Dr. Keith Roach

DEAR DR. ROACH: I am a 69-year-old who used to walk up 75 to 90 flights of steps several days a week as exercise. After a steering wheel airbag went off and damaged my heart, I am afraid my ability to do that stopped. After years of medications, I am now on a pacemaker, which definitely helps.
Could the exercise I was doing have weakened my heart to such a degree that it could be viewed as overdoing it, therefore exacerbating my condition? — Anon.
ANSWER: In general, exercise does not harm the heart. On the contrary, exercise is almost always good for the heart. However, there are exceptions. In healthy people, there is an optimal amount of exercise, and extreme levels of exercise (on the order of running more than 10 miles a day every day) begin to decrease the benefit that a person gets from exercise. (This remains controversial, but I am convinced from the data.)
In people with severe heart disease (the kind with blockages in the arteries), overdoing exercise can lead to a heart attack, but these are exceptions. For every person who gets harmed by overexercising, there must be a hundred who don’t get adequate exercise.
The fact that you have improved a lot on the pacemaker suggests that at least part of your problem wasn’t with the pump function of your heart, nor with the arteries leading to your heart, but with the electrical supply.
Once a pacemaker is in, that problem is immediately alleviated, but the heart may still be deconditioned (“out of shape”). Regular exercise will help the problem.
Your cardiologist can better answer the question for you and also give advice on building up your exercise tolerance over time.
DEAR DR. ROACH: Colds and flus seem to linger in my lungs and nose for a week or more after all other symptoms have passed. If my phlegm and mucus are clear or white and I otherwise feel healthy, am I still considered infectious? — S.C.
ANSWER: The color of sputum and mucus is not a reliable indicator of whether an infection is caused by bacteria or viruses, nor of whether you are still infectious. Colds and flus, like COVID, are caused by viruses. A person is most infectious starting a day or two before they get symptoms until a day or two after symptoms start. Most people are no longer infectious after five to seven days of having symptoms, but unfortunately, that’s not 100% certain.
Part of the body’s response to infection is to make a great deal of mucus to wash the infection away. This can lead to us being very uncomfortable, with copious sneezing, runny noses and productive cough. In some people, this tendency is more prolonged. It sounds like you might be one of those people in whom the body’s response to infection causes more symptoms than the infection itself.
We can test pretty well for COVID infectiousness with home testing, but those home tests don’t exist for the flu or other viruses. Following the same advice for COVID — staying home for at least 24 hours after a fever has gone, or at least five days of isolation without a fever — will minimize your infectiousness to family and friends.
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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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