A Question of Health: Is aspirin the only help for mini-strokes?

Q. I have had a number of mini-strokes, but fortunately none has left me with any permanent disability. I have been advised to take a daily dose of aspirin to thin the blood, but I am finding that aspirin upsets my stomach. What else can I do to prevent further strokes?

Q. I have had a number of mini-strokes, but fortunately none has left me with any permanent disability. I have been advised to take a daily dose of aspirin to thin the blood, but I am finding that aspirin upsets my stomach. What else can I do to prevent further strokes?

A. You have had transient ischaemic attacks or TIAs. These are similar to strokes, but the difference is that strokes cause permanent damage to the brain, while TIAs resolve within 24 hours, leaving no damage or disability. Aspirin, even in small doses, will reduce the chance of further TIAs. Try taking 75mg after food. If your stomach can't tolerate that, use a form of aspirin known as enteric-coated. This has an outer coat that sometimes makes it less irritant. If that fails, discuss with your doctor a drug called dipyridamole, which has similar effects to aspirin without the stomach side effects. Smoking is another important risk factor for strokes and TIAs, so if you are a smoker it is essential that you stop completely.

Q. I am developing a pinkish growth on the surface of my eye and although it is not painful, I am worried that it will soon begin to interfere with my vision. Could this be the beginning of a cataract?

A. Cataracts develop within the eye, not on the surface, and they are not visible when you look in the mirror. If this growth is on the surface of the white part of the eye it is probably a pterygium (the "p" is silent when it is pronounced). A pterygium is a benign growth that is more common in people who have lived in hot, sunny climates. Exposure to ultraviolet light is one of the factors that cause it to develop. A pterygium is usually wedge-shaped, and as it grows it slowly advances towards the pupil. It can be removed by a relatively simple operation, but if it is not causing any discomfort and is not interfering with your vision, there is no need to have it removed. There are other types of growth that can appear on the surface of the eye, and it is important to see a doctor who can make a definite diagnosis.

Q. I heard recently that grapefruit juice can influence the effectiveness of some drugs. Is this true? Which drugs are affected by grapefruit juice?

A.Bizarre as it may sound, it is true that grapefruit juice can interfere with the metabolism of quite a large number of drugs. The effect - called The Grapefruit Juice Effect - is usually to increase the amount of a drug that circulates in the bloodstream, sometimes by a substantial amount. There is a long list of drugs that have been reported to be affected by The Grapefruit Juice Effect. The most important ones are cyclosporin (used to stop rejection of transplanted organs) and a widely used antibiotic called erythromycin. A commonly used antihistamine - Triludan - was withdrawn from the market last year because it caused heart irregularities that were made worse when it was taken with grapefruit juice. Some blood-pressure and angina drugs called calcium channel blockers (the names all end in "pine") are also influenced by grapefruit juice. If in doubt, read the patient information leaflet with the tablets and ask your doctor.

Please send your questions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail to health@ independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions