>> hello and welcome to "in good shape," your weekly health show here on dw. the renaissance physician paracelsus believed that it's the dose that makes the poison. this certainly applies to the amount of sun your skin gets. the sun is absolutely essential for life on earth, but it's dangerous too, since uv radiation causes your skin to age and also triggers skin cancer. so no matter what color your skin is, you should take care to protect yourself from too much sun. how to do so effectively, and how to treat skin cancer, will be one of the topics on today's show. and, of course, we have lots more for you. here's what's coming up --

in shape in school - preventing back pain with exercise in the classroom a shunt in the skull -- the operation that can cure one form of dementia. and a sting on the skin - what attracts mosquitos, and how to keep them at bay. one in three cases of cancer is skin cancer. that's a lot. but there's some good news. since doctors don't need x-rays or fancy lab tests to examine your skin, tumors can be detected at an early stage - and treated. when it comes to skin cancer, most people think of malignant melanoma. but there are other types of carcinoma to watch out for. of course, prevention is always better than needing a cure. protecting yourself means shielding your skin from too much sun. and regular visits to the doctor for screening. >> 43-year-old susanne hoffmann regularly visits her dermatologist to have her moles looked at.

over the years, she's had a few removed. seven years ago, she had her first cancer scare. >> i found something that looked suspicious. it didn't look like a normal liver spot. so i went to my dermatologist and had him examine it. it turned out to be non-melanoma skin cancer. >> non-melanoma skin cancer is usally caused by too much exposure to the sun. it tends to form on the surface of the skin, around the nose, the lips or the forehead. >> i do love the sun and i always did. in the past we weren't aware of the risks of sunbathing. when we were younger we'd go to the outdoor swimming pool and we'd never apply sunscreen. >> dermatologist christiane bayerl sees a lot of patients with various types of non-melanoma

skin cancer. >> basal cell carcinoma appears as a red patch with dilated blood vessels and often a raised bump. it might bleed. squamous cell carcinoma appears as an ulcerated lesion. >> the tumour that susanne hoffmann discovered was a basal cell carcinoma. it was surgically removed -- the standard treatment for non-melanoma skin cancer. two months ago, she had another removed. but her regular check-ups also revealed a malignant melanoma. >> it was quite a shock. i was used to treating the non-melanoma skin cancer. but being diagnosed with a malignant melanoma is something else. becoming a cancer patient takes its' toll.

>> susanne hoffmann's malignant melanoma was surgically removed before it spread. >> basal cell carcinoma never spreads and squamous cell carcinoma is only likely to spread after decades. then it might spread to the lymph nodes. >> susanne hoffmann is now ultra-strict about applying sunscreen. she also uses a moisturizer and face powder with factor iv protection. she still enjoys the sunshine but makes sure she stays in the shade. she misses sunbathing but now that she's experienced the consequences first-hand, she's not taking any risks. >> joining me in the studio is dr. claas ulrich, a skin cancer specialist from the charite clinic here in berlin. thanks for joining us.

we just saw that relatively young people can also contract skin cancer. which groups are most in danger? >> well, of course, it is mostly the fair skinned population, but of course, those who have already had a lot of uv exposure in their life or those who live in sunny environments like australia, new zealand, south africa, or even the central area of the mediterranean. and, of course, everybody who is, so to say, defenseless. >> what about people with workers skin tones. are they prone to skin cancer? can they even get skin cancer? >> they can, but that is very, very rare. in black people from the central africa area, for example, ella noma is only very rarely found on the palms and soles -- melanoma is only very rarely

found on the palms and soles, which are not pigmented. the non-melanoma is a sandpaper type feeling. in the black skin cancer, the melanoma, you should recognize any change of the pigment from brownish to blackish, whitish to reddish. then ask a sn cancer specialist for advice. >>he signs i >> there's ay interesting role called the ugly duckling role from the fairy. the black duck was the one that was not liked. that translates to if you have a lot of lack moles, the softer colored ones are the most dangerous ones and vice versa. >> it's more like the exception to the rule. >> absolutely.

