DEAR DR. ROACH: I am an 84-year-old white male who is undergoing a procedure next week. My pre-op CAT scan results showed many “white spots” in both upper legs, and I’m told that this plaque is a calcium-based substance. This caused me to ask the physician assistant if the pH of a person’s blood could be turned slightly acidic so it would slowly dissolve the calcium deposits over time. The PA couldn’t answer my question, but would you answer it? — W.L.

ANSWER: Plaque is the substance that builds up in the walls of the arteries, whether it’s the blood vessels of the heart, the brain or anywhere else in the body. Plaque consist of variable amount of fat, muscle and blood cells and calcium. The plaque is covered by a fibrous cap and the lining of the blood vessel.

If the plaque ruptures, exposing the inner contents, the body responds by rapidly forming a blood clot. This blood clot prevents blood from flowing through the vessel, often leading to death of the tissue supplied by that blood vessel. In the heart, that’s called a heart attack; in the brain, it’s a stroke; in the rest of the body, it’s just called an infarction of whatever organ is being supplied by the clotted artery.

Removing the plaque and reversing arterial disease has been the goal of medical treatment. There are some treatments known to be successful, at least some of the time: statin drugs (the connection for other cholesterol drugs is not as well established) and significant lifestyle change, including a very low fat diet, stress reduction and tobacco cessation. Many, many other treatments have been tried, but the evidence for success and reproducibility has been limited.

Unfortunately, as nice as the idea of flushing out the blockages sounds, there are two major problems. The first is that the plaque itself is not in contact with blood directly, except in the case of acute rupture and infarction; the second is that blood pH is tightly regulated. So many things go wrong inside the body with the slightest adjustment in pH. Many forms of calcium (such as bone) will dissolve in strong acid — even in vinegar, with a pH if about 2.5. The normal blood pH level is about 7.4. Levels below 6.9 or above 7.6 are incompatible with life — enzymes stop working and even the blood cells become incapable of delivering oxygen if the pH changes.

DEAR DR. ROACH: I had a traumatic head injury in May 2019. Everything is back to normal except that I cannot smell anything. This is very sad to me as well as dangerous. My neurologist has told me several times there is nothing that he can do for me, nor can anyone else that he would know. I am devastated about this. I was in a coma and in the hospital for six weeks. My skull was cracked, and my brain filled entirely with blood. I would appreciate anything or suggestion you can give to me. — M.W.

ANSWER: I am sorry, but it is likely that there is nothing that can be done for you. Severe head trauma can damage the olfactory bulb, the part of the brain responsible for the sense of smell. Trauma may also sever the nerve cells that go through the cribriform plate, a bone with many small delicate holes that can be injured with head trauma.

Only about 10% of people with loss of smell due to head trauma recover over time. There is still hope, but any improvement would be expected to happen within a year.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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