Dear Dr. Roach: I am a 69-year-old male who is being treated for high blood pressure and high cholesterol; both are well-controlled. My recent cholesterol level was 150 mg/dL with an LDL of 56 mg/dL and an HDL of 42 mg/dL. I’m on 10 mg of rosuvastatin, and I do intensive workouts with a trainer four days a week and hike two to three days a week. I never get chest pain or unreasonable dyspnea. I have lost 20 pounds in two years. My mother had a cardiac stent put in at 82 and died of aortic stenosis at 86.
Four years ago, my CT calcium score was 920. I had another test done this week, and my score was 1,100. I see a cardiologist annually because of it. My EKG is normal, and my cardiologist appears unconcerned about these results. He told me to take 81 mg of aspirin a day, but advised against a stress test since I’m asymptomatic.
He said that over time, the calcium deposits can “coalesce” and raise the score, but this doesn’t mean I have fatty plaque that could rupture and cause an unexpected heart attack. He feels that I probably have stable coronary artery disease that could eventually cause warning symptoms, which is when he would do the testing.
It was my primary care physician who ordered the test. My cardiologist discouraged doing it. His advice makes sense to me, but should I get a second opinion?
C.S.
I agree with your cardiologist about not getting a stress test. You are already on the appropriate medical treatment for coronary artery disease (blockages in the arteries), so making 100% certain of the diagnosis wouldn’t change that. Even if you had an angiogram, in absence of symptoms, there is pretty good evidence that placing a stent would not prevent a heart attack or make you live longer, since you are on effective medical treatment.
There has been much debate about whether a beta blocker would be of benefit in preventing a heart attack in people who have stable coronary artery disease without symptoms. A recent study seemed to show a small benefit in preventing a heart attack, but the jury is still out. Finally, a higher dose of rosuvastatin to get your LDL even lower may also slightly reduce your risk of a heart attack. Studies have shown an increased benefit all the way to an LDL level of 30 mg/dL.
Dear Dr. Roach: I’ve lived the majority of my 72 years in great health, which I attribute to daily exercise and good nutrition. So, I was surprised when a mild bronchial infection left me with a severely plugged ear that sounds like someone has slipped a potato chip bag in my ear canal.
I’ve tried all the Google remedies — heat, as well as a mixture of water and hydrogen peroxide using a dropper — but no success. Could this be a wax buildup?
B.L.
It’s possible, but I don’t think so. The association with the bronchial infection leads me to suspect the problem isn’t in the external ear. It might be in the middle ear because of an inability to equalize pressure due to dysfunction of the Eustachian tube, which probably got congested during your viral respiratory infection. It will get better, but a decongestant can remedy it faster.
Incidentally, I don’t recommend hydrogen peroxide in the ear, even if it’s diluted. It’s too irritating to the ear canal skin. Over-the-counter ear drops are safer, but you should have an exam to see whether your ears are plugged up by wax.
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 [email protected]
