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Estazolam - Estrogens - Eszopiclone - Exemestane - Exenatide

August 13, 2009 | Leave a Comment

Generic Name
Estazolam (es-TAZ-oe-lam) V
Type of Drug Benzodiazepine sedative.
Prescribed For
Insomnia and sleep disturbances.
General Information
Estazolam is a member of the group of drugs known as benzodiazepines. They work by a direct effect on the brain. Benzodiazepines make it easier to go to sleep and decrease the number of times you wake up during the night. Estazolam is considered an intermediate-acting sedative and generally remains in your body long enough to give you a good night’s sleep with minimal “hangover.”
Cautions and Warnings
Do not take estazolam if you are allergic or sensitive to any of its ingredients. Severe allergic reactions may occur. People with respiratory disease taking estazolam may experience sleep apnea (intermittent cessation of breathing during sleep). People who already have, or suspect they have, sleep apnea should not take estazolam.
People with kidney or liver disease should be carefully monitored while taking estazolam. Take the lowest possible dose to help you sleep.
Clinical depression may be increased by estazolam, which can depress the nervous system. Intentional overdose is more common among depressed people who take sleeping pills than among those who do not.
All benzodiazepines can be addictive if taken for long periods of time and can cause drug withdrawal symptoms if discontinued suddenly. It should be used With caution in people with a history 0 YATUg dependence. Withdrawal symptoms include tremors, Muscle cramps, insomnia, agitation, diarrhea, vomiting, sweating, and convulsions.
People with a history of seizures should not abruptly stop taking estazolam.
Possible Side Effects
♦    Common: drowsiness, headache, dizziness, talkativeness,
nervousness, apprehension, poor muscle coordination, light-
headedness, daytime tiredness, muscle weakness, slow-
ness of movement, hangover, and euphoria (feeling “high”).
♦    Less common: nausea, vomiting, rapid heartbeat, confusion, temporary memory loss, upset stomach, stomach cramps and pain, depression, blurred or double vision and other visual disturbances, constipation, changes in sense of taste, appetite changes, stuffy nose, nosebleeds, common cold symptoms, asthma, sore throat, cough, breathing difficulties, diarrhea, dry mouth, allergic reaction, fainting, abnormal heart rhythm, itching, acne, dry skin, sensitivity to bright light or to the sun, rash, nightmares or strange dreams, sleeplessness, tingling in the hands or feet, ringing or buzzing in the ears, ear or eye pain, menstrual cramps, frequent urination and other urinary difficulties, blood in the urine, discharge from the penis or vagina, lower back and joint pain, muscle spasms and pain, fever, swollen breasts, and weight changes.
✓    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    As with all benzodiazepines, the effects of estazolam are enhanced if it is taken with an alcoholic beverage, antihistamine, sedative, barbiturate, anticonvulsant medication, antidepressant, or monoamine oxidase inhibitor antidepressant.
•    Carbamazepine and phenytoin may reduce blood levels and the effectiveness of estazolam by stimulating liver enzymes responsible for its breakdown.
•    Ketoconazole, itraca(\ailzAe, netazodone, fluvoxamine, diltiamm,’isoniazid, some macrolide antibiotics, contraceptive drugs, cimetidine, and disulfiram may increase the effect of estazolam by interfering with the drug’s breakdown in the liver. Probenecid also increases estazolam’s effects by interfering with it passing through the kidneys into urine.
•    Cigarette smoking, rifampin, and theophylline may reduce the effect of estazolam.
•    Levodopa + carbidopa’s effectiveness may be decreased by estazolam.
•    Estazolam may increase the amount of zidovudine (an HIV drug—also known as AZT), phenytoin, or digoxin in your bloodstream, increasing the chances of side effects.
•    The combination of clozapine and benzodiazepines has led to respiratory collapse in a few people. Estazolam should be stopped at least 1 week before starting clozapine treatment.
Food Interactions
Estazolam may be taken with food if it upsets your stomach.
Usual Dose
Adult (age 18 and over): 1-2 mg at bedtime.
Senior: 1 mg at bedtime. Small or frail patients should start on 0.5 mg. Dosage should be increased cautiously.
Child (under age 18): not recommended.
Overdosage
The most common overdose symptoms are confusion, sleepiness, depression, loss of muscle coordination, and slurred speech. Coma and death may also occur. People who take an estazolam overdose must be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach: Call your doctor or a poison control center before doing this. The victim must be taken to a hospital emergency room for treatment if 30 minutes have passed since the overdose was taken or if symptoms have begun to develop. ALWAYS bring the prescription bottle or container.
