Q. Although I have absolutely no symptoms, I have a narrowed artery in my neck. How should this be treated?
A. Unfortunately, there is no easy answer to your question.
First, here's some background. About one in 10 people older than 70 has a narrowing without symptoms in one of their carotid arteries (the artery that runs up each side of the neck and brings blood to the brain; you can feel its pulsation just below the corner of your jaw).
Such blockages can lead to a stroke, so preventive treatment is important. We have three different treatment methods available: medicines (including those to treat high blood pressure, diabetes, high cholesterol, and something to thin the blood like aspirin); insertion of a stent, a Slinky-like device that helps to keep the artery open; and surgery. But which is best?
Unfortunately, we really don't know! The clinical trials that have been done to date don't provide a definitive answer. We believe that certain patients are at higher risk for stroke and might well benefit from surgery or a stent, but identifying those patients is difficult.
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How should you be treated? Certainly with optimal medical therapy as discussed above, and maybe with surgery or a stent if you are at higher risk. By the way, with all of these interventions, patients also need to stop smoking, lose weight, and increase their exercise program. As always, discuss this difficult problem with your health care provider.
Q. The reports about a new bird flu outbreak in China concern me. Should we be worried in North Dakota?
A. The emergence of this new strain of virus -- called H7N9 -- that previously has not been found in animals or humans is of concern globally, even though all of the cases reported so far have been confined to China.
Some 131 confirmed cases have been reported, and about a quarter of the patients have died. Infected patients have developed severe pneumonia, respiratory distress, shock, organ failure, encephalitis and muscle damage, all indicative of a severe infection by this influenza type A virus.
Fortunately, the number of new cases appears to be slowing, so perhaps the outbreak is being contained. And fortunately, there has been no evidence of ongoing or sustained human-to-human transmission of the infection. However, that doesn't mean that such transmission couldn't develop, and then we could be facing a worldwide epidemic that could conceivably touch us in North Dakota.
Containment efforts in China seem to be working, and the world's public health units are on alert for any cases appearing outside of China. (Dr. Ray Goldsteen, director of UND's Master of Public Health Program, has written prior columns about the importance of public health units performing active surveillance for infections such as H7N9).
A vaccine against the virus is being developed, and currently there is no restriction on travel to China. The Centers for Disease Control and Prevention has, however, suggested the following precautions for travelers to China: avoid touching birds or other animals; be sure all food is fully cooked; practice good personal hygiene with hand washing; and seek medical attention if you become sick.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.
The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.
