Why won’t they unblock my neck arteries?

I RECENTLY had an ultrasound scan for pain on the left side of my neck and was told that I had a calcified carotid artery.

The hospital told me to take atorvastatin (which I cannot have) and clopidogrel (which may upset a separate stomach condition).

In a letter to my GP, it said: ‘Refer him to us when he develops a stroke or heart attack.’

Why must there be a lifethreatening incident before it does anything? I am 68. Graham Wiggins, Dartford, Kent.

Wof and, or hardenoccursposes ThisThe ‘calcified’. cholesterolover plaquesgreatis in anda time,an sign HEN becomescalciumhavethe risks narrow importantcause have have that lining.for built an turnedthe future accumulatedfatty and, deposits calcified,up arteries artery, arteryplaqueshealth. inside chalky,if this to it

example,even arteriesIn And thea heartif — coronaryit it the can affectsattack. two cause arteries,majorthe angina carotid bloodforor vesselscan The lead dangerthatto a supply stroke.is that the the brain intima,— it the blood artery’sclots form lining,on the ulcerates roughened and surface.detach Partsand travelof the clotup may into then the brain, blocking smaller vessels and causing a stroke.

Carotid artery disease may not cause any symptoms at first, and plaques are often discovered only by chance if a scan is carried out for some other reason (as in your case — your calcified artery will not have been the cause of your neck pain, but was discovered because of it).

Sometimes, carotid arteries are only spotted after someone has already had a transient ischaemic attack (a ‘mini stroke’) or a major stroke.

Whatever the circumstances, when these plaques are found it is imperative to promptly prescribe treatment to make them stable — in other words, less prone to clots forming on their surface — and ideally shrink the plaques, to protect against future strokes.

The only way to do this is by taking a statin at the correct dose, along with another drug to make the blood cells involved in clotting (the platelets) less sticky, such as low-dose aspirin or clopidogrel.

This combination is what was prescribed in your case.

There is a surgical option, called carotid endarterectomy, which involves removing the cholesterol deposits from the carotid artery.

This has been extensively studied and, in selected cases, is effective, though patients are still treated with a statin both before and after the operation.

It is only recommended for those with greater than 50 per cent blockage in the artery, perhaps because the operation itself poses risk of a stroke.

However, if the artery is blocked completely, then the danger is greater than the benefit.

Your scan will have revealed the extent of the blockage; your right carotid artery should also have been scanned.

I would recommend that you ask your GP to refer you to a vascular surgeon for detailed advice about your situation.

MEAN WHILE, I suggest that you reconsider the reasons why you can’t take atorvastatin. You do not specify in your letter why this is, but some people are concerned about statins’ possible side-effects, such as muscle pain.

Readers of the Daily Mail will be aware that there is a great debate between the country’s two leading medical journals — the BMJ and The lancet — about whether, for otherwise healthy people, the risks of statins’ side- effects are higher than acknowledged.

The BMJ says the risks are greater. My personal view is that the risks are overplayed.

I’ve found side- effects can be prevented by starting my patients at a low dose — 5mg once weekly, rather than 20mg or 40mg daily — and working up slowly over several months: 5mg twice weekly, then three times weekly and so on.

As for clopidogrel, it may cause gastric side- effects such as indigestion, but you can take steps to guard against this if there is a good reason to take the drug, as there is in your case.

In the meantime, I’d suggest eating at least three tomatoes a day — the gel surrounding their seeds contains a substance that alters the stickiness of the platelets, reducing their tendency to trigger the clotting process. AN ENDOSCOPY last year revealed I have a hiatus hernia. It now protrudes a lot and makes my clothes hang awkwardly. I take two omeprazole capsules daily and don’t eat spicy food or eat late. I am very conscious of the swelling — is there anything I can do?

Daphne Jones, Torquay, Devon. A HIATUS hernia occurs when part of the stomach pushes up through a defect in the diaphragm — the dome of muscle that divides the chest and the abdomen.

Normally, the diaphragm fits tightly around the lower end of the oesophagus or gullet, and thickened sections of muscle in this part of the diaphragm act as a sphincter or valve to prevent the stomach contents rising. If those muscles weaken, as is common in middle age, the valve action fails and a gap opens up, allowing the stomach to push through the widened space.

This may occur silently — without symptoms — or it may cause symptoms such as heartburn, chest pain or difficulty swallowing.

But what it does not cause is a bulge in the abdominal wall, so your swelling must come from something else.

I would suggest it is a ventral hernia. This is when the contents of the abdomen — mainly the intestines — push out through a weak point in the muscles of the abdominal wall.

THE rectus abdominis muscles, which form most of the front wall of the abdomen, meet in the middle and are separated only by a thin line of connective tissue.

This can pull apart if the muscles weaken and stretch.

Ventral hernia is often caused by being overweight or by earlier pregnancies, and there’s no reason you can’t have these two common problems at the same time.

An ultrasound scan of the abdominal wall should confirm my theory — perhaps your GP will agree to arrange this.

Then it would be a decision about whether to request referral for ventral hernia repair — usually through keyhole surgery to implant a titanium mesh, which strengthens the abdominal wall, and to stitch the abdominal muscles back into place.