DEAR DR. ROACH: What's your opinion on cooled thermotherapy for benign enlargement of the prostate? I recently was put on Flomax and finasteride, and was given the option of having this procedure to eliminate taking these two drugs.
My urologist has had great success, while my internist says the success rate is only 60 percent. My internist did say it's great if it works. – S.V.
ANSWER: Benign enlargement of the prostate is very common in older men, and medications like tamsulosin (Flomax) and finasteride (Proscar) often are used, and are pretty effective in most men. The most effective treatment remains surgery, called transurethral resection of the prostate, TURP, which reduces symptoms by at least half in 98 percent of men. Unfortunately, TURP causes side effects in at least 20 percent of men, so there are several procedures designed to try to get the benefit of surgery without the drawbacks.
Cooled thermotherapy is a procedure using a microwave device to reduce prostate tissue. It isn't as effective as TURP: Only 72 percent of men reduce their symptoms by half or more; however, it has reduced side effects, such as need for blood transfusion. Unfortunately, there were more symptoms of uncomfortable urination, urgency and need for a catheter after surgery.
I think both of your doctors are right: Some men have good experiences, but not everyone will get relief. Some serious side effects are better with thermotherapy, and others are worse. You need to decide how much taking the medications bothers you and if you can live with the symptoms the way they are.
READERS: The new booklet on the prostate gland discusses cancer, enlargement, infections and erectile dysfunction in detail. 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 up to four weeks for delivery.
DEAR DR. ROACH: I just read your column regarding the shingles vaccine. I am an insurance agent who is often asked about coverage for the shingles vaccine. The Affordable Care Act does include this under preventive care for individuals 60 and over. Preventive care is covered at 100 percent for health plans that are not grandfathered. (Grandfathered health plans are plans that have been continued virtually unchanged since 2010. They are not required to comply with all aspects of ACA, so these plans might not provide this service.)
You also may be interested in knowing that, in our area, the Department of Health clinic does offer the shingles vaccine for a fee of $5 for individuals over the age of 50 who do not have it covered under a health plan. I am not aware if this is unique to our area, or if it is a widespread provision.
ANSWER: Thank you for writing in. Others wrote to me that their Department of Health paid for most or all of the cost. Some said they could get the vaccine covered at a pharmacy but not at physician's offices.
DEAR DR. ROACH: I am a 64-year-old male in good health. I had an outbreak of blister-like sores on my upper torso, in my mouth and near my eyes. I had an almost-incapacitating feeling and was able to consume only liquids and shakes because of the mouth blisters. The blisters took their course in seven to 10 days and scabbed over. These episodes reoccurred three separate times, returning two to three weeks apart.
Just prior to the outbreaks, I started taking Aleve because of sore knees while I was walking. On the third outbreak, I consulted my dermatologist, and he observed a reddened throat without any noticeable soreness on my part, so he swabbed the throat, and it showed strep throat. The sore throat was treated, and I believe I was also given steroids.
The physician's diagnosis was erythema multiforme. The doctor thought the EM was related to the strep throat, and he wasn't sure if the Aleve played a role. I am interested in your thoughts on the possible causes of the EM and the chances of it returning. I have been blister-free for a year now, but fear that the EM will return or that there is some underlying autoimmune issue. – T.C.
ANSWER: Erythema multiforme is a skin rash with a characteristic target appearance. They tend to appear on the backs of hands to the elbows, or on the legs from the top of the feet to the knees, and then appear closer toward the body. They stay for a few days and then leave after two weeks or so.
EM has been associated with many medical conditions, including autoimmune diseases; however, 90 percent of EM is related to infection. The most common infection is herpes simplex (the cause of cold sores as well as genital herpes). Strep throat is not a common cause of EM. However, the naproxen (Aleve) is a well-known cause.
I would advise against using Aleve or related medications, and reassure you that the likelihood of a hidden autoimmune disease is low.
DEAR DR. ROACH: I am in good general health. My problem is not being able to drink enough water to quench my thirst, especially in warm weather. If I drink more than 25 ounces per day, my stomach becomes upset. In warm weather, I have to balance my fluid intake between dehydration and an upset stomach. I am not diabetic. Is there a solution? – E.K.
ANSWER: A sensation of feeling bloated after fluid intake is not uncommon among athletes during competitions. I have heard many possible treatments. These include sipping fluids slowly over time; however, some people seem to find relief by gulping fluids down in large amounts, the theory being that distending the stomach stimulates it to contract and send the fluid into the intestines to be absorbed.
Having some food with the fluid helps many people, especially starchy foods (like cereals or crackers) to absorb lots of water. Tepid water may be more easily absorbed than ice-cold water. If none of these works, you might try adding a little fruit juice and very little salt to your water, which should reduce the stomach upset.
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 www.rbmamall.com.
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