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Keith W Roach, MD, New York, NY (2026)

08/12/2026

Dear Dr. Roach: I had a very unpleasant experience a few days ago, and I’d like your opinion. I am 90 years old and was awakened early in the morning with an extreme heaviness in my chest. I have a concierge physician, and they told me that if I was able to drive, I should come right over to the office, where I had my blood pressure taken, as well as an electrocardiogram (EKG) and blood work done.

I did this, and I was then told to go home and wait to find out if I’d had a heart attack (as markers in the blood would confirm). As I was leaving the office, the doctor gave me a nitroglycerin tablet to put under my tongue, and I passed out. (I had never fainted before in my life.)

When I came to, I was on the floor, and there were men moving me onto a gurney and taking me to an ambulance. I was in the emergency room for over 4 hours, and every test came back negative. I had to get a ride back to retrieve my car at the doctor’s office and finally returned home after a very traumatic experience.

My question to you is, why was I given nitroglycerin when the heart attack hadn’t been confirmed? I’ve since done research, which has shown me that none of this should’ve happened. In hindsight, we think it was acid reflux. -- B.K.

Answer: I think there were several errors along the way. The first one is that the sudden onset of extreme heaviness in your chest should’ve prompted you to call 911, not your physician. Paramedics would likely get there much faster and are experts in the emergency treatment of acute coronary syndromes. They have the necessary equipment and training to treat you correctly if your heart stopped.

I’ve known too many people who died while driving themselves to the hospital or to their doctor. The doctor should have called 911 on your behalf or told you to do so. I also disagree with sending you home while your doctor was waiting for the results of your blood tests. If your doctor was worried enough to order these tests, you should’ve been in a monitored setting until they came back negative.

Giving nitroglycerin to a person with extreme chest heaviness who had a strongly suspected heart attack is sometimes appropriate, even before the EKG or blood tests confirm the diagnosis. It sounds like your doctor did check your blood pressure before giving it to you, and hopefully, they listened to your heart to check for valve problems before giving it to you.

However, they shouldn’t have sent you out immediately after giving you nitroglycerin. It’s an extremely powerful drug, and we shouldn’t give it to any patient on their way out of the office. At age 90, a drop in blood pressure should’ve been predicted, and you should’ve been in a controlled situation.

Doctor’s offices in general aren’t set up to optimally deal with a heart attack. With such a concerning story, you should’ve been in an ambulance as soon as possible, then to an emergency room with appropriate monitoring and resuscitation equipment that is immediately available. People who are at risk for heart disease (even with just their age) should call 911 with symptoms concerning a heart attack.

After awakening with chest pain, a 90-year-old sought treatment for a possible heart attack. Then things took an unexpected turn.

07/28/2026

Dear Dr. Roach: I know this maybe an ignorant question, but what exactly constitutes protein? I know that it naturally comes from livestock and their byproducts. But one can find diverse categories -- such as cereals, pasta, sweet/salty snacks, and even soda pop -- with “protein” displayed on the packaging. What’s up with that? -- E.M.

Answer: I’m sure that many people have the same question. There are three major macronutrients (molecules for us to get the calories that we need for all of our activities), and most foods contain some amount of all three macronutrients. One is carbohydrates -- simple sugars and starches that provide most of the calories in fruits, vegetables and grains, including all the products that we make from grains like bread and pasta.

Another is fat, which are high in a few fruits like avocados but otherwise mostly come from animals (meat, milk, cheese and eggs) or are extracted from seeds or olives. Fats have the most calories per gram. Finally, proteins, which are strings of amino acids, are the major component of the calories in meat (along with fat and a little bit of carbohydrates). But milk and cheese, nuts and seeds, and most vegetables and grains have some protein in them.

Wheat is relatively high in protein compared to many grains, with wheat flour containing anywhere from 7% to 14% protein. Food manufacturers can use a higher content of wheat flour to increase the protein content of their products, but drinks (and perhaps the other snacks) probably have protein added to them.

