DEAR DR. ROACH: My husband has been diagnosed with cardiac amyloidosis. The doctor has started him on Vyndamax, a very expensive drug. Without this drug, he is lucky to live, at the most, two years. Is this drug a miracle, and does it guarantee that he will live many more years? — T.W.
ANSWER: There are several types of cardiac amyloidosis — a disease in which abnormal proteins are depos-ited in many tissues, including the heart, where the protein interferes with heart function and leads to heart failure.  Tafadamis (also known by its brand name, Vyndamax) is used in transthyretin amyloid cardiomyopa-thy (ATTR, of which there are two types that both get treated with tafadamis).
Subjects in the trial on tafadamis were followed for two-and-a-half years. Half of the group were given tafadamis, while the other half were given a placebo, which looked like the real drug but had no activity. Of those who got the inactive placebo, 43% died in the two-and-a-half-year time span of the study, but of those who received tafadamis, 30% died. Thirteen percent, or about one in eight people, who received tafadamis lived, when they were expected to die. In addition, there were fewer hospitalizations and less loss of ability to exercise in those taking tafadamis, com-pared with the placebo. There were no serious side effects that were more frequent in the tafadamis group.
Tafadamis definitely affords a big improvement in the outcome of people with ATTR-CA. However, I would not call the drug a “miracle,” nor is there a guarantee of living many more years. To me, a miracle is when someone recovers when no doctor expected them to. I have seen a few in my career, and they are very powerful. I have seen many treatments that have incremental improvements in outcomes, and over time, that has led to dramatic improve-ments in many diseases.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu.
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 ​ANSWER: I’m afraid I don’t have a good answer for you. It is true that most authorities recommend an intensive breast cancer surveillance program for women at a high risk of breast cancer, in the range of a 20% to 25% lifetime risk. (The average risk for developing breast cancer for a woman born today is estimated to be about 13%.)
The Tyrer-Cuzick model of esti-mating breast cancer risk tends to give higher estimates than the other commonly used models, such as the BRCAPRO. Other models may not put you over the threshold for inten-sive screening with MRIs, which is usually combined with mammograms.
The question about gadolinium (the chemical element used in the contrast dye for MRIs) is important because some people do store gadolinium in various tissues, including the brain, but the clinical significance of this is unknown. (People with kidney disease can develop a skin disease due to
gadolinium, so they aren’t recommended have MRIs with gadolinium.)
Although gadolinium can stay in the body for months or years, there has been no evidence of harm from gad-olinium in brain tissue, despite these agents having been used for many years. Some agents have less retention than others. The U.S. FDA has man-dated patient guides for these contrast agents, which relay the information above.
Given that there is a probable benefit to intensive screening for breast cancer in your case due to your high genetic risk, and no more than a theoretical risk from gadolinium, I believe that the benefits outweigh the risks, but I can’t say that with complete certainty.

ANSWER: There are animal studies suggesting benefit from oral cannabidiol , a component of cannabis (hemp) that has no psychoactive component (it’s the THC in cannabis that gets peo-ple “high”). I found some small studies showing pain relief from topical CBD in people with neuropathy , but not for arthritis. Several people, like you,  have written to me with reports of pain relief.
Topical CBD is probably very safe. Even oral CBD should be safe, but studies have found that many products labeled CBD have trace, or more than trace, amounts of THC, enough to make a urine test positive for cannabis.

Until there is some evidence of effectiveness, I can’t recommend it, but people can try it based on safety and anecdotal reports.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to
ToYourGoodHealth@ med.cornell.edu.
© 2023 North America Synd., Inc. All Rights Reserved

