DEAR DR. DONOHUE: My 71-year-old husband has diabetes, high blood pressure and high cholesterol. Six years ago he had six heart bypasses, and they are still open. He has one carotid artery closed, and the other is 50 percent closed. He has been told to have his narrowed aortic valve replaced because of shortness of breath.

One surgeon told him he would live only two years without surgery. Another surgeon doesn’t think that at age 71 there would be a favorable outcome. He said if my husband lives through the operation, he would be confined to the hospital for at least one month. What is your opinion? – J.P.

ANSWER: Your husband is a complicated medical case, and he, you and his doctors are confronted with a difficult choice. A narrowed aortic valve – aortic stenosis – makes it difficult for the heart to empty all its blood into the aorta. It has to generate great force to get the blood through the narrow exit.

Three symptoms indicate when a person with a narrowed aortic valve is getting into serious trouble. They are: shortness of breath when mildly or moderately exerting, chest pain when active and episodes of fainting. Any one of them is a concern.

When aortic stenosis makes a person short of breath, that person, on average, has only about three years of life left. That’s an average and doesn’t apply to all.

Surgically installing a new valve is the ultimate treatment. Your husband’s age is not a contraindication. His general health might be. The second-opinion doctor is a bit pessimistic for my books. I would not anticipate that your husband would have to remain in the hospital for a full month after surgery.

In lieu of surgery, medicines can make your husband more comfortable, but they are not likely to add many years to his life. Nitroglycerin relieves chest pain if he’s having any. A low-salt diet will make him less breathless. Some say that a statin drug – the popular cholesterol-lowering medicines (Zocor, Pravachol, Crestor, Lescol and Lipitor) – can prolong the life of people with narrow aortic valves.

With as many problems as your husband has, a trip to a large medical institution would provide an unbiased third opinion. There are many such places in your state – four medical schools.

DEAR DR. DONOHUE: What is the gallbladder’s function? What causes gallstones? Why are they so painful? – R.P.

ANSWER: The gallbladder, pear-shaped and about the size of a pear, is the storage tank for bile (gall), which is made in the liver. It can hold about 1 ounce (35 ml) of bile. It adheres to the undersurface of the liver. When a person eats something fatty or fried, the gallbladder contracts to shoot a jet of bile into the intestine for digestion.

One component of bile is cholesterol. When bile becomes oversaturated with cholesterol, the cholesterol doesn’t stay dissolved. It forms small crystals, which become big stones. Cholesterol stones are the most common variety of gallstones. A high-fat, high-cholesterol diet is partly to blame. Estrogen, the female hormone, is another factor, and it’s the reason why women have more gallstones than men. But perhaps the greatest influence is genes. Native Americans and Mexicans are two groups that form more gallstones than any other ethnic group. That’s genetic.

When a gallstone blocks the gallbladder’s bile-drainage duct, bile cannot exit it. Pressure in the gallbladder rises, and pain results.

DEAR DR. DONOHUE: In a recent column, you discussed grapefruit’s effect on medications. You provided a list that included Norvasc, which I take.

I checked on the Web and found that Norvasc can be taken with grapefruit juice. Do you have recent information that says differently, or was Norvasc included in error? – D.B.

ANSWER: You are quite right, and I was quite wrong. People on Norvasc (amlodipine) can take their medicine and eat grapefruit without any worry.

Grapefruit doesn’t alter the blood concentration of Norvasc. I made the mistake because other medicines in Norvasc’s class can interact with grapefruit. Thanks for spotting the error.

DEAR DR. DONOHUE: About two months ago, I became short of breath when I did my usual housework. It got so bad that my husband insisted I see a doctor. He detected fluid in my right lung. The fluid was drained last week.

The doctor ran many tests but couldn’t determine what caused the fluid. Now the doctor wants me to have a biopsy. Do you think that’s wise? – T.R.

ANSWER: You didn’t have fluid in your lung. You had fluid in your pleura – the sac that covers your lung. Fluid in the pleura is a pleural effusion. Large pleural effusions compress the lung and make it difficult for a person to get enough air.

Heart and kidney failure, advanced liver disease, cancer, infections and many other conditions can lead to a pleural effusion.

It’s most important to determine the cause so it can be eliminated. Without finding a cause, a person risks having the effusion return.

If noninvasive tests – blood tests and the like – can’t determine the cause, then a biopsy is the next step.

It can probably be done on an outpatient basis. Yes, I think it is very wise to have a biopsy done.

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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