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Dear Dr. Roach: I have been vegan for 15 years. I avoid sugar, limit salt and have no caffeine. Recently, a pharmacist told me that I will not get proper protein unless I add fish to my diet. However, long ago, my doctor told me that my vegan diet was good and that I should take vitamin B-12 daily. I have been doing that daily. What are your thoughts on adding fish?

– S.N.

A: I agree with your doctor. A vegan diet can be a very healthy one, and avoiding sugar in particular helps assure that it is. The issue of adequate protein is brought up frequently, but most Americans consume more than twice the recommended daily allowance of protein. Plant foods have plenty of protein, and you certainly do not need to eat fish in order to get adequate protein. I think fish can be a healthy part of a diet, but it is not necessary.

Pre-op testing

Dear Dr. Roach: I just wanted to respond to a recent letter from a patient complaining about extensive preoperative testing. I am a physician anesthesiologist and frequently work in the office where we prepare patients for future surgery. The writer was correct. It is frustrating to everyone when a patient in excellent shape and under close and regular observation by a competent physician needs to go through the pre-op evaluation process. Unfortunately, such a patient is in the minority, and we don't have a good way to identify them until they arrive in our office. The vast majority of patients are not in great shape, don't see a doctor routinely, can't recall most of their medical history, don't know what prescription drugs they take, are morbidly obese, have undiagnosed medical conditions or all of the above. Receiving anesthesia for surgery is very safe in the United States because we have worked very hard to make it so. We can all recall in years past, when someone was told they were "too old" or "too sick" for successful surgical outcomes. Generally, we can perform a safe anesthetic on most patients if we have all the necessary information to tailor the anesthetic to their individual needs. I can't tell you how many times I have found undiagnosed heart murmurs, ischemic heart disease and undiagnosed diabetes on a patient simply being evaluated prior to surgery. The current system is not perfect, but I implore your readers to appreciate that we live in a society where everyone demands the best care and the best outcome, regardless of how they may have abused or neglected their bodies for decades before they arrive in the operating room. We genuinely want the best for each patient. I consider it an honor and a privilege to care for my patients. If I were in this only for the money, I would have quit years ago.

– Dr. Jane Caldwell

A: Thank you for writing and for reminding me that the patients I see, like the one who wrote in, are the ones who are at low risk for finding undiagnosed conditions during a pre-operative evaluation. I also appreciate the reminder that most physicians are motivated by far more than economics.

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Recurring vaginal infections are often troubling to women. The booklet on that topic explains them and their treatment. Readers can order a copy by writing: Dr. Roach, No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.

Dr. Keith Roach writes for North America Syndicate. Send letters to Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu.

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