DEAR DR. DONOHUE: To celebrate their 50th wedding anniversary, my mother and father took a trip to Hawaii. They live on the East Coast, so this involved lots of time on an airplane. My father died on the plane before they landed in Hawaii. My mother thought he was sleeping until it was time to deplane. An autopsy showed a pulmonary embolism. My mother blames herself for his death, because she pushed this trip. Can you explain his cause of death to my mother so she can get over her guilt? — M.S.

ANSWER: A pulmonary embolus is a blood clot in a lung. Most of the time, the clot forms in the legs and is carried to the lungs through the circulation. A large pulmonary embolus often is deadly. People do survive smaller ones.

Blood that’s circulating sluggishly tends to clot. Long trips in a car, bus or plane force people to stay seated for hours on end. Not moving around traps blood in leg veins, and a clot forms. Your father had no warning that this was happening. A piece of that leg clot — an embolus — was swept into his lungs. Your mother had no role in this. It could have happened to your dad when he was taking a car trip some miles from his home. It happens to bedridden people even in the hospital. Most hospitals now have programs that make patients confined to bed move their legs often. They give patients compression hose to keep blood from stagnating in the legs. All those who take long trips should get up and walk about as frequently as possible.

Your mother bears no responsibility for your dad’s death. It was an unfortunate event over which neither she nor your dad had any control. I understand her grief and shock at losing her partner of 50 years so unexpectedly.

DEAR DR. DONOHUE: During my annual exam I always have an EKG. They’ve all been normal. This year the doctor tells me I have a left bundle branch block. He says I don’t need to do anything or take any medicine. This has made me a little edgy. My father died of a heart attack at age 49. I’m in my 70s, and I’d like to live much longer. What can you tell me about left bundle branch block? — R.J.

ANSWER: All hearts have a pacemaker, a little island of special cells that send out a blip of electricity. Two cables, much like electric wires, conduct that electrical blip to the lower chamber of the heart — the right and left ventricles. Each is served by its own cable, right and left. When the signal reaches the ventricles, they contract and pump blood.

Your left bundle is on the blink. It implies that there is some kind of heart problem. The heart arteries might be clogging a bit. At age 50, 0.4 percent of the population has a left bundle branch block. At age 80, 15 times that number have one.

Your heart still pumps normally. The electrical impulse reaches the left ventricle by taking a detour. You can do nothing on your own to correct the situation. You can do things that improve your heart’s health — watch your weight, control your blood pressure, exercise, don’t smoke and keep your cholesterol in the normal range. You should stay as active as your doctor permits. It is his job to watch you and detect any suggestion of advancing heart disease. A left bundle branch block can lead to more serious problems in the transmission of the electric signal from the pacemaker. For the present, you don’t need to do anything more.

DEAR DR. DONOHUE: I have just returned from the doctor’s office where I took my mother. She had a sore ear that was draining. The doctor said she has malignant otitis. She’s on an antibiotic. Does “malignant” here mean cancer? — S.K.

ANSWER: Malignant otitis externa is an infection of the ear canal with a hard-to-treat bacterium called Pseudomonas. The malignancy here indicates that the infection can spread rapidly and attack the skull bones. It is not a cancer.

Your mother is getting immediate attention. She should do well now that she’s on antibiotics.

This is an infection more common to older, diabetic patients. 

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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