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No need to panic about those blocked arteries

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Earlier this year, tests revealed that the arteries supplying my brain have become slightly furred. The doctor prescribed a daily aspirin and said no follow-up was necessary.

However, I was so shocked that I lost all desire to ask any questions. I am widowed and live alone, and it horrifies me that I am now at risk of a stroke. I have a healthy diet, am slim and only retired from nursing this year (I am already taking statins, but my cholesterol is within normal levels).

I would really appreciate your advice on how to manage this.

Valerie Suttle, by email.

Effective treatment for a blockage greatly reduces the risk of stroke

First let me reassure you that you are in a good position — slim, healthy and active — but I can understand your alarm.

Your condition occurs when cholesterol deposits (plaque) build up in the two carotid arteries that carry blood to the brain.

As you’ll be aware from your nursing training, these vessels are about the diameter of a slim pencil, and the blood flow through such large arteries is considerable. Cholesterol build-up in the carotid arteries does not usually cause symptoms, but if left uncontrolled, clots can form on them.

This, as you rightly point out, can lead to the clots breaking off and blocking a smaller vessel in the brain — causing a stroke.

However, a blockage does not always mean that a stroke is inevitable.

I once had a patient in his 80s who had no blood flow at all in either of his carotid arteries — they were completely blocked. Instead, his brain gained all of its blood supply from two much smaller arteries at the back of the neck — yet his general function and mental performance was good for his age.

Nevertheless, vigorous and effective treatment greatly reduces the risks. This means being as active as possible (at least one good walk every day), losing weight if overweight, and, if applicable giving up smoking.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.Always consult your own GP with any health worries.

The statin you take to lower your cholesterol must be at a dose that lowers your LDL ‘bad’ cholesterol, to a level lower than 2.5 mmol per litre; some patients need 40 mg or 80  mg daily to achieve this.

Indeed, at high enough doses, statins can actually shrink these cholesterol build-ups — as a recent study using a technology called endovascular ultrasound scanning has just shown for the first time.

Furthermore, control of blood pressure is critical. Even in your 60s and 70s it is possible to aim for a consistent systolic pressure (the pressure when the heart contracts) of 120mmHg.

This is the top number in a blood pressure reading, and it is worth buying your own machine to monitor this, as well as asking your practice nurse or GP to help you achieve it. Finally, the aspirin is vital to help reduce the stickiness of your blood so there is no unwanted clotting.

Be diligent about taking your medicines, follow the  lifestyle measures with enthusiasm, and relax: the future is not as bad as  you fear.

Recently, I have been suffering with a running nose that is more or less constant. Numerous tests proved inconclusive, and I was told to douse my nose with a mixture of bicarbonate of soda and sugar. Is there anything else that can help?

Brian Richards, Bridgend.

From your description, it seems to me as if you are suffering from a condition that is, somewhat inelegantly, referred to as ‘old man’s drip’.

The medical term is chronic rhinitis. It’s caused by inflammation in the nasal passages. This causes the blood vessels to swell, which triggers mucus cells in the nose to produce a discharge — that’s why the symptoms of rhinitis are blockages, a runny nose and sneezing.

The inflammation can be caused by an allergy, but I do not believe this is the case for you as your specialist will have included tests for allergies in their investigations. We must assume these proved negative, or you would be on an effective treatment by now.

Another possibility is non-allergic rhinitis — this affects over a fifth of adults and becomes increasingly common with age.

There are a number of different causes. The first is a malfunction in how the nervous system controls the blood vessels in the nose and sinuses, causing them to expand (vasomotor rhinitis).

In women, rhinitis can also be caused by hormonal changes such as an increase in oestrogen.

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Rhinitis may also be induced by medication: long-term use of nasal decongestant sprays can be a trigger, as can some blood pressure drugs, gabapentin (used for  epilepsy and nerve pain), aspirin and non-steroid anti-inflammatory drugs.

Then there is gustatory rhinitis, often occurring an hour or two after eating, and most common in elderly men. It is thought that food, for some reason, causes vessels in the nose to dilate.

In your longer letter, you described two very important tests, and I am relieved they came back clear. The first was to check that the nasal discharge was not due to a leak of cerebrospinal fluid, the clear fluid that bathes the brain and spinal cord.

There is a thin sheet of bone at the top of the nose that separates the nasal passages from the brain, called the cribriform plate. Even a minor head injury can trigger a crack in this plate, triggering fluid to leak down the nose. A chemical test can detect this fluid.

You also tell me you had an endoscopy — where a long, thin, flexible camera is put up the nose to check for nasal polyps or other abnormal growths. These tests came back negative, and you have been told to regularly use an alkaline nasal douche.

This should be made from a teaspoon of ordinary salt (not sugar) and a teaspoon of bicarbonate of soda dissolved in a pint or so of water, and stored in a bottle in the fridge.

Snorted up twice daily, this can be very soothing to an irritated or inflamed nasal lining. I suspect there has been an error of communication with yourself as I have never heard of sugar being recommended as opposed to salt — something for you to check with the clinic where you were treated and advised.

If this fails, another option is a spray containing ipratropium, which must be prescribed by your GP. Studies have shown that it is effective. I hope you find relief.

By the way... 

Liquid soap is ruining my hands

A dermatologist was telling me recently about the increasing number of patients he’s been seeing with a troublesome allergy to a commonly used preservative, methylisothiazolinone.

This is found in many products we all use. At low concentrations it’s highly effective as a biocide — an agent added to prevent unwanted growth of bacteria and yeasts.

In cosmetics the preservative is added to foundations, eye-shadow, and moisturisers; it is also used in shampoos and conditioners, liquid soaps, baby wipes and bubble baths.

Check the ingredients of your soap if you have recently developed irritated, cracked or itchy skin

It’s also in household products such as paint, adhesives, printing inks, polishes, detergents and fabric softeners.

The substance is safe and non-toxic but European regulations now permit stronger concentrations than previously allowed. It seems these greater quantities to which we are all exposed could be increasing the incidence of skin trouble.

The problem is that the additive is so widespread that when an eczema or dermatitis occurs it can be very difficult to track down the culprit. And once you do identify it as the source of your trouble, it is difficult to avoid.

General practice has for some time been banned from using good old-fashioned bars of soap, due to regulators believing soap was in some way dangerous, and could harbour bugs, so we are obliged to use liquid soaps.

Within months of starting to use these I suffered a painful cracking eczema on my fingertips, so severe that I could not even do up my shirt buttons.

For a long while, I was unable to work out the cause, but what is effectively an industrial injury did slowly resolve after I started to use an eczema emollient (Dermol) as a soap substitute.

Now my hypersensitivity has become quite a problem as most bathrooms and most public washrooms supply liquid soaps, and though fragrant and delightful to use, even one single exposure triggers a cascade reaction and within hours my fingertips are cracked, peeling and very sore, taking days to recover despite frequent use of safe moisturisers, cortisone creams and all measures.

The only way to avoid this compound is to check the ingredients list.

Be aware of this widespread and escalating problem, and if you know anyone who has recently developed irritated, cracked or itchy skin, and previously had healthy skin, alert them to this potential source of trouble.


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