Dear Dr. Roach: I recently was diagnosed with a benign pleomorphic adenoma of the parotid gland. My surgeon says that the mass should be removed, and explained many of the risks. The risks terrify me: Frey鈥檚 syndrome, facial paralysis, numbness.
My mass is 11 millimetres. Is that considered large? Could this mass be slow-growing, with little chance of it becoming cancerous? How long can I wait before agreeing to the surgery?
J.M.
I think I agree with your surgeon: Most masses like this should be removed. As with any procedure, there are risks and benefits. One risk is Frey鈥檚 syndrome (sweating around the face), which is a possible complication of the surgery. Another risk is damage to the facial nerve, which runs through the parotid, and damage to it during surgery can cause facial weakness and numbness.
That鈥檚 the bad news. The good news is that 11 mm is a small tumour, and the risks of complications are fairly low. For example, temporary facial nerve damage happens in 10 to 60 per cent of surgeries (depending on size and proximity to the facial nerve), but 90 per cent recover within one month. Permanent facial nerve damage occurs in zero to eight per cent of cases in different studies.
Balanced against the risks of surgery are the risks of not having surgery. Untreated, the tumour is likely to grow, making it harder and more dangerous to remove. However, there is always a small chance of transformation to a malignant tumour. If I had a patient in your situation, I likely would recommend surgery. If you are going to have surgery, it鈥檚 better to do so sooner.
Dear Dr. Roach: What is insulin resistance? Is there such a thing? Does it cause belly fat? How do we get rid of it?
My husband and I are in our 70s, have belly fat, are overweight and are Type 2 diabetics. I take metformin, while my husband is on insulin. We take medications for cholesterol and blood pressure. No matter what we do, we cannot lose weight.
We hear about belly fat being caused by insulin resistance and the pills that remove it. Do doctors know about insulin resistance and treat their patients for it?
G. and B.
Insulin resistance is the primary defect of Type 2 diabetes, but insulin resistance happens before diabetes is diagnosed. The exact mechanism that causes it is not clear. However, it is clear that belly fat is strongly associated with insulin resistance, and that behaviours that reduce belly fat tend to reduce insulin resistance. The preponderance of the evidence is that belly fat is a major cause.
Doctors are increasingly aware of insulin resistance, but some medications we use tend to worsen it. It can happen because of weight gain, but some medicines, especially some of the ones used in psychiatry, can cause insulin resistance by themselves. Some medicines used for blood pressure, including some beta blockers and thiazide diuretics, can worsen insulin resistance as well. Niacin, used for cholesterol, worsens insulin resistance and makes blood sugar higher in a large number of people who take it. There usually are alternatives to these medications.
Exercise improves insulin resistance, even if you don鈥檛 lose weight. Avoiding excess dietary sugars, even 鈥渘atural鈥� sugars in fruit juices and honey, decreases your need for insulin. Some diabetes medications help reverse insulin resistance. One of them, metformin, is increasingly used to prevent diabetes in people with insulin resistance.
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].
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