Keith Roach, M.D.

Dear Dr. Roach: I am 77 and exercise regularly. I just got a fitness tracker to monitor my heart rate, etc. I have always been very slow to get back to a resting heart rate. For instance, if I get my rate up to 130 beats per minute during exercise, it will be at 90 half an hour later, and at 70 after an hour. My resting heart rate is about 56 bpm. An online source suggests that the decline in my bpm is slow and can indicate susceptibility to a heart attack. I have friends as slow to cool down as I am. Do you see any problem with this? — M.S.

Answer: There are many metrics to gauge cardiovascular fitness, and how fast your heart rate returns to normal after exercise is a powerful one. However, the usual time periods that are referenced in studies are usually 1 and 5 minutes, not 30 and 60 minutes.

If the heart rate slows by 20 or more beats in the minute after exercising, that is a good sign. Slower recovery predicts greater risk, with the most dangerous result being only a 5 beat reduction in the first minute after exercise. Slow response at 5 minutes also predicts a greater degree of risk.

The average age in typical studies is 57. The fact that you are 77 makes related data harder to interpret for you.

Regular exercise remains a great way for anyone keep up cardiovascular health. If you do have a slower-than-ideal heart rate recovery, it is worthwhile to consider additional treatments (possibly including a statin or aspirin) that might reduce your risk. A cardiologist is the right person to discuss this with.

Finally, very strenuous exercise, the kind that jacks your heart rate up to its maximum, is probably best avoided unless your cardiologist specifically gives you the OK to participate.

Dear Dr. Roach: I’ve been diagnosed with mucous membrane pemphigoid with epithelial dysplasia. It affects my gums under an upper denture. What type of doctor should I see for treatment, an internist or an immunologist? I had this for two years before it was finally diagnosed after a second biopsy. I’m very scared. — D.V.

Answer: Mucous membrane pemphigoid is a rare autoimmune disease that causes blisters and erosions in the mouth, but it may also affect the eyes, nose, upper airway and other mucous membranes. This disease tends to happen in older adults. Antibodies to a cellular structure called the “basement membrane” are thought to cause the symptoms, but what causes the body to make the antibodies is unknown.

Treatment is designed at reducing the activity of the immune and inflammatory systems. Corticosteroids such as prednisone can be applied directly to the spot by way of a gel or ointment, or by oral tablet in more severe disease. Some experts inject steroids into the area of disease activity, especially if there is a limited area involved. More severe disease requires more potent agents against the immune system.

Dermatologists are the experts in treatment of pemphigoid of all types, but may certainly consult with other experts, including dentists and other specialists as necessary.

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