Dear Dr. Roach: I am a woman who is 68 years old and in generally good health. In September 2021, after a couple episodes of faintness when tilting my head back, I was given a CT angiogram with contrast. The diagnosis was fibromuscular dysplasia (the report noted a “beaded appearance” of the artery), with no dissection or hemodynamically significant stenosis. At the time, I was told to take aspirin daily and not to look up.
It seems to be getting worse, as I cannot tilt my head back for more than a few seconds before noticing an effect (i.e. when drinking, especially from a bottle, or looking for something on an upper shelf). Are the “beads” going to continue to grow, resulting in more problems and me having to constantly look down? Is a stroke inevitable from the lack of blood flow at some point in the future?
When I do have a more significant episode (I haven’t completely passed out yet), is there anything I can do to help restore equilibrium (maybe a boost of oxygen)? Are there things that may make it worse, like lifting heavy boxes or vibrations from a sonic toothbrush?
C.B.
Fibromuscular dysplasia (FMD) is a disease of blood vessels caused by excess fibrosis of the blood vessel itself. It is not atherosclerosis. Cholesterol is not found in the artery, and it is not an inflammatory disease. It isn’t known why people get it.
Headaches are more common than the lightheadedness you noticed. Other organs can be involved, including the kidney, and FMD is one of the more-common causes of “secondary” high blood pressure, even though it is not a common problem. (The best estimate is only 0.02% of the general population.)
The good news is most experts find that this condition does not worsen over time. Most people like you with FMD in the carotid arteries did not progress with follow-up repeat imaging studies. A stroke is not likely and certainly not inevitable. Ultrasounds are preferred over CT scans to look for progression because an ultrasound does not have ionizing radiation. Careful monitoring of blood pressure and kidney function is wise.
If you do have another episode, keeping the neck in a neutral position is important. Oxygen isn’t helpful. I don’t think lifting or brushing your teeth is likely to cause your symptoms.
Dear Dr. Roach: I am an 86-year-old male. Several years ago, I had about a third of my prostate removed because I couldn’t pee. After the surgery, all was well with a steady stream. That is, until about two weeks ago, when during one of my many trips to the bathroom, I had a hard time starting. The stream was stop-and-go. This continues to this day. The symptoms are much worse at night.
Any thoughts about the sudden change in my urinating?
D.S.
A sudden change in urinary symptoms should make your physician consider a urine infection. Men with enlarged prostate glands are at a high risk for this. If the urine test doesn’t show an infection, your urologist will consider other possibilities, such as the prostate gland continuing to enlarge. Despite the surgery, you have symptoms again. You might have developed a stricture, which is a kind of scar tissue near the surgical site. Certainly, a visit to your regular doctor or urologist is called for.
I would also be sure you aren’t taking any medications that can exacerbate prostate symptoms. Over-the-counter cold/allergy medicines — both antihistamines and decongestants — are the most common. If you just started taking these for allergies, they could be the likely cause.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
