Dr. Roach

Dr. Keith Roach

DEAR DR ROACH: I am a 75-year-old male who has had benign prostatic hyperplasia (BPH) for about 20 years and have taken tamsulosin during this time. I have always had to urinate at least once per night and up to three to four times per night periodically.
Two weeks ago, I had a chocolate craving just before bed and had three Hershey’s Kisses. That night, I did not get up once and did not have a severe urge to urinate when I did wake up. So, I started eating three Kisses before bed nightly and got the exact same results. On night eight, I refrained from the Kisses and got up twice to urinate. I’m in my second week of eating Kisses with the same positive results. Is this by total chance, or is there a real connection? — P.R.
ANSWER: Getting up multiple times in the night can certainly be from an enlarged prostate, and tamsulosin is a common and effective treatment. When I see persistent symptoms despite tamsulosin, I consider the possiblity of an overactive bladder (OAB), although it could be just severe BPH.
Chocolate tends to make OAB worse, so I don’t think OAB is likely in your case. I tried to find out why chocolate might make BPH better. Some studies found that it may work as a hormone blocker (similar to the prescription drug finasteride), but I doubt that’s the case for you, since finasteride takes weeks or months to become effective.
I did find several case reports of people having improvement in their symptoms from eating chocolate, so it could be possible that it’s working. It is also possible that you are having a placebo response; you believe it might help, so it does. But since you didn’t take it as a treatment (at first), this also seems unlikely to me.
Chocolate has fewer side effects than many of our prescription drugs, though, so I wouldn’t dissuade you from enjoying your modest dose of chocolate at night.
DEAR DR. ROACH: Perhaps you have noticed all the commercials on television advertising every kind of medication you can think of. Occasionally, I will see an ad stating that if you take the medication they are advertising, there is a certain percentage of effectiveness quoted.
For example, one ad said that there was an 85% rate of protection for those who took the medication. My question is, what happens to the unfortunate few who are in the 15%? Do they get a full-blown case of the ailment, or do they get a milder form of the ailment? What happens to them? — D.D.
ANSWER: The answer really depends on the particular condition. Since you mention “protection,” I can think of many ads I see for the shingles vaccine. In this case, the vaccine is effective at preventing the disease entirely. (New estimates are about 79% effective a year after vaccination.) However, even if a person gets the disease, they are much less likely to get the dreaded complication of postherpetic neuralgia.
On the other hand, medication taken regularly to prevent HIV infection (pre-exposure prophylaxis, or PrEP) is about 99% effective for people who are compliant with treatment. Unfortunately, when the rare person on PrEP does get an infection, they are more likely to acquire a drug-resistant strain, so the preventive treatment was not helpful for them in this case.
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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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