ArcaMax

DEAR DR. ROACH: Is 18 years a record for living without a stomach? A family member had stomach cancer when he was 70 and had his stomach removed. He consulted with a dietician and has been able to eat small but frequent meals and take enzymes, vitamins, and other things. But slowly, he lost weight.

Now, at 88, he is down to 84 pounds. His muscles are also affected. He used to play racquetball regularly, but this came to an end during COVID and wasn't picked back up after the pandemic. He can no longer walk without assistance. They are putting a feeding tube into his small intestine to supplement what he usually eats.

Are you familiar with this type of thing? What else can be done, or is this the end? Will he starve to death? -- Y.F.

ANSWER: I have seen many patients with stomach cancer and have never seen this degree of weight loss, but weight loss is very common after removing the stomach. This degree of profound weight loss is very disturbing and usually results in a worse outcome, so effective treatment is overdue. A feeding tube, which isn't often the appropriate treatment for weight loss, seems to be an important short-term treatment. I assume that he has had extensive evaluation for a recurrence of diseases, including CT scans.

You mention that he has been getting vitamins; B12 and vitamin D levels are often profoundly low after gastrectomy (removal of the stomach), so these should be checked, even if he has been on replacements. If no other cause is found, it might be worth a try to use an appetite stimulant.

In addition, I would formally measure his total calorie input in a day to see whether the problem really is that he isn't getting enough calories. I would be worried that he isn't absorbing all of them.

There is no reason for him to starve to death. In the very worst case, nutrition can be given intravenously while they figure out why he is losing so much weight.

DEAR DR. ROACH: I am an 84-year-old male in amazingly good health and physical ability. But after running about 3 miles, I noticed some minor chest discomfort. After a calcium score test and stress test, my doctor wanted to place stents in my coronary arteries.

I read a National Institue of Health study from 2020 regarding stent outcomes versus medication and lifestyle changes, and it showed no difference in the outcomes. So, I decided not to do the stents. I no longer do any distance running, but I do weight training and a stationary bike exercise for 10 minutes without any chest issues. I now take statin drugs, blood pressure medicines, and baby aspirin.

Are you familiar with this study, and am I doing a reasonable thing by not having the stents inserted? -- T.E.

ANSWER: Whether stents are beneficial in people with stable coronary artery disease remains somewhat controversial. Although stents in combination with a healthy diet, exercise and medication may improve symptoms better than lifestyle changes and medication alone, there are no data to show an improvement in lifespans or in preventing heart attacks.

Your cardiologist wanted to reduce your symptoms, but if you aren't having any now, then stenting isn't indicated. If you had to reduce your running because of chest discomfort, then stenting might possibly allow you to exercise more without these symptoms.

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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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