Having more protein doesn’t always make a food “healthier.” We need a balance of carbohydrates, fat and protein in our diets, and most North Americans get plenty of protein without having to search for products that are especially high in it. Still, higher protein meals tend to be more filling, so often people will eat less from a high-protein meal than a high-carbohydrate one.

Dr. Roach addresses why adding extra protein into your diet may not be necessary.

07/28/2026

Dear Dr. Roach: I wanted to write in regarding your recent column on using turmeric as supplement for pain relief from osteoarthritis. While research indicates that black pepper can increase the bioavailability of turmeric by up to 2,000%, AI tells me there’s no definitive research showing that turmeric and black pepper give greater pain relief than turmeric alone. Is AI correct on this one?

If so, is there any other reason to take turmeric with black pepper? For example, learning that pepper increases turmeric’s bioavailability by up to 2,000% creates a big placebo effect for me, which can be a good thing. -- R.L., PhD

Answer: You’re quite right that black pepper (or its extract, piperine) dramatically improves the absorption of turmeric’s active ingredient (curcumin). It’d make sense that this would prove its effectiveness, but no study has been powered well enough to prove it.

This reminds me of a well-known paper that was published in 2003. It ironically argued that parachutes had never been proven to be safe and effective to reduce injuries when jumping out of an airplane. (The point is obviously that some things don’t need a study.) The authors advised those who disagreed to volunteer for the parachute study.

In a major challenge to this paper, a 2018 study did randomize 23 people to a parachute versus an empty backpack when jumping out of aircraft, and parachutes didn’t reduce injuries. Though, this was likely due to the fact that the planes and helicopters being used in the study were on the ground and unmoving at the time, so no study subjects were injured. (Who said researchers don’t have a sense of humor?)

For people who want their turmeric or curcumin to work most effectively, supplements should be coadministered with piperine (many come formulated together). Those who use their turmeric with food should also use black pepper.

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07/15/2026

Just a few minutes on the Oath of Hippocrates. There's a lot of misunderstanding about it. Here's a translation (by William H.S. Jones) from the ancient Greek from 1923, considered the standard:

"I swear by Apollo Physician, by Asclepius, by Health, by Panacea and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.

Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my in*******se with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me."

Some misunderstandings:
-"First, do no harm" is not part of the Oath. There is an injunction against deliberate harm, however, which is not at all the same thing. Sometimes we do have to cause harm: it's our judgment of the risks of harm against the potential for benefit that is really the issue, and that is not always simple. That's why we have medical science informing us.

-Nobody forces you to take this oath. You recite it or not, and not all medical schools use it. Very few use this ancient version, there are modernized ones available, that don't include the injunctions against abortion and lithotomy.

One important part of the Oath that is seldom discussed is the OBLIGATION to teach medicine.

source: https://omnika.org/texts/158
for more reading: https://www.health.harvard.edu/blog/first-do-no-harm-201510138421
to go down a rabbit hole: https://en.wikipedia.org/wiki/Hippocratic_Oath

...

06/26/2026

DEAR DR. ROACH: I’m a 62-year-old woman in fairly good health. I’m currently on Wellbutrin, carvedilol, Farxiga, Entresto and spironolactone, and my blood pressure is very well-controlled. I also recently started Zoloft. About eight months ago, I started feeling bad and spoke to my doctor about it. She wasn’t concerned at the time and said that it might be due to my recent weight loss. I’ve lost about 25 pounds.

I went to my cardiologist and had an echocardiogram and stress test done, and both were normal. Recently, I read about ferritin levels and the symptoms of a low ferritin level, which matched all of my symptoms -- fatigue, breathlessness, dizziness and brain fog. I asked my doctor to check my iron levels, which all came back normal except for the ferritin level. It came back at 39.1 ng/mL, which I’ve read is on the low end and could be causing my symptoms.

I am a frequent blood donor and have given blood four times during the past eight months. My hemoglobin level was normal at 13.4 g/dL, while my iron was low and my total iron-binding capacity (TIBC) was high. Could the frequent blood donations be leading to my lower levels of ferritin? Other than limiting the number of times I give blood in a year, is there anything else I can do to bring my ferritin levels back up to a more normal range? Or do you think there is something else that is causing my symptoms? -- K.B.

