When is a heart valve leak not worth worrying about?

DEAR DR. ROACH: I was diagnosed with a minor to moderate tricuspid valve leak, as well as a minor to moderate aortic valve leak and a trace mitral valve leak. My doctor says that there is no need to worry; he says we will just watch it. He also says that I can live a lifetime and not have any changes. Is he right? I’m worried all the time about this. I do not have any signs of heart disease as of yet. — Y.A.

ANSWER: The echocardiogram is a high-resolution type of sonogram. It uses soundwaves to take pictures of the heart. The quality of echocardiograms has dramatically improved. They are so sensitive that small amounts of leak (also called “regurgitation,” which is when blood flows the wrong way through a valve) can be found in 80 to 90 percent of healthy people. While I can’t comment on your specific echocardiogram, my experience is that the vast majority of trace or mild leaks seen in valves by echocardiogram are not concerning. They likely have been that way for many years, and are unlikely to change. In someone with no symptoms of heart disease, I agree that there almost never is a reason to worry.

DEAR DR. ROACH: I took my 79-year-old mother to the emergency room in December because she had been suffering from a sharp pain in her lower-right abdomen since the day before. They discovered a 12-cm tumor, which was biopsied and determined to be gallbladder cancer that already was eating into the liver. We were told that her condition did not support surgery, nor was radiation or chemotherapy an option. We were told that this is a rare cancer and, as such, not much research money is spent on finding treatments.

She had a CT scan in April 2017 after being admitted for severe diarrhea; it showed gallstones. But she was asymptomatic, so the doctor said they would just monitor her.

How did she develop such a cancer without any symptoms or pain until it was too late? This blindsided us. As her daughter, am I susceptible to the same sort of cancer? Any insight into this terrible diagnosis is appreciated. — L.J.B.

ANSWER: I am sorry to hear about your mother.

Gallbladder cancer is a rare disease in North America, with only about one case per 100,000 people. Most people do not have symptoms for a long time, which is why your mother didn’t know about it until the tumor was very advanced, making it similar to pancreatic cancer. Pain is the usual first symptom, but people may have nausea, vomiting or loss of appetite.

The cancer can be hard to see on sonogram or CT, which is probably why the doctors missed it in April.

Having a family history does increase your risk for developing this cancer; however, even as her daughter, your risk is still very small. One study from Sweden, where this disease is a little more common, showed that 5 people per 100,000 with a family history of the disease will develop it.

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