Keith W Roach, MD

06/03/2026

Dear Dr. Roach: After a routine blood test raised suspicions, my husband was diagnosed with monoclonal gammopathy of undetermined significance (MGUS). At first, we thought this wasn’t a big deal, but further tests indicate that he’s in the “high risk” category, although he doesn’t have symptoms. The hematologist/oncologist has indicated that he has a 50% chance of developing a blood cancer called multiple myeloma in 20 years.

My husband is very upset and feels that a death sentence is hanging over him. The oncologist says he has to be monitored every three months. I’ve tried to be reassuring, but I don’t really understand what we’re facing either. Fifty percent does seem like a very high risk, but what does this mean on an annual basis? My husband’s in his early 70s. Is there anything he can do to better his odds? His weight is normal, and he tries to be active. — L.C.

Answer: I understand that a 50% risk sounds scary. I wish there were treatments to prevent the progression of MGUS to myeloma, but there are no approved treatments, although there are several agents in clinical trials.

The usual next stage in MGUS is a condition called smoldering myeloma. If your husband developed this, then there are treatments to reduce the risk of this condition, which progresses to myeloma. However, a risk of about 50% over 20 years (58% is often quoted in the literature for high-risk MGUS) means that 97% to 98% of people will be fine each year. These are pretty good odds. If he makes it to 80 without problems, he’s still 97% to 98% likely to make it to 81 without developing myeloma.

I don’t mean to sound blunt and unfeeling, but all of us are living under a death sentence. Nobody lives forever. This new diagnosis does make things a bit worse — but only by a bit. Almost 75% of people with high-risk MGUS haven’t progressed to myeloma in 20 years when considering the competing causes of mortality. Your husband would be in his early 90s by then.

His oncologist is quite right that careful follow-ups are necessary so that if he does go on to the next stage (smoldering myeloma), he can then consider treatment.

Dear Dr. Roach: After a routine blood test raised suspicions, my husband was diagnosed with monoclonal gammopathy of undetermined significance (MGUS). At first, we thought this wasn’t a big deal, but further tests indicate that he’s in the “high risk” category, although he doesn’t have sym...

06/03/2026

DEAR DR. ROACH: I’m a relatively healthy 82-year-old male who was diagnosed with cervical myelopathy a few years ago. I’ve managed to cope with it, but now the symptoms are starting to affect my daily activities. My question is: What can I expect in the way of recovery and a return to normal activities post-surgery? I play golf regularly, walk my dog, visit the gym, and do yard work. -- R.L.

ANSWER: The fact that you’re so active with your cervical myelopathy (a condition of damage to the spinal cord, usually from degenerative spine disease) is a very good sign for your recovery.

While I can’t predict how long it’ll be for you, most people return to driving within two weeks, while biking, running and swimming (which are pretty close to the kinds of activities that you’ve been doing) can take anywhere from six weeks to three months. However, I’d expect you to get better faster than the average person since you’re doing so well before surgery.

The specific type of surgery affects a person’s recovery as well, with laminoplasty providing a faster recovery than fusion procedures and posterior fusion taking longer than anterior fusion. Only your surgeon can comment on the type of surgery that they have planned. A rehab program after surgery is likely to speed up your recovery, so I recommend them.

Cervical myelopathy is a condition of damage to the spinal cord, usually from degenerative spine disease.

05/22/2026

DEAR DR. ROACH: I’m 67 and in decent shape. I run 3-4 miles three times a week and lift weights three days a week. I take 20 mg of rosuvastatin daily. My LDL cholesterol is 85 mg/dL, and my HDL is over 80 mg/dL. I have controlled blood pressure at 125-130/80 mmHg with an angiotensin II receptor blocker (ARB).

Seven years ago, my provider asked me to do a coronary artery calcium (CAC) scan because it could be performed at no cost to me. I did, and my score was 530. The recommendations were to get on a statin, which I was already on (rosuvastatin), as well as low-dose aspirin.