ANSWER: Ferritin is an iron storage protein, so your ferritin level is a pretty good indication of the iron levels in your body, although it isn’t perfect. In your case, your low iron and high TIBC essentially make the diagnosis of low iron a certainty. (Definitive proof of iron deficiency comes from a bone marrow biopsy, which is almost never done for the purpose of iron evaluation.)

You don’t have anemia, but it’s become clear that low iron (as a marker for iron deficiency) can cause significant symptoms even without anemia. Fatigue is the most common symptom, but decreased exercise ability, cognitive problems (“brain fog”), and depression and anxiety are also well-documented.

Restless legs syndrome, which many people aren’t aware that they have, is also associated with low iron. Cravings for unusual foods, called “pica,” is also associated with iron deficiency. (Ice is classic, but I’ve seen many different cravings, including a person who ate two boxes of Triscuit crackers a day.)

Blood donations are the most likely cause of your iron deficiency; however, every person over 45 should be up-to-date with their colon cancer screenings. If you’re due, you should get a screening test (ideally a colonoscopy; if not, a combination stool test), as colon polyps or even cancer are common causes of iron deficiency. It could make low iron worse on top of your blood donations.

Of course, I can’t be sure that it’s your low ferritin. Some of the many medications you take have side effects that could explain the symptoms. The medications you’re on suggest that you’re being treated for heart failure, which can cause many of your symptoms, especially fatigue. Still, given your low ferritin level, your doctor should recommend iron supplementation, and you should hold off on donations until your ferritin is back in the normal range.

If this doesn’t improve your symptoms, then it’s time for a more comprehensive look.

Ferritin level is a pretty good indication of the iron levels in your body.

06/24/2026

DEAR DR. ROACH: I’ve decided that it’s time for me to find a new primary care doctor. My biggest concern is access to my medical records. I currently have access to a patient portal to request doctor appointments or prescription renewals and review test results. Since the health care providers in my area use different portals, I need to know if I’ll have access to my past records.

More importantly, will my new physician have access to my CAT scans, doctor’s notes, and other information that I’m not privy to through the patient portal?

In the past, I know I could request that “paper” copies of my records be sent to my new doctor. I’m not sure if this would be a feasible option in this digital age. I’m hoping that there’s a federal or state law that would require health care providers to release this information in a manageable way. Your answer will greatly impact which new primary care physician I’ll choose. -- J.K.

ANSWER: The federal law that regulates the release of medical information is the Health Insurance Portability and Accountability Act (HIPAA). The main goal of HIPAA is more about protecting your privacy than facilitating the release of information, but it does allow physicians to share information under certain circumstances without your explicit consent.

In general, you’ll still likely have access to your electronic medical records, even if you’re no longer seeking care at a certain health care system. Furthermore, you should have access to your labs, imaging results, and even physician notes. (My patients usually read my notes and get their lab results and CT scan results before I do.)

Many medical systems do allow physicians to retrieve information from outside systems. Sometimes this requires explicit written consent, but it’s very easy to do. The trend has been leaning toward more openness among medical records systems, which has made it much easier for me to access my patients’ records from outside of my hospital system.

Also: Did you know there are several infections transmitted by tick bites? Here's a rundown.

06/24/2026

DEAR DR. ROACH: A friend of mine told me that she nearly died from ehrlichiosis, which comes from a tick bite, after walking through the woods in Connecticut. She said there are other diseases that are transmitted by ticks as well. I’d only heard of Lyme disease, so I found this surprising. -- J.B.

ANSWER: There are many tick-borne infections. Since I practice in the Northeast United States, I’m very familiar with human monocytic ehrlichiosis, which is endemic in the Southeast, South Central United States, and mid-Atlantic, but it can occasionally be found outside of this area.

In adults, the major symptoms are fever, nonspecific symptoms like muscle aches and fatigue, sometimes gastrointestinal symptoms like nausea and vomiting, and rashes in a minority of cases. Low white blood cell and platelet counts are frequently found and are a strong indicator of the diagnosis.

