Medical Tests & Procedures Archive


Ask the doctor: When to remove carotid blockage?







Anthony L. Komaroff, M.D.


Q. At what percentage of blockage of the carotid artery do you consider surgery? I am a 73-year-old man with a 70% blockage, and my doctor says to wait a year and check back then.

A. As you know, your carotid arteries are the main blood supply to a large part of your brain. Blockages definitely pose a threat to the brain, but there are risks to the treatments as well.

Are high tech heart tests best?

Some popular heart imaging tests aren't for everyone.

If your doctor wants to get a better idea of the health of your heart, you may be advised to have a new high-tech imaging test that uses computed tomography (CT) scans, either a coronary artery calcium (CAC) screening or a coronary CT angiography.

The popular fix for droopy eyes

When is surgery warranted?

Droopy upper and lower eyelids change more than just your appearance; they can block your peripheral vision. The fix is blepharoplasty, a procedure that's now one of the most popular facial plastic surgeries in the United States. "I see it every day in my practice. It's one of the most common procedures I do," says Dr. Suzanne Freitag, director of ophthalmic plastic surgery service at the Massachusetts Eye and Ear Infirmary. But how do you know when surgery is right for you?


Before After

Photos courtesy of Dr. Suzanne Freitag

The problem

The skin around your eyes is the thinnest on your body, and it's always in motion. The eyelids stretch with age, causing lax, droopy skin. In addition, puffiness may result from eye socket fat falling forward with age. This excess skin in the upper eyelids and "bags" in the lower eyelids may interfere with your vision. "Some patients have skin so droopy it hangs over the top eyelashes and they can't open their eyes. They want relief," says Dr. Freitag. Other people want to regain a more youthful appearance.

New attack on precancerous patches

58 million of us have actinic keratoses. Now treatment is easier.

They look minor. They are usually pea-sized rough patches, often scaly and with surrounding redness, on sun-exposed skin. But actinic keratoses (AK), caused by too much sun exposure, are nothing to dismiss. "They can progress to skin cancer, or there can be so many that it's difficult to pick out lesions that are already skin cancers," says Dr. Suzanne Olbricht, associate professor of dermatology at Harvard Medical School.

Recovering from coronary bypass surgery

Here's what you can do to get back on your feet quickly.

More than 415,000 people with coronary artery disease undergo coronary artery bypass grafting (CABG) every year. It's a big operation, but remarkably safe: although results vary among cities and states, the combined survival rate for all CABG procedures performed in Massachusetts hospitals is 98.7%.

Pelvic organ prolapse

How does controversy affect your treatment?

Pelvic organ prolapse is in the national spotlight because the surgical mesh sometimes used to keep pelvic organs in place can cause complications: infection, pain, urinary trouble, and recurrence of the original problem. So what do you do if you're struggling with a sagging bladder, uterus, or rectum?

The sagging truth

For about 50% of mostly older women, the connecting tissues and muscles that hold the pelvic organs in place weaken and stretch over time, causing the organs to descend (prolapse) into the vagina. Sometimes an organ falls so much it's visible at the vaginal opening. That happens to 10% to 15% of all women, according to Dr. George Flesh, director of urogynecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates.

News briefs: Education, psychological support vital for ICD users

An implantable cardioverter-defibrillator (ICD) helps establish a healthy heart rhythm and prevent sudden cardiac death. But psychosocial support needed to adjust to life with an ICD is often overlooked after the devices are implanted.

Ask the doctors: Can I have heart surgery while taking pain medication?

Q. I have had back problems for decades, and I have become quite dependent on oxycodone, regardless of whether my back is acting up or not. Now I am going to need heart surgery, but the surgeon I was sent to won't operate unless I can get off the pain pills. That seems cruel. What is he thinking?

A. Certainly if surgery were urgent, you could have a heart operation. But since your surgery is not urgent, it would be much better if you find a way to stop your oxycodone use first. You are going to need pain medications in the period after surgery, and when someone has addiction problems, the clinicians never know whether they are giving too much or not enough of these medications. In addition, surgeons want their handiwork to have lasting benefit, so showing that you can control your addiction problem helps assure your doctors that you will able to stick with your regimen after surgery—that is, take the medications you need to prevent recurrence. Even though this advice may seem hard-hearted, it is surely based upon some past experiences.

Radial artery grafts prove durable

In coronary artery bypass grafting (CABG), the internal mammary (or thoracic) artery is the graft of choice for bypassing blockages in the main coronary artery, because it tends to remain open and functioning well for many years.

Choosing a heart surgeon

The way public data are presented may influence your choice.

If you're shopping for a car, it's easy to find information on gas mileage, repair rate, and other factors of interest to consumers. Moreover, it's possible to compare models in order to find which one is most likely to meet your needs. Can you do the same with heart surgeons?

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