Archive for October, 2014

Prostate Cancer: A New Test To Determine if Watchful Waiting is Appropriate

October 10, 2014

Prostate cancer affects 1 in 6 American men and causes over 25,000 deaths per year, making prostate cancer the second most common cause of death due to cancer in men (first is lung cancer).

Men who have a biopsy that is positive for prostate cancer are confronted with a decision regarding treatment. If the man has a life expectancy of greater than 10 years, he would be a candidate for surgical removal of the prostate gland, radiation therapy, or even a program of watchful waiting or referred to as active surveillance. So what is a man to do with a diagnosis of prostate cancer? Now there is a test, Prolaris, that will help men decide which cancers are aggressive and may require more aggressive treatment, i.e., surgery or radiation, and which cancers are indolent and the men may be candidates for watchful waiting.

Until now the only consideration for men with prostate cancer was the grade of the cancer and the stage of the cancer. However, there are men with low PSA levels and a low grade or Gleason score, who have an aggressive tumor as determined by the Prolaris test and perhaps should consider additional treatment.

How is the Prolaris test performed?

The doctor can submit your original prostate biopsy for analysis and this will look at several genetic markers to determine the Prolaris score. No additional blood test or biopsy is required. The Prolaris test provides an accurate assessment of the aggressiveness of your tumor.

The Prolaris score provides information that helps you and your doctor make the best treatment decision. For example a low risk Ca and low Prolaris score, may persuade you to consider watchful waiting and have close follow up with a digital rectal exam and a PSA test every 3-4 months. On the other hand, a high Prolaris score is suggestive of an aggressive tumor and more aggressive treatment may be selected.

Bottom Line: Until now no lab test or imaging study can determine the aggressiveness of your prostate cancer. Now you and your doctor can make a more informed decision about the potential of your cancer to remain slow growing and you would be a candidate for watchful waiting or the prostate cancer is more aggressive and more aggressive therapy is in order.

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What Happens After A Vasectomy?

October 10, 2014

A vasectomy, using the no-scalpel, no needle technique takes just a few moments to accomplish in the doctor’s office. However, there are some precautions that are necessary after the procedure.

Most often, men are concerned about the pain involved in a vasectomy procedure as well as having a healthy, functional sex life afterwards. The no needle technique using a local anesthetic and the no-scalpel procedure which allows the procedure to be accomplished through a quarter inch opening without requiring an incision, causes minimal or no pain during or after the procedure.

Post Vasectomy Advice

  • The vasectomy procedure lasts anywhere from 10-12 minutes.
  • Patients do not require any general anesthesia and often take a Valium tablet before the procedure to remove the anxiety often associated with the procedure.
  • A bag of frozen peas or ice should be placed on top of the underwear over the scrotum to help reduce any swelling. Instead of frozen peas, you can place a few ice cubes in a zip lock bag and place this over the scrotum for a few hours after the procedure.
  • You may feel an ache in your testicles which is treated with extra strength Tylenol or Aleve.
  • You will need to have a ride home if you take the Valium.
  • It is recommended that vasectomy patients abstain from sex for 3 days.
  • You should have no activity the day of the procedure and minimal activity for 2-3 days after the procedure. You can resume all activity including heavy lifting and bike riding seven days after the procedure.
  • You will need to use some form of contraception until your semen is examined under the microscope to be certain that all sperm are absent from the ejaculate. I suggest that you have 15 ejaculations using contraception and then bring in a specimen for me to examine. If no sperm is seen, I will ask for a second specimen a few days later and if the second specimen is without sperm, you will be considered sterile and can stop using contraception.

Bottom Line: While pain tolerance varies from person to person, the pain following a vasectomy is generally a mild discomfort as long as instructions are followed. Avoid heavy lifting and strenuous exercise, take pain medication when necessary and place ice on the scrotum to speed up recovery time.   Finally, a vasectomy is not a protection against sexually transmitted diseases (STD).

Vasectomy For Male Contraception-What Are the Alternatives?

