DEAR DR. DONOHUE: I’m a 66-year-old woman who had a scare last week. While visiting my daughter, I got an attack of dizziness, and I couldn’t talk. My daughter rushed me to the hospital, and the doctors told me I had a ministroke. Will you please explain its significance? — L.H.

ANSWER: A ministroke, also called a TIA (transient ischemic attack), is a warning alarm that there’s trouble with the blood supply to the brain and that a full-blown stroke could happen. Such is the case for 15 percent of those with a ministroke within three months of its occurrence. Symptoms are the symptoms of stroke: numbness of face, arm or leg; inability to move the arm or leg; mental confusion; slurred speech; the inability to express oneself; dizziness; or loss of balance. The symptoms last only a short time — two to 15 minutes, and never longer than one day. Full recovery occurs. However, treatment must begin immediately to prevent a stroke.

The carotid arteries, the large arteries on the right and left sides of the neck, have to be examined to see if they have a buildup of plaque obstructing blood flow to the brain.

You must go on a program that lowers cholesterol, and that’s most often achieved by taking statin medicines (Lipitor and Zocor are examples). Blood pressure has to be controlled. Medicines that prevent platelets (clot-forming cells) from clinging to plaque in arteries are usually part of the regimen.

If a significant blockage is found in one of your carotid arteries, then a decision has to be made about cleaning out that artery. A vascular surgeon can open the artery and clean it out, or it might be cleaned out like heart arteries are — with a special kind of catheter, a thin, pliable tube that is inched into the area of blockage from a surface artery.

The booklet on stroke presents the details of this debilitating condition and how it’s treated. Readers can obtain a copy by writing: Dr. Donohue — No. 902, Box 536475, Orlando, FL 32853-6475. 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.

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DEAR DR. DONOHUE: I have peripheral neuropathy, and it’s not from diabetes. Currently I am using capsaicin gel. It helps some, but often I am wakened with a lot of pain in my feet. My doctor prescribed Lyrica and Neurontin. I do not do well on painkillers. The next day I am groggy and have an uneasy feeling, so I do not take these drugs. I wonder if there are other preparations that might help my neuropathy. — H.D.

ANSWER: We have two kinds of nerves: motor nerves that bring instructions to muscles on how to move, and sensory nerves that bring sensations to the brain, telling it how we feel. Neuropathy indicates nerve damage. You have a sensory neuropathy, which causes you pain.

Both Lyrica and Neurontin come in many different strengths. Perhaps a lower dose would control your pain without making you groggy.

Antidepressants control pain. Amitriptyline, Cymbalta (duloxetine) and Effexor (venlafaxine) have deadened pain for many people with peripheral neuropathy.

Lidocaine, a numbing agent, is available in patches and gels, and is applied to the skin. It doesn’t make people groggy.

A new formulation of capsaicin is the Qutenza patch. It is approved for the treatment of pain that often follows an outbreak of shingles, but it can be used for other neuropathies too. The patch has to be applied by a doctor.

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DEAR DR. DONOHUE: How can you tell if you have a blocked carotid artery? The left side of my face feels tight. — T.C.

ANSWER: Facial tightness isn’t a sign of a blocked carotid artery. A person cannot tell if the carotid artery is blocked. A scan or an ultrasound provides such evidence.

I wish I could come up with a diagnosis for your facial tightness. I have to admit that I don’t have an idea.

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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