DEAR DR. DONOHUE: My cardiologist gave me a transesophageal echocardiogram and said I have an opening between heart chambers. He called it a patent foramen ovale. He said it could be repaired by passing an instrument from a leg vessel into the heart. If I have this procedure done, I can come off blood thinners. I had a stroke last year, and that’s the reason I take blood thinners. Do you have information about this procedure? – G.C.

ANSWER:
During fetal life, blood does not go through the fetus’s lungs. It passes through a hole in the wall between the upper right and left heart chambers. The wall is called a septum, and the hole is a foramen ovale. The foramen ovale closes by the third month of life. Yours has stayed opened (“patent”).

Many people have a patent foramen ovale and suffer no consequences. You, however, had a stroke. A clot in one of the body’s veins passed through the open hole between the atria and was carried by the circulation to your brain. That caused your stroke.

People who have had a stroke and have a patent foramen ovale should have the hole closed, lest they suffer another stroke. Blood thinners are good preventive medicines, but they are also burdensome to take.

The technique your doctor mentioned is much like having a heart catheterization to inject dye into heart arteries. Once the dye is injected, X-ray pictures disclose obstructions to the flow of blood in those arteries.

The catheter (a slender, flexible tube) used to close heart holes is a special kind of catheter. It has a device that opens up and plugs the hole once the doctor has maneuvered the catheter into position.

Just as for X-ray pictures of heart arteries, this special catheter is inched into the heart by threading it through a groin artery. Prior to the days of catheters, the only way patent foramen ovales could be closed was by open-heart surgery.

DEAR DR. DONOHUE: I understand that lipomas are fatty tumors. Do you know what causes them? Can they become cancerous? I have several of them. – B.M.

ANSWER:
Lipomas are common. I don’t know their cause. In a moderately large city, you could easily fill a large football stadium with all that city’s citizens who have a lipoma.

They are fatty tumors. They are soft, painless masses whose favored site is the trunk. Other frequent places where they are found include the neck, forearms and under the arms.

They are not usually cancerous. Large lipomas greater than 4 inches (10 cm) in diameter and lipomas on the thigh have to be watched with extra care. Such lipomas might be cancerous. Any lipoma that begins to grow rapidly greatly increases the suspicion of cancer.

If lipomas interfere with movement, are in a sensitive location or are cosmetic eyesores, a doctor can remove them without much ado.

DEAR DR. DONOHUE: Some years ago, when my now-grown children were young, we were warned not to give aspirin to children to lower their temperature when they had a fever. There was talk that giving feverish children aspirin could put them into a coma.

I don’t hear this spoken of today. Why? Was it a false alarm? – W.R.

ANSWER:
The aspirin-fever combination can cause Reye’s syndrome.

Some years ago, the association between aspirin and Reye’s syndrome was made. After that, doctors were able to recognize the syndrome because guidelines were established. It usually happens to children whose fever is caused by chickenpox or influenza. Lowering the elevated temperature of children with those illnesses (and a few others) with aspirin can bring on a syndrome where the children begin to vomit, become belligerent and then appear confused. The confusion can progress to seizures, stupor and coma. Brain swelling causes those symptoms. In addition, liver failure occurs.

Thanks to an extensive campaign to educate people about the danger of lowering a child’s fever with aspirin (unless the doctor approves), the number of cases of Reye’s syndrome has dwindled to such a low number that cases of it are rare.

DEAR DR. DONOHUE: When our son was a teenager, he suffered from seizures. He was put on medicine for seizure control and remained on it for six years. He never had one when he took the medicine. He is now off medicine and has not had a recurrence.

My husband and I happened to be at a gathering that my son and his wife were also attending. I saw my son drink alcohol. When he was seeing the neurologist and taking medicine, the doctor told him not to drink alcohol. Is it safe for him to do so now? – X.B.

ANSWER:
A one-time seizure patient who has been off medicine for years without having the seizures come back has the odds stacked in his or her favor of not experiencing seizure return.

It still is a good idea for those people to be quite careful about alcohol intake throughout their lives. One or two alcoholic drinks in one day ought to be the limit.

If your son wants to be assured that alcohol will not set off seizures, he can obtain that assurance by abstaining from alcohol.

To answer a question like this one, I put myself in the shoes of the person on the receiving end of the advice. In this case, I would opt not to drink alcohol.

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.



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