Dear Dr. Roach: About three months ago, I bled a bit while urinating. This was the first (and only) time in over 30 years since menopause that this happened. An ultrasound was performed, and they found a mildly thickened endometrium (6.1 mm) with scattered cystic change, but without focal lesion.
My gynecologist is suggesting an endometrial biopsy. I am concerned because I have no symptoms other than kidney stones. I’m due to see a urologist, but even with the kidney stones, I have no symptoms. I am 80 and concerned about anesthesia. Should I go ahead with the biopsy?
L.O.
A thickened endometrium is concerning for uterine cancer. The most common symptom of uterine cancer is abnormal uterine bleeding. This usually takes the form of red, pink or brown spotting. However, it sounds like you had blood in your urine, which is more concerning for kidney stones than uterine bleeding.
Your ultrasound is abnormal; 5 mm is the limit of thickness for a normal endometrium. Getting a biopsy is clearly the recommended procedure, as it gives guidance on the next steps. Still, your risk of uterine cancer is small. You do not have to proceed with the biopsy if you do not want to.
An endometrial biopsy is an in-office procedure with minimal risk. My textbooks say there is minimal pain, but my patients tell me this isn’t always the case. You don’t have to receive anesthesia; you can take pain medication (such as naproxen), get a local anesthetic, or do both. I’ve had several patients who’ve requested a nerve block and were very happy with their decision.
If the biopsy shows cancer of the endometrium, surgery is the preferred treatment, but radiation is a possibility for some people.
Dear Dr. Roach: I have always been a runner, but foot pain has kept me from running in the past few years. Now I have severe pain, even when walking. An MRI showed nothing wrong. The foot and ankle specialist I saw did X-rays and found a large bone spur. He said that surgery to remove the bone spur could get me to walk and run again. I’m 70 and unanxious to have surgery, and the surgeon says he does many of these surgeries with a good outcome. What do you think?
E.W.
Insertional Achilles tendinopathy is a cause of foot pain where the Achilles tendon is inserted into the calcaneus, the heel bone. This problem frequently happens in runners, especially those with tight calf muscles. The damage done to the tendon sometimes causes a reaction in the bone, causing an osteophyte (a bone spur).
Conservative management includes rest, ice and physical therapy to help with strength and flexibility. Anti-inflammatory medicines may be helpful. Splinting at nighttime, orthotics, or special shoes are helpful for some people. Prior to considering surgery, experts will consider shockwave treatment, although it’s not clear how effective this is.
If surgery is considered, there are several different techniques, and your surgeon will pick what they think is best for you and what they have the most expertise in. Patient satisfaction rates are reported to be between 86%-95% with surgery.
Given the fact that your life has already been affected, and the likelihood that your pain and decreased ability to exercise is likely to worsen, you should seek more aggressive treatment. If physical therapy and other nonoperative treatments have failed, I recommend you strongly consider surgery.
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 [email protected]