>> we have a viewer question. margot bachholz from chile writes that she spent a lot of time tanning when she was young, though she didn't usually get a sunburn. she's now 64, and is beginning to get red spots on her face, and also has many dry areas there, though they don't itch and she doesn't have other symptoms. she wants to know whether she did permanent damage back then that is only showing up now? >> sooner or later, that can become dangerous for her, and she should seek advice from a dermatologist for therapy. >> ok, good. zakir khan from pakistan: my question is, is sun all the time in the day dangerous for skin or it might be useful for it as well, i mean early in the morning, when it's intensity is low, does it have any good effect on the skin? >> the worst is the midday sun because that is extremely rich in ultraviolet radiation of the b type.

>> ok, we will see each other again in just a moment. a dark tan has long been considered a mark of health and beauty, at least here in germany. that is strange since tanning is actually the skin's attempt to limit the cell damage caused by uv rays. >> when the skin is exposed to ultraviolet rays, the cells on the surface of the skin start to produce a dark pigment called melanin. this makes the skin appear darker and acts as a kind of natural sunscreen to protect the body's dna against harmful uv rays. but the protective role played by melanin is limited. so anyone whose skin is exposed to the sun for any length of time should always use sunscreen. dr ulrich -- what about the skin's natural protection

system? when should i use sun-block? >> whenever the challenges for the skin would be too big for its natural defense. if you go to a more sunny environment or go out mountaineering on the weekend or or a water sport, you should consider additional sunblock for your skin. >> one guest wants to know about the spf protection factor and what they mean. >> the ef -- spf are grades of sun protection and basically tell you in which timeframe the sunburn individually is delayed, compared to milder or softer version. >> can you even use those to get your skin a little bit lighter? nilutpal karmakar from india -- what are the measures we can take so that our skin doesn't turn dark under the sun?

>> photo blocking or a sun blocking is a popular thing to get your skin lighter and is used in asia. you should also consider to mind the midday sun completely. >> if i take a sunblock, how long can i stay in the sun with maximum protection? >> basically, it depends a little bit on what part of the world you are. even 100% block lets do a couple of uv rays, so that is a very individual thing, but never abuse photo protection in order to spend all day in the sun. >> does it help if i repetitively cream myself with the bloc? >> that puts on additional protection, but you will never have a 100% shield. >> what about zinc in sunblock?

a guest from uruguay wants to know if the zinc oxide in sunblock is helpful? >> it is a relatively safe and old-fashioned protection. it is safe, but cosmetically not so nice for most people because they are afraid of the whitening effect of old-fashioned sunscreen. >> because i look pale. >> yes. in europe, we like to have transparent photo protection. >> other alternatives to those sunblock techniques like textile techniques? >> i think textiles should come before additional photo protection is creamed on. a hat, a longsleeved shirt or long trouser, those are basically the pillars of photo protection. and behavior -- mind the lunchtime sun. >> is the color of the textile protection important?

>> black partly is better than white, but most important is the advert of the textile. if you are the thicker one or a special photo protected textile, and there's brand-new labels developed all over the world at the moment, that gives you additional security. >> ok, and our viewer from -- our viewer kadri haapoja from estonia asks: are there foods that can help protect you (beta carotins)? >> antioxidant-richfood, meaning fruits, and what we call the mediterranean diet, meaning tomatoes, paprika. >> sums like that as an add-on but does not save you completely. dr claas ulrich, thanks for joining us on in good shape. do you know what i like most about talking with experts here

on "in good shape?" your input! so please keep those questions coming in. especially if you have one about this topic, which will be covered in an upcoming show: >> we'll be talking about loss of eyesight in an upcoming show. it can happen suddenly - or it can happen gradually. which conditions cause it? and what can be done to prevent it from happening? if you have any questions, email us at ingoodshape@dw.de. the keyword is "eyes" and the closing date is july 15th. you'll find our mailing address on our website. >> have you ever missed a couple of days at work because of lower back pain? here in germany, backache has a major financial impact. a big german insurance company did the math: about 40 million working days are lost in in the country every year due to this condition alone. and back pain doesn't just affect construction workers or people who perform heavy manual labor. long hours of sitting at a desk can also pose a threat to your health. and that's not true only for adults: even school-children can

