DEAR DR. ROACH: Can high blood pressure cause blood clots, blindness and strokes? Or is this caused by taking the wrong combination of blood pressure medicines? — Anon.
ANSWER: High blood pressure over months or years causes damage to the lining of blood vessels. This can indeed predispose a person to a stroke. Reducing blood pressure gradually reduces risk of stroke.
Blood clots also can cause strokes, but these usually are not linked to blood pressure, high or low, and instead are linked to conditions that affect the blood itself or that affect the rhythm of the heart. Some medicines, such as estrogen, make blood clots more likely.
In people with very high blood pressure, lowering it too much, too quickly can cause strokes. The blood pressure needs to be reduced gradually, which usually can be done as an outpatient. There are still a few times when people with extremely high blood pressure are admitted to the hospital, where blood pressure can be brought down very slowly in a controlled environment.
High blood pressure is one of the most common ailments for the general population. The booklet on it describes what it does and how it’s treated. Readers can order a copy by writing: Dr. Roach — No. 104W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: In March 2013, I fell and landed on my left side. Since then, I have had quite a lot of pain. I had an MRI that showed I have a tear of the gluteus medius muscle. I was advised to have a surgical repair done as an outpatient. My family doctor wants me to wait and talk to another surgeon. My pain is aggravated by pressure and weight-bearing activities. What is your suggestion? I’m 77 and in pretty good health, and I walk my dogs several times per day. — M.C.
ANSWER: Gluteus medius tears are an increasingly recognized cause of hip pain. The gluteus medius muscle helps hold the hip in place during walking. They often are treated conservatively, with injection and physical therapy. They can be mistaken for trochanteric bursitis, but persistence of pain despite treatment should make the physician consider alternate diagnoses, and an MRI usually makes the diagnosis.
In your case, you have been suffering for two years, and I agree that it’s time to consider surgical repair. However, I also have to agree with your family doctor that a second opinion may be wise. There are several new surgical techniques, and you want an experienced surgeon operating on you. Talking to a second surgeon at the very least can make you more confident that the surgery is necessary.
Postoperative recovery may require six weeks of crutches or other assistive device, and another six weeks in a hip brace, although the exact recovery depends on you and the type of surgery performed.