Recently, a new primary care physician asked me to repeat the test, and my score was 1,200. The higher progressive score alarmed me as the report said that my chances of a cardiac event were extremely high over the next few years. My physician then referred me to a cardiologist.

The cardiologist eased my concerns somewhat, as he said that although this is a high score, it doesn’t mean anything other than lots of calcium in my artery plaque. He did schedule me for a stress test. Can you please provide your take on the interpretation of my calcium score and the potential benefit in getting the test? -- R.S.

ANSWER: A CAC scan is an easy way to get additional information about a person’s risk of having a heart attack. I don’t recommend these scans for my low-risk patients, nor do I recommend them for my patients who are already on treatment.

I find them most useful in people where it’s not clear whether they should be on treatment such as a statin (like the rosuvastatin you are on). Sometimes I have a patient who is equivocal about being on a statin (which I understand), and sometimes I’d like to get more information before giving a recommendation to a patient.

The ideal CAC score is zero. However, a high CAC score doesn’t guarantee a heart attack. I use the MESA score (tinyurl.com/MESARisk) in combination with your clinical factors, and the tool estimates your risk of having a cardiac event (heart attack, cardiac arrest, death due to a heart attack or stroke, or confirmed blockages that lead to surgery or a stent placement) at 14.8% in the next 10 years. If you had a calcium score of zero, your risk would only be 2.3%, so the CAC really did make a significant difference in understanding your risk.

In my opinion, a stress test is a reasonable suggestion. The point of a stress test is to see whether there are any blockages that are large enough to restrict blood flow to your heart when you exercise. If there are, then additional information, such as a direct look at your coronary anatomy with an angiogram, can provide your cardiologist with the information needed to recommend a balloon procedure and stent, cardiac surgery, or different medications.

The newest guidelines that were just released this past March recommend an even lower LDL than your current result. (The recommendation is below 70 mg/dL, with consideration to below 55 mg/dL.) The European guidelines recommend an LDL below 55 mg/dL, with a goal of below 40 mg/dL for people who’ve had more than one cardiac event. This can usually be achieved with a maximum-dose statin, usually in combination with ezetimibe or a PCSK9 inhibitor -- or both.

The larger the risk you have for heart disease, the more important it is for you to improve other factors, including blood pressure, smoking, diet and exercise.

https://www.oregonlive.com/advice/2026/05/dear-doctor-a-high-cac-score-doesnt-predict-a-heart-attack-heres-what-you-can-do-to-help-prevent-one.html

The number in a calcium scan alone doesn't necessarily mean you're heading for a heart attack.

05/15/2026

DEAR DR. ROACH: I’ve seen a number of stories lately about people who’ve been arrested for behavior that doesn’t seem to be criminal, but the behavior is odd. Some of these people are homeless, and I wonder if they are mentally ill and aren’t taking prescribed medication. -- P.L.P.

ANSWER: Mental illness often leads to behaviors that definitely seem odd. Behaviors like hoarding, which can be found by itself or with several different mental illnesses, often affect the individual but sometimes lead to risks for others who live with them. These behaviors can lead to interactions with police that would be considered a “public nuisance.”

Mental health remains stigmatized, and there are often inadequate resources to help people with mental illnesses. This leads to a situation where there are three to six times as many people with mental illnesses in the criminal justice system than expected. People with mental illnesses are also much more likely to be homeless. Most mental health disorders are treatable, but the treatment received while a person is homeless or incarcerated is often poor.

It’s common for people with mental health disorders to stop taking their medication. These medicines can have side effects that make people feel unwell or just not themselves. Many times, I’ve seen people stop taking them while they feel well, which causes their problems to become much worse.

Substance abuse is also a major issue. Substance abuse can make any mental health condition worse, and it can be very difficult to properly diagnose a person while they are actively using recreational drugs. A prolonged hospitalization is necessary to make a diagnosis for them and receive proper treatment, but this is very expensive.

Odd behaviors in an ideal world should trigger an investigation into whether a person who has a mental health disorder is in need of treatment. In this ideal world, early treatment could lead to improvements in a person’s quality of life and prevent the homelessness or arrests that too often accompany untreated mental illnesses. Unfortunately, we live in a world that is still pretty far from this ideal one.