adults -- develop back problems. >> bärbel ehrig teaches fifth graders. unlike many of her colleagues, she doesn't insist that her students sit still. movement is good for their backs. >> it's important for everyone to learn to listen to their bodies -- to know what's good for the body and what's bad for it. >> these exercises aren't designed just to strengthen the back. according to bärbel ehrig, they improve the students' learning abilities. it's worth interrupting class for a few minutes of activity. >> it definitely helps. it wakes you up and improves your concentration so you can work longer. >> sitting at a desk for long stretches isn't healthy. bärbel ehrig believes that parents also have to do their bit to get their kids moving. >> i don't neccessarily mean sports. children should be outside playing catch or hide and seek

or on their scooters. >> bärbel ehrig is in charge of the health and fitness issues at her school. she also makes sure the students' schoolbags aren't too heavy. that's another cause of back problems. experts say the weight of a schoolbag shouldn't exceed 10 to 15 percent of the student's body weight. in sports, these eleventh graders are learning how important it is to look after their bodies -- and not put their backs under undue stress. >> now sit down gradually as though there were a bar stool behind you but it's incredibly hot, so you stand up again... >> the girls enjoy the class a lot. >> it feels good - it's a different way of moving. >> it's good to do something that's useful. normally you don't really think

about how you sit. >> or how you lift. bärbel ehrig tells her students how to make sure they're not overtaxing their backs with wrong movements. >> you can teach basketball or football or the high jump, but that's not the sort of thing that changes the way people move every day. i have to change the way they think so that they incorporate activity into their day to day lives. >> and that's exactly what's bärbel ehrig does with her students. >> more and more frequently, i see patients in my office with memory problems. that's of course partly due to the fact that people are living longer, and the average patient is older. but that doesn't comfort people who are beginning to lose their memory. that's always scary. many of my patients and their loved ones worry about dementia. however, impaired brain function in the elderly is not always necessarily due to alzheimer's. sometimes a disease called "normal pressure hydrocephalus" can cause it. and this can be treated -- with amazing results.

>> dieter schröder is in his early 70's. he suffers from a range of problems related to old age. he has difficulty walking, for example. but today he's having tests done to see if the cause is an underlying condition that could be treated. his wife christine was getting fed up. >> once when the weather was nice we wanted to go out for a walk. we thought we'd just go around the block, very slowly. but we'd only gone half way when it got so bad that the last few meters were agony. >> forgetfulness is another problem. >> sometimes when we're chatting and my wife says something, i completely forget what she's said.

she always says, but i just told you! but i simply can't remember. and i remember less every day. it's a terrible problem and it worries me a lot. >> his neurologist suspects that dieter schröder is suffering from 'normal pressure hydrocephalus' (nph). this is a type of brain malfunction caused by excessive production of cerebrospinal fluid. it can cause lasting damage. dieter schröder is having tests done in the hospital. neurosurgeon alexander könig asks him if he has the main symptoms of the condition: these are gait disturbance; forgetfulness, inattention, and incontinence. dieter schröder confirms that he suffers from all these problems. >> with patients suffering from normal pressure hydrocephalus, the pressure of the cerebrospinal fluid doesn't remain constant for 24 hours a day. if the condition is untreated

for months or years it can cause secondary damage to the brain. >> an mri can help rule out other conditions. the dark patches show that neural water has collected in the brain's chambers, the ventricles. this can cause forgetfulness, which is the next thing the dotor tests with his patient. the doctor also checks dieter schröder's gait. >> he is taking steps that are about half as long as his foot. this is fairly typical and a lumbar puncture provides the most conclusive evidence of nph. this involves taking a sample of neural fluid from the canal of the spinal cord. >> a lumbar puncture entails collecting cerebrospinal fluid over a period of three days.

this has to happen in a hospital. it allows doctors to reach a conclusive diagnosis. >> if the symptoms start to improve, a valve can be inserted into the skullcap which regulates pressure to the brain. this is what's called a cerebral shunt. >> the basic principle is that surplus neural fluid from the brain chambers is directed to the adbominal cavities. the technical term we use is ventriculo-peritoneal shunt'. >> the treatment can reverse the symptoms and restore normal functioning. >> this method brings about a noticeable improvement to the patient's gait. it becomes less unsteady, they can take bigger steps and there is also an improvement in cognitive deficits such as loss of memory as well as incontinence problems.

