Patient’s abdominal aneurysm elusive in tests
Dear Dr. Roach: In January, I received a diagnosis of an abdominal aortic aneurysm measuring 2.9 centimeters. In April, another ultrasound showed that the AAA measured 3 cm. This past October, I had another ultrasound and was told there was no AAA! The doctor said it must have disappeared, or maybe it was just a “dilatation that was misdiagnosed because the report shows nothing.”
Now, it would be great if I don’t have an AAA, but two ultrasounds by two different entities came up with the same diagnosis five months apart, and everything I’ve read says AAAs don’t diminish in size or disappear completely. What is your take on this latest development? Should I request another ultrasound for confirmation, or can I be confident (and thrilled) that the latest results showing no AAA were correct? K.M.
Dear K.M.: The aorta is the largest blood vessel in the body, coming directly off the left ventricle in the heart and providing arterial blood to the entire body. It can dilate, either in the chest or in the abdomen, and when it does, the risk of rupture increases as it gets larger. It must measure greater than 3.0 cm to be considered aneurysmal, so yours may not even have made the cutoff.
It’s also important to consider the context. AAAs are more common in men, especially those who have smoked, but having high cholesterol and high blood pressure are additional risk factors. You having more risk factors would make me much more concerned than if you had few or none of these.
Ultrasound is very seldom wrong in making the diagnosis. As a general rule, however, when a laboratory or imaging study shows conflicting results, another should be ordered to resolve the issue. A CT scan is an alternative to ultrasound.
Dear Dr. Roach: What are some ways I can ease hard bowel movements with a lower-carb diet? I am trying to lose weight to lower my A1C. J.S.
Dear J.S.: First off, a little information about carbs. There are multiple types of carbohydrates. Simple sugars, like table sugar and honey, will raise your A1C (a measure of overall blood sugar) if taken in excess. Virtually all authorities recommend very limited amounts of these. Starches — such as most white breads, pasta and rice -- are long strings of sugar molecules that are broken down quickly in the body. These also are generally poor, when taken in excess, for both weight and blood sugar control.
Fiber is an indigestible carbohydrate that generally helps people feel fuller, may reduce A1C and eases hard bowel movements. Fiber is my recommendation for you, and it can be found in food, especially vegetables and some fruits. It also can be found in whole grains (processing the grains to make white flour removes most of the fiber).
While fiber can be taken as a supplement, a diet high in whole grains, vegetables and fruits is considered by most experts to be a healthy diet, even though all of these are mostly carbohydrates. A diet that is almost exclusively protein and fat can help with weight loss but is not the optimal diet for most people for overall health, in my opinion.
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