Dr. Roach: Odd behaviors in an ideal world should trigger an investigation into whether a person who has a mental health disorder is in need of treatment.

05/15/2026

DEAR DR. ROACH: I’ve read about urolithin A. Is this something I should take for general health? -- D.D.

ANSWER: Urolithin A is thought to work by increasing the body’s removal of old and poorly functioning mitochondria. This way, the body makes newer and healthier mitochondria, which are structures inside the cell that provide energy for the cell to work. Mitochondria make ATP, which is the basic unit of energy inside the cell. Nearly all cells contain mitochondria, but cells that intensely use energy, such as muscle cells, have lots of mitochondria.

A 2002 study tested whether urolithin A would be effective at improving function. The primary outcomes of the study were how long a person could walk in 6 minutes and the total amount of ATP that the muscles can make. Subjects in the study had baseline measurements and were treated with urolithin A (1,000 mg) for four months -- or a placebo pill that looked identical but didn’t have an active ingredient.

After four months, repeat measurements didn’t show a difference in either primary outcome with the subjects who were treated with urolithin A. However, those who took urolithin A had slightly better muscle endurance at the end of the four-month period. Urolithin A has minimal toxicity at the studied doses.

In my opinion, there is good “biological plausibility” that this supplement might help, and although there seem to be some benefits, there isn’t compelling evidence for me to recommend it yet.

05/12/2026

DEAR DR. ROACH: I am a 61-year-old retired African-American woman. This past week, I just had a Pap smear (I hadn’t had one since 2021) and was told that it was positive for human papillomavirus (HPV). I’m upset because I was celibate from 2021-2024, and then in January 2024, I got married to my current husband, who lives in Africa. I was there for a week, and we honeymooned and consummated our marriage. I came back home and have since been monogamous.

This week, I found out that I have HPV. What can I do? Will the vaccine help? I’ll be going back to Africa later this year to be with my husband on a spouse visa for about six months, and I don’t know what to do. My doctor didn’t say much besides the fact that she would check me again next year. I’m so stressed and upset because of this. Can you give me your advice? -- Anon.

ANSWER: I read the report that you sent me, and you have a lower-risk type of HPV -- not one of the high-risk groups (genotype 16, 18 or 45). Although the type of HPV you have can lead to changes in the cervix that can cause cervical cancer, it is unlikely.

Most women clear the infection without treatment, and since you have a lower-risk type and are in your 60s, you are even less likely to develop problems. More than 95% of women in this group of lower-risk HPV genotypes cleared the infection. Fewer than 5% went on to develop the precursor to cervical cancer called CIN 2 (“Cervical Intraepithelial Neoplasia Grade 2”), or worse.

Your doctor did what is recommended, which is to recheck in a year. At this point, it’s very likely to be gone. (Of course, she could have done a better job of explaining.) In the unlikely event that the HPV is still detected, your doctor would recommend a close look at your cervix through a colposcopy to see if there are any abnormal areas of the cervix, which could also be biopsied at the same time.

If there aren’t any abnormal areas, then you’d be recommended another follow-up in a year. But if there were areas of CIN2 or greater, these would be removed with a LEEP (loop electrosurgical excision procedure).

I understand why you are stressed and upset. This is how mostly everyone feels when they hear this news. Fortunately, your body is very likely to cure itself within the next year or so, and your doctor will check to make sure that it’s fully gone.

Dr. Roach: Most women clear the infection without treatment, and since she has a lower-risk type and is in her 60s, she is even less likely to develop problems.

05/12/2026

DEAR DR. ROACH: I’m 79 years old and had a few cancers (lung removed, prostate cancer) in the past. I currently have neuropathy. I notice that when I consume food with high sodium, the pain is extreme, and drinking water helps. My question is: Is there a device to measure sodium in the blood? Diabetics have a blood checker to measure, so I was wondering. -- J.S.

