Archive for August, 2016

Can you discuss hormonal therapy to treat prostate cancer?

DEAR DOCTOR K: My doctor has proposed androgen deprivation therapy to treat my prostate cancer. Can you tell me about this treatment?

DEAR READER: Androgens are the family of male sex hormones that includes testosterone. When prostate cancer develops, testosterone contributes to the growth and spread of the tumor. Androgen deprivation therapy deprives cancer cells of this stimulation. Also known as hormonal therapy, it can be a powerful weapon in the fight against prostate cancer.

How can I avoid flare ups of COPD?

DEAR DOCTOR K: I have COPD. What can I do to avoid symptom flare-ups?

DEAR READER: Chronic obstructive pulmonary disease, or COPD, is a long-term condition that makes breathing difficult. Breathing is a lot easier if you take your medicine and do any other therapy as directed.

Could my new diabetes medication be dropping my blood sugar too low?

DEAR DOCTOR K: I'm in my early 80s. I was recently put on a new type of medication for Type 2 diabetes. Since then, I've felt lightheaded a few times and have also fallen twice. Could my blood sugar be dropping too low? What should I do?

DEAR READER: Yes, your blood sugar could be dropping too low. That could make a person feel lightheaded and increase their risk of falling. If you're in your early 80s, you may be at extra risk, because people at that age often have multiple chronic medical conditions.

What are some ways besides testosterone therapy to increase my energy?

DEAR DOCTOR K: I often feel quite tired. My doctor says this fatigue may be caused by my low-normal testosterone level. I'd rather not go on testosterone therapy. What are some other ways to enhance my energy?

DEAR READER: Research studies have not demonstrated a clear value in giving testosterone therapy to men who may be experiencing symptoms of low-normal or slightly low blood levels of testosterone. In fact, some studies have even indicated that such treatments may raise the risk of heart trouble. So I can certainly understand if you'd rather avoid testosterone therapy to relieve your fatigue.

What is pelvic organ prolapse and what can be done to treat it?

DEAR DOCTOR K: My doctor checked me out because I was leaking urine. She said I have pelvic organ prolapse. Can you tell me what it is, and what can be done about it?

DEAR READER: Pelvic organ prolapse is a condition in which tissue from the uterus, bladder, urethra or rectum drops down into the vagina. As many as 1 in 3 middle-aged women have some degree of pelvic organ prolapse.

Can you tell me about different types of abdominal fat?

DEAR DOCTOR K: In a column about abdominal fat, you talked about two kinds of fat -- brown fat and white fat. I'd like to hear more about them.

DEAR READER: I'm glad you asked, because the discovery of these two types of fat could prove to be very important. In the column you refer to, I discussed how visceral, or abdominal, fat (which accumulates deep inside the abdomen) is more harmful to our health than subcutaneous fat (the fat just beneath the skin). But when it comes to fat, it's not just location that matters. Color counts, too -- and brown is better.

Why did my doctor measure the blood pressure in my leg to check for blockages?

DEAR DOCTOR K: My right calf starts aching when I exercise. My doctor said she wants to do a test that is like taking my blood pressure in my leg instead of my arm. Does that make any sense?

DEAR READER: I can understand why that seems confusing, but your doctor is right. She is probably worried that the arteries to your right leg have blockages from plaques of atherosclerosis. When you exercise, your leg muscles need more blood; it provides the nutrition they need to work. When blockages prevent your leg muscles from getting the blood they need, they scream in pain.

How can I help my teen to get more sleep?

DEAR DOCTOR K: My teenage daughter stays up late, then has a hard time waking up for school. I don't think she's getting enough sleep. What can I do to help her fall asleep at a reasonable time?

DEAR READER: Not getting enough sleep can have serious consequences. This is especially true for children and adolescents, whose developing brains are very sensitive to insufficient sleep. Teens need as much sleep as do adults, maybe more. They need eight to 10 hours for optimal function, but studies have found that few get this much sleep.

What should I feed my baby if I need to avoid rice cereal?

DEAR DOCTOR K: You recently wrote about the dangers of feeding rice cereal to babies. Can you tell me more about this? What should I give my baby instead?

DEAR READER: For years, rice cereal has been a go-to food for parents when they start their babies on solid foods. My Harvard Medical School colleague Dr. Claire McCarthy, a primary care pediatrician at Boston Children's Hospital, says it's time to change that.

Can you tell me about a drug combination my doctor prescribed to lower my cholesterol?

DEAR DOCTOR K: Despite taking statins, my cholesterol hasn't dropped as low as my doctor would like. I figured he'd put me on the new PCSK9 inhibitors. Instead, he suggested that I stay on my statin, but also take another drug called ezetimibe. What can you tell me about this combination?

DEAR READER: From what you say, I assume your doctor has used the highest dose of the most potent statins before giving up on those drugs. There are very few people whose cholesterol does not drop substantially on statins alone.