Dear Dr. Roach: I am a 78-year-old man who suffered a ruptured aorta six months ago. It was successfully repaired, and I am in generally good health, physically active, back to the gym (less weight than before) and I feel about as I did before the rupture. I want to get back to playing touch rugby, which means running hard for short distances for an hour, but I can’t find any research that says whether this is a reasonable activity. My doctor says, “Why take a chance?” Because it’s part of my life, that’s why. Do you know of any authoritative research on this? — I.C.
Answer: You are a very lucky man. Most people do not survive a rupture of the aorta, the largest blood vessel in the body, which usually is a complication of an aortic aneurysm. These most commonly occur in men over 60, often with a history of high blood pressure or smoking. (Men between 65 and 75 who have EVER smoked should get a screening test for an aortic aneurysm.)
Fortunately, those who make it to the hospital to get repair and have a successful surgery have a very good prognosis, with survival rates nearly as good as people who did not need the surgery.
I could not find a definitive answer for you in the literature, so my advice is based on my clinical experience and by my understanding of the anatomy and physiology after repair. The graft that takes the place of the diseased aorta is very strong, and the connections on either side are likewise unlikely to fail. Here is the big issue, since many people with disease of the aorta have disease in the heart or other blood vessels, and an evaluation may be recommended if not already done: As long as you don’t have any other medical problems, then moderate and intermittently strenuous exercise is reasonable. I don’t think you are taking an unnecessary risk by engaging in this kind of exercise. You’ve been given a second chance most people don’t have: Live your life to the fullest.
Dear Dr. Roach: Would you recommend a prophylactic hysterectomy and oophorectomy for a 52-year-old overweight woman to address the increased cancer risk from long-term obesity? — J.T.
Answer: Surgery to prevent ovarian cancer is considered in those who are at the highest risk for ovarian cancer. This means those with genetic syndromes — BRCA 1 and 2 mutations, Lynch syndrome and some other less common genetic variants such as BRIP1 — who have lifetime risk of ovarian cancer, including fallopian tube and peritoneal cancer, of up to 46%.
The average woman has about a 1.5% risk of developing ovarian cancer in her lifetime. Obesity might increase that risk to 1.8%. There are clear risks of doing this type of surgery, and the risk of surgery outweighs the benefit in average-risk women and for those with mild risk factors, like obesity. Some experts will consider prophylactic surgery if the woman needs surgery anyway, such as removing the ovaries as well during a hysterectomy for fibroids. But never as a stand-alone surgery.
Cancer of the uterus (endometrial cancer) is likewise not recommended for prevention via hysterectomy in average-risk women, or even in women with obesity, who are at higher risk. Endometrial cancer risk can be reduced through weight loss (bariatric surgery, for example, reduces risk by 50% to 80%).
I don’t advocate for surgical prophylaxis except in women at highest risk due to genetic causes, like Lynch syndrome. Women should report any abnormal bleeding promptly.
Editor’s note: 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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.