Jul

16

COUGH. COMPLETE INFORMATION ON SYMPTOMS AND TREATMENT.

July 16, 2009 | Leave a Comment



COUGH

Trying to ease a cough ough can be a frustrating exper*ence. If it arrived with a cold or another upper respiratory tract infection, it’s likely to go away eventually, but those 2 or 3 weeks of suffering until it does can be miserable. Way back before the end of the last century, Americans could buy cough medicines that worked. Codeine-containing antitussive syrups were widely available without prescription. Physicians also recommended terpin hydrate, an expectorant, from the late 1800s until the early 1990s. In theory, an expectorant simply loosens up the stuff in the lungs and makes it easier to cough up. But many people found that terpin hydrate offered more benefit.

Q.For years I used terpin hydrate as an expectorant when I had a cough. It worked. It was sold over the counter and one small bottle would last me the entire cold season. Over-the-counter cough remedies on the market today are no better than water. They just do NOT work. Is terpin hydrate still available? I’ve never found another cough syrup that works so well, but I can’t find it in my local drugstores.
A. Terpin hydrate was a popular cough medicine from the late 1800s until the early 1990s. Then the FDA banned it on the grounds that it had not been proven effective.
As an expectorant, terpin hydrate was supposed to loosen mucus and relieve coughs. It was derived from natural sources such as oil of turpentine or compounds found in oregano, thyme, and eucalyptus. Terpin hydrate is no longer available in the United States. Instead, you may want to try a different old-fashioned remedy. Vicks VapoRub contains similar ingredients: oil of turpentine, thymol, and eucalyptol. Don’t take it internally. Just rub it on the chest or the soles of the feet to ease a cough.
Another approach is thyme tea. Use 1/2 teaspoon of dried thyme leaves from the kitchen spice shelf per cup of tea. Some people like to add lemon and honey. Others prefer chicken bouillon for flavor. Terpin hydrate was removed from the market because the FDA did not receive enough data to support its use when they were reviewing over-the-counter (OTC) drugs for effectiveness. (A high-ranking FDA official admitted to us off the record that he had used it and found it helpful. But the agency needed real data, not testimonials.) Perhaps the fact that it had been around for so long and no one company had a strong vested interest in it meant that no one wanted to invest in research on tenpin hydrate. Or maybe it really doesn’t work quite as well as people believed. But in any event, after it was banned, Americans needed to look for other cough remedies.

Codeine Cough Medicine

Codeine at prescription doses is generally considered an effective cough suppressant, but even the lower-dose OTC forms are becoming much harder to find. If you have a cough, your doctor might write you a prescription. It is legal in some states for people to buy low-dose codeine cough syrups if they sign for them. Presumably, that step offers extra security against abuse. But even where OTC codeine is legal, many chain drugstores won’t sell it without a prescription. They simply don’t want to be bothered. If you live in a state where codeine may be sold without a prescription, check with an independent pharmacy. Otherwise, ask your physician about a prescription. Codeine can be constipating, and long-term use can lead to dependence. But for a short-term annoying hack, this is a very helpful medication. Codeine not only is a good cough medicine, it also is extremely good for relieving pain. When combined with aspirin or acetaminophen, it practically sets the standard for pain relief. Codeine can also be useful in alleviating diarrhea, though it isn’t necessarily the first choice for that problem.
Side effects: Constipation, drowsiness, upset stomach Downside: Can cause dependence. May require a prescription.
Cost: Approximately $6 to $10 for a bottle.

Dextromethorphan

By far the most readily available cough medicine is dextromethorphan. It is the primary ingredient in most OTC cough syrups, including Robitussin DM (the DM stands for dextromethorphan) and many other popular brands. Dextromethorphan has been almost the only choice for nonprescription cough relief for years. It is considered fairly safe because (unlike codeine) it is not classified as a narcotic. The effectiveness of dextromethorphan has been questioned, however. The American College of Chest Physicians issued guidelines in 2006 on the diagnosis and management of cough that discourage the use of dextromethorphan or any other OTC cough medicine. According to Richard Irwin, MD, the head of the committee that developed the guidelines, “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough.” That’s a pretty discouraging view, since very few coughs actually warrant a doctor’s attention. If the cough has lasted for more than a couple of weeks, or if you are otherwise sick, then you should by all means see your doctor. But a regular cough from a cold probably won’t benefit from anything your doctor can do.

