DEAR DR. DONOHUE: During my annual physical, my primary-care physician felt a strong pulse while checking my abdomen. A CT scan revealed an abdominal aortic aneurysm enlarged to 5.2 cm.

I am told that for men my age (72), this is a rather common affliction, and that the standard treatment is to insert a stent into the abdominal aorta through the groin area, rather than abdominal surgery.

Will you comment on how common aortic abdominal aneurysms are in men over age 65 and the risks/benefits of abdominal surgery versus a stent? — J.S.

ANSWER: An aneurysm is a bulge in an artery, a weak spot. It comes mostly from artery hardening. That sounds paradoxical — hardening should strengthen a structure. Artery hardening, however, causes the artery wall to degenerate and weaken. The aorta, the body’s largest artery, is the artery where most aneurysms arise, and the section of the aorta that passes through the abdomen is the area where they are most frequently found.

Most aneurysms are silent. Large ones cause abdominal or back pain, and doctors can feel them as abnormal abdominal pulsations. They are rare in men younger than 60. Between the ages of 65 and 75, 3 percent to 5 percent of men have one; after age 75, more than 7 percent have a significant aneurysm. For every woman with an aneurysm, four men have one. The decision to repair the aneurysm is made when it reaches a diameter of 5.5 cm (2.2 inches) or when the aneurysm grows more than half a centimeter (1/5 inch) per year. Circumstances often dictate that smaller aneurysms be repaired sooner.

Open surgical repair entails removing the aneurysm and substituting an artificial graft. The mortality rate for this surgery is around 3 percent in the month following surgery. Recovery takes a couple of months. It is a major procedure, and people in frail health usually are not candidates.

Endovascular stent graft involves threading a replacement stent through a groin artery and into the aorta. When the doctor reaches the aneurysm site, the stent graft is opened and tacked in place. The mortality rate in the month after surgery is lower with this procedure. However, a substantial number eventually require reintervention for problems like leakage. Patients do recover more quickly from this procedure. The choice between these two procedures lies with the patient and the doctor, and depends on the patient’s general health.

DEAR DR. DONOHUE: I would like your opinion of a newer nonsteroidal anti-inflammatory drug, the Flector patch. The patches are about 4 inches by 5 inches and are applied to the skin for 12 hours. For me, they were prescribed for back pain. They have brought me periods of relief. They come with the usual lengthy descriptions of possible ill, if not fatal, side effects. Can you help me feel safe in using them occasionally? — M.B.

ANSWER: All NSAIDs (nonsteroidal anti-inflammatory) medicines like Advil, Aleve and Motrin and 15 others come with a long list of frightening side effects. The Flector patch (diclofenac) carries the same warnings as the others. I wouldn’t hesitate to use it as you do. The manufacturer gives good advice: Use exactly as prescribed, in the lowest possible dose that brings results and for the shortest time. You are doing that. You’re safe.

DEAR DR. DONOHUE: When my mother was hospitalized, she was placed on thyroid medicine. Now the doctor says she doesn’t need it. She had something called euthyroid sick syndrome. What’s going on? — M.M.

ANSWER: Sometimes illnesses not related to the thyroid gland produce lab results suggestive of thyroid trouble. The “eu” of that syndrome is a Greek word meaning “well.”

People with the syndrome don’t really need thyroid treatment. When the illness causing the falsely positive thyroid tests is taken care of, the tests revert to normal.

Thyroid medicine isn’t needed.

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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