Ask the Doc...
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Our panel of doctors offers advice and suggestions in answer to questions from readers.
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Heart trouble
S. Venkiteswaran:
The patient, Mr. Chandru, has already undergone two angioplasty operations in the last 6-7 years with three stents. The problem was 90-95 per cent block. Would you be kind enough to suggest ways and means to avoid further deposition of platelets/fat/cholestrol in the heart arteries? The patient has normal cholestrol and slightly higher triglicerides. Please suggest ways to increase HDL and lower LDL. The blocks had occurred even when the cholesterol level is within normal limits. Please oblige by suggesting the proper food style, life style and other things to avoid further blocks. The patient is around 60 years and is a pure vegetarian.
Dr. P. Ramachandran, Senior Consultant Cardiologist, replies:
Mr. Chandru may have "abnormal tissue growth" at the stented site and using drug-coated stents can lessen this. The stents are impregnated with minute amounts of powerful inhibitors of tissue proliferation. When after the stents, patients require another mode of treatment for angina CABG surgery can be advised. Coronary blocks reflect a long pathophysiological process. For long periods, the depositions inside the coronary arteries may remain silent and a sudden trigger can expose the deposits into the lumen causing acute symptoms with risk of MI due to occlusion of lumen and propagation of bits of blocks to distal vascular bed.
Vegeterianism and apparently normal cholesterol levels do not give immunity from CAD. The risk factors are numerous — age, sex, hypertension, diabetes, smoking, obesity, lack of physical activity, hyper or dyslipidaemia. The newer risk markers are lipoprotein (a); homocystine and fibrinogen. Interestingly, when many risk factors are present individually, they may not be harmful but their "interaction" is much more harmful. "Resting" state factors can get "oxidised".
Absolute change in lifestyle - healthy, balanced diet, regular walking, abstinence from smoking and drinking, fixing lower targets for BP, sugar and cholesterol in such patients is beneficial. HDL cholesterol protects by suppressing the harmful LDL and can be increased by drugs - Fibrates and niacin. There are reports of weekly injections of APO-Milano-A to increase HDL. Currently statins are recommended to all patients with heart disease irrespective of their cholesterol levels.
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Tumour?
Santosh:
I am a 28 year old studying in the United States. I have recently developed some lumps on my body — two on the stomach, two on inner thighs and one on my left arm just above elbow. I showed this to a university doctor and he said they were benign. But I spotted four more. For last six months I have been under tremendous stress about my finances. I had a chronic problem of uneasiness in my stomach. All through the day I feel severe strain in my stomach except at night. But now I am overcoming that stress problem. Please suggest what I should do.
Dr. Uma Krishnaswamy, General Surgeon, replies:
As indicated by your University doctor, these are benign lumps that are no cause for worry. These may arise either from fat or from nerves under your skin. They are unrelated to stress. No treatment is required for these. If it becomes problematic, in terms of increase in size or pain, then the lump may be removed by a minor operation.
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