>> in a matter of hours, the redirected neural fluid is having a positive effect on dieter schröder. >> there's a very noticeable improvement in his gait. he's taking half as many steps and his steps are much longer. this confirms the normal pressure hydrocephalus diagnosis in our opinion. the only therapy is operative. that's the course of action we recommend in this case. the couple decide that dieter schröder will definitely opt for a "cerebral shunt. >> i hope that i'll feel better after the surgery and that i'll be able to walk again more normally. >> that's what we're aiming for and we see this as the only option. >> after surgery, taking a walk around the block should no longer pose a problem to dieter schröder.

>> i hate being bitten by mosquitos, even though they don't carry dangerous diseases here in germany. the itching and burning a bite causes is really annoying. but in many regions of the world, the insect can do much worse. mosquitos can transmit serious pathogens like those that cause malaria or yellow fever. in fact, well over a million people still die from those two diseases every year. reason enough to take a closer look at this pest, and how to protect yourself from it. >> it's a beautiful day and everyone's outdoors. there's just one problem. mosquitos also love the warm weather. and they can really spoil the fun. like other insects, they feed on plant juices. but they also need human blood to reproduce. it contains proteins that the female of the species requires for egg production. it's a myth that mosquitoes

prefer sweet blood. the greatest attractant to mosquitos is carbon dioxide. ammonia and lactic acid in human sweat lead them to their victims. it remains unclear why some people are more likely to be bitten by mosquitos than others. dutch research on malaria mosquitos suggests that it migt have something to do with bacteria. the test persons who get bitten the least have a greater variety of bacteria on their skin, including large quantities of what's called pseudomonas bacteria. it seems mosquitos don't like the way the bacteria smells. the discovery could help in the development of n n mosquito repellents. when mosquitos bite humans, they know exactly what they're doing. they plan their attack carefully. they tend to be especialy

active at night and don't bite any old place. when a mosquito lands on your skin it sticks its proboscis into you. its anticoagulant saliva contains proteins that prevent your blood from clotting. it then sucks your blood into its abdomen. how can you prevent mosquitoes from biting you? mosquitoes lay their eggs in water so it's a good idea to keep fresh or stagnant water in your garden covered up. many insecticides are effective but contain chemicals that can be harmful, so should be used sparingly. fragrance lamps, on the other hand, tend not to be very effective at all. while uv lamps kill other, harmless insects. taking a shower before you go to bed can help given that mosquitos are attracted to sweat. mosquito repellent creams or sprays can also prove effective. tests show that the most

effective ones are those that contain icaridin or deet. but deet is known to have damaging effects on the nervous system. it should only be used in places where mosquitos carry dengue fever or malaria. the safest way to prevent bug bites is to sleep under a mosquito net. or kill them before they get to you. >> hard to believe, but that's all for today. if you'd like to share any special tips on how to deal with mosquitos, please don't forget that you can always friend us on our bilingual facebook-page. that wraps it up. we'll be back next week -- same time, same place. i look forward to it. until then, always remember to try to stay "in good shape." captioned by the national captioning institute --www.ncicap.org--

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[upbeat instrumental music] ♪ >> mcfarland: thoracic and abdominal aortic aneurysms affect thousands of people in the united states each year. but many of those sufferers do not know there's anything wrong. this makes aortic disease truly a silent epidemic. >> it's often called a silent killer, because most aortic aneurysms do not cause any symptoms while they are growing. and often, the first sign of symptoms are when they start leaking or rupturing. >> about 15,000 patients a year die in the united states from abdominal aortic aneurysms that are either not known or that have been left untreated. >> mcfarland: while it is often missed, it can also be misdiagnosed. a big clue is there's a family history and a strong genetic component.

