Can a Massage Cause Stroke?

PORTLAND, ORE.: X-rays show that I have calcium in my aorta. My doctor said a lot of people my age (79) have it, and that it is nothing to worry about. Can you tell me more about this condition?
Dr. Patrick T. O'Gara: Calcium in the wall of your aorta, the largest artery in the body, indicates cholesterol-filled plaques of atherosclerosis. The same process can affect the arteries of your heart, neck and legs. Your doctor is correct that it is a common finding among people of your age group. Finding the calcium should trigger a review of your risk factors for developing heart disease or stroke. Have your cholesterol profile checked, make sure your blood pressure is in a good range, watch your diet, exercise regularly, keep your weight down and don't smoke. Talk with your doctor about whether you require any specific treatment, other than these healthy lifestyle approaches, to lower your risk. Ask your doctor as well if the calcium pattern might suggest an aneurysm—or enlargement—of the aorta, not just atherosclerosis. If it does, other tests might be needed.

SANTA FE, N.M.: I have deep muscle massage every month or so, including the muscles of the neck. Someone told me such massages could loosen plaque in my carotid arteries and cause a stroke. Could this happen?
It's very unlikely that deep muscle massage would loosen an arterial plaque and cause a stroke. Your therapist is likely to stay away from direct pressure over your carotid arteries in the neck. Manipulation of the head and neck during chiropractic treatment has been reported to cause a tear (or dissection) in the carotid or vertebral arteries with resultant stroke. An arterial dissection is different from a loosened plaque and requires a different treatment approach.

ATLANTA: I am 70 years old, and my systolic pressure runs between 117 and 130. My diastolic pressure used to be around 70, but recently it has been as low as 50. My doctor tells me that 50 is better than 70, but it seems low to me. What do you think?
Your systolic blood pressure (the upper number) is excellent. The diastolic pressure (lower number) often falls as a person grows older, because the walls of the arteries lose some of their normal elastic properties. There's really nothing you can do to reverse this trend. There are other conditions related to heart-valve disease or shunts that can also lower the diastolic pressure; your doctor can identify these by a careful physical exam. While some studies have suggested that a diastolic pressure of 70 may be ideal, most authorities do not consider lower numbers to be of any significance in active persons who don't have symptoms that indicate the blood pressure is too low.

CARSON CITY, NEV.: About a year ago I had a stent put in, and I was put on low-dose aspirin and Plavix. Now my doctor wants me to take Coumadin because I have atrial fibrillation. I didn't have any bleeding problems on aspirin and Plavix, but I'm worried about being on three drugs that prevent blood clots. Should I be worried?
You're right to be worried about the risk of bleeding with these three blood-thinning medications, although for many people, the combination is not a problem. Low-dose aspirin should be continued indefinitely in most people. Clopidogrel (Plavix) is recommended for 12 months after a stent implant, in patients who are not at high risk of bleeding. But it is not clear that treatment beyond one year is necessary, so talk to your doctor about how long you need to remain on clopidogrel. Whether a person should take warfarin (Coumadin) to prevent a stroke depends on how great your risk for a stroke is. Your doctor can estimate this risk by using what is known as the CHADS2 risk score (Congestive Heart Failure, Age, Diabetes, History of Stroke). You should review your score with your doctor and then decide if warfarin is likely to be safer or better than aspirin alone for the treatment of your atrial fibrillation.

AMES, IOWA: Can you have bypass surgery if you already have a stent? And can you have a stent if you previously had bypass surgery?
It's possible to have either or both. Sometimes a previously placed stent will fail (blood flow through the stent will slow or stop). This can cause recurrent angina pain or even a heart attack if not treated. Bypass surgery is sometimes required. Conversely, bypass grafts also can fail—up to half of all of vein bypass grafts will fail within 10 years—and can be treated with stents. In some centers, patients now undergo a planned "hybrid" type of procedure in which some blocked arteries are treated with stents and others are treated with bypass grafts.

FALL RIVER, MASS: I have atrial fibrillation and was recently switched from a calcium-channel blocker to a beta-blocker called sotalol. The doctor says the beta-blocker works better than the calcium-channel blocker in my case, but I think it makes me tired and causes me to gain weight. Am I imagining this?
You might be right. Sotalol is a more powerful medication than the calcium channel blocker for the treatment of atrial fibrillation. It has two major side effects: it can slow the heart rate excessively, and it can provoke a more worrisome heart rhythm disturbance. For that reason, it is usually started under monitored conditions in the hospital. Like many beta-blockers, it can also cause fatigue in up to 20 percent of individuals, so your tiredness could be a side effect of sotalol. Weight gain is not usually associated with the drug, but your fatigue could be causing you to exercise less. You should talk with your doctor about an alternative treatment.

NEW YORK: Every time I try to donate blood, I feel like I'm going to faint. What can I do to prevent that feeling? People need blood, and I want to help.
You have what is commonly referred to as "vaso-vagal syncope." Fear and pain from the needle entering your vein can activate a reflex within your brain that directs your blood vessels to dilate and your heart to slow. This, in turn, causes your blood pressure to fall and make you feel as if you might faint. Many folks actually do faint. You don't really have much control over the situation and might not be able to counteract this exaggerated physiologic reflex. Here's one suggestion. On the day you are to give blood, drink lots of liquid (to be well hydrated) and wear elastic stockings (this pushes blood from your legs into your circulation). Then ask the technicians to take your blood while you're lying down with your feet propped up. All of these measures will protect against your blood pressure dropping too low. There are a few medical treatments that can be tried for patients with severe fainting disorders, though they would not be recommended for healthy volunteer blood donors.

CHICAGO: A friend told me that everyone who takes a statin drug to lower cholesterol should be taking coenzymes Q10, too. My doctor disagrees. What's your opinion?
In a very small number of patients, statins can cause muscle problems, but we don't understand why that happens. Some studies (but not others) have found that statins cause a decrease in muscle levels of coenzyme Q10 (CoQ10), which has led some to recommend that patients on statins take CoQ10 supplements. However, there are no published randomized controlled trials to tell us whether CoQ10 supplements are effective and safe when used either to prevent or counteract muscle aches. I agree with your doctor that there is inadequate information to recommend it as a routine measure.

LOS ANGELES: I am a 75-year-old man. The top number of my blood pressure is between 135 and 145 and the bottom number around 75-85. My doctor says this is fine, because blood pressure goes up in older age. Is my pressure too high?
Your blood pressure is very good: according to current guidelines, it is not high enough to warrant drug treatment, absent diabetes, chronic kidney disease or heart failure. Drug treatment is usually reserved for blood pressures above either 140mm Hg systolic (upper number) or 90mm Hg diastolic (lower number). It would be wise to reduce your sodium intake by not adding salt to your food, exercise regularly (up to six times per week for 30-45 minutes per session), avoid too much alcohol (more than two drinks per day) and keep your weight down. Medications like ibuprofen and other nonsteroidal pain relievers can also elevate your blood pressure. Recommendations for drug treatment, when life style changes are not adequate, are likely to change over time. Many now think that the blood pressure should ideally be as low as 115/75.

O'Gara is director of clinical cardiology at Brigham and Women's Hospital, associate professor of medicine at Harvard Medical School and a member of the editorial board of the Harvard Heart Letter. Readers should consult a medical professional for an accurate diagnosis.

© 2008