AAA Screening Only Applies To Patients Who Are At A High Risk
DEAR DR. ROACH: I was offered a low price to get abdominal aortic aneurysm (AAA) screening. Is it worthwhile? Who should get screened? -- K.D.
ANSWER: The aorta is the largest blood vessel in the body that comes directly off of the heart, goes down through the chest and diaphragm via the aortic hiatus, and into the abdomen. From there, it splits into two iliac arteries to provide blood to the pelvis and legs.
An AAA is a dilation of this large blood vessel. If the aorta dilates too much, the wall weakens, and the aorta can rupture -- a catastrophe few people survive. For this reason, people who are at a higher risk for AAAs are recommended for screening.
The usual recommendations of screening for men include those between 65-75 who have smoked. An ultrasound is a great screening test as it has no ionizing radiation and is very accurate. It is also reasonable to screen men and women who have a family history of needing an AAA repair or death due to an aortic rupture.
Screening is otherwise unlikely to lead to improved outcomes, so I don't recommend AAA screening for low-risk men or women, regardless of the out-of-pocket cost.
DEAR DR. ROACH: I'm 65 years old, and for the past year, I have not been able to maintain an erection while making love with my wife. I can still ejaculate, just not inside her. With cuddling and heavy petting, which we both enjoy, I do get the necessary erection, but it's usually short-lived.
I am mostly healthy, work out every day, and try to eat right. I've recently seen a new doctor for a general checkup, but lab results did not include my testosterone level. Since this is a totally new experience for me, should I ask for such a test? How can I ask the right questions without embarrassing myself or the medical staff? Any advice for this novice erectile dysfunction (ED) patient would be appreciated. -- S.K.
ANSWER: The best advice is to make another appointment to discuss ED. It is very common in 65-year-olds; your doctor won't be embarrassed about it at all, and neither should you. Sexual function is an important part of health for both men and women, and problems in this system need to be properly diagnosed and treated.
This is particularly the case for ED in men as it can be a sign of serious problems -- not only with testosterone but with blockages in the blood vessels. Your doctor will likely order a blood testosterone test but may do additional testing to help find the cause, even though no specific cause can be identified most of the time.
Treatment with sildenafil (Viagra) or similar medicines is likely to be effective. Although I see ads for doctors you can consult with by phone to get these medications, I strongly urge you to see your own doctor. A physical exam and other tests may be indicated, and as I said, ED may be the first manifestation of a different medical problem.
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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.
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