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CHOLESTEROL JUST 1 FACTOR IN CLOGGED ARTERIES

Question: Will you please explain why nothing gets written about people with low or normal cholesterol despite the fact that we too are subject to clogged arteries? Doesn't that fact suggest that there is something else at work in vessel clogging? I have total cholesterol of 130, an LDL level of 85 and HDL of 30. I am slated for heart surgery for two badly occluded arteries. What about people like me?

- J.B.

Answer: Cholesterol is only one of many factors to consider in the artery-clogging problem. High blood pressure, diabetes, smoking and being a man are other risk factors that call for evaluation every bit as much as diet.

In fact, perhaps the single biggest contributor to artery clogging and all the rest that follows from it is our genes.

So, behind your simple appeal lies the broader question of how we tend to overblow one aspect of an illness to the neglect of other, perhaps more-significant ones.

Now, let's look at your numbers. Your total cholesterol figure is quite low. But so is your high-density lipoprotein level. HDL, the good kind of cholesterol, should be greater than 35 to work preventively against heart and circulatory problems.

Consider a corrective program that would include exercise, weight reduction and emphasis on monounsaturated fats and oils.

WARNING: Given the state of your arteries, you need to be careful about any exercise program. You should get individual guidelines from your doctor.

Question: I have pseudogout. I have had an attack each of the past few years - pain and swelling. I see articles in which you say that pseudogout is preventable. I find nothing like that in my reading. Will you please elucidate?

- S.L.

Answer: With gout, uric acid forms tiny shards of crystal in joints. With pseudogout, the culprit is calcium pyrophosphate. The pain is the same.

The knee is a favored pseudo-gout target. A typical attack develops rapidly, reaching a peak in six to 12 hours and generally resolving itself in a few weeks.

Doctors can drain a swollen joint and inject cortisone into the area. That can clear things up nicely.

Less powerful oral anti-inflammation drugs, such as indomethacin, also are used.

I might have left a false impression in speaking of gout prevention. I might have implied that both gout and pseudogout are the same in that regard. Let me just say that there is a way to prevent pseudogout. It involves taking colchicine medicine daily.

Consult with your doctor the next time you get the joint problem.

For more information, see my report on gout. Readers can order the report by writing: Dr. Donohue - No. 13, Box 5539 Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (55 cents) No. 10 envelope.

For L.K.: I agree. Directions for taking medicines should be clear. They should not leave room for doubt. In general, though, when a doctor specifies that a medicine is to be taken four times a day it means every six hours. If the timing is not that critical, the patient might be told to space out the four doses in the waking hours so as not to disturb sleep schedules.