Blocked carotid artery in­creases stroke risk

The News Herald (Willoughby, OH) - - Your Daily Break - Keith Roach Con­tact Dr. Roach at ToYourGoodHealth@med. cor­nell.edu.

DEAR DR. ROACH » I have a carotid artery prob­lem. My right side is 79 per­cent blocked, but the left side is clear. My eye doc­tor said that surgery would not be nec­es­sary be­cause the left side could take over if the right side is blocked. My reg­u­lar doc­tor will nei­ther con­firm nor deny this. I am 85 years old and would like to avoid surgery. — J.L.W. DEAR READER » Al­though there are con­nec­tions be­tween the left side and the right (the com­mu­ni­cat­ing ar­ter­ies in the cir­cle of Wil­lis), a sig­nif­i­cant block­age on one side puts you at risk for a stroke on that side, even if the other side is clear.

In gen­eral, sur­gi­cal treat­ment is only rec­om­mended for peo­ple with a life ex­pectancy of at least five years, who have a sig­nif­i­cant block­age (de­pend­ing on the guide­line, “sig­nif­i­cant” ranges from greater than 60 per­cent to greater than 80 per­cent) and who have ac­cess to a cen­ter where the risk of death or stroke from the surgery is less than 3 per­cent. In peo­ple who are at high risk from surgery, plac­ing a stent in the carotid artery may be an al­ter­na­tive; how­ever, stan­dard surgery (carotid en­darterec­tomy) is the pre­ferred ap­proach. Peo­ple with symp­toms from the block­age or a his­tory of prior stroke (or a TIA, which is a tem­po­rary stroke-like syn­drome) are at much higher risk.

The av­er­age 85-yearold man has a life ex­pectancy of about six years: Yours may be less or (hope­fully) more and de­pends on your other med­i­cal con­di­tions, ge­net­ics and life­style.

I spent a lot of time try­ing to get spe­cific in­for­ma­tion on rates of com­pli­ca­tions with this surgery from the hospi­tal com­pare sec­tion of the pub­li­cally avail­able Medi­care data­base, but I could not get any­thing more than an over­all star rat­ing (1 through 5) for hos­pi­tals. I would like ex­act num­bers in order to choose the best hospi­tal in my area. I did find some com­pa­nies that rated hos­pi­tals, but they still did not give me the kind of data I wanted to eval­u­ate hos­pi­tals.

Be­fore con­sid­er­ing surgery, how­ever, it’s im­por­tant to rec­og­nize that with op­ti­mal med­i­cal ther­apy, your risk of hav­ing a stroke is only about 1 per­cent per year. Since you haven’t told me about any symp­toms or prior stroke, surgery might not be the best op­tion for you. Op­ti­mal med­i­cal ther­apy con­sists of quit­ting smok­ing (if you do); con­trol­ling blood pres­sure and sugar (if ap­pro­pri­ate); eat­ing a healthy diet, such as the Mediter­ranean diet; get­ting reg­u­lar but not overly vig­or­ous ex­er­cise; and man­ag­ing stress.

DEAR DR. ROACH » I’m drinking al­mond milk and or­ange juice for­ti­fied with cal­cium and vi­ta­min D to get my daily re­quire­ments of th­ese vi­ta­mins. Some­times I use the milk in my in­stant Cream of Wheat or oat­meal, and won­der if heat­ing th­ese vi­ta­mins in the mi­crowave or stove­top de­stroys their po­tency. — D.L. DEAR READER » Cal­cium is very sta­ble and won’t be dam­aged by heat­ing, freez­ing or re­ally any­thing you do to it. Vi­ta­min D also is rel­a­tively sta­ble: Oven-bak­ing foods with vi­ta­min D can de­stroy about half the vi­ta­min, but brief heat­ing does very lit­tle dam­age to vi­ta­min D.

Other vi­ta­mins are not so sta­ble. Vi­ta­min C in par­tic­u­lar is very sen­si­tive: Brief cook­ing or even sit­ting around on a shelf (such as canned vi­ta­min C-en­riched drinks) can de­grade most or all the vi­ta­min C. That’s one of the rea­sons to eat fresh, raw fruits and veg­eta­bles as part of your diet.

Other nu­tri­ents are para­dox­i­cal: ly­copene (a mi­cronu­tri­ent found in to­ma­toes) is con­cen­trated by cook­ing, so ketchup and tomato sauce and paste are the lead­ing sources of this nu­tri­ent in the U.S.

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