Home Remedies

There’s no good evidence for most of the home remedies that we are going to suggest. No one has done studies to see if thyme tea or horehound drops will really help. On the other hand, these approaches are inexpensive, so you can try them and judge for yourself if they work.

Vicks VapoRub

Vicks VapoRub shouldn’t really be classified as a home remedy. It is, after all, a perfectly respectable OTC product that has been a popular way to treat colds for more than a hundred years. According to the history, North Carolina pharmacist Lunsford Richardson set out to formulate a vaporizing cold’ salve for his own family. His children had come down with bad chest colds and the standard treatments of the day were messy and unsatisfactory.

The result of his effort was Vicks VapoRub. With its distinctive blue jar and unforgettable aroma, Vicks became known around the world as a remedy for congestion and other cold symptoms. It still contains the original formula: menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol, and turpentine oil in a petrolatum base. Parents everywhere rub Vicks VapoRub on their children’s chests to ease their coughs. Many of the herbal oils in this old-fashioned salve seem to help ease a cough. Menthol is found in many cough drops, and thymol has a reputation for fighting cough. VapoRub is even approved by the FDA for relieving congestion and cough. You could apply it to the throat and chest, as the instructions suggest, but go ahead and try it on the soles of the feet for a nighttime cough.

Downside: Not for internal use. Keep away from broken skin. Do not apply inside nostrils. No studies confirm that applying Vicks to the soles of the feet will work to calm cough. Cost:Approximately $6 to $10 for a jar, which will last quite a while
My son continues to have problems with ear infections, although he had tubes put in them at 8 months old. He is now 30 months old and has an ear infection with nasal and chest congestion.
I was looking for home remedies for coughs when I found your Web site. I read the idea of putting Vicks VapoRub on the soles of the feet Within 10 minutes be was asleep without a cough.
We heard from a nurse who had learned from someone in her church that Vicks could be smeared on the soles of the feet to ease a nighttime cough. As she admitted, this sounded a little crazy, but she was desperate enough to try it on her 4-year-old daughter. When she did, they both finally were able to sleep through the night. We don’t know why Vicks on the soles of the feet would work any better than Vicks on the chest. Perhaps it doesn’t. But we do know that we have heard from hundreds of people who have tried this trick and had success. We have used it ourselves and been pleased. Be sure to put on socks to protect the bed sheets. Coughs frequently are a consequence of colds, and chicken soup is a time-honored cold remedy. Beyond its long history of use for this purpose (the Jewish philosopher Maimonides is said to have recommended it), there is even research to demonstrate its value or relieving congestion from colds. So it is little wonder that chicken soup flavored with thyme can be helpful.

Q. My husband recently had a spell of heavy, nonproductive coughing and couldn’t reach his doctor. Robitussin DM didn’t do a thing. He went 2 nights with very little sleep and was miserable. I made him some chicken soup for supper, and after he ate a bowl of it he stopped coughing. During the night he started up again. With more chicken soup, the coughing stopped immediately and he finished the night sleeping well. I recalled what I’d put into the soup, and zeroed in on two herbs from my garden—three fresh sage leaves and some dried thyme. On the Internet I found that sage can calm a cough and thyme has been widely used as cough medicine. I made him 2 cups of thyme tea before he went to bed the next evening and he slept the whole night through. I think our experience shows that thyme is a good remedy to keep around until the doctor calls back.

Thyme

Thyme contains compounds such as thymol and carvacrol. This herb is listed in the PDR for Herbal Medicines as indicated for cough. and bronchitis. One to 2 grams of dried thyme leaves (1/2 to 1 teaspoon) are used to make a cup of tea. The recommended daily dosage is 10 grams spaced over the course of the day. Chicken soup with thyme is one way to get the essence of thyme. Another is to make a cup of thyme tea. Ordinary thyme leaves from the kitchen spice cupboard will work just fine-1/2 teaspoon to a cup of hot water, steeped for about 5 minutes. One reader reported getting a cough remedy over the counter when traveling in Germany. She found it very useful, much better than Robitussin DM, and wondered what it was. The medicine, called Makatussin, came as drops to be put on a sugar cube or in tea and contained Thymianfluidextrakt and Sternanisol. These are extract of thyme and star anise oil.

