DEAR DR. DONOHUE: My cholesterol rose from 216 a year ago to 238. My good cholesterol increased from 93 to 117, exceeding the increase in my total cholesterol. If a total cholesterol higher than 200 puts a person at risk, but the increase is good cholesterol, does the total count matter? – J.K.

ANSWER: Cholesterol is cholesterol. What makes it good or bad has to do with the protein it’s linked to. The linking protein acts like a truck transporting cholesterol through the blood. HDL (high-density lipoprotein) cholesterol, the so-called good cholesterol, is on a protein truck that takes it to the liver for disposal. LDL (low-density cholesterol) – bad cholesterol – is on a protein truck that dumps it on artery walls, and it can eventually occlude those arteries.

A reading of 200 mg/dL or lower (5.17 mmol/L) is the goal for total cholesterol. However, if most of total cholesterol is good cholesterol, then the upper total-cholesterol reading can be liberalized.

You can solve the problem by obtaining the ratio of total cholesterol to good cholesterol. That means you divide the total cholesterol by the HDL cholesterol number. A ratio of 5 for a man (4.4 for a woman) puts a person at an average risk of heart attack and stroke. A ratio of 3.4 for a man (3.3 for a woman) cuts the risk in half. A ratio of 9.6 for a man (7 for a woman) doubles the risk. These ratios can be obtained using either the Canadian or the United States units for measuring cholesterol.

Your latest cholesterol readings give you a ratio of 2.03. That’s excellent. You don’t have to be concerned by the rise in your cholesterol number. It’s all good cholesterol.

The cholesterol story is told in the booklet Controlling Cholesterol. Readers can order a copy by writing: Dr. Donohue – No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: In the past my gallbladder has given me problems, but not very bad ones. For the past month it has bothered me with pain, and my doctor sent me for a test that showed I have gallstones. She told me to watch what I eat. I asked if there was any medicine I could take, and she repeated to watch my diet. I would like your opinion. – C.V.

ANSWER: The pain of a gallstone attack is usually felt in the upper right corner or the upper midsection of the stomach. It can spread to the right shoulder, the right shoulder blade or the area between shoulder blades. Quite often people vomit during an attack.

I know of no diet that gets rid of gallstones. Staying away from fatty foods, fried foods and refined sugars might lower the chances for another attack, but diet doesn’t dissolve the stones.

Medicines can dissolve gallstones, but the stones have to be small. Furthermore, it takes a long time, and stones often re-form after the medicine is stopped.

The chances of a second attack are pretty high. Many doctors, therefore, advise their patients who have had gallstone attacks to have their gallbladder removed. Today such surgery is often accomplished with a laparoscope. Small incisions in the abdomen permit the doctor to insert the viewing scope and cutting instruments to remove the gallbladder. Recovery time is short, relative to ordinary gallbladder surgery.

DEAR DR. DONOHUE: Can you explain what costochondritis is? It hurts to breathe. Can you tell me the cause or offer any treatments? – A.H.

ANSWER: Costochondritis is an inflammation of the cartilage (“chondro”) that attaches a rib (“costo”) to the breastbone. The cause is something that has not yet been discovered.

Inflammation of one or more of those cartilage attachments makes breathing painful, coughing torture and twisting unbearable.

Simple pain relievers like Tylenol can tide some people over the period of inflammation. Anti-inflammatory medicines like ibuprofen also help. If the pain keeps recurring, an injection of cortisone into the area of pain can usually quell it.

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. Readers may also order health newsletters from www.rbmamall.com.