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Showing posts with label medication. Show all posts
Showing posts with label medication. Show all posts

Sunday, August 30, 2020

Peeing Problems ?


Men, if you are having trouble with urination, it could be due to an enlarged prostate.


WHEN it comes to men’s health, the prostate is one of the organs that garners the most attention as it is a vital part of the male reproductive system.

The prostate is a small, squishy gland about the size of a walnut, located deep inside the groin, below the bladder, at the base of the penis and in front of the rectum.

The prostate is a walnut-shaped male gland situated deep inside the groin, below the bladder.- 123rf.com

 An enlarged prostate is, by far, the top reason men have trouble peeing. The prostate gland sits right below the bladder. Urine travels from the bladder through a channel that runs right through the prostate to the urethra, where it exits the body.

A sexual gland, its most important function is the production of a fluid that, together with sperm cells from the testicles and fluids from other glands, makes up semen.

“When a man reaches climax, the sperm is mixed with water from the prostatic fluid and propelled out through the urethra tube.

“So, he ejaculates two things – the prostatic fluid and the semen,” explains consultant urologist Dr Datesh Daneshwar.

“This whole mechanism is so intricate that at the time of climax, he needs to stop peeing.

“There is a muscle that stops you from peeing, yet allows the semen to come out through the urethra via the penis and out of the body.”

Men often think that prostate enlargement (benign prostatic hyperplasia or BPH) is a natural part of ageing, but this is not necessarily true.

Says Dr Datesh, “With ageing, the prostate can enlarge, and if it does, it usually enlarges in the outward direction and doesn’t cause a compression of the urethra.

“It does not cause symptoms all the time and needs no treatment because it doesn’t trouble a man.

“But when it enlarges in the inward direction, it causes a blockage of the urethra and can lead to men having problems passing urine or with ejaculation; it can also cause erectile dysfunction.

“Being told on a routine ultrasound that your prostate is enlarged is not a reason to run to your urologist, unless you have some bothersome urinary symptoms – even something as trivial as needing to constantly get up in the middle of the night to pee.”

Aside from those who sit most of the day, avid male cyclists may also be at risk of developing prostatitis due to the compression of their pelvic area


No one knows the actual cause of prostate enlargement, although ageing, changes in the testicular cells and testosterone levels are believed to play a role in the growth of the gland.

The urologist says, “All the nerves that allow an erection are located around the prostate, and if you have an enlargement, these nerves are compressed and go wonky, so you will not have a proper erection.

“The inner part of the prostate is mostly muscle, so it’s pliable or elastic.

“Due to the enlargement, it becomes stiff – similar to inflammation that can take place in other body parts, e.g. the neck, legs, arms, etc.

“All this while, we have assumed that this enlargement has got to do with the increased number of prostate cells.

“However, I found that a lot of men have an injury to the prostate that makes the individual cells enlarged.”

For clearer understanding, Dr Datesh presents the following scenarios to his patients.

Imagine you have been hit hard on the arm.

When you put on a shirt, your hidden swollen arm may look “muscular”, but in actual fact, it is injured.

Or you could have hit the gym, worked out really hard and built your arm muscles, making you truly muscular.

The net result is the same: enlargement.

“The majority of men who have an enlarged prostate have a component of inflammation, which is known as prostatitis.

“It could be caused by swollen cells, which can be the result of a bacterial infection or injury.

“The bacterium that has been implicated in this is Chlamydia trachomatis, which is sexually transmitted (and causes chlamydia).

“It can remain dormant inside your prostate for years before acting up.

“As for injury, the mode is unclear – it could be caused by a catheter that was put into the penis during surgery or a camera that was inserted into the penis to remove a kidney stone, etc.

“Yet, there are men who have none of these, but still have an injured prostate,” he says.

He adds that, “Some factors that may cause the injury are excessive sitting or cycling.

“Any pressure on the perineum can lead to inflammation of the prostate and pelvic floor muscles, and this then causes urinary problems.”

A recurring problem

Besides urinary problems (i.e. dribbling, pain or too frequent), other symptoms of prostatitis include blood in the urine, groin pain, rectal pain, abdominal pain, lower back pain, fever, chills, body aches, urethral discharge, painful/ premature ejaculation, poor erection, lack of morning erection and sexual dysfunction.

