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History Trumps Screening Guidelines

Dear Dr. Roach: I have a family history of aortic aneurysm. My father was diagnosed with one at approximately 70 years of age. His was found when he was going to surgery for other problems, and the aneurysm was successfully repaired. My brother died of a ruptured aortic aneurysm at the age of 63, and my sister died of an aortic aneurysm at the age of 64. All three of my family members smoked and were overweight. I was checked four years ago, and at that time had no signs of an aneurysm. I have been advised that they do run in families. I have a few questions: How often should I be checked? Should my children or grandchildren be checked, and if so, at what age? Do smoking and being overweight contribute to the development of aortic aneurysms? — K.K.

Answer: An abdominal aortic aneurysm is a dilation of the aorta, the main blood vessel that takes the blood from the heart to the rest of the body. As the dilation grows, the walls of the aorta progressively become weaker, until the dilation exceeds 5 cm, at which point it is at such high risk for rupture, it should be surgically repaired. AAAs are much more common in men, and are much more common in smokers and in people with high blood pressure. The standard guideline is to check all men with any history of smoking for AAA once between ages 65 and 75, but not women.

However, guidelines are just guidelines, and there are clinical situations in which additional screening is appropriate. The most important advice I can give you and your family is to manage your risk factors as much as possible. Nobody should ever smoke, but given your family history, it’s even more important. Even moderate high blood pressure should be treated. As far as screening goes, it would be reasonable to screen first-degree relatives (meaning your siblings and your brother’s and sister’s children) somewhere around the age of 60. I also would consider taking another look at your aorta, especially if you were ever a smoker or had high blood pressure. If not, or if the repeat shows no dilation at all, then your risk is low.

Dear Dr. Roach: I have been diagnosed with diverticulosis, and have been advised that I am at risk of developing diverticulitis. Can you elaborate on precisely what each of these diagnoses consists of, the level of risk involved in moving from one to the other and what I might do to mitigate such risk? Thanks in advance for your help. — V.L.

Answer: Diverticula are small outpouchings in the wall of the colon. The condition of having them is called diverticulosis. These can cause problems most commonly through infection and by bleeding. When they become inflamed, usually through infection, it is called diverticulitis — the “itis” indicating “inflammation.” Eschewing nuts and seeds has long been recommended to prevent diverticulitis, although one recent study questioned whether this is important.

Diverticulitis usually is associated with both pain and fever, and is treated with antibiotics. Many surgeons recommend removal of the affected part of the colon, if possible, after an episode of diverticulitis, since the likelihood of recurrence is high. Bleeding usually comes from diverticulosis without diverticulitis.

Dear Dr. Roach: I underwent a TURP surgery at the age of 52 for difficulty urinating. The surgery was successful, but 11 years later, I began to have difficulty urinating at night. Flomax worked, but after four years it started making me dizzy. My urologist performed a cystoscopy and agreed to a repeat TURP. Unfortunately, it was not successful, and I am now taking the generic form of Flomax, tamsulosin. Strangely and thankfully, the generic form does not make me dizzy. Do you have any idea why the second TURP was not successful? — R.S.

Answer: “TURP” stands for “transurethral resection of the prostate.” It’s performed for symptoms of enlarged prostate. Fewer of these surgeries are performed now than when you had your first one, largely because medication treatment works very well. However, no operation is perfect, and a TURP occasionally makes symptoms worse. One of the reasons men sometimes don’t get better after having a TURP is the development of scar tissue. It makes sense that a second operation would be more difficult and would not have had as favorable an outcome.