Dr. Roach: Fatty tumor removal is not a simple solution

Dear Dr. Roach: I am an 88-year-old male suffering from a fatty tumor located on my gluteus maximus. Two different local gastroenterologists have refused to remove this 2.5-inch-diameter tumor, probably due to my daily blood-thinning medication apixaban. The tumor continues to grow and is becoming an impediment to good health. I am writing to you for a suggestion of how to proceed in this matter.

— R.R.

Dear R.R.: A lipoma is a benign fatty tumor. They are very common. They can occur almost anywhere on the body. The area around your gluteal muscles may seem unusual, but it’s not.

In general, a lipoma should be treated with surgical removal only when there is a good reason to do so. Pain is one good reason, and another is concern that it may not be just a benign lipoma, but rather a more worrisome tumor. Growth in the tumor, or a firm rather than typically soft texture, are reasons for concern. Some people have lipomas in cosmetically important areas, and some might also notice constriction of movement due to the lipoma.

The surgery isn’t always as easy as you might think. In some cases, the expectation of a quick and easy surgery ends up taking far longer and is far more invasive than expected. An anticoagulant like apixaban (Eliquis) could complicate the surgery, and stopping it has associated risks (you’re on an anticoagulant for a reason).

When two surgeons tell you not to operate, you should take their advice seriously. I’m not sure what you mean by “an impediment to good health,” but I would not rush to ask for surgery unless you have significant symptoms, as the cure is sometimes worse than the disease. Liposuction is a less-invasive option for some people.

Dear Dr. Roach: I am scheduled for an echocardiogram. It’s set for 3 p.m. in the afternoon. Do I need to fast for the day of the test? How about caffeine consumption? Is morning coffee a no-go? Is chocolate milk OK to consume prior to the procedure? What exactly are the dietary guidelines for an echocardiogram?

— B.M.

Dear B.M.: An echocardiogram uses ultrasound waves to look at the heart. Ultrasound exams of the liver and gallbladder are done while fasting, because food causes the bile ducts to empty, and that makes the examination more difficult. Food does not affect a regular echocardiogram, so you can eat and drink as you’d like.

However, a stress echocardiogram — one where you exercise or are given medicine to speed up the heart — often uses medications that can be affected by caffeine, so drinking coffee and even having chocolate are out for 24 hours due to the possible medication side effects.

It’s usually recommended to fast at least few hours before any exercise stress test simply for comfort. Exercising to maximal activity is not comfortable and can even be nauseating; doing so on a full stomach is a bad idea. Of course, asking the physician who ordered the test (or the one performing it) is your best bet for precise information.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.