Depending on the cause, prostatitis can come on gradually or suddenly.

It might improve quickly, either on its own or with treatment.

Some types of prostatitis last for months or keep recurring, which can greatly affect a man’s quality of life and cause low self-esteem.

To treat prostatitis, doctors will prescribe antibiotics, alpha blockers (to relax the bladder neck and muscle fibres where the prostate joins the bladder) and anti-inflammatory agents.

They may also suggest a prostatic massage, which can be very unpleasant.

Unlike BPH, which affects men above 50, most prostatitis patients are in the 30-50-years age bracket.

Dr Datesh says, “I have seen patients as young as 17 and as old as 90 with prostatitis.

“The management of this is different from standard management of BPH.

“Until now, we have never had a proper curative management, so the problem can be treated, but will come back every few months or years.

“A prostatitis patient then becomes a permanent patient of the urologist because his condition recurs.”

He relates a case of a 42-year-old fit and healthy patient who was rushed to the emergency department because he couldn’t pee after returning from a long flight.

A catheter was inserted and almost one litre of urine was drained.

He shares, “We started him on medicines and hoped he could pee.

“A few days later, we removed the catheter, and once again, he couldn’t pee.

“So, the next option would have been to do a surgical transurethral resection of the prostate, but that would have left him with sexual dysfunction for the rest of his life, and that wasn’t fair to the young man!”

He explains: “The surgery involves going through the urinary tube and coring his prostate from within to cut off the inner part (like removing the core of an apple) so that he can pee easier, but in the process, we would have altered the anatomy in the region and destroyed a lot of things.

“The man might end up having incontinence or retrograde ejaculation as the semen goes back into his bladder … everything goes haywire.

“An old man who cannot pee might be thankful, but not a young person.”

Instead, Dr Datesh treated him using antibiotics, along with low intensity shockwave therapy – a method that applies shockwaves directly to the prostate to reduce the inflammatory response and heal the tissues.

“After one session, this man was able to pee, and now, two years later, he’s peeing like a horse!

“I used to do the coring surgery every week, but I haven’t done one in two years because the shockwave therapy provides an effective option,” says the extremely pleased Dr Datesh, who is among the handful of local urologists practising this non-invasive method.

A ‘shock-ing’ option

Shockwave therapy has been around for 40 years and was initially used to break kidney stones, but has since been modified.

Instead of breaking, it creates regeneration and is used in wound healing, arthritis and muscle spasms.

In urology, it is considered new and has been used in the last 12 years to open up blocked blood vessels (due to diabetes, hypertension or heart disease) and enhance circulation to the penis.

“It also wakes up your stem cells to create regeneration.

“As we get older, our stem cells become more dormant and that’s why we don’t heal so well.

“It feels like acupuncture. There are zero complications, no burning sensation and no reported side effects.

“It’s not mainstream treatment, but the science is good and patients have this non-invasive option.

“There’s no fixed duration for treatment, but I do it twice a week for a total of 10 sessions, each lasting 12 minutes.

“Once the therapy is completed, antibiotics and alpha blockers are given for a month,” shares Dr Datesh.

While medicines (which come with side effects) can sort out 90% of prostatitis cases, there will be recurrence for 50-60% of patients after a few months or years.

With shockwave therapy, there is a 90% cure rate, but the studies only go back to the past eight years.

So far, Dr Datesh says the majority of his patients remain well.

“Like any muscular problem, it does go away, but there is a chance for it to come back and we don’t know why this happens.

“I’m extrapolating that humans are not supposed to be on their butts the whole day, but we cannot tell people to stop sitting!

“This problem is not seen in people who stand or do manual labour.

“How much butt tissue you have is also a factor, because without much flesh, the area is compressed further when you’re seated,” he adds.

Unfortunately, there are no tests or scans you can do to diagnose prostatitis – it’s a clinical diagnosis, akin to endometriosis in women.

“It’s very difficult to prove prostatitis microscopically or conclusively because we would have to take out the prostate and send it to the lab for analysis – obviously, this is not possible.

“So we have to put a lot of things together before coming up with a diagnosis.

Dr.DATESH DANESHWAR:
According to Dr.Datech,aAround 80% of men walking around with urinary problem and sexual dysfunction actually have prostatitis and don’t know it.

“They all want the blue pill (sildenafil)!” he says, smiling.

