Q: My wife is 29 years old. Few weeks back she started having pain in all her joints. When shown to an orthopaedic surgeon, they refereed her to a cardiologist. There it was diagnosed that she has arthritis related to the heart. One of the heart valve is mildly thickened. Now she is on painful injections of Penicillin (every 21 days). The doctor says that she might have to take these injections for life-time. My question is how does Penicillin work on body in such a situation? Is this injection a cure or preventer of escalation of further problem of heart/arthritis? Does this act as a mere painkiller? Are there any alternative reliable medicines? Please suggest.

A:It appears that your wife has rheumatic heart disease with only minimal affliction of the heart valves. The arthritis seems to be a part of rheumatic process. Sore throat (streptococcal throat infection) is the most acceptable cause of this complex process. Penicillin is the best preventive measure to prevent recurrences of rheumatic fever. A long acting shot once in 3 weeks is the preventive strategy. It is simple and she can take a tablet of paracetamol after the injection to make the injection more acceptable. Recurrences can lead to damage of the heart valve and a mild lesion can become severe, which should not be allowed to happen. It is also advisable to repeat an echocardiography once in a year. This is a good way of monitoring the heart valve performance.