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Ask Dr. Gott 5/18

Do benign polyps need to be removed?

DEAR DR. GOTT: I am an 85-year-old active female, still playing tennis, who was rushed to the hospital this past summer bleeding from six very large polyps in my stomach. The surgeon does not recommend surgery because of high blood pressure and a mitral-valve prolapse treated with drugs. I weigh 102 pounds and am 5 feet 3 inches tall. The gastroenterologist performed a second endoscopy, found the polyps are benign, and told me to return to him in a year. Do you have any recommendations as to treatment or surgery?
DEAR READER: I am somewhat surprised that your gastroenterologist did not try to remove the polyps during the endoscopy. Fortunately, the growths are benign, but they may bleed again. The specialist should address this issue -- perhaps with medication to treat the inflamed polyps. Obviously, surgery is best avoided if possible, but, at the very least, you need close monitoring.
Consider getting a second opinion from another specialist in the field. I am sure your current specialist will share a copy of the operative report with the doctor of your choice. If you feel uncomfortable with this suggestion, follow your gastroenterologist's recommendation and see him in a year.

DEAR DR. GOTT: About a year and a half ago, I was diagnosed as having an enlarged ascending aorta. At that time it measured 3.9 centimeters. My primary-care physician told me that it was not anything to worry about, as these things seldom turned into aneurysms, and that I should have it checked once a year. In the summer of 2005, I went to a cardiologist to get his opinion. He agreed with the original diagnosis, and, after some additional tests, he told me to return the following year.
During the summer of 2006, I had an MRA at the cardiologist's request, and the diagnosis is as follows: "Moderately dilated aortic root measuring up to 4.5 centimeters. The transverse aorta at the arch measures 3.6 centimeters." He now thinks I should repeat the MRA in six months. Should I be concerned more than I have been? Why does the latter doctor refer to it as an aneurysm when I was told that they seldom become one?
DEAR READER: The aorta is the major artery supplying blood to the lower body. For reasons not fully understood, some patients develop a thinning of the aortic wall that stretches and makes the aorta enlarge. This is called an aneurysm and is potentially dangerous because if the aorta stretches and leaks -- or, worse yet, ruptures -- death is a certainty. If appropriate testing has shown an aortic aneurysm, the situation must be monitored. Should the aorta stretch to 5 centimeters or more, seriously consider surgical repair of the weakened arterial wall.
According to your measurements, about two years ago, your aorta measured 3.9 centimeters. Now it is 4.5 centimeters. I agree with your cardiologist. However, I question the need for an MRA test. The procedure is expensive, and I believe that your aortic measurements could just as easily be determined by periodic ultrasound examinations. Follow up with your cardiologist in any case.

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