“They need to sort out their prostatitis, then they can enjoy life.”

Men who don’t ejaculate enough may also experience some amount of prostatic inflammation at some point.

“Best to do it three times a week!” he says with a wink.

Good urine flow

Men, irrespective of age, are supposed to have good urination and morning erections their whole lives – it shows that their hormone levels and circulation are intact.

For the past decade, Billy (not his real name), 54, had been experiencing poor urine flow.

It started when he took antinausea pills before going fishing.

Once he returned to shore, he couldn’t pee.

“Apparently, these pills can make any underlying prostate issues surface.

“I sought treatment, and for a while it was okay with medicines, but the problem returned three years ago.

“Although I had no other symptoms, I knew it was a prostate issue as I’m a doctor myself,” says the anaesthesiologist.

He did a series of tests and scans to rule out cancer.

Besides an enlarged prostate and a slightly elevated prostate-specific antigen test level, the results came back negative.

He was prescribed drugs and hormone suppressants.

Billy shares, “The flow was improving, but it still wasn’t good and the side effects were unpleasant.

“It reduced my sexual satisfaction as it caused dry ejaculation.

“I was contemplating surgery because both my late father and grandfather had similar problems and underwent surgery in their 50s.”

For a year, he lived with the dysfunction until he found out about shockwave therapy.

Six sessions later, he noticed an improvement.

“Since the scans and tests showed nothing, the urologist decided to treat my symptoms as prostatitis.

“My pee is much better now than it was 10 years ago.

“I’m at the stage where I only take drugs once a week or when necessary.

“I believe I have an enlarged prostate and prostatitis as both can co-exist.

“I would probably need surgery at some point, but hopefully, I can delay it for another 10 years,” he says.

Dr Datesh concludes, “Men, be aware that urinary problems are not normal at any age, and if you have them, it is not necessarily related to cancer or BPH. You’re not doomed.

“It could be an inflammatory problem or as the Malays would say‘ masuk angin’. Get it checked.”

By REVATHI MURUGAPPAN starhealth@thestar.com.my

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Sunday, July 26, 2020

Attacking the brain

Stroke kills more women than men each year but there are preventive steps you can take to minimise your risks.



IN Malaysia, strokes are the third leading cause of death for women, following heart attacks and pneumonia.

For some unknown reasons, many women choose not to join a post-stroke rehabilitation programme.

It is more deadly to women than breast cancer, and if it doesn’t kill you, can leave you with permanent disabilities.

A stroke is sometimes known as a “brain attack.”

It occurs when blood flow to a part of the brain is blocked by a blood clot or plaque, and brain cells begin to die.

Here are some facts about how strokes affect women differently from men:

> More women have strokes later in life.

> After age 85, stroke affects many more women than men.

> It is twice as common for women between 20 and 39 to have a stroke compared to men of the same age.

> Having a history of problems during pregnancy like gestational diabetes or preeclampsia.

> Using hormonal birth control while smoking.

> Being on menopausal hormone therapy during or after menopause.

> Experiencing migraines with aura, atrial fibrillation (irregular heartbeat), and diabetes.

Many strokes are preventable and treatable.

By knowing your risk factors and making healthy changes, you can minimise your risks of experiencing a stroke.

Three types of stroke

Ischemic stroke is the result of blockage of blood flow to the brain. This is the most common type of stroke, and it happens most often when a person has a blood clot or atherosclerosis, a condition when an artery is clogged with plaque

Hemorrhagic stroke, caused by bleeding into the brain.

This type of stroke happens when a blood vessel in the brain bursts, and blood bleeds into the brain.

An aneurysm, which is a thin or weak spot in an artery that can burst, is responsible for this type of stroke.

Mini-stroke, also called a transient ischemic attack or TIA, can happen when, briefly, less blood than normal flows to the brain.

TIA usually lasts only a few minutes or up to several hours. Many people aren’t even aware that they had a stroke.

Stroke affects different parts of the brain, and depending on which part, you may experience problems with speech, movement, balance, vision or memory.

Division of brain

The brain is divided into four main parts: right hemisphere; left hemisphere; the cerebellum; which controls balance and coordination; and the brain stem, which controls all of our body’s functions that we don’t think about, such as heart rate, blood pressure, sweating and digestion.

A stroke can happen in different parts of the brain.

