DEAR DR. DONOHUE: I am a 70-year-old man, active and in good health. I am a smoker. I would like your advice. I have a blocked carotid artery that requires fixing. I have a choice of surgery or angioplasty. I would like to know the dangers involved. Which would you recommend? – Anon.

ANSWER: On both sides of the neck is a large artery, the carotid artery. If either the right or left carotid artery is significantly plugged with a buildup of cholesterol, fat and clotting cells (plaque), blood flow to the brain is in jeopardy, and the person is at high risk of having a stroke.

We now have two ways of dealing with this common problem. One is an operation. The surgeon opens the neck with a scalpel, exposes the carotid artery, enters it and peels away the plaque that clings to the artery wall. This surgical procedure is a carotid endarterectomy. Surgical dangers include stroke, bleeding and infection. Death is possible but that possibility is quite small. The dangers of the operation fade when they’re compared with the dangers of doing nothing and having a stroke.

The second approach to the problem is angioplasty. The doctor inserts a soft, narrow tube into a groin artery, advances it to the carotid artery and removes the plaque through the tube. Quite often, the doctor, at the conclusion of cleaning the artery, inserts a stent through the tube. A stent is a metal mesh that expands to keep the artery propped open. The dangers of angioplasty are similar to the dangers of an endarterectomy. Since there has been no cutting of tissues, recovery is faster.

Which would I choose? I’d ask my surgeon which is the better choice for my particular circumstances. I would also ask my family doctor what doctor has the best results for either procedure.

I don’t mean to nag, but you must stop smoking.

DEAR DR. DONOHUE: My chest X-ray report states: “There are old healed, calcified granulomas at the left lung base. Several calcified lymph nodes are noted. This is consistent with old granulomatous disease.” I had a breast operation 45 years ago. Does this chest X-ray have anything to do with that operation?

I am 83, healthy and busy at my job in an office. – M.N.

ANSWER: Granulomas are small mounds of dead cells that succumbed when they fought off an infection. A calcified granuloma is one that the body has covered with calcium to create a coffin for the cell remains. Calcified granulomas are evidence of old infections but not active infections. The TB germ and fungi are examples of infections that form granulomas. You do not have TB. You do not have a fungal infection. In the past, you might have had either. They have nothing to do with your breast operation.

You are 83, healthy and still working. Don’t let this report upset you. Bring it up with your family doctor at your next visit.

DEAR DR. DONOHUE: I have to disagree with you on the matter of a virus being the only way to catch a cold. We would have more cures for illnesses if more doctors were not so set in their ways. – E.G.

ANSWER: I’m only slightly set in my ways. However, since Louis Pasteur in the late 19th century pretty well proved that germs – viruses, bacteria, etc. – are the causes of infectious diseases, I cling to his germ theory. The only germs that are implicated in colds are viruses.

DEAR DR. DONOHUE: Two years ago, I contracted a liver abscess, which led to septic shock, acute respiratory distress syndrome, kidney failure, edema and multi-organ failure. The sepsis turned out to be due to Klebsiella in the abscess. What could have caused the abscess, and how can it be prevented? – K.C.

ANSWER: You didn’t have a bad time. You had an awful time. Klebsiella is the name of a bacterium, a distant relative of the E. coli bacterium of which you might have heard. Klebsiella is all over the place. It usually causes urinary tract infections and pneumonia. How it got into your body and how it landed in your liver is something that you might never learn. It could come from a colon diverticulum, from the appendix or from a gallbladder infection. You’re not likely to see a repeat.

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.

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