>> i found out later that my mother had two and that it is hereditary. my mother's was exactly where they found my first one, and it was the one on the aorta. >> mcfarland: in addition to genetics, lifestyle factors, like whether or not someone smoked, or simply just being male, can also increase the risk. in this program, we'll take a look at thoracic and abdominal aortic aneurysms: see how they're diagnosed, highlight the importance of aneurysm screening, and showcase the lifesaving interventions and latest advancements in managing this condition. [upbeat instrumental music] ♪ >> male announcer: major funding for healthy body, healthy mind is provided by

novartis oncology. novartis oncology strives to become the world's premier oncology business by consistently discovering, developing, and making novel therapies that may improve and extend the lives of people living with cancer. and by incyte corporation. incyte's vision is to become a leading biopharmaceutical company focused on improving the lives of patients with serious unmet medical needs. additional funding provided by: abbott. ironwood pharmaceuticals. janssen pharmaceuticals inc. and by w.l. gore and associates.

>> mcfarland: nearly 50,000 people die each year from all types of aortic disease, more than breast cancer or aids or even motor vehicle accidents. but despite this large number, many people have never heard of thoracic or abdominal aortic aneurysms, and therefore they have no idea how to recognize the signs that a potentially life-threatening rupture may be about to occur. >> kind of lucky, isn't it? [laughs] >> yes. >> mcfarland: dr. michel makaroun is professor of surgery and the chair of vascular surgery at university of pittsburgh medical center. >> the aorta is a very large blood vessel. this is the main blood vessel that comes out of the heart and distributes the blood to all the organs. >> mcfarland: the aorta is called the thoracic aorta as it leaves the heart, ascends, arches, and descends through the chest until it reaches the diaphragm. the aorta is then called the abdominal aorta after it has passed

the diaphragm and continues down the abdomen. the abdominal aorta ends where it splits to form the two iliac arteries that go to the legs. dr. amit patel is a vascular surgeon at atlantic health system in new jersey. >> the aorta is the largest blood vessel in the body. it begins at the heart and goes through the chest into the abdomen. >> mcfarland: an aortic aneurysm is a general term for any swelling or ballooning of the aorta to 1 1/2 times its normal size, typically representing an underlying weakness in the wall of the artery at that location. there is weakening, and with the blood pressure and the pulsation of the heart pumping, the weakened area enlarges, very similar to a bubble on a tire tube or a garden hose that's been left on. while the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture, which causes severe pain, massive internal hemorrhage, and unless treated immediately,

death. aortic aneurysms are most common after the age of 60. approximately 5% of men over age 60 develop an abdominal aortic aneurysm. and men are five times more likely than females to suffer an aneurysm. aortic aneurysms can develop anywhere along the length of the aorta. the majority, however, are located along the abdominal aorta. about 90% of abdominal aneurysms are located below the level of the renal arteries, the vessels that leave the aorta to go to the kidneys. about 2/3 of abdominal aneurysms are not limited to just the aorta but extend from the aorta into one or both of the iliac arteries in the legs. >> hello, mrs. massa. how are you? >> mcfarland: dr. robert rhee is chief of vascular and endovascular surgery at maimonides medical center in brooklyn, new york. >> the most common types of

aortic aneurysms are generally in the abdomen. they're called abdominal aortic aneurysms, or triple "a" in short. >> the second most common is of the thoracic aorta, and aneurysms are seen in the chest as well. >> mcfarland: the artery typically has three layers: an outside layer, called the adventitia; a layer in the middle, which has most of the muscle and is called the media; and the layer on the inside, which is called the intima. >> when--what happens with the aneurysm is, those three layers all start to enlarge, thin out, and the entire lumen-- or the cavity inside the aorta-- starts getting bigger. it's akin to blowing a balloon, where you're gradually thinning out the wall and getting it bigger. and that can affect any portion of any artery. >> mcfarland: even though an aneurysm occurs on the

