How to slow heart rate after exercise

Q: 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.

A: 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 to 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.

Q: 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.

A: 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.

Q: My spouse, now 61, had shingles two years ago. Though the rash cleared up quickly, the nerve pain has never subsided. Is the virus still at work, or does she have permanent nerve damage? Because her doctor has always kept her vaccines up to date, we are not sure how she missed getting a shingles vaccine, unless she was below the recommended age threshold at that time.

B.L.

A: Shingles is the reappearance of the chickenpox virus after it has lain dormant for years (usually decades) in the body. It could be since the time of the original chickenpox infection or, less likely, since vaccination with the varicella vaccine.

During the time of the rash, and often for a week or two afterward, the pain is due to inflammation and damage to the nerve, called acute neuritis. After four months, however, the diagnosis is now called postherpetic neuralgia, and it is a type of neuropathy, the general term for nerve damage.

The older a person is, the longer postherpetic neuralgia tends to last. About 20 percent of people will have pain for their lifetime, but your spouse is still more likely to have the pain go away than last forever. I am hopeful the nerves will recover and that the damage is not permanent.

Until her recovery, I hope she is getting some treatment to relieve the pain. Gabapentin and pregabalin are the most commonly used treatments. If a person can tolerate the full dose (it can take weeks to get people to tolerate the full dose of gabapentin, which is up to 1200 mg three times daily), it can be very effective, dramatically improving a person’s quality of life.

The newer shingles vaccine, a two-dose recombinant vaccine with the brand name Shingrix, became available in 2017 and is very effective. Your wife might have missed the new recommendation of getting it at age 50, as the old one-dose vaccine Zostavax (no longer available in the U.S.) was recommended to be given over age 60. Readers over the age of 50 who have not had the two-dose Shingrix should get vaccinated, even if they have had the old shingles vaccine, and even if they have had a history of shingles in the past.

Q: For the past three years, my creatinine levels have been pretty much normal. I am 75 years old, and my blood pressure is controlled with medication. However, last week, my creatinine level was elevated. On the eve of my lab test with dinner I took a couple of hard liquor drinks. Would this elevate my creatinine?

J.M.

A: Alcohol can absolutely damage the kidneys. Since creatinine is a test of kidney function, the alcohol could have affected the results. In fact, a binge (defined as four or more drinks for women, five or more for men at any one time) can cause acute kidney injury. “A couple” of drinks might meet criteria for a binge, depending on how large the drinks are. One and a half ounces of 80-proof liquor is a standard drink, and some people pour much larger portions.

However, what’s more likely is that alcohol drinking often leads people to get volume-depleted. “Dehydrated” isn’t the correct term, since people lose salt as well as water, and I suspect this is the reason your creatinine is elevated. Still, there are many causes, and since your creatinine was higher than usual, it’s worth rechecking. Be sure to drink plenty of fluid and avoid excess alcohol before your next blood draw.

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 or send mail to 628 Virginia Drive, Orlando, FL 32803.