October 10, 2014

A vasectomy is a method of male birth control that should be considered carefully as it is, for the most part, a permanent form of sterilization. The procedure using the no-scalpel, no needle technique can be done in minutes. However, reversing the vasectomy takes several hours in the operating room and is usually not covered by insurance. Before you move forward with a vasectomy, it is important to review vasectomy alternatives that are available.  If you have any doubts about having children in the future, you should explore temporary birth control options.

Tubal ligation, commonly referred to as getting your ‘tubes tied,’ is a procedure used for female sterilization. The fallopian tubes, the small tubes that transport the egg or ovum from the ovary to the uterus, are closed off by various methods (severed, sealed or pinched) to block the eggs from reaching the uterus.

Essure

Essure is a permanent method of birth control where small metal coils are placed in the fallopian tubes. The coils cause scar tissue to form, which blocks the eggs from reaching the uterus. The coils are inserted vaginally during a hysteroscopy procedure. Unlike tubal ligation, there are no incisions or anesthesia used. Birth control is needed for several months after the procedure until the scar tissue has completely formed.

Bottom Line: Vasectomy should be considered a permanent form of contraception. If there is a possibility that you might want more children in the future, I suggest that you consider temporary forms of birth control that are non-surgical. There are a variety of options available including condoms, birth control pills, cervical cap, diaphragm and, yes, abstinence!

Patient Education About Healthcare Purchases Over the Internet: If It’s Too Good To Be True, It Probably Isn’t

October 1, 2014

Many of our patients are besieged with unsolicited Internet advertisements offering them unbelievable solutions and cures to most of mankind’s medical maladies. Patients come to and ask for advice about these promises to magically restore their health.

Since I receive so many request from patients to evaluate these offerings, I have put together five questions that patients should ask themselves before proceeding to buy from websites offering outlandish claims including restoring the fountain of youth!

  1. Does it claim to cure everything? Some of these ads offer to cure diabetes, arthritis, cancer, promote weight loss, prevent baldness and restore hair, remove wrinkles, increase sex drive and cure erectile dysfunction…just to name a few! Since the days of the traveling medicine man shows and snake oil salesmen, there have always been those that offer to sell the unwary elixirs, lotions, potions, monkeys paws and pills that will cure “all that ails ya”. Physicians know that there is not one single remedy that will cure everything.
  1. Are they trying to sell you something? Any website that reports a new discovery that requires the viewer to buy an E-book or pay for specialized treatments that are only available from their facility should be a red flag. Also any site that encourages you to encourage your friends to sign up as resellers, as in Amway pyramids, should make the buyer very cautious.
  1. Has this treatment already worked for thousands of anonymous people? The less reputable sites will post the outrageous benefits that have been received by unverifiable individuals who don’t give their name and city but only their initials.
  1. Is this the medical secret doctors don’t want you to know about? Of the country’s 600,000 physicians, I doubt if there any of them who are a part of a secret conspiracy to keep people sick so that the doctors’ appointment books and schedules remain full. Physicians are appalled and insulted at such a suggestion. People become doctors because they are interested in helping others.
  1. Are there any peer reviewed medical studies that can support their claims of curing so many maladies? It is difficult for the public and the media who are not trained in science and the scientific method to discern that a claim or a medical study is a well thought out evaluation that meets the criteria of a double blind study with placebo controls. So many of these unreasonable and dramatic claims suffer from confirmation bias which is giving more weight to an opinion or conclusion that supports those promoting or selling the products. This is the benefit of a peer review process for a scientific research report or article where multiple independent reviewers and scientists review the same study or research.

My advice to patients: If you answer yes to one or two of these questions, be cautious and ask the seller for more information. If you answer yes to three or more of these questions, shut down the site and don’t walk away, but run quickly and demand that they take you off of their mailing list!

I hope you have found this information useful and will help guide your patients on unsolicited Internet purchases. For more information about buying medical products over the Internet, encourage patients to speak to their physician. Final advice: Caveat emptor or let the buyer beware has never been more appropriate.