DEAR DR. ROACH: I have HIV and pulmonary hypertension. I was part of a research study, and a scan found blockages of about 50% in my carotid arteries. I’ve never had any symptoms or a stroke. Do I need to have surgery? — V.P.

In general, screening for blockages in the carotid arteries that provide blood flow to the brain is not recommended, but occasionally, I do see people who get the diagnosis made as part of a study or as a result of a diagnostic test that was performed for some other reason. Screening means that there are no present symptoms, and the management of asymptomatic blockages is different from symptomatic ones.

Not everybody with blockages needs surgical intervention. Guidelines recommend against surgery in people with no symptoms and less than 70% stenosis. Only when the blockage is greater than 70% is surgery considered.

Medical treatment is effective at reducing the risk of a stroke and includes a high dose of a potent statin agent; aspirin; the careful control of high blood pressure and diabetes (if appropriate); quitting smoking; a healthy diet (such as Mediterranean-style); regular exercise; and weight reduction in some people.

HIV itself increases the risk of stroke by about 40% compared to people without HIV, so it is appropriate to be more aggressive at reducing risk factors. This is similar to what we see in people with chronic inflammatory diseases like rheumatoid arthritis, who have a higher heart disease and stroke risk than what would be expected based on their other risk factors.

Your HIV provider may wish to consult an expert in cardiovascular disease prevention to help you reduce your stroke risk, although many HIV experts are also skilled primary care doctors themselves. Keeping HIV under control (ideally with no detectable virus) may help reduce inflammation and consequently help bring down the additional risk of heart attack and stroke associated with HIV.

DEAR DR. ROACH: My spouse is frustrated by a nagging case of plantar fasciitis. It’s been continuing for five or six months now. No amount of stretching, icing or resting seems to help. They are considering using a plantar fasciitis sock device that holds the foot in a specific position to provide relief. I am wondering if you could provide any other suggestions on how to reduce or eliminate this problem. — M.R.

Plantar fasciitis is among the most common causes of foot pain, with nearly 1% of people complaining of plantar fasciitis pain in the previous month. Inflammation and pain most commonly occur at the bottom of the foot, just in front of the heel. The pain is often worst during the first step in the morning. Rest and cushioned shoes or heel pads are helpful for most people. I am cautious about recommending stretching, especially when the pain is severe, as overdoing the stretch can make things worse. Still, most people find stretching to be of benefit.

When symptoms do not get resolved with conservative management, I refer patients to a podiatrist. Some people just take a long time to heal, but 80% are better within a year. When conservative measures have failed to bring relief, your spouse’s podiatrist might consider an injection of a steroid.