I’m on statins. But do I actually need an op to unblock my arteries?

I HAD an angiogram recently, and the results were a shock to both me and the cardiologist. Sixteen arteries connecting to my heart are clogged and very thin. The doctor has prescribed 20mg atorvastatin and 81mg aspirin daily and I am taking fish oil caps

You do not give any details about why you were given an angiogram (a type of X-ray to examine the blood vessels). But the fact that you have been diagnosed with coronary heart disease before any damage has occurred is a relief, as you are now on protective medication.

I should explain that the two coronary arteries (and the smaller vessels branching off them) are the heart’s only source of oxygenated blood. So a blockage here (due to the build- up of fatty deposits, called atheroma or plaques) is very critical.

The danger is that it will deprive part of the heart muscle of blood — triggering a heart attack.

Your letter mentions 16 arteries being clogged — perhaps you mean 16 points of severe narrowing? But wherever these are, you are now protected by the atorvastatin, which, along with the aspirin, helps prevent blood clots forming and blocking arteries completely.

If your cholesterol drops low enough, so that your LDL (lowdensity lipoprotein, often referred to as the ‘bad’ cholesterol) level is 2mmol/litre, the plaques of cholesterol are likely to reduce in size.

Your dose of atorvastatin may be increased to 40mg or higher in due course to achieve this.

For

many patients, treatment with tablets will be sufficient, even if the plaques are widespread. But some people have plaques that are large enough to pose a serious threat. Where possible, these patients are offered angioplasty.

In this procedure, a tiny balloon on the end of a catheter is threaded up an artery in your arm and inflated near the obstruction. A stent — a small metal mesh tube — is then inserted to hold open the artery. Doctors may decide that this procedure will not sufficiently protect the patient from a heart attack or improve their blood flow, in which case an operation to bypass the obstruction may be carried out.

This is a major operation where the chest is opened up and a pump is plumbed into the circulation to take over the job of the heart during the operation, while the surgeon connects lengths of vein ( taken from the legs) to the coronary arteries to divert the flow past the obstructions.

up to four vein grafts can be added. The decision to carry out a bypass, rather than a less invasive angioplasty, is made by the cardiologist and cardiothoracic surgeon.

Which procedure is chosen depends on what your angiogram has revealed and on what will result in the best and safest outcome. My advice is to accept the recommendations of those experts. I WAS diagnosed with housemaid’s knee in May. Since then, I’ve been using a support bandage and have avoided excessive kneeling.

The swelling has subsided slightly, but I am a keen runner — I attend a weekly 5k park run, take part in the occasional 10k and have been training for a half marathon.

Is it safe to run at a gentler pace or should I stop? I am 49.

Philip Hollowell, Wallington, Surrey. THE medical name for housemaid’s knee is prepatellar bursitis — the patella being the kneecap. It is essentially a swelling at the front of the knee, and usually occurs as a result of repeated pressure.

We see it in people who spend a lot of time kneeling as part of their job — for example, professional carpet layers.

There is a similar problem known as clergyman’s knee, which is presumably associated with the pressure applied when kneeling at prayer.

The swelling occurs when there is damage to a bursa — fluid-filled sacs under the skin, usually around the joints, which act as a cushion against friction between the tendons and bones.

They can also form between bones and the skin.

(There are other less common causes of bursitis, such as the inflammatory conditions gout and rheumatoid arthritis, or infection, which can develop after, say, kneeling on a drawing pin — and these may be more painful.)

AS

You have had this problem for more than six months, it is classed as chronic bursitis. The swelling does usually subside after a few months, as you have discovered, but only if you completely avoid kneeling.

If you cannot avoid kneeling altogether, I suggest that you use protective cushioning.

Wearing a knee support, as you do, is also a good idea — the firm, tubular, elastic garments you can buy from a chemist are ideal.

It may be tempting to ask a doctor to draw off the excess fluid using a needle and syringe but, in most cases, this should be avoided, as it can open a highway for germs.

Some doctors inject a steroid into the bursa to reduce inflammation, however that also carries an infection risk.

Bursitis on the kneecap is unlikely to be connected to running, and I cannot see a problem with you continuing this hobby.

But, to be on the safe side, you could try running at a gentler pace, just in case your technique is somehow aggravating the problem.