DEAR DR. DONOHUE: I broke my thigh bone in an automobile accident and had to have surgery to repair it. I did fine for the first two days after surgery, but on the third day I had pain in my thigh that was the worst I ever suffered. I called for the nurse, and she said she’d have a doctor look at it. No one came for about three hours. By then I was in real agony and could not catch my breath. I had a pulmonary embolus and could have died. Please discuss this. People should know about it. – G.G.

ANSWER:
A pulmonary embolus is a blood clot in a lung blood vessel. The consequences of such a clot depend on how big the clot is. They vary from trouble breathing to death.

Most of these clots arise from a clot lodged in one of the deep veins of the leg. The post-operative period is a hazardous period for clots. People are immobile in bed. Immobility causes blood to pool in leg veins. Pooled blood forms clots. Pieces of clots in deep leg veins can break loose and be swept in the circulation to the lung, where they plug a lung blood vessel – a pulmonary embolus. Lung tissue dies – a pulmonary infarction. A large pulmonary embolus stresses the heart, causes a drop in blood pressure and prevents sufficient oxygen from getting into the blood. Up to 30 percent of untreated pulmonary emboli are fatal.

Immediate treatment is needed to raise blood pressure and to get more oxygen into the blood. Anticoagulants keep more clots from forming and keep already-formed clots from enlarging. In certain circumstances, medicine that dissolves the clot is given, but since such medicine can have serious complications, it isn’t started in all cases.

People should know about pulmonary emboli. They should know that they can happen in many other circumstances too. On a long car trip, if people don’t take a break every now and then to move their legs, clots can form in the veins and can give rise to pulmonary emboli. The same happens in airplanes. On a plane, tensing and relaxing the leg muscles every 15 minutes keeps blood from pooling in leg veins.

DEAR DR. DONOHUE: High blood pressure is always listed as a contributor to heart attacks and strokes. How does that work? I have high blood pressure, but on medicine my readings are good. Does that mean I am not at risk for a heart attack and stroke? – M.B.

ANSWER:
One reason why high blood pressure causes heart disease stems from the rise in pressure, which forces the heart to work much harder to pump blood. Enlargement compensates for the extra effort required, but it can do so for only a limited time. If the pressure isn’t lowered, the heart eventually gives out – heart failure.

High blood pressure does a number on the inner lining of arteries. It roughens them. That makes the lining a perfect place for the deposition of cholesterol and other elements. In time, the deposit grows so large that it blocks blood flow. If that happens to a heart artery, a heart attack occurs; if to a brain artery, a stroke occurs.

Once blood pressure comes back to normal, the threat of stroke and heart attack goes away.

DEAR DR. DONOHUE: This might not be a health question, but it’s a matter of importance to my husband and me.

My husband makes enough coffee at one time to last two days. He puts the leftover coffee in the refrigerator and reheats it the next day.

My daughter and son-in-law visited us for a week. My son-in-law refuses to drink coffee brewed the day before. He says it becomes too acidic and can harm the stomach. We’ve been doing this for 35 years, and we are in good health. Is my son-in-law right? – R.M.

ANSWER:
Coffee stored for 24 hours doesn’t have more acid than freshly brewed coffee. It might contain a little more caffeine because on reheating it the second day, some water is lost. But that’s nothing to take to the Supreme Court.

If your son-in-law wants fresh coffee daily, have him make it.

DEAR DR. DONOHUE: Please write about asthma in young children. Do steroids in high doses affect children in the long run? I worry about these drugs. – E.T.

ANSWER:
The “steroids” you’re talking about are cortisone drugs, some of medicine’s most powerful anti-inflammatory drugs. Powerful drugs always have powerful side effects, so they must be used with discretion. Asthma also has powerful side effects, and death is one of them. When asthma doesn’t respond to other drugs, then the cortisone steroids have to be used.

An asthma attack involves a sudden constriction of the airways, along with a copious production of mucus in the airways. Getting air into and out of the lungs is a major challenge. Affected people feel like they are being choked. They cough and wheeze. The chest is tight. They become quite breathless. The airways have to be expanded quickly to get sufficient air into the lungs.

Cortisone steroids can soothe the airway inflammation that causes their constriction. When used in high doses for long periods of time, they can slow a child’s growth, but the child’s final adult height is minimally affected. They can also cause bone and muscle weakness. They make children and adults susceptible to diabetes. They weaken the immune system and make users prone to infections.

However, in asthma, cortisone steroids are most often given through an inhaler. That limits their absorption into the blood and limits their side effects considerably. Inhaled cortisone steroids have far fewer side effects than do those same drugs when given by mouth or by injection. Children can safely use them, and often must use them.

The asthma booklet describes this illness in great detail. Readers can obtain a copy by writing: Dr. Donohue – No. 602, 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.

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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