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Despite a Healthy Lifestyle, Blocked Artery Needs Treatment

Dear Dr. Roach: In December 2013 I had a blood clot in my left eye. It blocked my vision and then passed after about 25 minutes. My doctor had many tests done, and one indicated that I have plaque in my right carotid artery. The left artery is clean. My cholesterol is perfect. My health is and has been perfect.

I have been vegan for 14 years. That diet keeps me healthy. As a result of this clot, my doctor has put me on statin drugs. First was atorvastatin, second was pravastatin. I HATED them both. They made my body weak, ache and hurt all over. Now I am on a third statin, Crestor, which I take every other day. So far no big aches or pains, but it has been only a few days. I do not like to take pills and take only vitamin B-12, baby aspirin and a multivitamin.

Because my cholesterol is normal and healthy, I prefer not to take any pills, but my doctor thinks it will be helpful with regard to the plaque in the carotid artery. Do you think the statin drug is necessary? Are there other alternatives? I would love a second opinion. — E.E.

Answer: A vegan diet and a good blood cholesterol levels both help ensure a low risk for blockages in the arteries due to cholesterol plaque. Unfortunately, even the lowest-risk person can still get blockages, which may lead to TIA or stroke (you had a special kind of TIA, consisting of temporary vision loss, still often called by its Latin name, amaurosis fugax). Plaque in the carotid artery makes blockages in the heart more likely as well.

Both the statin drug and the aspirin reduce risk of a sudden catastrophic event, like heart attack and stroke, and I would recommend that you continue. I hope you tolerate the Crestor better than the other two. Sometimes, only one of the statin drugs seems to work well for any given person. There are alternative medications to statins, but none is proven to reduce risk to the same degree.

One alternative to medical management is surgery. Surgery is indicated for most people with a blockage in the carotid of more than 70 percent.

It sounds like you are very healthy, but everyone with blockages in arteries should look carefully at their lifestyle, including diet, exercise and especially smoking, to see how to reduce their risk without surgery or medication.

Dear Dr. Roach: One encounters many forms of “hand sanitizer” products these days: in medical waiting rooms, restrooms, public places and in our kitchen.

These are waterless, very quick drying products; we even have them in our automobile.

When one has many daily occasions to clean the hands, is it better (for your skin) to use soap and water, or the modern hand-sanitizer products? — N.M.G.

Answer: The jury is out on which is more effective, if you compare good technique with one against the other. Both are effective at reducing bacteria on the hands. However, alcohol-based sanitizers are easy to use, portable, fast and are less irritable to the hands than repeated washings. There is better compliance with them, and so they are more effective in the real world.

Sanitizers are not effective against all germs. They do not kill the spores of Clostridium difficile, a cause of severe diarrhea. However, soap and water wash the spores off and are effective where sanitizers are not, so soap and water should be used in cases of known or suspected C. diff diarrhea. Sanitizers also are not effective against norovirus, another infectious diarrhea. They also can’t remove grease.

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 write to P.O. Box 536475, Orlando, FL 32853-6475.