The German government has approved both herbs for colds and coughs, confirming what our readers have found for themselves.

Other Herbs

A number of other herbs have traditionally been used for uncomplicated coughs. Licorice is classic for sore throat and cough. It can raise blood pressure, so we don’t recommend it for people with hypertension, but for short-term use, it could be helpful. Menthol seems to have been approved by the FDA, since it is found in most OTC cough drops (as well as Vicks VapoRub). Linden flower tea is a European favorite for cough, but may be difficult to find in this country. Elderberry flowers can also be collected and dried for use in tea as a “homegrown” cough remedy. You’d have a hard time finding elderberry flowers in a store, although there are some elderberry products that use the berries themselves, rather than the flowers.

Q. With my high blood pressure, it’s hard to find cold or cough medicine that is safe. My sister recommended black elderberry extract and zinc. It did the trick.
A. Elderberry-flower tea is a traditional remedy for colds and coughs. Many herbalists believe elderberry is more effective than echinacea.
Studies of zinc used against colds have produced mixed results, some positive but others negative. Neither remedy should increase blood pressure, though.

Ginger tea is one of our favorite cold remedies, and it also may help to ease a cough. One animal study found that a component of ginger called shogaol worked at least as well as dextromethorphan against cough. That may mean simply that shogaol is just as good as placebo, now that the effectiveness of dextromethorphan is in question. Nevertheless, ginger tea is tasty and not very expensive.

Another old-fashioned approach to calming a cough is horehound. Candies flavored with this herb are still available in some stores and catalogs (such as the Vermont Country Store) that pride themselves on carrying old-time products. There’s no good research for any of these herbal products, but also no indication that they would cause any serious reactions, either.
Some people find that sucking on a piece of hard candy works quite well to ease a daytime cough, whether or not the candy has any active ingredients such as licorice or menthol in it. One scientist has suggested that part of the reason most cough syrup is sweet is not only to mask the nasty flavor of dextromethorphan, but also to recruit the brain’s own opioids, endorphins, in calming the cough. 161 Since opioids are very effective against cough, this is an appealing hypothesis.

Chocolate

Another possible remedy fora simple cough may surprise you. Chocolate lovers though we are, we never suspected that theobromine, one of the essential components of chocolate and cocoa, would have any benefit against cough. But that is exactly what British researchers found in experiments with guinea pigs.” They gave the guinea pigs citric acid to make them cough, then gave them theobromine purified from cocoa. The theobromine overcame the induced cough. An experiment in humans confirmed that theobromine is also effective against coughs in people.
The question is, how much chocolate does it take, and in what form? Unfortunately, we do not have an answer to that extremely practical issue. The researchers used theobromine alone, which is not available to the rest of us. But all of us have access to chocolate. You could do some experiments of your own to find the most palatable and effective cough-suppressing chocolate. ,
Here’s what pediatrician Alan Greene, MD, says about using chocolate against cough:
How much chocolate would this be? Chocolate preparations vary widely, depending on their cocoa content but dark chocolate often has up to about 450 milligrams of theobromine per ounce. Milk chocolate has far, far less. Two ounces of dark chocolate was about the amount of theobromine used for the adults.
Theobromine has been tested and shown to be effective in suppressing a cough. We don’t know of any way to get theobromine except to eat some chocolate, preferably dark chocolate. Savor it, and remember that it has other health benefits if consumed in moderation.
Side effects: Allergy is possible.
Downside: Dose unknown. Excess chocolate consumption -may lead to weight gain.
Cost: Highly variable, no prescription dispensing fees
Half that maybe plenty for kids (but of course there is still a lotto learn about this marvelous food). Will that much chocolate keep them awake? Even though theobromine is structurally related to caffeine, studies have shown it doesn’t interfere with sleep at those amounts. I used some fine dark chocolate for my own family during our latest viral cough illness, and our coughs disappeared nicely. What a pleasant way to get through a cold!
One other odd cough remedy may be worth a try. This one has not been tested in guinea pigs, but some people find that drinking Concord grape juice helps to ward off colds and ease coughs. There is research demonstrating that Concord grape juice has measurable anti-inflammatory activity. But we don’t know what component of grape juice, if any, might be contributing to its cough-calming effect.
Q. My wife used to get sore throats every winter. They’d hang on for weeks and develop into aloud, hacking cough. Until she recovered, neither of us would get much sleep.
Then I remembered that my sister had a similar problem with her four growing boys. In desperation, she tried a remedy she read about. drinking -red” grape juice regularly.
My wife and I started drinking a glass of Concord grape juice every day fall through spring, and the prob-lem vanished. Since then, we’ve almost never had a bad cough.
We drink half a glass of grape juice and add a half glass of water. Do you know why this works?
A. Purple grape juice has a surprising number of potential health benefits. Research has shown that it can reduce bad cholesterol, lower blood pressure, and help keep blood vessels flexible. There are even some data to suggest that certain ingredients in grapes may support the immune system. Whether this effect would help ward off sore throats and coughs we do not know.