Tick-borne diseases can be transmitted at the same time. Anaplasmosis, which is similar to erlichiosis, is carried by the same tick as Lyme disease (I. scapularis, the blacklegged or deer tick), and we commonly see people who are coinfected. Babesiosis is also transmitted by the deer tick, so coinfection isn’t uncommon. Ehrlichiosis is carried by a different tick (the lone star tick), so coinfection with Lyme disease is less common.

It isn’t uncommon to treat patients for multiple infections until the lab tests confirm the diagnosis. Doxycycline treats Lyme disease, erlichiosis and anaplasmosis, but not babesiosis or Borrelia miyamotoi, so additional antibiotics are used in the case of possible coinfections.

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06/23/2026

This important study provides strong evidence that getting a booster Covid shot has benefits, even in people who have had multiple vaccines. I recommend following your doctor’s advice about getting the vaccine. I plan to recommend my patients get a booster once we see the level of Covid start to increase in the community.

This case-control study estimates vaccine effectiveness of 2025-2026 COVID-19 vaccines among adults with COVID-19–associated emergency department or urgent care encounters and COVID-19–associated hospitalizations.

06/22/2026

Dear Dr. Roach: I read your recent column on prostate biopsies. I'm no doctor, but I'd advise against them. My boyfriend got a biopsy in 2012, which I believe caused his cancer to spread beyond his prostate into his bones. He died three years later in 2015.

Think about this: A needle is inserted to extract cells so that they can be tested. When the needle is pulled out with its open end, and cancer is present, cells in the needle can then come out of the open end, causing cancer to spread throughout the prostate. It may be rare, but this is documented (tumor seeding).

— B.S.

Dear B.S.: I must disagree with you in the strongest possible terms. A biopsy is an essential piece of information in order to know how to treat a patient. Over decades and tens of millions of biopsies, there have been 42 total cases of seeding that were reported worldwide from the needle tract. This extremely rare event shouldn't prevent a man from understanding what the best treatment of his prostate cancer will be. Other studies haven't shown an association between a biopsy and a subsequent spread of the disease.

I'm very sorry about your boyfriend, but given the slow growth rate of prostate cancer, it's likely your boyfriend had prostate cancer that spread to his bones years before the biopsy was done.

He died three years later in 2015.

06/22/2026

Dear Dr. Roach: I read about a new weight-loss drug that is still in its clinical trials. It's called retatrutide, and it may have the ability to reduce body weight by as much as 28% over a relatively short period of time. What are some of the dangers of losing weight too quickly?

— B.G.

Dear B.G.: I also read the initial studies on retatrutide, and I'm very impressed with the results. The level of weight loss that was seen is in the range of what is expected with bariatric surgery. It acts similar to semaglutide (Wegovy) by stimulating the GLP-1 receptor, but like tirzepatide (Zepbound), it also stimulates the GIP receptor.

Unlike either of these drugs, it also acts on a third receptor, glucagon, and this combined action has shown remarkable results, with nearly two-thirds of study subjects no longer being classified as obese while on the drug.

You're wise to ask about the side effects of so much weight loss. Regardless of the underlying reason for the weight loss, there's the potential for harm whether you lose weight through medications, surgery, or careful adherence to diet and exercise. Gallstones are common during rapid weight loss, and some experts use medication to prevent them.

Bone mass can be lost by both men and women during weight loss. Making sure that a person gets enough protein and vitamin D can reduce this, and people who are at risk (such as those who had low bone mass to begin with) may be recommended medications to prevent the progression to osteoporosis.

We've seen loss of muscle mass with the existing GLP-1 drugs. To some extent, this is because a person no longer carts around so much weight. Regular exercise, especially weight lifting, and adequate protein intake can help reduce muscle loss as well.

When eating only a few amount of calories to lose weight, a person needs to be careful that they get all the micronutrients they need. I recommend working with a registered dietician or nutritionist to avoid deficiencies.

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Keith W Roach, MD

08/12/2026

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