Dear Dr. Roach: My friend has been diagnosed with “stiff heart,” but since there is no treatment, he has given up on his condition. With so much progress in medicine, is there anything we can do?

C.L.

It’s not always easy to infer a medical diagnosis from such a simplified description, but my guess is that your friend has a type of heart disease called “heart failure with preserved ejection fraction” (HFpEF). It is possible that he is suffering from the disease.

The left ventricle, the chamber of the heart that supplies oxygenated blood to the body, is actually hard and requires high pressure to completely fill the chamber. Damage to the heart in HFpEF can be caused by a variety of conditions, including high blood pressure, diabetes, obesity, blocked arteries, atrial fibrillation, kidney or lung disease, sleep apnea, and simply aging.

The underlying disease should be treated whenever possible. Special treatments for HFpEF can be frustrating, but medical advances are catching up. New classes of drugs have been shown to improve symptoms.

If there is volume overload (swelling of the legs or lungs, etc.), you should use diuretics to lose fluids. Once excess fluid is removed, treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists has been shown to improve symptoms and outcome.

The use of semaglutide has been shown to improve exercise capacity and quality of life in obese people with HFpEF, and the use of semaglutide to protect the heart in this setting has just been directed by the Food and Drug Administration. is.

However, there are other possibilities, such as amyloidosis. In addition to the treatments listed above for heart failure, there are special treatments depending on the type of amyloidosis.

Dear Dr. Roach: I just got over a bad case of shingles. I thought I had chicken pox when I was younger, but I ended up getting shingles two months ago. After the blisters begin to disappear, the nerve pain and rash are painful and extremely debilitating. Once this tragedy passes (if it ever does), should I get the new and improved shingles vaccine at some point, or is it safe to get it for a while? I’m 77 years old and still basically healthy.

H.B.

To be clear, you got shingles because you had chickenpox years ago. The varicella virus is called the varicella-zoster virus because it causes chickenpox (varicella) and shingles (shingles). Shingles develops when your immune system is weakened, which can be caused by age or stress. As you rightly say, shingles can be devastating and the pain can last for weeks, months (sometimes even years).

Unfortunately, people can get shingles more than once, so you should definitely get the new two-dose Shingrix vaccine, which reduces the risk of shingles by as much as 97%. You can get the vaccine as soon as all the lesions have crusted over, but you don’t need to do it right away, but you don’t want to wait a year.

You may be asked about getting a second full vaccination after getting shingles despite receiving a new vaccine. You will also be asked about vaccinations for those under 50 years of age. We cannot answer this question because we do not have enough data, but this type of case should be treated individually by your doctor. It may make sense to use the shingles vaccine at a younger age or as a second dose.

Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into his column whenever possible. Readers can email questions to him at ToYourGoodHealth@med.cornell.edu.