Treating Cough in Children

It is hard on parents to listen to a child coughing away. It may even be hard on the youngster. Sometimes coughs keep them awake at night. And because children are so susceptible to colds and other respiratory tract viruses, they seem to get a lot of coughs. But parents should refrain from rushing to the drugstore for cough remedies. A study published in Pediatrics found that the two main ingredients in OTC cough medicine, dextromethorphan and diphenhydramine, were no better at easing children’s coughs than a placebo syrup was.
According to the lead author, Ian Paul, MD, assistant professor of pediatrics at Penn State Hershey Medical Center, “One of the conclusions you could come to from the results of our study is that these medicines don’t work [for kids]. And in fact this is what evidence-based reviews of the medical literature have found before, that the existing evidence doesn’t support the use of these medicines for acute cough due to a cold . In addition, these medicines are not without risk. According to Dr. Paul, the children who received the standard ingredient in most cough medicines, dextromethorphan (DM), had a harder time falling asleep. That’s the last thing an anxious parent wants for a sick kid.
What to do? For a nighttime cough, we are partial to Vicks on the soles of the feet. Grape juice is certainly popular with most youngsters and would be worth a try.
Concord grape juice has anti-inflammatory properties, but we don’t know of any studies that confirm it has cough suppressant activity.
Side effects: None known.
Cost: About $4 to $5 for a 64-ounce bottle.
ing the day, a lunch of chicken soup with thyme in it would not be amiss. We don’t know for sure that any of these remedies will work for kids, though. We have received many testimonials on vanquishing kids’ coughs with Vicks, however, so we suspect it is likely to help.

Conclusions

These suggestions are not intended for a cough that has lasted longer than a few weeks, or one that is accompanied by fever, pain, or other symptoms of serious illness. They are aimed primarily at the annoying but not dangerous cough that often crops up at the tail end of a cold or the “flu” and hangs in there even though the patient is feeling much better otherwise.
When it comes to coughs and colds, be very cautious about medicating children. Although there are lots of products on the market aimed at kids, very few have been tested on children. And often, when they are tested on children, they don’t seem to work very well. For youngsters, less is definitely better.
•    Codeine-containing cough syrup is one of the most effective remedies for cough. It may be difficult to purchase without a prescription. But if your cough is troubling you, ask your doctor to write one. Don’t overuse it, because it can be constipating.
•    Vicks VapoRub, with its familiar aroma of menthol, camphor, and eucalyptus, is worth trying. If you don’t want to put it on your chest, try it on the soles of your feet (under your socks) for a cough-free night.
•    Chicken soup with thyme is a comfort food that could help control a cough.
•    Several herbal teas may be helpful. Try ginger, mint (menthol), elderflower, or linden flower tea. Sweetening the tea slightly with honey may help the brain’s own opioids kick in to help with that cough.
•    Suck on hard candy flavored with licorice or horehound.
•    The theobromine found in chocolate is active against cough. Perhaps the best way to get it is to melt a square or two of dark chocolate in your mouth.
•    Concord grape juice has its enthusiasts, and very little risk.

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Jul

15

Recovery from Prostate Surgery.

