DEAR DR. DONOHUE: I had bypass surgery in 1992. Since then, I have watched my diet and my weight. I am also a type 2 diabetic. I have now been diagnosed with three blocked arteries.

I am told I need bypass surgery again. I was also told about a new procedure called enhanced external counterpulsation. According to an article I got off the Internet, the results of this procedure hold up just as good five years later as those of open heart surgery. What do you think of EECP? Would it be the right choice for me, at age 77? Should I opt for surgery? What would you do if you were in my position? – A.P.

ANSWER: Enhanced external counterpulsation – EECP – is a somewhat new procedure used for people with clogged heart arteries and angina chest pain or congestive heart failure. These people aren’t responding to conventional treatment, and corrective surgery is not an option for them.

Three inflatable cuffs encircle the legs from ankle to thigh. The cuffs are timed to inflate and deflate at just the right time and in the proper sequence to send a wave of blood into heart arteries to nourish the heart muscle and to make it stronger and a better pump. A treatment session lasts one hour, and five treatments are given each week for seven to eight weeks.

EECP can increase a person’s ability to function better and to have less chest pain. How long the effect lasts is something that is in question. It might encourage the growth of new heart arteries. I don’t think many doctors feel it serves as a substitute for bypass surgery.

I would go for the surgical treatment unless my heart doctor said that EECP was a suitable alternative for me.

Coronary artery disease – the plugging of heart arteries – is discussed at length in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue – No. 101, 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: Recently I was in the company of a woman who had one of her breasts removed due to cancer. She insisted that she had been told that the two most prevalent causes of breast cancer are: freezing water in plastic containers and then drinking it after it thaws, and cooking food in a microwave oven in a plastic container. Do you agree with her? – J.W.

ANSWER: This information has been falsely ascribed to Johns Hopkins University. It doesn’t come from Johns Hopkins. It isn’t true.

If you freeze water in plastic bottles that were previously used for some other beverage, wash the bottles after each use to eliminate bacteria, just as you would with cups and glasses.

DEAR DR. DONOHUE: What kind of fat is in vitamins A, D, E and K? Does it cause high cholesterol? Does it stay in the liver and cause liver damage? – M.F.

ANSWER: There’s no fat in any vitamin.

Vitamins A, D, E and K are “fat-soluble” vitamins. That means they dissolve only in fatty substances and fatty foods, and they get into the blood through the absorption of fats.

Fat-soluble vitamins are also stored in body fat. If excessive doses of these vitamins are taken day in and day out, high levels can build up in the body.

An overload of vitamin A can lead to liver scarring. Vitamin D in excess raises blood calcium to high levels. Large amounts of vitamin K can work against blood-thinning medicines like Coumadin. Vitamin E in more than the recommended daily dose might bring on heart failure.

CONFIDENTIAL TO JANET: Please write back with your address in the letter. Envelopes are separated from letters. Explain what happened once again, and I will see that the matter is taken care of.

DEAR DR. DONOHUE: My doctor says I have angina. I thought angina was chest pain. When I’m rushing a bit, I get short of breath, but I don’t have chest pain. Would you call this angina? – W.W.

ANSWER: I’d call it angina if I had some other evidence that you have coronary artery disease – heart arteries that are filled with plaque (a mound of cholesterol, fat and platelets stuck to the wall of a heart artery). Chest pain is the primary symptom of angina, but you can have partially blocked heart arteries without having any chest pain or with symptoms other than chest pain.

Older people with coronary artery disease often become breathless and fatigued quickly when they are exerting more than usual. Frequently, they don’t have chest pain. Nevertheless, their EKG shows signs that the heart isn’t getting enough blood. If the EKG is normal, a stress test produces evidence of insufficient blood getting to the heart muscle.

Did your doctor give you any angina medicine, such as under-the-tongue nitroglycerin? If it relieved your breathlessness, that suggests coronary artery disease, whether or not you have chest pain.

The booklet on coronary artery disease describes this problem and its treatment. Readers can order a copy by writing: Dr. Donohue – No. 101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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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