Dr. Keith Roach

DEAR DR. ROACH: Do people with pacemakers need to be concerned about wireless devices? — B.L.
ANSWER: In most cases, there is very little risk to a pacemaker from wireless devices. However, there are some exceptions, so it is prudent to stay away from some types of devices as much as possible.
For instance, anti-theft systems in department stores and metal detectors (including portable detectors) can potentially cause electromagnetic interference with a pacemaker, so those with pacemakers are advised to spend as little time around them as possible. Don’t lean against a department store security device or a metal detector. If you are required to undergo extra security at an airport, advise security personnel that you have a pacemaker so they can keep the handheld device away from your chest.
Strong magnets are a potential problem for those with pacemakers, but more so in people with automated implantable cardioverter-defibrillators. Headphones and earbuds have magnets, so keep them away from your pacemaker. A person with a pacemaker should also avoid extremely powerful electronic equipment such as arc welders. Cellphones are very unlikely to cause problems, but even so, don’t carry it directly over your pacemaker.
A very long list of what is considered safe can be found at tinyurl.com/pacemakerEMI, thanks to the American Heart Association.
DEAR DR. ROACH: I have a question about my recent A1C test result of 7.7%. For years, I’ve had stable pre-diabetes with ascending readings of 6.2%, 6.4% and 6.6% from 2018 to 2022. Back in 2005, it was 6.1%. All other test results were normal for me this year.
My primary doctor recommends that I begin taking metformin now. However, in response to a question about postponing metformin until retesting, he said it would be OK to delay taking it until I get retested in three to four months. I just turned 84 this past June and am in good health, except for high blood pressure. Should I begin metformin now or wait for the retest in three to four months? — J.S.
ANSWER: You have moved from pre-diabetes to diabetes. Now that you have diabetes, treatment becomes more important.
The first line of treatment is not medication, but addressing any lifestyle issues. While some people can eat as well as possible, exercise daily and still get diagnosed with diabetes, the vast majority of people with diabetes benefit from a comprehensive look at their diet, ideally from a registered dietician or nutritionist who has expertise in treating diabetes. About 150 minutes of exercise per week is a reasonable goal for most, but some people need to start with a more modest goal, while others can accomplish even more.
If medication is needed, metformin is the usual first choice for most — but not everyone — so I have to defer to your own doctor, who knows your medical history (and kidney function, which is critical for metformin). A goal A1C level of 7.5% is reasonable for a healthy 84-year-old like yourself.
My experience is that some patients are motivated to try healthier behaviors if they know they can avoid medicines by improving them, but some people are doing the best they can and still need medication to keep their diabetes under optimal control.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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