Prostate often blamed for bladder problems

DEAR DR. ROACH: I'm 87 and have an enlarged prostate. When I get the urge to urinate, which is often, I have to go at once. Do you think that taking a bladder-control medicine would interfere with the Cardura (doxazosin) I'm taking to keep my urine duct (urethra) open? It's getting to be a big problem. Hope you can help me. – CB

ANSWER: Both men and women can have urinary urgency (the sensation of needing to go right away), and sometimes this can lead to accidents. In women, the problem usually is attributed to bladder spasm, and in men it may be attributed erroneously to the prostate. Of course, it is possible to have both prostate problems like benign enlargement of the gland and bladder spasm, but oftentimes the problem in men is solely the bladder.

Some people need treatment for both, and there are no interactions I could find between doxazosin and bladder spasm agents like Detrol (tolterodine) or Ditropan (oxybutynin).

The booklet on men's health discusses prostate gland enlargement. Readers can obtain a copy by writing: Dr. Roach – No. 1001W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I read and hear of great health benefits attributed to eating nuts. I have a very healthy heart, but no one can consider himself beyond the specter of cancer. Also, possibly my neurological or other systems that deteriorate with age could benefit from eating nuts. Unfortunately, eating nuts or peanuts results in constipation that can last for days. Foods with dairy or egg components give me the same problem. Do I do myself a disservice by not eating nuts? Should I consider episodes of constipation worth the benefits? – J.M.

ANSWER: I have carefully read the new studies on nuts, and they confirm previous studies showing that nut consumption is associated with a lower risk of heart disease and overall death and, as you note, reduced cancer risk as well. However, this doesn't prove that eating nuts reduces those risks. It is possible that people who eat nuts have other behaviors that are really responsible for their lower risk of disease. However, the authors of the study did as good a job as possible to reduce that possibility.

In your case, I would think of nuts as a medicine. You have to consider the benefits (possibly lower risk of cancer and other diseases) against the side effects (constipation, which can be very unpleasant and reduce quality of life). One estimate is that nut consumption may increase lifespan by as much as a year. You may have less benefit than other people from nut consumption because of your healthy heart. That would make me less likely to recommend nut consumption for you. If your constipation were more than mildly annoying, I probably wouldn't "prescribe" nuts. Similarly, people with nut allergies, which are increasingly common, cannot enjoy the health benefits of nuts. Only you can determine if the modest improvement in (possible) life expectancy is worth the symptoms.

DEAR DR. ROACH: I have been having weird spells for about six months. They occur only occasionally and last a couple of days and nights. They awaken me out of sleep and are a little frightening.

It starts with a burning sensation on the right side of my nose. I feel as if I have to remember something, and a wave of warmth floods over my upper torso, down to my arms. I feel my heart fluttering, and am a little sick to my stomach. I also have funny sensations in my right ear. It lasts a few seconds, and I just have to ride it out. When it's over, I feel weak for a while.

I saw a neurologist, who mentioned that it might be anxiety, which made me mad — being awakened out of a sound sleep doesn't seem to me that I am anxious, as I have no trouble sleeping! He wanted to put me on a medication with a lot of side effects, such as dizziness and hallucinations. I do not want to be on medication, but I also don't want to have a grand mal seizure. He could not tell me if I could have one or not. I only want affirmation that I am not crazy! — L.G.

ANSWER: You aren't crazy. Your neurologist may be right — this can be related to anxiety — but I wouldn't jump to that diagnosis without considering a few things first.

A warm sensation over different parts of your body should make your doctor think of conditions like carcinoid syndrome and pheochromocytoma. These are tumors that secrete hormone-like substances that can cause odd feelings, such as flushing or warmth, in different parts of the body. They can be screened for with simple urine and blood tests. I agree with you that being awakened with this sensation makes anxiety or panic attack less likely. It does not sound like a seizure disorder to me.

Sometimes, people notice sensations that defy medical explanation. In that case, we generally just try to make sure it isn't something that doesn't threaten life or health and help people minimize and live with the symptoms.

DEAR DR. ROACH: I have to take levothyroxine in order to obtain an acceptable TSH number. I have read that some doctors are stating that there is a relationship between hypothyroidism and gluten intolerance, possibly even celiac disease. Is this proven to the point that a patient should alter his or her diet and give up the basic foods of bread and cereal? — R.K.

ANSWER: People with celiac disease have a much higher risk of autoimmune thyroid disease (especially Hashimoto's, the most common cause of low thyroid) than expected, to the point where everyone with celiac disease should have a blood test to look at thyroid levels. Celiac disease, or intolerance of gluten in general, may have few or subtle symptoms, and it might be worthwhile to consider testing for celiac disease in people with autoimmune thyroid disease. However, I would not recommend a drastic change in diet for people with thyroid disease if there are no symptoms.

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]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive Orlando, FL 32803. (c) 2015 North America Synd., Inc. All Rights Reserved