Aortic dissection often leads to death

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DEAR DR. DONOHUE: My grandfather, 76, just died of an aortic dissection. It happened very quickly, and he barely made it to the hospital; he died shortly after. Our family isn’t too clear on what happened, and if this is hereditary. Should all of us be checked for it? – K.D.

ANSWER: The aorta, the body’s largest artery, is welded to the heart and receives all the blood the heart pumps with each beat. The aorta runs from the heart to the bottom of the abdomen, where it divides into two arteries for the legs. Its many branches supply the entire body with blood.

An aortic dissection is a tear in the aorta’s wall, often in its first part, the part in approximation to the heart. The inner lining of the artery separates from the wall. Blood under high pressure from just being pumped seeps into the space opened up by the tear and peels more of the lining away from its wall.

Extreme chest pain – worse than the pain of a heart attack – is the salient symptom of a dissection. This is a true emergency, and even with great care and prompt attention, death often results.

One emergency treatment is lowering blood pressure to stop further dissection of the aortic lining away from its attachment to the aortic wall. Most dissections require surgical repair.

The cause of aortic dissection is often high blood pressure. In only a few cases is aortic dissection the result of an inherited disorder, and for those few cases, other signs of the inherited disorder are readily recognized. If your grandfather had one of these rare inherited problems, the doctors would have told your family. They did not. Your family does not need to be checked for aortic dissection.

DEAR DR. DONOHUE: My husband has been told he has a bulging disk in his back. What is that? Does he need surgery? The doctor has told him that since his back pain is not all that bad, he should not make any rash decisions about treatment. What do you think he should do? – T.M.

ANSWER: Disks are shock absorbers interposed between adjacent backbones (vertebrae). They’re about one-quarter the thickness of an individual backbone. Their center is filled with a spongy, gelatinous material that absorbs the many shocks and stresses inflicted on the back. The outer rim of the disk is a fibrous material. The “bulge” is a protrusion of the inner, gelatinous material through the fibrous outer ring.

Not every bulging disk needs to be repaired. Not every bulging disk causes pain. When one does, 70 percent or more of affected people are free of pain in one month. Your husband’s doctor stands on solid ground when he tells him not to make rash treatment decisions.

Your husband needs some physical therapy for his back, and he needs instructions on how to protect his back.

The booklet on back problems deals with the causes of back pain and their treatments. Readers can obtain a copy by writing to: Dr. Donohue – No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My son is 32. He is 6 feet 8 inches tall. Both my husband and I are over 6 feet. When he was in the Army, someone told him he might have Marfan’s syndrome. We have searched on the Internet and have found little information about this. Would you fill in the details? – W.R.

ANSWER: People with Marfan’s syndrome are tall and have long, thin arms and legs, with spidery, long fingers. The lens of the eye is often displaced in Marfan’s patients. The dangerous changes of Marfan’s take place in the heart and aorta, where heart valves can be defective and where weak spots, which are liable to burst, can develop in the aorta.

All tall people don’t have Marfan’s syndrome. Who was the someone who told him he might have it? If it was his doctor, I might listen if the young man has some of the other findings of the syndrome.

DEAR DR. DONOHUE: My 19-year-old daughter swims for her university. She has had shoulder problems off and on since she swam in high school. We have had her examined many times, but nothing has turned up. Do you have any ideas of what might be going on and how to deal with it? – K.K.

ANSWER: Swimmers put a great deal of stress on the shoulder, the body’s most versatile joint. It has the greatest range of motion of all joints, and swimmers have the greatest number of shoulder problems of all athletes. A competitive swimmer makes up to 20,000 shoulder revolutions every week. That’s 20 times the number of revolutions that a baseball pitcher makes, so you can see why the shoulder is a source of trouble for swimmers.

I can’t tell you what your daughter’s problem is, but I can give her a few tips on how to save her shoulder.

If she develops even the slightest twinge in her shoulders, she should take time off until it goes away. She needs to keep the shoulders rested, because shoulder muscles fatigued by overuse cannot keep the upper arm in the shoulder joint. That leads to misalignment of the shoulder, which creates problems for the shoulder’s rotator cuff.

I trust that her swimming coach has analyzed her stroke technique. A minor adjustment in her stroke could restore her shoulder health.

If she hasn’t done any weightlifting, she should. She should do exercises with somewhat-light weights but with high repetitions three times a week. She doesn’t need to participate in prolonged weight training during swimming season, but she should do so when she’s not in actual training.

She should apply heat to her shoulders before swimming, and she should ice them after a swimming session.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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