Tag Archives: Blockage

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

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.

BLOOD VESSELS: THE “SYSTEMIC ARTERIAL SYSTEM”

BLOOD VESSELS; it is hard to overestimate their importance. They are literally our lifelines, delivering the oxygen and nutrition necessary for life. We are as old as our blood vessels.

I will divide blood vessels into 4 components with rather separate domains: The Systemic Arterial system, the Pulmonary circulation, the Venous system, and the Lymphatic system, and will discuss these separately.

SYSTEMIC ARTERIAL SYSTEM

The Boy Scouts taught me the pressure points; The radial, at the thumb-side of the wrist, the brachial, on the inside of the upper arm, and the inguinal in the groin area. Pressure on these sites will stop arterial bleeding distally.

You should be able to locate the radial artery pulse, and begin to appreciate its strength and regularity. Strength in case you encounter a person who isn’t moving, and regularity for yourself; many older people develop an irregularity called Atrial Fibrillation, and you might be the first to discover it..

ANEURISMS are swelling of the arteries, and the swelling may thin the arterial wall so that it can burst. A Cerebral aneurysm can burst and cause a stroke-like problem. If an aortic aneurism bursts, the internal blood loss can be fatal.

RAYNAUD’S Phenomenon is fairly common, and consists of an over-reaction to cold, where arteries of the hands constrict, and the fingers get white and cold. Burger’s disease involves small arteries, and often is associated with Raynaud’s. The arteries carry the blood distally (away from the heart), continuing to divide into ever smaller arterioles which terminate in capillaries, which branch out in such an arborization as to supply all cells except cartilage and parts of the eye.

HYPERTENSION develops when the arterioles, under hormonal or neural influence, constrict, increasing the resistance to blood flow, and so the pressure. Increase in sodium retention and therefore the blood volume can also increase pressure.

ATHEROSCLEROSIS is the common disease of western life style. Excessive calories and sedentary life style combined with genetic defects in fatty metabolism produce cholesterol plaques which narrow and stiffen the arteries, often leading to BLOCKAGE of blood flow. Blockage of flow to the HEART, BRAIN, KIDNEYS, BOWEL, or EXTREMITIES each produce their separate disorders of Myocardial Infarction, Stroke, Renal artery Disease. Intestinal ischemic syndrome, and Claudication.

Atherosclerosis

These disorders will each be separately discussed. I have always thought of vascular disease as a special class of CAUSATIVE MECHANISMS when trying to develop a DIFFERENTIAL DIAGNOSIS of a patient’s problems. Blockage to an area results in PAIN or LOSS OF FUNCTION.

Stroke is usually painless with blockage, since the brain has no pain sensors. Blockage of the renal artery often causes complex difficulties including Hypertension, because the kidney is an endocrine organ in addition to its excretory function.

A good Friend and patient showed what careful self-care can accomplish. It all started with a myocardial infarction, the first sign of his blood vessel disease. He had a complication in his workup, and had to have emergency bypass surgery. There had been damage to the heart muscle, with a large reduction in his EJECTION FRACTION.

His cardiologist gave him at most 5 years to live. That was 25 years ago, before the development of the statin drugs. He was given a draconian low cholesterol diet, which he followed exactly. One one visit to the cardiologist, he inquired whether he could have other areas of arterial blockage. His doctor then listened to his neck and discovered a bruit (noise) in the carotid artery, after which he had a Carotid endarterectomy.

In an orthopedist office for back pain, the orthopedist left the room, and my friend noticed in the CT scan report mention of cysts in the kidneys.

The Orthopedist cared mainly about his bones, and had overlooked the “incidental finding”. His brother had died of mesenteric artery blockage from atherosclerosis, he had stomach symptoms, and sure enough he also had arterial blockage to the intestines.

Bottom line: it pays to be an ACTIVE PARTICIPANT in our medical treatment, and even though we all have genetic determinants, we can make our health BETTER with attention to our health, especially SLEEP, DIET and EXERCISE.

–DR. C

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #2: NASAL CONGESTION

Chronic nasal congestion, the constant condition of not being able to breathe through your nose, can be a major problem, interferes with sleep (often via sleep apnea), undermining one of the 4 pillars of health (sleep, diet, exercise and intellectual stimulation). Well, maybe a second one as well, since it is hard to function intellectually when you are sleepy all the time.

Chronic nasal congestion in kids is often due to allergy and associated ADENOID (located at the back of the throat) ENLARGEMENT. Adenoids can cause sleep apnea and pulmonary hypertension, ear infections and sinusitis.

If left untreated, the bones of the face don’t grow properly, and the constricted bony structures can lead to later problems. Nasal polyps can be a factor in nasal airflow blockage, and their removal may benefit the blockage.

If associated with sinusitis and aspirin (aspirin is rarely used in children anymore because if Reyes’ Syndrome) sensitivity, the combination is known as “sampters’ triad. Regrowth of the polyps is common and aspirin desensitization may be helpful.

ALLERGIC RHINITIS is treated by avoidance, medication and desensitization. SINUSITIS can cause chronic nasal blockage. Both medical and surgical treatments are useful.

One-sided nasal blockage raises a red flag. One of my young patients had pushed a rock into his nose, which I then removed. Nasal polyps can be on one side, and can be removed, NASAL SEPTAL DEVIATION can cause one-sided nasal blockage, and if severe can be surgically corrected.

The nasal tissues are “erectile tissues” I have a nasal septal deviation to my left side. I SLEEP ON MY SIDE to CONTROL my SLEEP APNEA (more when I get to that subject, which certainly qualifies as a chronic problem), When I sleep on my right side, I don’t breathe as well since my “good side” is down and becomes study.

Those lucky people who breathe freely on both sides, and who sleep on their sides, may possibly be aware that the DOWN SIDE (my good side, above) blocks up. It seems that the nasal tissues are “erectile tissues” body wants to REST one side at a time, and the down side is easier, since gravity pools the blood there.

Nasal tissues are under the control of the autonomic nervous system, decongest (nasal passages are open) with the alarm (fight or flight, “sympathetic”) reaction, and do the opposite (tissues congest, nasal passages close) when the “parasympathetic” takes over after a meal, when you are “vegetating”. in front of the TV

OPINION: HEART AND BRAIN HEALTH ARE LINKED FOR LIFE

Your heart and your brain are your two most vital organs, and if you enjoy life, they should be a top priority. These amazing structures are tethered to life-giving support by your arteries, just as the new you was tethered by your ubilical cord.

Life is fragile, hanging by a thread, or an artery. over the span of your life, These arteries can become plugged by fatty deposits called plaques. A healthy life style-SLEEP, DIET and EXERCISE– could slow down or prevent this atherosclerosis.

But everybody should know about the symptoms of HEART ATTACK and STROKE (1) and how to respond if the arteries sustaining your heart or brain become blocked.

You should be familiar with the hospitals in your area. How close are they? What are their capabilities? Are they Class 1 for heart attacks and stroke? Do they have a CATH LAB?

SPEED is important. Within minutes of the BLOCKAGE of an ARTERY to your heart or brain, vital cells start to die. The goal is to remove the blockage as soon as possible. CALL 911 as soon as you have heart attack or stroke symptoms. Don’t be afraid of the ER because of Covid, since almost all now use TELEMEDICINE SCREENING to keep infected patients segregated.

Alas, for many people, such PREVENTATIVE MEDICINE requires too much SELF DISCIPLINE AND CONVICTION. America has an epidemic of OBESITY and an avalanche of tasty FAST FOODS provided by a CONSUMER SOCIETY that is ever-attentive to the latest fads and trends.

DR. C