July 15, 2009 | Leave a Comment

Recovery from Prostate Surgery

Whatever anyone tells you, a prostatectomy is a major operation and you need to allow yourself sufficient time to recover from it bupropion. Men are notoriously impatient, especially if they have to go back to work, but you must accept that you will probably have to slow down for a while. Don’t expect miracles, and don’t be too hard on yourself. You may not have had a leg amputated, but you have nevertheless had a major operation and you must make allowances for this. You must not expect too much of yourself during your recovery period in order to give yourself the best chance to get better as quickly as possible. Any impatience may, in
the long run, only make matters worse and set you back on your road to recovery. Exactly how long it takes you to get yourself back to a state of good health depends to a large extent on how fit you were before you had the operation. It also depends on how large your prostate gland was, and on whether or not there were any complications as a result of surgery.

Remember that old cliche about time being the great healer? It may not be very original but, like a lot of cliches, it’s true. So grit your teeth and take things easy for a while. It may take as long as three months before you feel completely well again, but once you do, you’ll be utterly convinced that it was worth every minute!

Your bladder

In the first few weeks after your operation, don’t be surprised if your symptoms do not seem any better than before. They may even seem worse. This doesn’t mean that the operation hasn’t been a success - only that you haven’t healed yet. It can take anything up to about six weeks for the cut surface inside the prostate to heal over completely. Expecting everything to work perfectly before this happens is unrealistic. Until then, you will have to be prepared to make allowances. Even when your urinary system returns to a state of good health, do not be surprised if you have problems getting used to this. You’ve probably spent a long time - years maybe - getting used to having to empty your bladder all too frequently, and it may take a long time -several weeks, probably, or even months - before you succeed in unlearning those habits. Be patient and you will gradually build up confidence in your bladder again until you are able to forget about it completely.

Medication

You will probably still be taking a course of antibiotics when you leave hospital. You must be disciplined about taking these. Remember to finish the course, and don’t just stop taking the pills as soon as you feel better. This could set you back a long way and allow any leftover bacteria to multiply and mount another attack just when you’re least expecting it and you’re congratulating yourself on getting better .

AFTER AN OPEN PROSTATECTOMY

If you’ve had an open prostatectomy, you will have stitches in your abdomen and you will have been given strict instructions on what you can and can’t do. You will be tired after your general anaesthetic and you will need to look after your wound. A district nurse will probably come to your house every other day to change the dressing, and she will take the stitches out when necessary. You will have been told what movements you can make to avoid putting too great a strain on both the scar and the surrounding muscles. You should also:
• Avoid carrying anything at all heavy - even a full kettle may be too heavy, so fill it only half full.
• Get out of your chair cautiously and gently by wriggling your way to the edge of the chair before getting up.
• Build up slowly to normal activities.
• Use your common sense at all times and don’t attempt to do too much.
• STOP immediately if you suspect you are doing too much.
Even when you’ve had the stitches removed, you will still need to be careful. It takes a good six weeks for the wound to heal itself, and several months before the abdominal muscles get back to their full strength.

AFTER A TRANSURETHRAL PROSTATECTOMY (TURP)

If, on the other hand, you’ve had the more common transurethral prostatectomy (TURP), you won’t have any visible signs of your operation, like a scar, and it’s all too easy to forget that you’ve actually had an operation at all. But you have, and you mustn’t forget it. Any operation puts a great physical strain on the body and, as a result, takes a surprisingly long time for you to get over. In hospital, you will have spent most of your time sitting or lying in bed. You probably won’t have done anything more strenuous than reading or watching television. As soon as you get home, the temptation will be to resume all your favourite occupations - going for a walk in the park, perhaps, or doing a bit of gardening. But it is not a good idea to get back into the swing of things too soon. This should be a slow and gradual process, and you must be careful not to push yourself too far, or to do more than you can genuinely cope with. In the meantime, make sure that you get plenty of rest. Get up late, have a rest whenever you feel you need one, and go to bed early. Whenever you are sitting, remember that a firm seat is more comfortable than a soft one that can press upwards between the buttocks.
The problem is obviously greater for people who live alone and who are looking after themselves. But even where this is the case -perhaps even more so, in fact, because you can’t risk driving yourself so hard that you make yourself ill - you must restrict yourself at First to doing the essentials. You’ll obviously need to do the cooking and washing, but most other things can wait. There is absolutely no shame in spoiling yourself at a time like this. Your priority is to get well, and everything else comes second to that average.