Special Information
Never take more estazolam than your doctor has prescribed. Avoid alcoholic beverages and other nervous system depressants while taking estazolam.
Exercise caution while performing tasks that require concentration and such as driving: estazolam may make you tired, dizzy, or lightheaded. People taking estazolam or any other sleeping medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, and cooking with no memory of the event.
If you take estazolam daily for 3 or more weeks, you may experience some withdrawal symptoms when you stop taking the
drug, especially temporary sleep disturbance. In rare cases, patients discontinuing estazolam have suffered seizures or delirium. Patients with a history of seizures should taper when stopping use
of this drug.
If you forget to take a dose of estazolam and remember within about 1 hour of your regular time, take it right away. If you do not remember until later, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Estazolam absolutely should not be used by pregnant women or by women who may become pregnant.
Estazolam passes into breast milk. The drug should not be taken by nursing mothers.
Seniors: Seniors are more susceptible to the effects of estazolam. Type of Drug

Estrogens (ES-troe-jens)
Brand Names
Generic Ingredient: Conjugated Estrogens Premarin    Premarin Cream
Generic Ingredient: Conjugated Estrogens (Synthetic) Cenestin    Enjuvia
Generic Ingredients: Conjugated Estrogens + Medroxyprogesterone
Premphase    Prempro
Generic Ingredient: Esterified Estrogens Menest
Generic Ingredients: Esterified Estrogens + Methyttestosterone Estratest
Generic Ingredient: Estradio(& Alora,
Climara Divigel Elestrin Estrace Estraderm
Estring Estrogel
Evamist Transdermal Spray Femring
Femtrace Gynodiol
Innofem Menostar Vagifem
Vivelle Vivelle-Dot
Generic ingredients: Estradiol + Drospirenone Angeliq
Generic Ingredients: Estradiol + Levonorgestrel Climara Pro    Nuvaring
Generic Ingredients: Estradiol + Norgestimate 99 Pretest
Generic Ingredient: Estropipate
Ogen Cream    Ortho-Est
Generic Ingredients: Ethinyl Estradiol + Norethindrone Activella Combipatch    FemHRT 1/5
Prescribed For
Moderate to severe menopausal symptoms such as hot flashes, night sweats and sleep problems, vaginal dryness and irritation (creams and gels); also prescribed for ovarian failure, osteoporosis prevention, male breast cancer, advanced prostate cancer, abnormal bleeding of the uterus, female castration, Turner’s syndrome, and birth control.
General Information
Six estrogens have been identified in women but only 3 are present in large amounts: estradiol, estrone, and estriol. Estradiol is the most potent and most important. Other estrogens are produced by chemical conversions in the body. Estradiol, for example, is transformed into estrone, which in turn becomes estriol. Estrogens all have the same actions and side effects; only potency varies. More potent types require smaller dosages to produce the same effect.
Millions of women have taken hormone replacement therapy (HRT) to manage menopausal symp<oms, but studies show that HRT doeq WMpYove quality of life for most. Women who experience severe menopause symptoms must weigh the benefits of prolonged hormone replacement therapy against its risks.
Estrogens are largely responsible for the growth and maintenance of the female reproductive system and sex characteristics. They affect the release of hormones from the pituitary gland (con-troller of hormone production and regulator of basic bodily functions). These hormones control the functioning of capillaries (smallest blood vessels), may cause fluid retention, affect protein breakdown in the body, prevent ovulation and breast engorgement after childbirth, and influence the shaping and maintenance of the skeleton through an effect on calcium.
Estrogen products differ in their hormone content and dosage. Some may affect one part of the body more than another. Generally, though, estrogens are interchangeable as long as dosage differences are taken into account.
Cautions and Warnings
Do not take estrogens if you are allergic or sensitive to any of their ingredients.
Products containing an estrogen and a progestin should not be used for the prevention or treatment of bladder-control problems, heart disease, or mental decline (dementia).
