DEAR DR. ROACH: When is a full hysterectomy called for, as opposed to a partial one? I have a cyst on one ovary that has not changed in three years. My doctor has been watching it via ultrasound every six months. She says that in my stage of life (long past menopause, I went through it early at 39, I’m now 57), ovaries are nothing more than cancer makers. I also have a fibroid in my uterus (she is less concerned about it), but she is suggesting a full hysterectomy rather than just removal of the ovaries. I’m nervous of any surgery, but I’m sick of going every six months, waiting for bad news! What is your recommendation? Full, partial or nothing? — E.A.

ANSWER: I asked my colleague Kathy Huang, director of minimally invasive gynecologic surgery at New York Hospital in Queens, since this is beyond my expertise. She said: “She definitely does not need a hysterectomy; there is no indication for it. As for the cyst, it would depend on whether it is simple or complex, and its size. I would guess that the ovarian cyst is not malignant, since it has been unchanged for three years, so at most I would recommend removal of tubes and ovaries. Actually, the ovaries continue to produce hormones even after menopause, albeit at 50 percent of premenopausal levels, so they aren’t useless.”

Based on her recommendation, I would ask you to think which is worse — an operation (laparascopic operations, performed with three small incisions, are usually much easier than the older, open procedure), or getting the ultrasounds?

It seems to me the surgery would be worse, but only you can make that decision.

DEAR DR. ROACH: After a triple bypass heart surgery, I was diagnosed with peripheral artery disease. I underwent a procedure to remove the blockages in both legs, but have continued to experience leg pain while walking. I can walk only a short distance — a block or less — then I have to stop until the pain subsides. When I sit still there is no pain. Walking up an incline is worse; walking up stairs is terrible.

My cardiologist says I should walk as much as possible. I don’t know if this helps or if it only keeps the pain from getting worse. — L.D.

ANSWER: Peripheral artery disease is common but underdiagnosed. Pain in the calf or other part of the leg with walking, relieved by rest, is the hallmark of this condition. It’s important to get a correct diagnosis, because there is treatment available: medications, surgery and therapy.

Because PAD and heart disease go together so commonly, diagnosing PAD can lead to diagnosis and treatment of heart blockages as well. Managing risk factors (high blood pressure, cholesterol and smoking) is important, and those need to be aggressively treated if present. You already have had a procedure to treat the blockages, which helps most people.

You didn’t mention any medication treatment, but the drug cilostazol is effective for many people with PAD. However, an exercise program may be the most important treatment. I agree with your cardiologist that more exercise is better, and studies have shown dramatic improvement in the amount that people can walk with exercise. A supervised exercise program is best, but any exercise is better than none. Walk fast until you have to slow down, then walk slowly until you have to stop and rest. Repeat the cycle for 30-60 minutes, at least three times per week. You should see real benefits within a few weeks.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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