If you need heart surgery, don’t delay.

The surgery is so much less traumatic and the recovery quicker than 20 years ago, but it should not – as with those solemn wedding vows – “be taken lightly”. Timing is everything, especially for those who are only moderately bothered by anything that needs fixing.

Replacement of the constricted aortic valve (aortic stenosis) illustrates this point. There is no doubt of the merits for those who suffer from the classic symptoms of shortness of breath and chest pain on exertion, as the replacement restores their limited prognosis from just 18 months to that which is normal for their age.

But what if the heart is still functioning normally, as is the case for nearly half of those diagnosed? Certainly, the tight valve is likely to cause problems later on, which could be avoided by a preventive procedure, but it risks causing serious, life-threatening postoperative complications. This dilemma has recently been forcefully resolved in favor of “sooner rather than later”.

Reviewing recent evidence, Professor Tan Yuan writing in the journal Frontiers in Cardiovascular Medicine concludes that the prospects for survival after “early” valve replacement significantly outweigh any adverse consequences of the operation.

The timing of joint replacements, for painful arthritis of the hip and knee, poses a similar dilemma. How serious must the loss of mobility be to justify an operation? For the hips, it is again “sooner than later” according to a study of Swiss orthopedic surgeons: because the probability of a normal restoration of function is considerably greater if the operation is performed when ‘It’s still possible to walk for 10 minutes or more without pain. Similar considerations apply to knee replacement surgeries, but are rather more problematic, as the operation is not as successful. Compared to success rates with hips (95%), success rates with knees are in the 80% range, meaning that a proportion of patients will not benefit each time they are carried out. Yet the view that surgery should be deferred until demonstrably necessary is contradicted by recent findings.

A quick dip is an easy way to thaw a frozen shoulder

The many maneuvers to thaw a frozen shoulder, recently featured in this column, could be aided by harnessing the gravity-defying floating effects of swimming.

When a badly frozen shoulder prevented clarinetist Judith Denny from playing her beloved instrument, a doctor at the Musician’s Clinic recommended several sessions in the hydrotherapy pool. On one occasion she took a deep breath, dove to the bottom and to her surprise “my frozen arm rose to the surface and I heard the crackle of what I can only presume were adhesions to the inside the joint”.

A reader from Suffolk describes a similar experience. Several years ago when he was told there wasn’t much he could do for his frozen shoulder, he had a ‘strong urge’ to go swimming anticipating it might help him. . It was early May, so it was a cold dip in the sea, but “the result was extraordinary,” he said. A day later, the range of motion in his shoulder, he estimated, had improved by 50%. After more daily swims over the next few weeks, “I was pretty much able to completely forget about it.”

Testing the Waters on This Remedy for a Nasty Cough

Finally, my thanks to a lady in Dorset for passing on to me her new remedy for a persistent cough, which was getting worse at night, attributed to asthma but not alleviated by the bronchodilator inhaler. She recently spent a week in hospital dealing with a urological problem that required her to drink two liters of water a day. “Imagine my surprise when I got home to find that my cough was gone,” she wrote. Since sticking to her daily two-litre diet, she hasn’t coughed once. The only plausible explanation that occurs would be that the high fluid intake might have loosened some sticky secretions in the lungs.