DEAR DR. DONOHUE: About three years ago, I had a procedure to reduce the size of my prostate. It was Greenlight PVP laser procedure. My doctor did it on an outpatient basis. Since then, I have a normal flow for someone who is 79 years old. I sleep through the night without having to get up to go to the bathroom. Perhaps you could comment on this treatment. – L.M.

ANSWER: Prostate gland enlargement – benign (noncancerous) prostate hyperplasia or hypertrophy – is something that happens to just about all men. Fifty percent of men between the ages of 51 and 60 have some gland enlargement, and by age 80, more than 80 percent have it. Not all these men have to deal with its exasperating consequences – frequent urination, nighttime urination, difficulty starting the stream – but enough do that it is a quite common problem.

Sometimes medicines can relax the chokehold that the big prostate has on the urethra, the tube draining the bladder, and there also are medicines that shrink the gland.

When medicines strike out, a large number of invasive procedures are readily available. The standard operation, TURP – transurethral resection of the prostate – is done with a scope and instrument passed into the urethra and advanced upward to the gland. The doctor shaves away portions of the gland. TUNA – transurethral needle ablation; TUMT – transurethral microwave therapy; and TUIP – transurethral incision of the prostate are procedures done very much like a TURP, but they employ different techniques for reducing the gland’s size. Some are done in the doctor’s office.

Greenlight Laser Photovaporization is a technique in which the prostate gland is downsized by vaporizing the excess with a laser that emits a green light. One big advantage this offers is a reduction of bleeding. The green-light laser seals blood vessels in the process. I am sure many men readers will appreciate your bringing up the topic.

The booklet on the prostate gland, both enlargement and cancer of, summarizes treatments for these conditions. Readers can order 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I read your article on the shingles vaccine. I, too, was told by my doctor to get it.

I take Arava for rheumatoid arthritis. Fortunately, my pharmacist checked my medicines, and it seems that Arava causes a problem with the vaccine. No one knows for sure exactly how far ahead of time one should quit taking it before getting the shot. Do you have any information? – Anon.

ANSWER: Arava can make a user more susceptible to infection. Since the shingles vaccine contains live but weakened shingles virus, people on Arava shouldn’t get the shot. Arava has a long half-life. In two weeks, only half the blood level of the drug has been eliminated. In another two weeks, half of that half has been eliminated. The drug cholestyramine, taken for 11 days, can make Arava nondetectable.

Speak with the doctor who has prescribed Arava. It seems to me more to your benefit to continue with Arava until your arthritis is controlled than to stop it for the shingles vaccine. If the doctor feels the vaccine is important for you right away, he can speed up the elimination of Arava by using cholestyramine.

DEAR DR. DONOHUE: For the past six years, my annual blood work shows my liver enzymes to be somewhat elevated. The doctor will send me to the lab for a second test, which comes back normal. I am on generic thyroid hormone and wonder if it could be responsible. – M.R.

ANSWER: The thyroid medicine is not a likely cause of liver enzyme elevation. Slight elevation of liver enzymes is a common experience. If, on repeat testing, the values are normal, no further investigation is needed.

How high were the first readings? If they were less than three times normal, observation is the usual course of action.

DEAR DR. DONOHUE: When I was 18, I was in a car accident, and they had to remove my right ovary. Ever since then, I have done well and have had no trouble. I am now 28 and am getting married in three months. Someone told me that I could have children that were either boys or girls but not a boy and a girl. One ovary produces eggs for girls and the other for boys. Is this the case? – M.M.

ANSWER: There’s not a grain of truth to that.

A woman produces ova that have the X chromosome. A man produces sperm with either the X or the Y chromosome. A fertilized egg that gets the Y chromosome is a male – XY. A fertilized egg that gets the male X chromosome is a female – XX. It’s the male’s sperm that determines gender.

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.

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