Q: I am a 75-year-old female in fairly good health. My primary care doctor considers me pre-diabetic but another doctor told me my fasting levels of 108 are not indicative of pre-diabetes. I do have an arrhythmia and a pacemaker but I am very busy raising two grandchildren. I do like to hike and walk when I can find the time.
In 2009 I had drainage tinged with blood from my left breast for 7 to 10 days. It stopped and never occurred again. I was referred to a surgeon and he did smears of the fluid and ordered an ultrasound. A small nodule was found in the nipple area and a biopsy was done. A metal bead was injected into the site. I had follow-up mammograms and exams. Everything came back negative and no further tests were ordered except a yearly mammogram. One thing makes me uneasy, though. Since this occurred, my breasts have gradually decreased in size until they are almost flat to my rib cage. I noticed it with my left breast first, now both breasts. I have always been small breasted but this doesn’t seem normal when I have not lost any weight otherwise. The doctor said that’s just what happens as you get older and the muscles are affected. To me there’s a difference between sagging breasts due to the aging process and flesh disappearing without weight loss.
I have not had a CT scan and with a pacemaker, I probably can’t have an MRI. Even though it’s been a year and a half, I still worry about breast cancer. I need to stay alive for my two grandchildren as I am their only support person, both financially and otherwise. I follow your column in my local newspaper and really respect your advice and opinions.
A: Thank you for the compliment. I will do my best to help you understand what is happening.
To begin with, MRIs don’t use radiation; however, they do involve the use of powerful magnetic fields. So, you are correct that individuals with a pacemaker or defibrillator should not have MRIs performed. CTs may be used in in those with pacemakers or defibrillators but depending on the scan location may interfere with the reading.
Sometimes nipple discharge is of little to no concern and will cease on its own without treatment. The occurrence can actually be quite common and may originate from several benign (non-cancerous) conditions to include infection, abscess, fibrocystic breasts, or an intraductal papilloma. The use of some medications might even be to blame — specifically cimetidine, metoclopranide, triclic antidepressants, verapamil, reserpine, and others. Some herbs such as anise and fennel could have caused the problem. Further, an infection such as mastitis can develop in women who are not lactating. Were this the case, the breasts would have been warm to the touch, painful and red. If your breasts have been irritated by rubbing against clothing, or if you have severe hypothyroidism, that could be the cause of the discharge. Advancing age in women who have been pregnant at least once can cause discharge and inflammation. When inflammation occurs, the discharge may contain blood. So, as you can see, there are many possibilities to consider.
I would be remiss if I failed to indicate the risk for possible cancer would be higher if only one breast was affected (which it apparently was) , if the discharge contained blood (which you indicate it was), if you had or now have a breast lump (which you make no mention of), and are aging (along with the rest of us); however, I must state once again that most discharge is either normal or is caused by a benign condition that can be treated. You indicate your testing was negative in the past. It appears your physician is top notch and taking good care of you. Follow his or her advice, hope for the best and have mammograms every six months or whenever advised.
The breast reduction you have experienced may simply be the result of menopause and the hormonal changes that have occurred in your body. We all adjust to hormonal changes differently. I don’t feel you can read anything ominous into the fact that you are smaller than you were when you were younger.
In terms of your pre-diabetes, I frankly would not worry about that, either. You are not a candidate for medication at this stage. Watch your diet, exercise as much as possible, avoid sweets and high-fructose corn syrup, and continue to provide the loving care you are giving your grandchildren.
Readers who would like related information can order Dr. Gott’s Health Reports “Diabetes” and “Menopause” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) or print an order form from www.AskDrGottMD.com.
