MEN'S HEALTH MATTERS:The benefits of stopping smoking are immediate, so do what the doctor ordered
Q I HAVE recently suffered a minor stroke and the doctor said that I must give up cigarettes. He also started me on a blood pressure lowering drug and a blood-thinning tablet. How essential is it that I comply with this advice and take the medications?
A It is absolutely imperative that you give up smoking as smokers have up to four times the incidence of strokes and heart attacks over those who are non-smokers.
Giving up smoking has an immediate beneficial effect on the circulation as the "stickiness" of the blood almost immediately decreases. In addition, smoking significantly reduces the potential benefit of the blood-thinning drug on which you were started.
Treating high blood pressure reduces the possibility of a major stroke or heart attack by about 40 per cent and the aim of your doctor is to achieve a blood pressure level as close as possible to 130/80 without you experiencing a drop in blood pressure when you stand which might make you dizzy. Your doctors will check your blood pressure lying and standing to make sure that this does not occur.
Blood thinning tablets (eg aspirin) can reduce the incidence of heart attacks and strokes by about 25 per cent and it is imperative that you comply with this therapy. If you are planning to take aspirin it is important that your doctor knows if you have a history of heart burn or peptic ulcers. In this situation you can be prescribed a medicine that will help protect the stomach against potential side effects of these blood-thinning agents.
Your doctor may also start you on a cholesterol-lowering drug. People who suffer a mini-stroke are often started on cholesterol lowering treatment even if they have a normal cholesterol as these drugs not only reduce the cholesterol level but they can also help to reabsorb the cholesterol from the artery wall and may smoothen the inner lining of the wall itself.
Overall the combination of stopping smoking, controlling blood pressure, blood thinning and cholesterol lowering treatment can reduce the possibility of a further stroke or heart attack by up to 80 per cent and the combination of these therapies have had a revolutionary effect on the further reduction in strokes and heart attacks in patients who experience one of these events.
Your medication may require adjustments from time to time, and it is very important that you make every effort to fully comply with all the therapies that are prescribed for you. Should you have any side effects or new symptoms then you should report them to your doctor and appropriate action can be taken.
Q I have a stone in my kidney, and my consultant has arranged for shock wave treatment to this stone. What does this mean?
How soon do you think I will be able to resume normal activities?
A Extracorporeal shock wave lithotripsy (ESWL) is a modern, non-surgical way of treating kidney stones. This is usually performed on an outpatient basis. You will be asked to lie on your back on the treatment table (because your kidneys are situated in your loin area).
Ultrasound equipment and X-ray screening is used to provide a precise image of the stone(s) in your kidney or ureter (the muscular tube that carries the urine from each of your kidneys to the bladder).
Pulses of energy are then aimed at your stone, causing mini-shockwaves, which will break the stone.
Initially, these shockwaves will "weaken" the stone, but may not necessarily break it completely.
Therefore, you may need more than one session of lithotripsy to get rid of the stone. The treatment will usually last about 20 minutes during which time you will hear a "clicking" noise and feel something like a "flicking" on your back/front.
Most people tolerate the procedure very well and often describe the treatment as uncomfortable rather than painful. Some people notice discomfort over the kidney or blood in the urine, both of which usually resolve within a few hours to days.
Occasionally a general anaesthetic is required, and this will be arranged in advance if necessary. It is extremely important that you drink a lot of fluid after your treatment, which will help flush out the kidneys.
Very rarely a small fragment of stone can lodge in the tube connecting the kidney to the bladder, blocking the kidney off and giving rise to pain and infection.
You can resume normal activities the day after your treatment and you should remain as active as you can after the treatment.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin, with a contribution from Prof Bernard Walsh, consultant physician, St Jamess Hospital, Dublin, and Mr Frank D'Arcy, specialist registrar in urology, Beaumont Hospital, Dublin.