BLADDER CONTROL

The great majority of prostatectomies are successful, and recovery is usually straightforward. Having said that, though, recovery can sometimes be slow, and efficient urination is something you may have to work at will.
Just after the operation, the urethra may be swollen, which may in turn be painful. This pain can make the urethral muscles contract from time to time, which can mean that the flow of urine is either slow or intermittent. Bruising of the tissues around the urethra can also prevent the muscles surrounding the urethra working properly, which can mean that the urethra neither opens nor closes completely. This can result in a low stream of urine, of continual leakage of urine. Such problems are, of course, unpleasant and debilitating, but they should disappear as soon as the swelling and bruising get better, which should take only a fortnight or so.
Another problem following the operation may be that you suffer from just as bad - if not worse - a degree of frequency and urgency of urination as you did before the operation. This is likely to be brought about by inflammation of the prostate and urethra, and may continue until the cut surface of the prostate is completely healed, which can take as long as six to eight weeks. It can last even longer 11′ you develop a urinary tract infection, which is a good reason to have your urine tested at your six-week check-up. It may surprise you to know that the opposite problem of an absence of urgency can, contrary to what you might expect, be
even more worrying than its presence. This is because if you suffered from chronic retention of urine before your operation, your bladder may have become so accustomed to holding a large amount of urine that it does not send the right signal when it is full. The danger, in this case, is that the bladder may become so full that it will be unable to contract properly and empty itself efficiently. You will have to empty it by the clock - say every hour or so - until you begin to feel the natural urge to urinate. This should happen spontaneously, if gradually. In short, you can expect your bladder to behaving abnormally for up to six weeks or so after the operation.

Bladder training

You will probably benefit from training - or retraining - your bladder to hold more urine and to last comfortably for longer periods of time. This should help reduce increased frequency and urgency of urination, as well as night-time urination.
Start by making a urination chart, or frequency/volume chart, detailing the time and amount of urine each time you go to the toilet. Equip yourself with a measuring jug, of the type you can buy in hardware or kitchen equipment shops, so as to measure the volume of urine. Continue keeping this chart while you are bladder training. You will probably be used to emptying your bladder each time you feel the slightest urge to do so, or even each time you pass a toilet ‘just in case’. Stop doing this and gradually increase the time between visits to the toilet. Start by holding on for another two minutes after you feel the need to go to the toilet, then increase this to five minutes, then another five minutes, and so on. All this is easier said than done, but there are a few ‘tricks’ that should make it easier for you to hold on between visits.
• Sit rather than stand when you feel the desire to urinate.
• Keep still rather than moving around.
• Pull up your pelvic floor muscles.
• Cross your legs.
• Hold your penis, if you can do this discreetly .
• Take regular, slow, deep breaths.
• Think about something else to keep your mind off your bladder.
• Try to do something else to take your mind off your bladder, such as making a telephone call, or reading the newspaper.
You will find that you can gradually manage to hold on for longer and longer intervals. Aim, ultimately, for an interval of three to four hours.
Bladder training can achieve a lot for most people in just four weeks. Try to keep it up for three months or, even better, six months. Don’t expect to have dealt with all your problems even after six months. Symptoms can continue to improve for as long as a year -or even longer.

RESUMING SEXUAL ACTIVITY

You can resume sexual activity as soon as you feel up to it. Some doctors are wary of advising patients to do this, in case of disturbing clots and scabs, others say that the passage of semen cannot do any more harm than the passage of urine. Be alert to how you feel, and follow your natural inclinations. You may, however, not feel like sex for some time after the operation. If this happens to you, you shouldn’t worry It does not mean that you have lost your sex drive or your potency as a result of the operation - it simply means that you have a natural degree of fatigue after what is, after all, a major operation side affects. This is even more likely if you have had a general anaesthetic.

Retrograde ejaculation

You are unlikely to ejaculate in quite the same way as you did before the operation and may experience retrograde ejaculation. This means that semen goes backwards up the urethra into the bladder, rather than forwards and down into the urethra. This often has the effect of making you sterile, and a lot of men find this a very difficult hurdle to deal with, even if they do not actually want to father any more children. In their eyes, the fact that they are now sterile seems to emasculate them in some way, to make them less of a man. It is important that a man is told that this is a likely side-effect of a prostatectomy before the operation, as this seems to help them deal with it better. Even if you do have retrograde ejaculation, this cannot guarantee that your partner won’t become pregnant and you should still use some form of contraception if this is an issue. You cannot rely on a prostatectomy to give you a reliable form of contraception medicare. It is estimated that between 5 and 10 per cent of men are still fertile afterwards. If you want a reliable and permanent method of contraception, you may want to discuss the possibility of having a vasectomy with your surgeon, as this can easily be done at the same time as a prostatectomy. Your urine will probably look a little cloudy after intercourse, as the semen that went into the bladder is washed out. You may also find that you bleed slightly after intercourse during the first six weeks or so after the operation - just as you notice a little blood in your urine - but as long as this is not a large amount of blood, you should not have anything to worry about.

