DEAR DR. DONOHUE: I am a 46-year-old man who does heavy physical labor and who is an active person in all sports. I had a physical exam and my blood pressure was 180/120. The doctor put me on medicine, and it lowered the pressure some but not enough. The doctor thinks that my high pressure could be due to a problem with blood flow to my kidneys, and that entails surgery. What’s he talking about? – L.N.

He’s talking about renovascular hypertension, a special kind of high blood pressure due to narrowing of a kidney artery. It’s a potentially correctable kind of high blood pressure.

The kidneys make renin, a body chemical that keeps blood pressure up when it starts to drop. If one kidney has a narrow artery feeding it, that kidney thinks blood pressure is on the low side. It starts putting out too much renin, and blood pressure rises.

Tips that renovascular hypertension might be present include things like a sudden onset of high blood pressure, readings over 160/100, a relatively young age for the onset of high blood pressure and blood pressure that doesn’t respond well to the ordinary blood pressure medicines.

A number of tests confirm kidney artery narrowing. Renal arteriography is one of them. The kidney arteries are injected with dye that outlines any constriction. Ultrasound and magnetic resonance angiography are two other methods of detecting this problem.

If there is a constriction, treatment can bring blood pressure to normal. That usually entails propping open the narrowed section with a stent or surgically removing the narrowed section and replacing it with a graft.

All in all, this isn’t the worst thing that could happen to you. It’s treatable, and results of treatment are gratifying.

DEAR DR. DONOHUE: I had a chest X-ray that showed everything was normal except for “calcifications of the aortic valve.” My doctor says this is nothing. Could the calcifications come from the calcium I take to prevent osteoporosis? – L.M.

Heart valves calcify for many reasons, but taking calcium supplements is not one of them.

The aortic valve has three “leaves,” pie-slice pieces that come together to close the valve and stop blood flow. Some people are born with a valve having only two leaves. Those valves often calcify later in life. Even minor defects of the valve can lead to calcification. Aging is another cause. Rheumatic fever, a formerly common childhood problem, produces calcified heart valves. If the valve becomes narrowed or leaky because of calcification, then corrective measures have to be taken. Those measures usually are surgical.

Heart valve disease is a confusing subject. The booklet on those conditions sheds light on them. Readers can order a copy by writing: Dr. Donohue – No. 105, Box 536475, Orlando, FL 328536475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have tarsal tunnel syndrome. I have pain on the bottom of my foot. My doctor says I might need surgery. What is that surgery? – C.V.

Carpal tunnel syndrome is the wrist’s equivalent of tarsal tunnel syndrome. In carpal tunnel syndrome, pressure on the nerve passing through the wrist produces pain, numbness or peculiar sensations in the fingers.

In tarsal tunnel syndrome, pressure on the nerve that passes through the ankle to the foot produces the same kinds of sensations on the big toe side of the sole. Rest and anti-inflammatory medicine (Motrin, Advil, Aleve and many others) can reduce swelling and relieve pressure on the nerve. Sometimes an injection of cortisone hurries things along. Only when these treatments fail is surgery considered. Surgery frees the nerve from whatever is entrapping it. It’s a relatively simple procedure.

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

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