largest arteries in the body, most people have no symptoms. in fact, the majority of patients do not know that there is anything wrong. >> occasionally somebody with an aneurysm can have back pain, for example. occasionally they may feel some tenderness when they push on their abdomen. but by and large, most patients do not have any symptoms. >> mcfarland: if left unaddressed, most aneurysms tend to grow over time. and as they are growing, the tension on the wall becomes greater and greater. however, as long as they do not rupture, most patients with aneurysms will not die from them. but if the aneurysm is large, over a certain size, the chance of rupture becomes significantly higher. rupture means a disruption of the layers that are still containing the blood. ruptures can be lethal if not treated immediately. >> and that's this entire aneurysm over here, which in this case is close to

eight sonometers, which is extremely large. when those layers rupture, you tend to bleed. the blood will dissipate in the surrounding tissues. it can remain contained for a short period of time, occasionally allowing somebody to reach a hospital to be treated. >> mcfarland: in most aneurysm ruptures, bleeding can be so massive that it creates an immediate, life-threatening emergency. that's why the most concerning complication of an aneurysm is the risk of rupture itself. although aneurysms are typically asymptomatic, there are a variety of risk factors and causes. >> abdominal aneurysms are more common. and since men more commonly have aneurysms, men are more likely to have abdominal aneurysms. in terms of thoracic aneurysms, it is fairly even between men and women. we know that aneurysms do run in families, and oftentimes they'll have some

history of-- you know, a parent or a sibling or even grandparents who had an aneurysm in the past. >> we know who is more likely to have an aneurysm compared to the general population. there are certain genetic predispositions that are clearly at play. aneurysms tend to occur in families in at least 20% of the patients who have aneurysms. >> mcfarland: another risk factor for aortic aneurysm is cigarette smoking. smoking not only increases the risk of developing an abdominal aortic aneurysm, but also, among active smokers, the chance of aneurysm rupture is more common. although aneurysms most commonly form in the abdomen or chest, they can form anywhere in the body. >> the distribution in any particular patient is not always easy to understand or predict, so that's how we have to look. every time that somebody

presents with an aneurysm in one part of their body, we have to look for aneurysms in other parts of the body. >> most aneurysms are found incidentally either on physical exam or some type of imaging study--cat scan, ultrasound-- that is done for something else. >> mcfarland: ultrasound is a technique that uses sound waves to image areas of the body. it is both painless and noninvasive. medicare will pay for a one-time preventive ultrasound screening for triple "a" for beneficiaries who are at risk as part of their "welcome to medicare" physical exam. "at risk" is generally described as having a family history of triple "a" or being a man aged 65 to 75 who has smoked at least 100 cigarettes in his lifetime. eligible beneficiaries must receive a referral for the screening. mary anne stickles is retired now, but she worked for more than 50 years, most of that time as a city manager.

she was diagnosed with an aneurysm after going to the doctor for another health concern. she was taken completely by surprise. >> i had been losing weight for a long time, and my husband kept getting upset, sent me to the doctor's. the doctor couldn't find out why, so i had all these tests done. when they did a sonogram, they found that i had a tumor in my bladder, but they also found the aneurysm. if i had not gone there, i would never have known i had one. >> mcfarland: after her diagnosis, mary ann also discovered she had a genetic connection. >> i found out later that my mother had two and that it is hereditary. my mother's was exactly where they found my first one,

and it was the one on the aorta. >> mcfarland: john dacosta also found out he had an aneurysm while being treated for another condition. >> i went to a radiologist, and he read my x-rays and said, "incidentally you have a aortic aneurysm that's already 3.2 centimeters." >> dr. dacosta, a practicing anesthesiologist in pittsburgh, pennsylvania, understood that he had many risk factors, and any one of them, or a combination, may have been the cause. >> i was already a kidney transplant, and i was starting to have some diabetes. and i was also before in my life a severe cigarette smoker. >> mcfarland: while many are discovered accidentally, there are tests and ways to diagnose if an aneurysm is suspected. >> the first suspicion would lie in the physical exam, and then the first test that we would