In the right half of the brain, a stroke can cause:

> Mobility issues on the left side of your body.

> Problems with misjudging distances. This can cause falls, or inability to guide your hands to pick something up.

> Short-term memory loss. You may be able to remember events from 10 years ago, but may forget the directions to your regular grocery store.

> Misjudgement of abilities to do things and unusual behaviour such as leaving your house without getting fully dressed.

In the left half of the brain, a stroke can cause:

> Mobility issues on the right side of your body.

> Difficulty completing everyday tasks quickly.

> Trouble speaking or understanding others.

> Memory problems, or a tough time learning new things.

In the cerebellum, a stroke can cause:

> Dizziness, nausea (feeling sick to your stomach), and vomiting.

> Stiffness and tightness in the upper body that can cause spasms or jerky movements.

> Balance problems.

> Eye problems, such as blurry or double vision.

In the brain stem, strokes are most harmful.

Impulses that start in the brain must travel through the brain stem on their way to the arms and legs, so individuals that suffer a stroke in the brain stem may also develop paralysis.

Beware of these symptoms

Some women are more at risk because of certain health problems, family health history, age and habits. These are called risk factors.

There are certain risk factors that cannot be changed, such as age, race or ethnicity, or family history. The only thing that you can do is to control other stroke risk factors, such as high blood pressure, diabetes, smoking and unhealthy eating.

Common symptoms of stroke include:

> Trouble seeing in one or both eyes.

> Severe headache with no known cause.

> Trouble walking, dizziness, or loss of balance or coordination.

> Numbness or weakness of face, arm, or leg, especially on only one side of the body.

> Confusion or trouble speaking or understanding.

Recovering from stroke

The process of recovery can take a lot of time and depends on many factors, like the type of stroke you had, the area of your brain affected, and the amount of brain injury.

Recovery begins once you are medically stable, and this is within a day of suffering the stroke.

Your next steps will involve changes in everyday habits, medicines and rehabilitation.

In some cases, surgeries may be needed to lower the risk of another stroke.

The first step is to learn about your condition and what you should do during recovery.

Your doctor, nurses and physical therapist can answer questions you may have about about the treatment and rehabilitation.

The next critical step is to take steps to prevent another stroke from happening.

Stroke patients are always at a higher risk of having another down the road, so you need to:

> Identify and control your personal risk factors.

> Be consistent with your treatment plan. It is designed to help you recover from your stroke and prevent a recurrence.

> Continue taking medications even if you feel better. Discuss with your doctor before making changes. Also, determine the rehabilitation services you will need.

For unclear reasons, many women do not join a post-stroke rehabilitation programme.

After a stroke, you will often recover some function in the first few months. This is part of the body’s natural healing process.

But women who do go to stroke rehabilitation reap the following benefits:

> Regain as much independence as possible.

> Relearn skills and abilities that were damaged or lost.

> Learn to cope with any remaining limitations.

Setting a goal
Settling a goal can motivate you to measure your progress - TNS
Another important step is to set goals for your recovery.

You need to set realistic and measurable goals for recovery in every area of your life that has been affected.



Stroke recovery may be fast in the first few months, but it may slow down eventually.>>

When you set goals, it can motivate you to maintain progress.

Create a timeline for achieving long-term goals.

Take a multi-step approach for each goal and celebrate the short term wins when you gain them. And finally, don’t give up! The aftermath of a stroke can make patients feel powerless.

Part of your recovery is determining how to live as independently as possible.

Be reasonable with yourself, and be prepared to face challenges as you adapt to the differences in how your body works.

The road to stroke recovery may not be easy, but by focusing on celebrating your progress at every step, you can reach your goals.

Ensure you also have adequate nutrition and nutritional supplements to expedite the healing and recovery process.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Read more:

How to recognise signs of a stroke, and what to do ...



Remember "FAST": “Face” (does the face look uneven?), “Arms” (is one arm weak or numb?), “Speech” (does the speech sound strange?), and "Time" (4.5 hours before brain damage). If you notice these signs of a stroke, get the person to a hospital as quickly as possible. — Filepi


Boosting your brain function as you age




Brain Attack (Stroke) - UCLA Neurosurgery, Los Angeles, CA



Brain Attack: Stroke or Brain Attack is a disease that involves the blood vessels that supply blood to the brain - UCLA.



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