Ruptured aorta repair unlikely to fail

Dear Dr. Roach: Iama 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: 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.

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: Live your life to the fullest.

Dear Dr. Roach: Would you recommend a prophylactic hysterectomy and oophorectomy for a 52-yearold 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 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.

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.