Dear Dr. Roach: In December, 2013, I had a blood clot in my left eye. It blocked my vision and then passed after about 25 minutes. My doctor had many tests done, and one indicated that I have plaque in my right carotid artery. The left artery is clean. My cholesterol is perfect. My health is and has been perfect.
I have been vegan for 14听years. That diet keeps me healthy. As a result of this clot, my doctor has put me on statin drugs. First was atorvastatin, second was pravastatin. I hated them both. They made my body weak, ache and hurt all over.
Now I am on a third statin, Crestor, which I take every other day. So far no big aches or pains, but it has been only a few days. I do not like to take pills and take only vitamin B-12, baby aspirin and a multivitamin.
Because my cholesterol is normal and healthy, I prefer not to take any pills, but my doctor thinks it will be helpful with regard to the plaque in the carotid artery. Do you think the statin drug is necessary? Are there other alternatives? I would love a second opinion.
E.E.
A vegan diet and good blood cholesterol levels both help ensure a low risk for blockages in the arteries due to cholesterol plaque. Unfortunately, even the lowest-risk person can still get blockages, which may lead to a transient ischemic attack or stroke (you had a special kind of TIA, consisting of temporary vision loss, still often called by its Latin name, amaurosis fugax). Plaque in the carotid artery makes blockages in the heart more likely as well.
Both the statin drug and the aspirin reduce risk of a sudden catastrophic event such as heart attack and stroke, and I would recommend that you continue. I hope you tolerate the Crestor better than the other two. Sometimes, only one of the statin drugs seems to work well for any given person. There are alternative medications to statins, but none is proven to reduce risk to the same degree.
One alternative to medical management is surgery. Surgery is indicated for most people with a blockage in the carotid of more than 70 per cent.
It sounds like you are very healthy, but everyone with blockages in arteries should look carefully at their lifestyle, including diet, exercise and especially smoking, to see how to reduce their risk without surgery or medication.
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Dear Dr. Roach: One encounters many forms of 鈥渉and sanitizer鈥� products these days: in medical waiting rooms, restrooms, public places and in our kitchen.
These are waterless, very quick drying products; we even have them in our automobile.
When one has many daily occasions to clean the hands, is it better for your skin to use soap and water, or the modern hand-sanitizers?
N.M.G.
The jury is out on which is more effective, if you compare good technique with one against the other. Both effectively reduce bacteria on the hands. However, alcohol-based sanitizers are easy to use, portable, fast and are less irritable to the hands than repeated washings. There is better compliance with them and so they are more effective in the real world.
Sanitizers are not effective against all germs. They do not kill the spores of Clostridium difficile, a cause of severe diarrhea. However, soap and water wash the spores off and are effective where sanitizers are not, so soap and water should be used in cases of known or suspected C. diff diarrhea. Sanitizers also are not effective against norovirus, another infectious diarrhea. They also can鈥檛 remove grease.
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Dear Dr. Roach: I鈥檓 61 years old. About seven years ago, I noticed my stool had taken on a consistency somewhere between solid and a diarrhea state. I have never had any occurrence of constipation, regardless of what I eat. I鈥檝e heard many folks my age (or even 15 years younger) would love to be in my shoes. My stool used to come out in a normal, harder state, and this current 鈥渕ushy鈥� excrement signifies a change in my colon鈥檚 functioning. Have you heard of such a thing? Should I be concerned? I鈥檝e never had a colon-oscopy. Am I at risk for cancer? There is no history of cancer in my family.
A.
This is not a usual warning sign of colon cancer. However, a change in bowel function should prompt an evaluation. Get the colonoscopy. Most people with colon cancer don鈥檛 have a family history.
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