I was diagnosed last year with a Hollenhorst plaque. I have a “blue cloud” in the corner of my left eye at all times. My doctors’ only instructions were to notify them of any changes. I am scared. Am I going to have a stroke in the near future? When I asked one of my doctors, he said to “just keep an eye on it.”

A Hollenhorst plaque is a cholesterol crystal that is seen in the blood vessels of the retina. In most cases, the cholesterol plaque had broken off from the carotid artery, the main blood vessel providing blood to the brain.

While I understand your concern about its effect on your stroke risk, it seems to be fairly small — in one study of 130 patients with Hollenhorst plaques, none of them had a stroke in the two years or so that they were followed in the study.

However, all of the patients studied had some degree of blockages in the carotid artery, and your doctor should consider looking for blockages in yours if he hasn’t already. In most cases, carotid blockages are treated with medication, especially a statin medication.

Aspirin might be appropriate for some people, but that is a discussion you should be having with an expert, such as your internist or cardiologist.

Warfarin should not be used to treat cholesterol plaques. The manufacturers of warfarin recommend stopping warfarin if a cholesterol plaque is found, as warfarin can increase the risk of further events. However, there might be some situations in which anticoagulants must be used, such as in the case of a pulmonary embolism.

I recently went to my dentist. He noticed that the enamel on the back of my upper teeth, especially the front, is wearing away. He asked me if I experience acid reflux. I said I don’t think so, because isn’t that something I’d notice? He then asked if I feel refreshed after waking up from eight hours of sleep. I’m a new mother, and babies are next-level exhausting. He said to try an experiment: Take a Pepcid at night and if I start to feel more refreshed, then I’m probably having acid reflux that prevents me from going into deep, refreshing sleep. Do you recommend this?

I admire your dentist for noticing the enamel loss and considering the diagnosis of gastroesophageal reflux disease. Dental enamel can be lost in an acid environment, so it’s a reasonable thought.

However, it is normally severe acid reflux accompanied by frequent acid taste in the mouth that leads to tooth damage. There certainly are cases of asymptomatic GERD, but I think tooth damage is unlikely without further symptoms.

Repeated vomiting, especially in people with a history of an eating disorder, is a much more common cause of enamel loss than GERD, and that may be a possibility.

I would not recommend a medication trial because there are no reliable symptoms. I agree with you that poor sleep in a new mom is not always due to reflux.

If GERD is really a concern, a diagnostic test, such as a 24-hour pH monitor or an endoscopy, would be my preference before considering a longterm course of treatment.

Dr. Keith Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. © 2019 North America Synd., Inc.


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