ANSWER: The body will maintain normal sodium levels under most conditions. Having a very salty meal isn’t enough to cause the sodium level to raise above the normal level, so a home-based device to measure plasma sodium in the way that people with diabetes measure plasma glucose wouldn’t be particularly helpful. (There are exceptions, such as people with certain kidney diseases.)

My advice is to look at the sodium content of the foods that you buy and avoid ones with a high sodium content. A goal of 2,300 mg of sodium is recommended by expert groups like the American Heart Association.

05/11/2026

Thanks for being a top engager and making it on to my weekly engagement list! 🎉

Adele D'Cruz, Susan Berquist, Jim Freeman, Donna Gray Stoneberg, Dottie Tabor

05/11/2026

DEAR DR. ROACH: I’ve been feeling just awful. My doctor put me through the normal tests, and all were good. A neurologist recommended that I get a cortisol test. I did, and it showed a high cortisol level. I’d never heard of this. Would you explain what high cortisol is, how it is treated, and if there are any natural cures or therapies? -- S.K.

ANSWER: Cortisol is a critical hormone that is needed for the function of many body systems. Without cortisone, the body cannot respond to stress, and a stressful event can literally kill a patient.

A medical condition called Addison’s disease is when the body cannot make cortisol (a type of steroid called a glucocorticoid). People with this condition need to take replacement cortisol or a synthetic form daily, and they need to take higher doses when under stress to prevent this. Addison’s disease was most often caused by tuberculosis, but the leading cause of Addison’s is an autoimmune disease of the adrenal cortex (where cortisone is made). People usually feel weak and tired with Addison’s.

Cushing’s syndrome is the opposite, where the body makes too much cortisone. The most common cause for this is a benign tumor. In Cushing’s syndrome, the list of possible symptoms is seemingly endless, but fatigue and muscle weakness, weight gain in the abdomen but muscle loss in the limbs, and skin and hair changes are common. People can experience the same problem when taking high doses of cortisol or similar steroids such as prednisone, hydrocortisone or dexamethasone.

A cortisol level of 18 isn’t diagnostic of Cushing’s but almost certainly excludes Addison’s disease. Depending on the time of day, cortisol levels can be between 5-25 mcg/dL, so a level of 18 mcg/dL in the morning may be normal. People with high levels of stress tend to have high to normal cortisol levels.

In contrast, a level of 18 mcg/dL at bedtime would be a very concerning sign for Cushing’s. If your doctors were worried about Cushing’s, additional testing could be recommended such as a 24-hour urine cortisol test, a bedtime salivary cortisol test, or checking the blood cortisol after suppressing its release with a medication that stops cortisol release.

An endocrinologist is the expert in making the diagnosis and treating diseases of the adrenal hormones, including Addison’s and Cushing’s.

Cortisol is a critical hormone that is needed for the function of many body systems.

05/11/2026

DEAR DR. ROACH: I am 77 years old, and I’m concerned about getting a prostate biopsy. My last PSA test jumped from 2.25 to 3.75 ng/mL, and an MRI came back healthy and normal with a PI-RADS code of 2. My urologist suggested a biopsy to be sure that everything is OK, but he also felt comfortable if I wanted to wait six months and get another PSA test done.

I am in good health, exercise regularly, and am not on any medications. Also, can strenuous bike riding affect my PSA score? -- W.B.

ANSWER: A PI-RADS score of 2 means that there is a small chance of clinically significant prostate cancer. The best estimate of your risk is between 4% and 6%. One question I’d ask is whether you’d undergo surgery if a biopsy showed cancer. Surgery is associated with a worse quality of life; erectile dysfunction and incontinence are common shortly after surgery and persist in many men.

The evidence suggests that in men over 75, surgery doesn’t improve their length of life. In a large study, the length of life was actually decreased in men over 75. Radiation treatment is a reasonable alternative for men with symptomatic prostate cancer, so in the unlikely event that you develop symptoms from prostate cancer, this would be a reasonable approach.

Also, bike riding (250 miles over four days) had an increase of less than 0.1 ng/mL for a PSA test.