ArcaMax

DEAR DR. ROACH: I'm a 70-year-old male who's active and healthy, and I eat a varied diet. I take the minimum dosages of levothyroxine and atorvastatin. Recently, I had a gastrointestinal bleed that was located in my ascending colon due to diverticulosis. There wasn't an infection or any pain at all. Just out of the blue, I had explosive, bloody diarrhea.

It was severe enough that I had a blood transfusion and was in the ICU for four days. An ablation was attempted but wasn't successful in finding the source of the bleed. It just stopped on its own, and I was sent home. I was told that chances are, it wouldn't happen again, but it may.

This is very frustrating. I have no restrictions and recovered fine after about three weeks. Is there anything I can do to prevent this? I really wasn't given any direction or dietary advice other than to eat my "normal diet as tolerated." -- A.W.G.

ANSWER: Diverticulosis is a condition of the colon where there are many small outpouches of the wall of the colon, called diverticula. These may remain asymptomatic for many years, but there are several potential complications of diverticular disease.

In addition to bleeding, which is the most common problem, one diverticulum (or several diverticula) may become infected, which is called diverticulitis. This often causes a fever and abdominal pain but can be quite serious with complications of abscess, a fistula (a connection between the colonic diverticula and adjacent structures like the bladder, vagina, uterus or skin), or a perforation into the abdominal cavity.

Although diverticulitis may cause bleeding, most bleeding comes from diverticulosis without diverticulitis. The bleeding usually stops spontaneously, but as many as a third of people with diverticular bleeding need an intervention like the ablation they attempted on you.

Unfortunately, you can have another episode. In a large study, 5% of people had another bleeding episode by the end of one year, 8% at three years, and 16% at five years. People who are taking anticoagulants and those who took blood pressure medicines were at a higher risk; fortunately, you take neither.

Although you can't prevent another attack completely, some lifestyle changes can help: a high-fiber, high-quality diet that's rich in fruits, vegetables, whole grains and legumes with limited red meat; maintaining a normal BMI; regular physical activity; smoking cessation; and limiting anti-inflammatory medicines.

Many people are still told to avoid nuts and seeds, but the latest evidence suggests that these are a part of a healthy diet and don't increase the risk of diverticulitis in people with diverticulosis. Of course, if you've had problems with certain foods before, it makes sense to avoid them.

DEAR DR. ROACH: In 1993, I experienced the worst headache of my whole life. It turns out that I had a brain aneurysm. The surgery to repair the aneurysm was successful, and I recovered with no deficits. The problem now is that no one knows what the clip is made of. I don't know if it's metal or plastic.

I've since had an MRI recommended to me for knee problems, but I'm afraid to even get near the machine in case the clip in my brain is metal. Is there any way to find out what aneurysm clips were made of in 1993? -- K.I.

ANSWER: Unfortunately, there's no way to be sure whether the clip is "MRI conditional" (meaning that an MRI is OK only when certain protocols are followed) based on when it was placed. The only way to be sure is to get your operative report from the surgery and get the manufacturer, model and type.

After 1995, most clips were MRI conditional, but the only way to be sure is a positive identification from your medical record.

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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.

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