To your good health: Determining risk of a stroke

DEAR DR. DONOHUE: I would like to know the risk of having a stroke when a carotid artery has a blockage. I was told that doctors don’t go by percentage of blockage now. How is the risk determined? — K.C.

ANSWER: An obstruction in the carotid artery, the neck artery that supplies the brain with blood, is not the only cause of a stroke. A piece of a blood clot that has broken off of a main clot elsewhere in the body and been swept into a brain artery is another cause of stroke. I mention this to keep it clear that a blocked carotid is but one risk for a stroke.

The doctors I know still use percentage of reduction in the interior of a carotid artery as a criterion of stroke risk. With a 60 percent to 70 percent or greater narrowing of the carotid artery, people benefit from the opening up of the artery, using a variety of procedures. Some experts feel that a 60 percent narrowing requires only blood-thinning medication, such as aspirin. Others feel that surgical removal of the blockage is indicated.

Other factors have to be considered: the patient’s age, the patient’s wishes and the patient’s health problems unrelated to the artery problem.

The booklet on strokes gives timely information on this dreaded cause of death and disability. Readers can obtain a copy by writing: Dr. Donohue — No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am an 85-year-old female, and my doctor has suggested a colonoscopy. I find it a degrading test. The doctor didn’t say why I needed it. Should a woman my age have it? — K.C.

ANSWER: The American College of Physicians recommends against screening colonoscopies for people 75 and older or for those people with a life expectancy of less than 10 years. Some add that screening can be stopped only if prior colonoscopies have been normal. No one I know recommends screening at 85.

DEAR DR. DONOHUE: I am a World War II vet. I told the Department of Veterans Affairs doctor that I have nervous feet. If I sit in a chair with my feet on a footstool, they always start moving. The same thing happens at night in bed. I can’t get to sleep. Can you tell me what this is? — F.B.

ANSWER: It sounds like a form of myoclonus — brief, involuntary movements of the feet and legs. Most often it happens when in bed, but it also can happen when sitting in a chair. Something in the nervous system has gone wrong. Mirapex and Requip are two medicines used to quiet these movements. See if the VA doctor agrees. It’s not such an uncommon disorder as you might think. It’s often seen with another condition called restless leg syndrome, a funny feeling in the legs that makes a person get up and move around to get rid of the sensation.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. © 2013 North America Synd. Inc.