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DEAR DR. ROACH: I am a 68-year-old male who has used cannabis for 51 years. During that time span, I graduated from high school and college with two bachelor’s degrees and two master’s degrees, and I spent 35 years as an accomplished educator, motivation-al speaker and author. I have been married to the same person for 31 years and have a wide circle of friends.
Twenty-five years ago, I had my thyroid removed due to cancer, and I currently take medication. I also inject testosterone and take medications for blood pressure and cholesterol, as well as Xanax. I retired to a life that involves little travel, choosing instead to spend my time reading, researching, writing and being active in my community. Once I began to notice a loss of motivation and diminished memory, I became proactive and decided to give up cannabis.
I have had no trouble quitting cold turkey and have no desire to return to it. My memory has vastly improved, and I still enjoy all the things that made my retirement enjoyable before I made this decision. After 10 weeks of not using, I still test positive for the metabolites using THC testing strips. I have read that normal detoxing for a heavy user is anywhere from six weeks to two months.
To aid in the process, I drink half a glass of lemon juice in the morning, drink two gallons of water or detox tea a day, cut red meat and dairy from my diet, spend an hour a day on the treadmill, and spend 40 minutes in a steam bath.
How long should I expect to continue testing positive? Is there any-thing else I can do to speed up the passing of the metabolites? — Anon.
ANSWER: The active form of THC, the primary chemical in cannabis that causes the psychoactive effects (i.e., the effects for people to feel “high”), accumulates in the fat cells, where it can be stored for long periods of time.
Research in laboratory animals con-firms that losing weight over the long-term releases the stored THC from the fat, making it more likely that a urine test will be positive in people who are losing weight (which might be the case with you, given your exercise and diet). Heavy users have told me that they feel like they are “coming out of a fog” for up to six months after stop-ping the use of cannabis. However, I can’t give you any evidence-based answer on how long you will continue to show positive results.
I don’t think drinking water and tea, nor the steam bath, are significantly helping you get rid of the accumulated THC in the body, but the diet and exercise changes probably are, if you are losing fat as I suspect. Even if you aren’t losing weight, you may be get-ting more muscular due to exercise and losing fat.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu

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DEAR DR. ROACH: My question regards the results of my fasting glucose tests for the past couple of years. I am 81 and weigh around 150 pounds. The medications I am tak-ing concern me, with relevance to the A1C levels of my quarterly blood work. My A1C levels have mostly been near mid-5%; the last showed 6%. Medications relevant to this that I am suspicious of are 100-12.5 mg of losartan/hydrochlorothiazide  (HCTZ) and 20 mg of simvastatin. I have read that these medications can have an effect of raising blood glucose. My doctor is adamant that this does not exist, but it seems to me that there is a conflict on this.
Should I perhaps ask him to change those medications because of my blood sugar? I am concerned about issues with the thiazide and the statin. — P.R.

ANSWER: There isn’t a conflict. You are absolutely right that both sim-vastatin (like all statins) and HCTZ (like all thiazides) increase blood sugar and the risk of diabetes. The risk, however, is small. For thiazides, the risk of high blood sugar seems tied to potassium levels — the lower the potassium, the higher the risk of diabe-tes. Interestingly, the losartan in com-bination with the HCTZ you are taking tend to raise potassium levels, so that combination may have a lower risk of worsening blood sugar levels than taking HCTZ alone. You are already taking the smallest effective dose of thiazide.
The risk of statins seems greater in higher doses and with more potent statins, like atorvastatin and rosuvastatin; however, the risk is still small. About one person in 100 treated with a high-dose intensive statin, such as 40 mg of atorvastatin for five years, would be expected to get diabetes, while a dosage of 20 mg of simvastatin would be expected to have an even lower risk.
The conflict isn’t whether the increased risk exists (it does), but whether the treatments to prevent heart attack and stroke are worth the increased risk. For nearly all people, the benefit of keeping blood pressure and cholesterol under control greatly outweighs the small increased risk of diabetes.
Given your normal A1C level, I would say your risk is low, and I do not generally recommend changing treatment based on your concern over blood sugar.
                                                                                    ***
DEAR DR. ROACH: I am a 64-
year-old man who recently had an ultrasound of my kidney to rule out any kidney stones. The utlra-sound was negative for stones, but the radiologist noted a 2.3-cm echo-genic nodule in the right lobe of my liver. The final impression was an incidental hemangioma in the liver. I was concerned, so I received an AFP (alfa-fetoprotein) test, which came back at 1.8 ng/mL.
Is an echogenic nodule/incidental hemangioma a reason to have fur-ther testing? — M.S.

ANSWER: Sensitive imaging studies, especially CT scans and MRIs, often reveal abnormalities that lead to a quandary of whether to get additional testing. For a mass found in the liver by ultra-sound, if it is less than 3 cm and meets the radiologic criteria for a hemangio-ma, no further testing needs to be done in people at low risk for liver cancer (such as people with hepatitis C or cirrhosis). As long as these hemangiomas cause no symptoms, they do not get treated.
The alfa-fetoprotein test is a blood test that, when producing abnormally high results, helps signify several types of cancers, including hepatocellular car-cinoma (classic liver cancer) as well as germ cell tumors (cancers of the repro-ductive cells, which usually occur in the gonads but can occur in the liver or else-where in the body). Your level is normal and not concerning.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions
to ToYourGoodHealth@med.cornell.edu.
© 2023 North America Synd., Inc.
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