Should I up my statin dose so I don’t have to get stents fitted?

Q After some investigations for chest discomfort, it’s been suggested I have narrowed coronary arteries and have been advised to have stents fitted.

I was given a leaflet with the possible risks, which include having a heart attack or a stroke, so now I’m really not keen on having it done.

Is there any other way of clearing the arteries with medication? Would increasing my statin dose help? A Narrowing of the arteries is caused by atheroma, a mix of fatty material and proteins. Statins work mainly by reducing the level of LDL cholesterol, which is found in atheroma, so they can prevent the amount of atheroma increasing.

There is also some evidence that they can help to stabilise and slightly reduce the fatty content of atheroma and help reduce inflammation in the artery walls. But unfortunately this effect is minor and does not make a significant difference.

Stents are tiny wire coils that are placed inside narrowed arteries, helping to prevent them becoming blocked. They are frequently used in the coronary arteries, which supply blood to the heart muscle, and are an important way of preventing a heart attack. They are placed via a tiny tube, or catheter, inserted into the main artery in the groin.

It is possible for the catheter to disrupt a piece of atheroma, which in turn could cause a heart attack, or stroke if it travels to the brain, but this is very rare.

The fact you have been advised to have stents means your coronary arteries are significantly narrowed, putting you at high risk of a heart attack, and your specialist will have judged that this risk is greater than the risk of having the procedure. I would encourage you to go ahead and have it done as soon as you can. Q I am 66 and was diagnosed with irritable bowel syndrome in my early thirties. I used to manage better with help from a nutritionist but since the pandemic it has worsened and I have started fainting when I have a flare-up. It can be very embarrassing, particularly as it happens alongside diarrhoea and vomiting. Is there anything I can do as it is really affecting my social life?

A In irritable bowel syndrome there is a problem with the functioning of the gut.

Normally food is passed along by regular contractions of the muscles in the gut wall, but in IBS, the contractions in some areas become overactive or underactive, leading to either diarrhoea with cramps or constipation and bloating.

The exact cause is not known but may involve overactivity of the nerve messages from the brain to the gut, as many people with IBS find their symptoms get worse when they are stressed or anxious.

Though it is not caused by an infection, IBS can sometimes start after a bout of gastroenteritis, suggesting that a change in the mix of healthy bacteria that normally live in the gut may trigger a change in gut function.

Some sufferers find that certain foods can trigger symptoms, so seeing a qualified dietician can often be helpful.

However, sometimes people can feel nauseous and lightheaded when they are having severe gut spasms, but it would be very unusual for IBS to cause vomiting or fainting.

Especially in view of your age, I would recommend that you talk to your GP straight away to see whether you need some further investigations for a different underlying cause.

Q I often get attacks of itchy thrush and am aware that there is some odour in my genital area at the end of the day, which means I now have a twice-daily shower. I normally use shower gel, but would it help if I switched to a special wash for the intimate area? And if so, will it help to wash inside my vagina?

A The skin of the vulva contains sebaceous glands that produce sebum, an oily substance that provides lubrication, as well as normal sweat glands like those found elsewhere on the body, and special apocrine sweat glands, which are also found in the armpits and produce sweat that has an odour.

Together these produce an acidic protective moisturising film and it is normal for this to smell slightly a few hours after washing.

The lining of the vagina is more delicate and contains a mix of bacteria that are essential for vaginal health, and it is normal for the vagina to produce about 3ml of acidic discharge each day.

Using soap (which is usually very alkaline) can disrupt the protective acid layer and although a cleanser is less likely to do this, many contain fragrances and perfumes, which can be an irritant.

The best cleanser for the vulva is plain water, but if you feel that is not enough, then use a gentle cleanser with no fragrance, either natural or synthetic, that won’t alter the levels of acidity.

There is no need to buy a special intimate wash, which are often more expensive than other cleansers, and there is certainly no need to use one that suggests it blocks odour or detoxes your genital area – in fact, that is the last thing you should do.

Also, you should never wash inside the vagina, even with water, as this will disrupt the natural protective layer and make you more susceptible to infections.

You say you are prone to thrush, but that itching may be due to skin irritation from your frequent washing. Next time you think you have a yeast infection or you feel the smell is particularly strong, contact the practice nurse at the surgery and ask if you can have a swab test to check if you do actually have an infection. In the meantime, please go back to just one gentle daily wash.

● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.