DEAR DR. ROACH: What’s your opinion on cooled thermotherapy for benign enlargement of the prostate? I recently was put on Flomax and finasteride, and was given the option of having this procedure to eliminate taking these two drugs.
My urologist has had great success, while my internist says the success rate is only 60 percent. My internist did say it’s great if it works. — S.V.
ANSWER: Benign enlargement of the prostate is very common in older men, and medications like tamsolusin (Flomax) and finasteride (Proscar) often are used, and are pretty effective in most men. The most effective treatment remains surgery, called transurethral resection of the prostate, TURP, which reduces symptoms by at least half in 98 percent of men. Unfortunately, TURP causes side effects in at least 20 percent of men, so there are several procedures designed to try to get the benefit of surgery without the drawbacks.
Cooled thermotherapy is a procedure using a microwave device to reduce prostate tissue. It isn’t as effective as TURP: Only 72 percent of men reduce their symptoms by half or more; however, it has reduced side effects, such as need for blood transfusion. Unfortunately, there were more symptoms of uncomfortable urination, urgency and need for a catheter after surgery.
I think both of your doctors are right: Some men have good experiences, but not everyone will get relief. Some serious side effects are better with thermotherapy, and others are worse. You need to decide how much taking the medications bothers you and if you can live with the symptoms the way they are.
DEAR DR. ROACH: I’m a retired ob-gyn and am married to a practicing MD. I’m writing you today about autism and its use as a diagnosis. My view is that each individual is unique, mentally and physically. While autism may be one way to describe a personality, each person must deal with the world on its terms, not because of a diagnosis.
I personally believe I am a variant of Asperger’s, but who knows? I don’t qualify as an Asperger’s if given a test prepared by psychologists/psychiatrists. Yet, I have had many life experiences that are best explained by an Asperger’s diagnosis. What are your thoughts on Asperger’s syndrome? — A.G.
ANSWER: Since I recently published a letter by an adult who believed he was autistic despite never having received a diagnosis, I have had several letters like this.
Autism, including its variant Asperger syndrome, is a spectrum of illnesses that share deficits in social interaction, communication and stereotyped, repetitive behaviors. In Asperger syndrome, there is no clinically significant delay in language and intellectual development.
I certainly agree with you that each person is unique and that the label of a psychiatric condition, such as autism, bipolar or a personality disorder, has only limited usefulness. In the best case, it can give a person a way to start learning how to overcome challenges that similar people have faced. At worst, a label predisposes others to look at the person through a certain lens and to expect certain behaviors. I have had many patients with psychiatric diagnoses ask me not to put that into their medical record, after having built up enough trust to share the diagnosis with me. People have had such negative experiences based on their diagnosis, their label, that I don’t blame them for wanting to avoid being stereotyped. There is so much variation in all of these conditions — even in those of us considered neurologically typical — that we need to recognize the good and the bad side of making such a diagnosis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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