YOUR SIX-WEEK CHECK-UP

By six weeks after the operation, most of your symptoms should have cleared up, though you may still be suffering from frequency and urgency of urination. You will probably have a check-up after six weeks, which is your opportunity to discuss anything that is worrying you. It is particularly important to have a test done on a urine sample, just to check that you are free of any urine infection. Some hospital clinics also like to repeat the urine flow test, which will indicate that the operation has been successful.

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Jul

2

Acne Overview and FAQs

July 2, 2009 | Leave a Comment

ACNE

•    Avoid sugar and refined Garbs and cut back on milk
•   Try an over-the-counter product with benzoyl peroxide
•    Ask your MD about a prescription for clindamycin gel
•    Apply prescription-strength tretinoin gel
•    Discuss Nicomide-T gel with your doctor
•    Ask your doctor about isotretinoin
•    Ask your doctor about photodynamic therapy

Acne is usually thought of as an adolescent problem, but dermatologists have been treating adults with blemishes for years. The technical term for such outbreaks of pimples is acne vulgaris. Common skin bacteria (mostly Propionibacterium acnes), the production of oils by the skin, and even the impact of hormones all seem to play a role in determining who gets acne and how severe it will be. When an oil-producing hair follicle becomes plugged up and the bacteria go to work feasting on the fatty acids trapped inside it, the body often reacts with inflammation. That’s what makes the pimple so sore and red.
Based on this scenario, there are four ways to tackle the problem of acne: discourage the bacteria, reduce the production of oil, control the hormones, or lower the level of inflammation. In practice, dermatologists mostly focus on bacteria and, oil production. But perhaps trying to lower the level of inflammation is more practical than they think.

The Anti-Acne Diet
Dietary recommendations for acne sufferers have a checkered history. Way back when, teenagers were told to lay off the cheeseburgers and french fries. If they stayed away from high-fat foods like milk shakes and chocolate, they were told, they’d have lovely, clear skin.
We don’t know how many kids with acne in the 1960s and 1970s followed that advice, but eventually dermatologists changed their minds. They did some studies and discovered that the amount of fat in the diet didn’t seem to correlate very well with the severity of blemishes. So they told their adolescent patients, “Never mind.” Diet was not considered a significant risk factor for acne.
Then a few dermatologists began to wonder if that advice was correct. An international team of investigators reported that clinical examination of 1,200 residents of Papua New Guinea (Kitavan Island) and of 115 hunter-gatherers from Paraguay did not turn up a single case of acne.’ Since 70 to 95 percent of adolescents and approximately half of people more than 26 years of age have facial acne in Westernized societies, the difference was striking. The researchers proposed that diet might play an important role. Specifically, they noted that the native peoples consume a diet composed of lowglycemic-index foods, with a minimum of refined foods, especially refined carbohydrates such as sugar and flour. (Presumably, their diets are also low in the unnatural trans fatty acids as well, since these are equally linked to processed foods. 2) Perhaps, the scientists hypothesized, this diet that minimizes insulin spikes might also benefit the skin.