obtain would be an ultrasound for the abdominal aortic aneurysms. if we felt something abnormal or if the patient has significant risk factors, such as being male, smoking, history of atherosclerotic disease, or even a family history of abdominal aortic aneurysms, we would screen with an ultrasound. and then a cat scan will be performed if the aneurysm is large enough or big enough to warrant treatment. >> mcfarland: the society for vascular surgery recommends that first-degree family members-- brothers, sisters, parents, or children of patients with aneurysms--undergo ultrasound screening if they are over the age of 55, especially if they have been smokers in the past. the society also recommends screenings for people between the age of 60 to 65 if they are now or have ever been smokers. coming up:

we'll see what methods are used to treat aneurysms and what types of lifestyle changes are needed to effectively manage this condition. the most common cause of aortic aneurysms is atherosclerosis, or hardening of the arteries. at least 80% of aortic aneurysms result from atherosclerosis. to see this program again or to watch any other program in the healthy body, healthy mind series, please visit our website at: >> if you stop smoking, your prognosis is excellent. >> mcfarland: once an aneurysm is found, then the next step is to develop an individualized method of treatment. just as there are various factors that can cause aneurysms, there are also varying criteria for determining which course of treatment to pursue. there are specific steps to take to monitor the size of the aneurysm if surgery isn't yet needed. >> in terms of treatments,

we always follow the size of the aneurysm, because as an aneurysm enlarges, the risk of rupture increases. but if it isn't enlarging and it's small, the risk of rupture is low. so patients who have small aneurysms are followed either with ultrasound or cat scans to follow the size. >> small aneurysms typically are innocuous. they don't cause any symptoms. they don't rupture. they don't embolize. they don't throw blood clots. so in general, the size of the aneurysm remains, probably today, the easiest thing we use in determining if treatment is necessary in the first place. >> mcfarland: both mary ann and john eventually had procedures to repair their aneurysms. >> i came here every six months because they waited until the aneurysm was, i think, 5 centimeters. but the aneurysm continued

to grow. >> mcfarland: once the aneurysm reached 4.9, it was time to make a decision. >> dr. makaroun said it was time to decide what to do, so we decided to do the surgery. >> mcfarland: there are two distinct procedures to treat the aneurysm. >> one is the standard approach that we have been using for 60, 70 years, and that's the surgical approach where we go in and dissect the part of the aorta that is deteriorating. so if it's in the abdomen, we typically have to do what we call the laparotomy. we have to open the abdominal wall and get to the aorta. if it's in the chest, we have to open the chest. and for the thoracic aorta, it's a thoracotomy. it's an opening in the chest. if it involves both the chest and the abdomen, then it's a very large incision. that's called a thoracoabdominal incision, where we open the chest and the abdomen to be able to address the entire aorta

at the same time. >> mcfarland: the other treatment was developed more recently and is called an endovascular stent graft repair. >> in terms of new technologies for aortic aneurysms, they're really the minimally invasive endovascular procedures. and these devices continue to evolve. they're able to treat more patients based on, you know, every individual patient being a little different. there are even devices now that can go around the important branches to the kidneys and in the legs. so as the technologies are improved, they're able to treat more and more patients. >> mcfarland: the type of procedure selected depends on the specific profile for each patient. in an endovascular stent graft repair, the surgeon makes a small incision in the groin area to allow access to the femoral artery. then a catheter is guided up through the femoral artery to the aneurysm. a stent goes up through

the catheter to the aneurysm, and it either expands on its own to strengthen the artery wall, or it is expanded with an angioplasty balloon. stent graft procedures are minimally invasive and do not have the risks or complications of major surgery. patients heal faster and spend less time in the hospital. average is between two to three days in the hospital. even after the minimally invasive procedure, patients need to monitor the size of the aneurysm and make some lifestyle modifications to stay healthy. >> i continued being taken care of every six months or so. every year, they would take ultrasounds and to see how the triple "a" was growing. and i took all the care that they asked me to take care, like i used to have high blood pressure, and i also was starting to have

