by going to the nearest hospital for symptoms of a heart attack.
Q. I'm 34 and have a skin condition called keratosis pilaris -- also known as chicken skin -- on my arms and legs. It makes my skin feel sandpapery, like having rough goose bumps. What causes this, and is there any way to get rid of it?
A. Keratosis pilaris is a very common and harmless skin condition that many people have, often without noticing it. KP is hereditary, so if you have it, chances are other family members do, too.
KP is a disorder of keratin development, the inert protein that makes up hair, nails and the outer layer of skin. Pilaris refers to hair shafts whose openings into the skin become plugged by keratin, producing the tiny bumps of KP. It occurs in both sexes and at all ages. It usually begins in childhood, although many people don't notice it until later in life.
The condition tends to worsen in winter, although many people first become aware of it in summer, when more bare skin is exposed. KP can occur anywhere but most commonly appears on the outside of the upper arms and thighs.
This condition doesn't cause any problems aside from the bumps and doesn't lead to anything serious. Occasionally, KP occurs together with a less common hereditary skin condition called ichthyosis -- from the Greek word for fish -- named for its scaly appearance. In rare cases, vitamin A or C deficiency can cause a skin condition similar to KP.
There is no cure for KP, and treatment is usually unnecessary. If the skin bumps are very bothersome, a salicylic acid ointment, such as in some topical acne remedies, temporarily clears the keratin plugs and smooths the skin. Follow-Up: Hemorrhoids
In response to my columns on hemorrhoids and their treatment, a reader related a discovery he made in dealing with this problem.
Through trial and error, he noticed that his hemorrhoids were irritated by scented or colored toilet paper. Using white unscented paper has helped keep the irritation under control.
Although I didn't mention it in my discussion, this technique can indeed help reduce the pain and swelling of hemorrhoids in people who are sensitive to the dyes or perfumes used in toilet paper. In fact, some physicians recommend using cotton balls moistened in warm water as a substitute for toilet paper during flare-ups to reduce irritation.
Hemorrhoids also are sensitive to straining, pressure and minor trauma. Minimizing these factors will usually allow the condition to clear by itself.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.