Aneurism surgery determined by size, growth

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DEAR DR. ROACH: I am a female, age 80, with controlled high blood pressure. I am mildly active, and though I tire easily, I have no complaints. My blood pressure in the past was difficult to control. I had a CT scan, which showed an aneurysmal dilatation of the ascending aorta, measuring 4.7 cm. Two years ago, the size was 4.5 cm.

I would appreciate your comments on any surgical options, progression of severity and prognosis. — S.S.

ANSWER: An aneurysm is a weakening and ballooning out of a blood vessel. In the aorta, we consider aneurysms of the thoracic aorta (in the chest) very differently from the more common ones of the abdominal aorta (often abbreviated AAAs). Thoracic aneurysms usually have no symptoms and are discovered incidentally when evaluating other conditions. Most cases are related to high blood pressure (as it sounds is the case for you), smoking or high cholesterol. However, about 20 percent of these aneurysms are related to a connective tissue disease such as Marfan’s syndrome or Ehlers-Danlos. Inflammation is an uncommon cause.

The size of the aneurysm is the most important predictor of whether it will rupture, which is the major and most devastating complication. Some authorities recommend surgery at 5 cm, others when it is twice the normal size (normal for women is 2.86). Rapid growth also is an indication for surgery. As best I can tell, you don’t meet any of these criteria.

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Given that there’s no urgent need for surgery, the standard recommendation would be careful control of your blood pressure, especially though use of a beta blocker, since these reduce blood pressure in a way that minimizes stress on blood vessel walls. (For you engineers and physicists, we try to minimize dp/dT, the instantaneous change in pressure over time, and beta blockers reduce the speed and strength of the blood ejected from the heart more than other agents.) Your doctor will continue to monitor the size of the aneurysm and look for any changes. Since yours is enlarging slowly, I would say that the prognosis is good that you won’t need surgery.

DEAR DR. ROACH: I have a 1.3-cm nonobstructing calcium stone in the midpole of my right kidney. The stone does not bother me. Will this stone dissolve? Are there foods I shouldn’t be eating? — J.W.

ANSWER: Kidney stones are very common, with 8 percent of women and 16 percent of men having one by age 70. About half of people who are found to have an asymptomatic stone will develop symptoms within five years. Stones generally do not dissolve on their own. Without knowing the exact kind of stone (there are several types of calcium stones), I can’t give specific advice, but there are a few general principles by which all people with stones should live. Probably the most important is to drink plenty of water.

The second is about calcium, and this one is surprising: A diet with lots of calcium actually reduces stone risk, but calcium supplements increase stone risk. So get plenty in your diet, and avoid supplements. As far as diet goes, avoiding too much meat and salt is important.

Some medical issues increase stone risk, such as hyperparathyroidism, which your doctor probably has checked you for. If your stone passes, it can be analyzed, and you can then get more specific advice on diet, especially whether to limit oxalates in your diet.

Dr. 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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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