DEAR DR. DONOHUE: I have been told and have read in many articles that nothing can be done for a diffusely and extremely enlarged prostate gland. Is this true? – J.C.

ANSWER: No, it’s not true.

With age, all men’s prostate glands enlarge. Diffuse enlargement – enlargement of the entire gland, not just a part – is the usual kind of enlargement. The normal prostate gland is about the size of a peach pit. Through the middle of the gland runs the urethra, the tube that empties the bladder. An enlarged gland squeezes the urethra so urine cannot properly drain from the bladder. Affected men have to run to the restroom all the time, day and night.

Medicines are one treatment for gland enlargement. One group of medicines relaxes the muscles within the prostate gland that pinch the urethra. They also relax the muscles at the bottom of the bladder to make emptying it easier. Uroxatral, Flomax and Hytrin are names of some of these medicines.

Other medicines actually shrink the gland. Proscar and Avodart are examples. It takes months before the results of these medicines take hold, but, given time, they work for many men.

Surgical procedures abound for men who don’t respond to medicines. A TURP – transurethral resection of the prostate – is the standard operation. No incision is made. Instruments are passed through the urethra to the prostate location and the excess prostate tissue is pared away. Newer procedures, not suitable for every man, can reduce the prostate size with lasers, microwaves, radio waves or balloon compression of the gland. The names of these procedures all begin with TU – transurethral. Like a TURP, they are done with the instruments inserted into the urethra without any skin incision. Many of them are done in the doctor’s office and the patient goes home the same day as the procedure. A urologist can tell you which one is best suited to you.

The booklet on the prostate gland explains both an enlarged gland and a cancerous gland. Readers can obtain a copy by writing: Dr. Donohue, No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a serious problem. I say “serious” because I have had a doctor laugh at me for asking the following question, for which, incidentally, I paid $25. For about six years, I can hear my heartbeat loudly in my left ear. No one can tell me why. I hear it 24/7. I am about to lose my sanity. I pray you can help. – D.M.

ANSWER: Lots of people hear their heartbeat in one or both ears. The condition is called pulsatile tinnitus. One of the biggest causes for it is artery hardening, something that comes with age. Blood flowing through less flexible arteries near the ear becomes noisy. People hear their own heartbeat.

Caffeinated beverages make the beating louder. Put a radio at your bedside and tune it to soothing music at night. The music can often muffle the heartbeat sound. If music doesn’t work, then turn the radio to a location where you hear static. Static often gets rid of the heartbeat noise. Sometimes changing the head position abolishes the beating sound.

A few rare conditions produce pulsatile tinnitus – a narrowed neck artery, an artery-vein malformation, a damaged aortic heart valve and high blood pressure are examples. I would guess these conditions would have been discovered in the six years you have had the problem.

DEAR DR. DONOHUE: I am 14. I have a habit of cracking my knuckles. My teacher says I will get arthritis if I don’t stop. Will I? – K.D.

ANSWER: I wish I could agree with your teacher. Cracking knuckles doesn’t lead to arthritic fingers. It leads to much annoyance. How hard have you tried to break the habit? Try harder. It gets on my nerves.

DEAR DR. DONOHUE: How come you never mention supplements as treatment for illness? I prefer natural treatment to treatment cooked up in some laboratory. – K.R.

ANSWER: By “supplements,” I take you to mean herbal remedies. I’m all for them if they have been subjected to the same unbiased testing that medicines are subjected to.

In Europe, herbal remedies are used more frequently than they are in North America. If there is evidence from European studies that they work, I recommend them.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com