Category Archives: Men’s Health

Medicine, Men's Health, Opinion

DR. C’S MEDICINE CABINET: BENEFITS OF “FINASTERIDE”

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Finasteride is a medication that I was given by my urologist, after my operation for an enlarged prostate with restricted urine flow. It was used to prevent the re-growth of the prostate, and subsequent recurrence of urinary obstruction.

It is also recommended to treat male-pattern baldness. That it is used to treat male problems suggests that it has something to do with testosterone, and indeed it does. Finasteride (proscar) is a 5-alpha reductase inhibitor, preventing testosterone from being converted to dihydrotesterone, the active form, in the prostate and the skin.

Finasteride is well studied, and has been found to decrease PSA in the blood, and is suspected of interfering with the use of PSA as a screening device for Prostatic Cancer. It has also been suspected of increasing severe, high grade cancer. These findings have been refuted in later papers.

It has also been found to decrease sexual function, which it has in my case. I have continued it for several reasons.

First, my urine flow remains fine. Second, the bulk of the data indicates that it hinders prostatic cancer formation; and in a previous posting, I stated that Prostatic cancer in 88 year-olds is almost universal. Third, we are continuing in a Covid 19 pandemic.

One of the markers for severe infection is male-pattern baldness, which finasteride prevents. I did find in my reading about finasteride that there is a 1 mg. dose, and I am taking 5 mg..

When the Covid epidemic slows, I will probably opt for the 1 mg. Dose, which produces a significant effect, though of course less than the 5 mg. Less medication is usually better.

For Patients with BPH opting for medical treatment, Finasteride is usually recommended along with an alpha adrenergic agonist to relax the bladder sphincter.

For the men out there, facing an ever-increasing likelihood of BPH, or wanting to slow down baldness, you may eventually be making the decision whether or not to take this effective medication.

–Dr. C.

Men's Health, Videos, Women's Health

HEALTH VIDEOS: “YOU HAVE THE GUT MICROBIOME YOU DESERVE” (CAMBRIDGE)

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Do you have good or bad microbiome? Or do you have the microbiome you deserve?

Gut Microbiome, the new Open Access journal from Cambridge University Press and The Nutrition Society has published its first papers, including the animated abstract above from the paper: Hill, C. (2020) “You have the microbiome you deserve,” Gut Microbiome, Cambridge University Press, 1, p. e3.

Access the paper here: https://bit.ly/3bFOjc7

Men's Health, SLEEP, Videos, Women's Health

HEALTH: “6 TIPS FOR BETTER AND LONGER SLEEP” (VIDEO)

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Want to not only fall asleep quickly but also stay asleep longer? Sleep scientist Matt Walker explains how your room temperature, lighting and other easy-to-fix factors can set the stage for a better night’s rest.

Sleeping with Science, a TED series, uncovers the facts and secrets behind our nightly slumber. (Made possible with the support of Beautyrest)

Check out more: https://go.ted.com/sleepingwithscience

Medicine, Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #14: TRIGEMINAL NEURALGIA

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My Mother had Tic Douloureux, the traditional name for Trigeminal Neuralgia. I remember her suddenly covering her face with her hand and grimacing, but this was only occasionally.

Compression, degeneration or inflammation of the 5th cranial nerve may result in a condition called trigeminal neuralgia or tic douloureux. This condition is characterized by recurring episodes of intense stabbing , sever, excoriating pain radiating from the angle of the jaw along one or more branches of the trigeminal nerve on one side. Usually involves maxillary & mandibular branches, rarely in the ophthalmic division. Usually above 50 years and more in females. Can result from a redundant loop of superior cerebellar artery. Surgery is the treatment of choice.

TD is not very common for “101 chronic conditions”, but it is the most common cause of chronic facial pain. It occurs in the FACIAL region supplied by the 5th cranial, or TRIGEMINAL nerve. This is about the area covered by your widely spread hand, pinkie on the nose, and the butt of the palm along the jawbone.

Brief shocking pain occurs in “PAROXYSMS” in the facial area, on ONE SIDE, and TRIGGERED by tooth brushing, touching the face, or even by the blowing of the wind. This description is so typical and specific as to be “pathognomonic”, and can be diagnosed over the telephone.

Variants can give continuous pain, or occur on both sides, but the “classical” variety is most common. You should contact your Doctor, since some cases are caused by Multiple Sclerosis or a tumor. Effective medications are available, such as carbamazepine.

TD can be familial, but is often caused by compression of a nearby artery, and “decompression” is currently the most effective surgical treatment. It is one of the few “chronic 101” conditions not to be substantially prevented or helped by our old standbys, sleep, diet and exercise.

That being said, it is sometimes helped by exercise, and almost never occurs during sleep. The August 20, 2020 New England Journal of Medicine Has an excellent Review article, which will be appended to this posting.

–Dr. C.

Medicine, Men's Health, Opinion

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #13: “BENIGN PROSTATIC HYPERPLASIA” (BPH)

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I have known about the Prostate gland, which surrounds the urethral channel exiting the bladder, since med school. I have seen evidence of its enlargement in the increasing time it takes older men to empty their bladders.