diabetes, so i had to control my diet, control my blood pressure. and i started doing exercise and walk as much as i could to maintain my weight. >> mcfarland: unfortunately for mary ann, the size of her aneurysm limited her options. >> i was not a candidate for the stent because of the abnormal shape of my aneurysm. i was hoping i would have a nice little scar, but i have also a scar just like my aneurysm. they did the surgery. i was here in the hospital i think for five days. >> we did everything right through the groins and without doing an open operation, so you should really feel only minimal pain. >> surgery patients need to follow a few steps in the recovery process. >> once it's repaired, essentially any thought of limitation goes away.

there is some limitations early on after surgery, especially open surgery, to allow the muscle to heal in the incision we use to get to the aneurysm. and that's typically a matter of weeks-- six to eight weeks-- where we prevent the patient from using those muscles with heavy activity. >> mcfarland: while aneurysms have been asymptomatic and may be difficult to diagnose, advancements are being made, not only to improve treatment outcomes but also to identify and target aneurysms in people at risk. people at high risk include those who have suffered traumatic injuries in a vehicle accident, for example. >> patient's in a car accident, comes in to the emergency room, has a cat scan to evaluate for injuries, and they'll find the aortic aneurysm. traumatic aneurysms are emergent and typically need treatment very urgently, as it truly is a break,

you know. it's a vessel that's been torn, and if it's not repaired, you can, you know, hemorrhage from that defect quickly. >> mcfarland: in general, the earlier an aneurysm is discovered, the more options available to the patient and medical team. that's why there's such an emphasis on screening, risk factors, and accurate diagnoses. >> the newer diagnostic modalities are primarily centered around... getting a higher resolution of the extent of the aneurysm. there are no currently available diagnostic modalities that are better than ultrason-- duplex ultrasonography and the cat scan to diagnose these aneurysms. >> we are identifying more and more genetics makeup that are more common in patients with aneurysms. the more likely it is in the future to be able to develop a genetic test that will actually identify people who are

at a higher predisposition of having an aneurysm so that they can be tested for the presence of an aneurysm at different ages or different situations. >> mcfarland: the genetic connection is something all too real for mary ann, since she lost her mother to a ruptured aneurysm. it has made it clear to her that family members need to be aware of symptoms and be proactive in their testing. >> my husband was very, very concerned, as i said, because of my mom. my family has been impacted because the fact that it is hereditary. i called my siblings-- i have two brothers and a sister-- made sure they told their doctors that their parents had aneurysm and that their daughters and sons also did.

>> mcfarland: both mary ann and john have gained insight into their lives and are now able to share their experiences with others. >> my experience was very... comfortable and was-- people treating me very nice, and the results were very good, and i cannot see any other way of doing it. >> the aneurysm has given me a new appreciation for things. i try to eat healthier. and my life is good. i have one. that's the important thing. >> i don't think we need to check on you before then because everything else looks normal. >> okay, very good. >> okay? in general, everything's been going well, right? >> yes. >> okay. so i'll see you in five years. >> yes, sir. >> all right. >> mcfarland: living with a thoracic or an abdominal aortic aneurysm can be a frightening experience, especially if the diagnosis came as a complete surprise.

but fortunately there are new ways to treat aneurysms, which can be both effective and minimally invasive as well. that's it for this edition of healthy body, healthy mind. i'm dr. scott mcfarland. see you next time. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: to answer any specific questions you may have, be sure to contact your health care provider. to comment on today's program, please call: or email: or visit our website at: >> announcer: major funding for healthy body, healthy mind is provided by novartis oncology. novartis oncology strives to become the world's premier

oncology business by consistently discovering, developing, and making novel therapies that may improve and extend the lives of people living with cancer. and by incyte corporation. incyte's vision is to become a leading biopharmaceutical company focused on improving the lives of patients with serious unmet medical needs. additional funding provided by: abbott. ironwood pharmaceuticals. janssen pharmaceuticals inc. and by w.l. gore and associates. %