DEAR DR. DONOHUE: I need a second opinion, so I’m coming to you for it. I am an 80-year-old man and have had an abdominal aortic aneurysm for five years. It has reached a size where my doctor says surgery is needed. He suggested a graft through an abdominal incision.

My brother, three years older than I, had the same problem but had a repair that didn’t involve surgery. The graft was placed in the aorta through a leg artery. Which is considered the better procedure? — F.M.

ANSWER: An aneurysm is a bulge of an artery’s wall. The abdominal section of the aorta, the body’s largest artery, is the site for many aneurysms. The seriousness of the situation is judged by the size of the aneurysm. A bulge greater than 2.2 inches in diameter calls for treatment. An aneurysm is a weak spot and poses a threat of death should it burst. The result is a massive hemorrhage. The mortality rate of a burst abdominal aneurysm, even with emergency surgery, approaches 50 percent. Taking care of the aneurysm before such a catastrophe occurs avoids the danger of sudden death.

Standard treatment has been an operation in which an incision is made in the abdomen and the involved part of the aorta is replaced with a graft. It’s a serious operation with a considerably long period of recuperation. Nevertheless, it’s produced excellent results and has had many years that prove its worth.

The newer procedure is endovascular graft repair. A device, somewhat similar to a stent used to open blocked heart arteries, is inserted into a groin artery and manipulated to the aneurysm site in the aorta. There, it’s fixed in place. This is a much less demanding procedure and has a relatively short recuperation period. It’s a treatment that is of great benefit to those whose health or age makes them less-than-ideal candidates for surgery. Younger people with an aneurysm are encouraged to have the operation because its long-term results have proven to be enduring. If you prefer the endovascular repair, discuss it with your doctor; he or she will accommodate your wish unless there’s a compelling reason to perform surgery.

DEAR DR. DONOHUE: My 33-year-old son has just been told he has juvenile diabetes and must go on insulin shots. How is this possible? He’s definitely not a juvenile. I always thought diabetes ran in a family. Not a single relative on his father’s side or my side has diabetes. Please explain. — D.T.

ANSWER: Age is no longer the determinant of juvenile diabetes. The need to use insulin from day one of treatment is. Juvenile diabetes is now called type 1 diabetes.

Genetics isn’t the sole factor in the occurrence of diabetes. The risk of developing diabetes if a person’s family has no history of it is 0.4 percent. If a person has an identical twin with type 1 diabetes, the risk of coming down with it is 50 percent. If genes were the sole cause, the risk for an identical twin coming down with diabetes if the other twin had it would be 100 percent. Identical twins have the same genes.

DEAR DR. DONOHUE: After my last pelvic exam, the doctor told me I had a rectocele. He didn’t say anything about treatment.

I don’t have any symptoms, but I’m not sure what the symptoms would be. Will you clear this up for me? — A.H.

ANSWER: A rectocele (WRECK-tuh-seal) is a falling downward of the rectum into the vagina. The rectum lies behind and slightly above the vagina. This happens because supports of the rectum have given way. Symptoms depend on how far it has fallen. If it’s only a slight drop, the woman has no symptoms. I suspect that is the place you are. If the descent is considerable, then bowel movements become difficult. You would know if you need treatment.

Keeping your stools soft by increasing dietary fiber or by taking a stool softener will help matters.

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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