Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I’m an 82-year-old woman in good health. Last May, I began having migraine headaches preceded by an aura two to three times a week. They’re not as severe as they were when I was younger, but I hadn’t been having more than one or two a year since I was in my 40s. I had a scan of my brain in August, but it was normal. I can’t tolerate anti-inflammatory drugs, as they upset my stomach. Any suggestions as to whether I should be concerned and/or what to do about the headaches? — J.R.
ANSWER: New headaches in older people should raise the concern of different types of headaches from migraine, especially temporal arteritis. However, the presence of an aura, and the fact that you have had these before, makes migraine the most likely cause for you.
In people who are having more than 10 headaches a month, I usually recommend medication to prevent headaches, in addition to medication to stop the headache from happening. Medications like sumatriptan are among the most effective for acute treatment, while there are many options for preventive therapy, including over-the-counter options such as magnesium or the vitamin B2, riboflavin.
Given your age and the frequency of these headaches, getting a scan is wise, and I recommend you see your regular doctor or a neurologist who specializes in headaches for further treatment.
DEAR DR. ROACH: I was recently diagnosed with prostate cancer for the third time, and my radiation oncologist stated, “We can’t radiate a third time, as I don’t want to compromise your colon.”
He has suggested hormone therapy with Orgovyx, and my urologist is in agreement. My concern is the side effects; they are frightening. What are your thoughts, or other suggestions? — B.H.
ANSWER: Recurrent prostate cancer after treatment is always a frightening issue, and there are no easy choices. I don’t have enough information, such as the size and location of the prostate cancer, to give you definitive advice the way your urologist and radiation oncologist have. But when definitive therapy with surgery isn’t possible (in your case, two rounds of radiation may already make surgery impossible, or there may be other anatomical concerns), then the standard treatment is to prevent your body from being able to make testosterone. Most prostate cancers grow more with testosterone, and a low testosterone level (ensured with surgery or with medications like Orgovyx) usually keeps prostate cancer from growing.
The side effects can be challenging. Bone loss is a major problem and can lead to fractures, but it can be prevented with treatment. Symptoms of hot flashes can be treated with nonhormonal therapy. Sexual side effects are common and can be treated with advice and counseling, beginning even before medication is started — ask your doctor about this. Men with a history of heart problems should have a strategy in place to consider treatment of all cardiovascular risks, since very low testosterone increases the risk of heart problems.
Even though there are indeed many potential side effects of reducing testosterone with medicines like Orgovyx, these side effects can be managed, and you need to consider the fact that treatment for recurrent prostate cancer helps people live longer, and that the quality of life can be largely preserved.
Finally, there are some men with recurrence in prostate cancer who gain additional benefit from platinum-based chemotherapy, but for most men, the most benefit with the least effect on quality of life comes from reducing testosterone levels with medication.
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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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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