DEAR DR. DONOHUE: I was recently diagnosed as having an aneurysm in my abdominal aorta. I have no symptoms, but the doctor says I need surgery.

I don’t know much about aneurysms and would like some information. My father died from one at age 85. So did my uncle. Is it inherited? The size of my aneurysm is more than 5 cm. – J.V.

ANSWER: An aneurysm is an artery that has a soap-bubble bulge. It’s a weak spot, and the danger is that it can burst and cause major bleeding. The aorta is the body’s largest artery, running from the heart to the bottom of the abdomen, where it divides into two arteries that supply the legs. All along its course, it sprouts branches that bring blood to the entire body.

Aging, having to endure the pressure of blood as it comes out of the heart, smoking, high blood pressure and high blood cholesterol all contribute to aortic aneurysm formation. Genes most certainly have a hand in them too, and your family history has put you at risk.

Most people with an aneurysm have no symptoms. When symptoms occur, two common ones are low-back pain or pain in the abdomen just below the breastbone. If the aneurysm ruptures, pain is severe, blood pressure drops quickly and emergency surgery must be performed immediately.

Ultrasound pictures are the standard way to detect these bulges. If an aneurysm is larger than 5.5 cm (2.2 inches) or if a smaller aneurysm grows more than 1 cm (0.4 inches) in one year, then doctors advise surgery to replace the affected section of the aorta with a graft. Such aneurysms are likely to burst. Sometimes a procedure called endovascular repair can be employed. In this procedure, a polyester fabric stretched over a collapsed metallic support is inched into the aorta from a groin artery. When the doctor reaches the aneurysm site, the fabric is maneuvered into place and the support is opened like an umbrella. Not all aneurysms lend themselves to this procedure.

DEAR DR. DONOHUE: Several times a week my heart wakes me from sleep. It beats fast and sort of out of control. My pulse gets weak and then strong. I have always had good exams, and I don’t smoke or drink. I don’t take any medicines. I am careful about what I eat, and I exercise regularly. What do you think is happening to me? – R.T.

ANSWER: Your description fits atrial fibrillation. It also fits a number of other heartbeat irregularities. In atrial fibrillation, the upper heart chambers – the atria – are beating rapidly and chaotically. But heart-rhythm disturbances are impossible to diagnose from a description. A doctor has to listen to the beating heart or, better yet, obtain an electrocardiogram during the episode of abnormal heart rhythm.

You have to see your doctor. The doctor will most likely want to you wear a monitor that captures all heartbeats for one or many days. The evidence provided by the monitor permits an accurate assessment of what’s going on.

The booklet on heartbeat disturbances discusses common heart rhythm problems. Readers can obtain a copy by writing: Dr. Donohue – No. 107, Box 536475, Orlando, FL 38253-6475. 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: I had a high PSA reading and had to have a prostate biopsy. The report says prostate cancer with a Gleason score of four. What is that? – W.W.

ANSWER: When examining the biopsy with a microscope, the pathologist identifies the two most numerous kinds of cells. He assigns a number from one to five for each of those cell populations. One is the least-aggressive-looking cell and five is the most-aggressive-looking. The two scores are added. Two, therefore, is the best Gleason number, and 10 the worst. Your score of four indicates a fairly benign cancer.

It indicates a good prognosis. Gleason score, however, is not the only factor involved in estimating the cancer’s threat. The extent of its spread is also important.

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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