Q. My 14-year-old daughter has had moderate acne for nearly 2 years. There are always 5 to 10 small pimples on her forehead, and now she has 10 to 20 pimples on her cheeks as well.
Clearasil left bleach stains on her clothes. Antibiotics the doctor prescribed didn’t help and even seemed to make matters worse. The doctor suggested birth control pills, but that is not an option we’d entertain. Are there any natural remedies that might work? What about diet?
A. The purported link between acne and diet is controversial. Teens once were told to avoid chocolate and high-fat foods. That turned out to be unhelpful.
Research published in the Archives of Dermatology suggests, however, that diet actually may make a difference. Populations on low-carb diets that don’t make blood sugar rise quickly may be less prone to blem-fishes. Your daughter might try avoiding foods like candy, cookies, french fries, potato chips, sugar, and white flour to see if it helps her complexion.
Not all dermatologists have welcomed this new look at the possible role of diet. The epidemiological comparison suggesting that diet might be relevant in the development of acne triggered a series of comments under titles such as “Diet and Acne Revisited”.
It isn’t altogether clear why this development should be so unwelcome. Nutrition science is gradually reaching a consensus that a low-glycemic diet, one with the least amount. of trans fats as well as saturated fat, is probably preferable for long-term health in many respects. Such a dietary pattern seems to lower the risk of diabetes and heart disease. Encouraging young people to adopt healthy dietary habits at a time when they would be motivated by the short-term benefit of clearer skin might be a good public health strategy. Most patients seem to think that diet is important in treating acne, and they expect dietary recommendations from their doctor. In the meantime, dermatologists should be conducting research to determine if this dietary hypothesis is solid or if it is as far-out as many doctors think. Refined carbohydrates and trans fats like margarine might not be the only dietary culprits. A different study reviewed the dietary and dermatological histories of 47,355 female nurses and concluded that the more milk these women drank in adolescence, the more likely they were to have had severe acne as teenagers. The Harvard scientists who conducted this research suggest that hormones and growth factors found in milk might contribute to this problem. It appears that a good deal more research is needed before there will be a clear answer to the question of whether diet affects acne. In the meantime, motivated acne sufferers can do their own experimentation to find out if including less processed food and less milk in their diet might result in fewer blemishes. My son recently returned from a 5-day camping trip where he didn’t have milk or any of his acne medicine. To my surprise, his face looked beautiful. Maybe there’s a connection between clear skin and no milk. The dermatologist suggested eliminating milk to see what happens.

Conclusions
Blemishes are a common part of adolescence, but they also trouble many people well into adulthood. Changes in hormone levels seem to aggravate acne. Most treatments are aimed at killing or slowing down bacteria that are commonly present on and in the skin, and this usually works well until or unless the bacteria develop resistance. Stress seems to make acne worse (which is why college students have more zits during the week of final exams), but given the fact that stress is so hard to avoid, almost no treatments focus on controlling it. There are many approaches to acne treatment; if self-care does not prove effective, a dermatologist should be able to prescribe a therapy that will help.

•    Change your diet. A low-glycemic-index diet with very little sugar and other refined carbohydrates might improve skin significantly, and it will have other health benefits as well. Other things to avoid: milk and trans fatty acids, which are found in margarine and shortening. A study of dairy products and acne is currently under way.

•    Facial masks of clay may remove excess oil and help clear the skin. Other topical treatments include nutmeg mixed with milk or honey to make a paste for pimples. A tea tree oil gel (5 percent) is worth trying.

•    Wash morning and evening with a gentle nonsoap cleanser. Using a harsh or abrasive product may aggravate acne.

•    Ask your doctor about applying a topical antibiotic such as clindamycin or erythromycin. They can be helpful, but skin bacteria are developing resistance to these drugs.

•    Check with your doctor regarding a prescription for Retin-A. Be vigilant about protecting your skin from the sun or any other source of ultraviolet radiation while you are using this medicine.

•    Ask about Nicomide-T gel or cream. This vitamin-based topical medicine can reduce inflammation and may be almost as effective as some topical antibiotics.

•    Oral antibiotics may work even when topical antibiotics do not. Be sure to ask your doctor about side effects and interactions, and follow the dosing instructions carefully.

•    Women may benefit from birth control pills. Sometimes the diuretic spironolactone provides additional anti-acne power.

•    For severe acne that has not responded to other treatments, isotretinoin (Accutane, Sotret, etc) is an option. Discuss the risks and benefits thoroughly with your dermatologist before starting on a 5-month course of these pills. Because isotretinoin causes birth defects, women are required by the manufacturer to verify before taking any of this medication that they are not pregnant, and to confirm it again each month during treatment. They must also use two effective forms of contraception during the course of treatment.

•    Ask your dermatologist if Dusa Blue Light (photodynamic therapy) is appropriate for you. It should be administered by a dermatologist or plastic surgeon experienced with its use.

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