DEAR DR. DONOHUE: For years we teased my uncle about his beer belly, but we have recently learned that he probably has cirrhosis. His extended abdomen is caused by blood leaking into it.

I don’t believe you have ever addressed this particular problem. If my uncle quits drinking, will his beer belly go away? Half the family says yes; half says no. Please comment. – E.L.

ANSWER:
Liver cirrhosis is a liver filled with scar tissue. It creates a number of serious consequences. For one, blood that normally passes through the liver on its way back to the heart has to be rerouted. That increases pressure in the veins chosen as the new route to the heart. The increased pressure causes fluid to leak from the veins and fill the abdominal cavity. Fluid from the bloodstream — not blood — fills your uncle’s abdomen. This is not the common beer belly that comes from the excess calories provided by beer. That beer belly is fat.

A cirrhotic liver is a nonfunctioning liver. As a result, it stops making protein. Blood proteins keep fluid within blood vessels. Without proteins, fluid oozes out of vessels — another reason why a cirrhotic’s abdomen fills with fluid.

Furthermore, a cirrhotic liver cannot metabolize hormones that retain fluid and sodium in the body. Retention of both sodium and fluid is another factor in swelling the abdomen with fluid.

The condition of an abdomen filled with fluid goes by the name of ascites (uh-SIGH-tees).

If your uncle swears off alcohol, then he has a chance for ridding his abdomen of the fluid buildup. He must also cut back on the amount of salt he takes, just as those with high blood pressure do. His doctor will most likely prescribe a diuretic — a water pill. Diuretics rid the body of fluid by encouraging its drainage into urine. Almost 90 percent of those having ascites can obtain a significant decrease in the volume of abdominal fluid by abstaining from alcohol, reducing salt intake and taking a diuretic.

DEAR DR. DONOHUE: I am an insulin-dependent diabetic. I am 58 and have had diabetes for 18 years. My sugar tests are always good. My doctor has prescribed Altace from me to lessen or forestall problems that might befall my kidneys. I have looked in many pill books but find no mention of this benefit from Altace. Can this be confirmed? – R.M.

ANSWER:
Altace, whose generic name is ramipril, is an ACE inhibitor, a drug whose primary purpose is to lower blood pressure.

ACE inhibitors in general and Altace in particular have a number of beneficial effects for diabetics. They keep the blood pressure low. Diabetics are best served when their pressures are at or below 130 over 80-85, pressures that most other people could tolerate.

In addition, diabetes, irrespective of blood pressure, damages kidneys on its own. One sign of kidney involvement is microalbuminuria — albumin (protein) in the urine in such small quantities (“micro”) that it does not show up on standard urine protein tests.

Your doctor might have prescribed Altace because your urine showed a tiny amount of protein, or he might have discovered subtle signs that your heart arteries are clogging, another reason to prescribe Altace.

Even if your blood pressure is normal, there are compelling reasons to put a person such as yourself on Altace.

DEAR DR. DONOHUE: Could you discuss alcohol and a breast-feeding mother? My daughter thinks a couple of drinks are OK when nursing a 4-month-old baby. I disagree. Please give us some guidelines. – W.D.

ANSWER:
Alcohol passes from a mother’s blood into breast milk quite rapidly. Babies are small. Even tiny amounts of alcohol can make them drowsy. A drowsy baby drinks less milk. Its growth might be delayed.

In addition, a baby’s liver cannot detoxify alcohol as a mature liver can. That’s another reason why babies can be overwhelmed by even small amounts of alcohol in their mother’s milk.

If your daughter cannot live without alcohol, she should take only one drink a day, and she should drink that drink two to three hours before she feeds the baby. That gives the alcohol time to clear from her blood and breasts.

DEAR DR. DONOHUE: I read or heard that aneurysms run in families. Two of my sisters (one now confined to a wheelchair), a brother (deceased) and a maternal uncle (deceased) had aneurysms. My siblings and I are worried about our health. What tests should we have? – C.B.

ANSWER:
Aneurysms are pea-sized bulges through a weak spot in an artery wall. The bulge presents an occasion for possible catastrophe. It can burst and cause a massive bleed.

I confine my aneurysm remarks to brain aneurysms, since that appears to be the kind with which your family is so familiar.

A burst brain aneurysm produces a stroke. I take it that that is the reason your sister is confined to a wheelchair and why your brother and uncle died.

How to handle close relatives of people who have had a cerebral aneurysm presents a quandary. Having a close relative with an aneurysm increases the odds of you having an aneurysm two- to sevenfold. Detection of brain aneurysms used to rely on injecting dye into brain arteries — a procedure that is not without risk. However, newer imaging techniques markedly reduce risk. One of those tests is an MRA, magnetic resonance angiogram. It’s a combination of an MRI scan — the scan used most often for brain pictures — and dye to highlight brain arteries.

If an aneurysm is found, another quandary arises. Should it be treated? One surgical procedure is to place a clip at the base of the aneurysm to obliterate it. The operation can be hazardous. The decision to operate on an aneurysm that causes no symptoms is based on its size and the patient’s age.

A newer technique entails inching a pliable, soft, slender tube (a catheter) to the site of the aneurysm and then releasing tiny metal coils into the bulge to seal it off. It is a technique, however, not suited to every aneurysm.

Speak with a neurosurgeon. In your shoes, I would push for an investigation.

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.


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