BEGINNING THIS WEEK, DR. KEITH ROACH WILL BE ADDED TO THE BYLINE OF TO YOUR GOOD HEALTH.
DEAR DRS. DONOHUE AND ROACH: I am 84 years old, and I have been diagnosed with a carotid artery bulb. It seems to be growing with time. I have had an ultrasound of the artery, and the only diagnosis is some calcification. I cannot get any answers as to the possible cause and long-term consequences of having this enlarged artery in my neck area. Perhaps you can give me an answer. — J.P.
ANSWER: A "carotid artery bulb" isn't a diagnosis; it's the name of an anatomic structure. Also called the carotid sinus, it is a normal structure in the internal carotid artery (the major artery going to your brain), right where the artery begins.
I suspect the diagnosis is atherosclerosis of the carotid bulb: artery hardening or thickening of the artery walls with cholesterol and calcium. It puts people at higher risk for stroke. In addition, having atherosclerosis in the carotid bulb tends to mean that the same disease can be found in the arteries of the heart, which increases your risk of heart attack. The most common risk factors for this condition are smoking, high blood pressure, high cholesterol, diabetes and a family history of heart disease.
Fortunately, these risks can be lessened, even in an 84-year-old, with good diet, regular exercise and, in many cases, medication to lower cholesterol. If there is severe blockage in the carotid artery, surgery is occasionally done. Most people with this condition also should be taking aspirin, unless there is some reason not to. Internists and cardiologists usually manage the medical side of this condition: Surgery, if necessary, is done by a vascular surgeon.
It's also possible that "enlargement" in your case could be an aneurism of the carotid artery at the carotid bulb. This is an abnormal dilatation of the artery caused by weaknesses in the artery wall. Aneurisms are serious, and if very large (or getting larger), often require surgery by a vascular surgeon.
DEAR DRS. DONOHUE AND ROACH: My question is about taking blood pressure readings. I am 87 years old, female, about 5 feet, 5 inches tall and weigh about 130 pounds. When I go for a checkup with my general practitioner, the nurse takes my blood pressure before I see the doctor. The cuff feels comfortable, and the reading is always in the normal range. I have had my blood pressure checked at other places (clinics, etc.) and usually the cuff is inflated very tight (so tight that it hurts) and the reading is very high. If the cuff is inflated too tightly, could it cause a high reading? — I.S.
ANSWER: High blood pressure is one of the most common medical conditions, and correct treatment of blood pressure is essential in order to reduce the risk of heart disease and stroke. It is not uncommon for blood pressure to vary from day to day, or even during a single day, but the changes you describe suggest two possibilities.
The first is that the reading at your own doctor's office is right, and the other places are wrong, which is probably the most likely. Having blood pressure tested in a new place or by someone you don't know certainly can cause the reading to be elevated. Automated blood pressure cuffs in pharmacies, etc., are sometimes right but often are wrong — occasionally spectacularly. A very high pressure in the cuff, high enough to cause pain, can cause the blood pressure to go up, but not usually high enough to put people into the hypertensive range.
Another possibility is that the nurse in your doctor's office isn't inflating the cuff high enough to get the correct reading, or deflating the cuff too quickly. The wrong-size cuff can lead to large errors in blood pressure readings. While all of these are possible, a trained nurse who takes blood pressure readings every day is not likely to make errors consistently. You can ask your doctor to double-check the nurse's reading.
High blood pressure is one of the most common ailments for the general population. The booklet on it describes what it does and how it's treated. Readers can order a copy by writing: Dr. Donohue — No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.