When my dad had his prostate surgery, he said that he could blast the porcelain right off the toilet, I could then appreciate for the first time that enlargement of the prostate caused a weak urinary stream.

When I started waking up at night 3 or 4 times to urinate, it really hit home. I had to get something done. My Urologist was a very good one, like all of my doctors. As the old saying goes, the best is none too good when it comes to your health.

On my first visit, he ordered a “Urodynamic” study. In this test, done by a visiting nurse who had the equipment, a small catheter, or tube, ws passed into my bladder, after loading myself with water until I could hold it no longer. The pressure in my bladder was measured, the speed with which I evacuated my bladder was measured, the volume of urine I passed was measured, as well as the volume retained in the bladder.

With these numbers, my bladder volume, residual, and the resistance to flow was calculated. I was shown to have a small bladder, too much residual retained after I emptied it, and an excessive resistance to the flow of urine out of the bladder.

I have not seen the urodynamic studies mentioned in the modern workup of BPH, and it may not have been critically necessary. I did appreciate his thoroughness, however, and factored in the study when he gave me the options of medicine vs. surgery.

were two medicines mentioned, an alpha adrenergic agonist, and finasteride, an anti-androgen. Since I would have to take both meds the rest of my life, I chose surgical enlargement of the urinary passage through the prostate, known technically as a “roto rooter job”. I, too, noticed the power of my urinary stream after the surgery.

A good friend of mine, also a physician, took medicines for many years, in spite of increasing trouble urinating, getting up at night, and frequent bathroom trips during the day. He eventually went to see a urologist after he had to go to the ER for completely being unable to pass urine.

The Urologist declined to do surgery on the basis of his health, the unusually large size of the blockage, and degree of obstruction. He used a catheter to relieve himself several times a day for the rest of his life. Had I been in his shoes, I would have tried to find a willing surgeon somewhere, perhaps at a university med school.

But then again, I wouldn’t have waited so long. These days many more options are available, and the appended article discusses some of them. –

–Dr. C.

Men's Health, SLEEP, Videos, Women's Health

HEALTH VIDEOS: “HOW MUCH SLEEP DO YOU REALLY NEED?”

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You know you need to get enough sleep, but the question remains: How much is enough? Sleep scientist Matt Walker tells us the recommended amount for adults and explains why it’s necessary for your long-term health. Sleeping with Science, a TED original series, uncovers the facts and secrets behind our nightly slumber. (Made possible with the support of Beautyrest)

Check out more: https://go.ted.com/sleepingwithscience

Men's Health, PODCASTS, Resources, Women's Health

HEALTHY DIET PODCASTS: “SPOON-FED” AUTHOR & PROFESSOR TIM SPECTOR

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According to a recent study, obesity increases the risk of dying of Covid-19 by nearly 50%. Governments around the world are now hoping to encourage their citizens to lose weight. But with so much complex and often contradictory diet advice, as well as endless food fads, it can be hard to know what healthy eating actually looks like. 

How many pieces of fruit and vegetables should you eat a day? Will cutting out carbs help you lose weight? Is breakfast really the most important meal of the day? Speaking to Tim Spector, professor of genetic epidemiology at King’s College London about his new book Spoon-Fed, Madeleine Finlay asks why we’re still getting food science wrong, and explores the current scientific evidence on snacking, supplements and calorie labels. 

Tim Spector is a Professor of Genetic Epidemiology and Director of the TwinsUK Registry at Kings College, London and has recently been elected to the prestigious Fellowship of the Academy of Medical Sciences. He trained originally in rheumatology and epidemiology. In 1992 he moved into genetic epidemiology and founded the UK Twins Registry, of 13,000 twins, which is the richest collection of genotypic and phenotypic information worldwide. He is past President of the International Society of Twin Studies, directs the European Twin Registry Consortium (Discotwin) and collaborates with over 120 centres worldwide. He has demonstrated the genetic basis of a wide range of common complex traits, many previously thought to be mainly due to ageing and environment. Through genetic association studies (GWAS), his group have found over 500 novel gene loci in over 50 disease areas. He has published over 800 research articles and is ranked as being in the top 1% of the world’s most cited scientists by Thomson-Reuters. He held a prestigious European Research Council senior investigator award in epigenetics and is a NIHR Senior Investigator. His current work focuses on omics and the microbiome and directs the crowdfunded British Gut microbiome project. Together with an international team of leading scientists including researchers from King’s College London, Massachusetts General Hospital, Tufts University, Stanford University and nutritional science company ZOE he  is conducting the largest scientific nutrition research project, showing that individual responses to the same foods are unique, even between identical twins. You can find more on https://joinzoe.com/ He is a prolific writer with several popular science books and a regular blog, focusing on genetics, epigenetics and most recently microbiome and diet (The Diet Myth). He is in demand as a public speaker and features regularly in the media.

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Medicine, Men's Health, Opinion

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #12: “Prostate cancer”

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Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.

Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.

The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.

The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.

This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.

They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.

Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.

The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,

Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.

This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.

Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.

–DR. C

Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.