DEAR DR. DONOHUE: A month ago, my wife had a spell where she found it hard to talk. She couldn’t get the words out. It lasted about 45 minutes, and she has been fine since. She hasn’t seen a doctor in five years and doesn’t want to go now. Should I pressure her? – Z.J.

ANSWER: Definitely. Pressure her. You have given a good description of a TIA, a transient ischemic (is-KEY-mick) attack. It’s the temporary (“transient”) blockage of blood flow (“ischemic”) to the brain. Most TIAs last from five to 60 minutes, but never longer than 24 hours. Many refer to TIAs as ministrokes or small strokes.

A tiny clot might block a brain artery. Blood doesn’t get to the area of the brain supplied by that artery. A “spell” occurs. The clot dissolves, blood flows again, and symptoms disappear.

Since the whole episode is so short-lived and since no symptoms persist, people feel it must have been something unimportant. Far from it. A person who has had a TIA has a ninefold greater chance of having a stroke than does a person who has never had one. Close to one-third of TIA patients will have a full-blown stroke within five years.

These ministrokes have a formidable number of unrelated symptoms. Some people have the same kind of trouble as your wife; they cannot find words to express themselves. Others complain of numbness on one side of the face or in one arm or one leg. Still others complain of one-sided muscle weakness. Another common symptom is loss of vision in one eye. Double vision is a frequent symptom.

The brevity of these symptoms is no indication of their innocence.

Stroke prevention can entail clearing out a blockage in one neck artery, the carotid artery, by surgical removal (endarterectomy); inserting a stent (a mechanical device that keeps an artery open); or putting a person on blood thinners to prevent growth of any clot clinging to the wall of a brain artery.

The stroke pamphlet covers the large spectrum of stroke and stroke-related symptoms and treatments. To obtain a copy, write to: Dr. Donohue – No. 902, Box 536475, Orlando, FL 38253-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: How serious are basal cell skin cancers? My son just had one removed. He is quite tight-lipped, so I get no information from him. – F.F.

ANSWER: Basal cell skin cancer is the least threatening of the three common skin cancers: basal cell, squamous cell and melanoma. It rarely spreads and is almost always curable.

If left untreated, a basal cell cancer can burrow deeply into the tissues under it, but no one should let a basal cell cancer reach such a stage.

These skin cancers are masters of disguise. They might appear as dome-shaped, pearly nodules that slowly enlarge. The center often forms into an ulcer. However, they can also appear as an ordinary sore that does not heal. Suspect any nonhealing sore and show it to a doctor.

A doctor – usually a dermatologist – can dry them up with electric current, freeze them, or remove them layer by layer in a procedure known as Mohs’ surgery.

Your son must protect his skin from lengthy sunlight exposure. He must also return to the doctor on schedule, for he has a 40 percent chance of having another basal cell cancer emerge.

DEAR DR. DONOHUE: I have a niece with a young family. She is very much into natural foods, and she serves her children raw milk. I think this is a health hazard. Is it? – R.Y.

ANSWER: It is a hazardous practice. Pasteurization kills bacteria that can cause big troubles for all people, but especially for youngsters. If she insists on raw milk, she should pasteurize it by heating it to 145 F (63 C) for 30 minutes.

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.

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