Women with an intact uterus who choose hormone replacement therapy for menopausal symptoms should take the lowest effective dose for the shortest possible time to minimize the risks associated with these medicines. The results of a very large study called the Women’s Health Initiative (WHI) first published in 2002 and updated with new reports, have drastically changed the face of estrogen replacement therapy. The study found a small but insignificant increase in the risk of non-fatal heart attacks. There was no increase in heart disease in the estrogen plus progestin part of the WHI. Early results of the WHI found 4-6 more cases of invasive breast cancer for every 10,000 women in the study and tumors were harder to detect. But this result was not confirmed after more than 7 years of additional study. Estrogens may also lead to abnormal mammograms. An increased risk of a stroke was found in the WHI study. The risk of blood clots forming in the body was doubled in women taking hormone therapy. This study did show some benefits of long-term hormone replacement in colon cancer and osteoporosis, but these benefits may not outweigh the risks of hormone replacement therapy.
Women with liver damage or disease, blood-clotting problems, or abnormal vaginal bleeding whose cause is unknown, should not take estrogens.
Women who smoke cigarettes and take estrogen have a greater risk of cardiovascular side effects, including stroke and blood clotting.
Estrogens may increase the risk of endometriat cancer by 4.514 times in postmenopausal women taking them without progestin for prolonged periods of time; the risk depends on duration of treatment and dosage. Women who have a strong family history of breast cancer or who have breast nodules or cysts or an abnormal mammogram should be cautious about using estrogens. Women with estrogen-dependent cancer or breast cancer should not take estrogens, except some being treated for breast cancer that has spread. Women taking an estrogen for breast cancer that has spread to their bones can develop large increases in blood calcium.
Postmenopausal women taking estrogen are 2-3 times more likely to develop gallbladder disease.
Estrogens can raise blood pressure. Pressure usually returns to normal when the drug is stopped.
People with thrombophlebitis should avoid these drugs. The risk is greatest with very high dosages. Lower hormone dosages may not be a problem.
Estrogens should not be used to treat painful breast enlargement that sometimes develops after giving birth.
Estrogens can cause significant increases in blood triglycerides and cause pancreas inflammation in women with inherited blood-fat disorders.
Vaginal estrogen cream may stimulate bleeding of the uterus. It may also cause breast tenderness, vaginal discharge, and withdrawal bleeding if the product is suddenly stopped. Women with endometriosis may experience heavy vaginal bleeding.
Women taking hormone replacement therapy are at a 50% greater than normal risk of senile dementia.
Drospirenone, a progestin and an ingredient in Angeliq, can raise blood potassium levels in some people because it opposes the hormone aldosterone. It should not be used in people with conditions that can lead to high blood potassium such as kidney disease or a poorly functioning adrenal gland. Drospennone should be used with caution by women who we also taking other medicines that raise tl(QW potassium, such as nonsteroidal antiWkvmmMory drugs (NSAIDs), potassium-sparing diuretics, potassium supplements, angiotensin-converting enzyme (ACE) inhibitors, All receptor antagonists, and heparin. Your doctor may want to check your blood potassium level if you might be at risk of high blood potassium.
Possible Side Effects
v Most common: breast enlargement or tenderness, ankle and leg swelling, appetite loss, weight changes, water retention and bloating, nausea, vomiting, and abdominal cramps. The estrogen patch may cause rash, irritation, and redness where it is applied.
V Less common: bleeding gums, breakthrough vaginal bleeding, vaginal spotting or discharge, changes in menstrual flow, painful menstruation, premenstrual syndrome (PMS), absence of menstrual periods during and after estrogen use, uterine fibroid enlargement, vaginal Candida infection, a cystitis-like condition, mild diarrhea, yellowing of the skin or whites of the eyes, eye lesions, contact-lens intolerance, rash, hair loss, development of new hairy patches, migraine, mild dizziness, depression, increased sex drive (women), and decreased sex drive (men).
♦ Rare: stroke, blood-clot formation, dribbling or sudden passage of urine, loss of coordination, chest pain, leg pain, breathing difficulties, slurred speech, and changes in vision. Men who take large estrogen dosages for prostate cancer have a greater risk of heart attack, phlebitis, and blood clots in the lungs. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Phenytoin, ethotoin, mephenytoin, and topiramate may interfere with estrogen’s effects.
•    Estrogens may reduce the effect of oral anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
•    Estrogens may increase the side effects of antidepressants and phenothiazine sedatives.
•    Low estrogen dosages may increase 0\enolhiazine’s effectiveness.
% ‘ittrogens may increase cyclosporine and corticosteroid blood levels. Dosage adjustments of the non-estrogen drugs may be needed.
•    Estrogens may reduce the effectiveness of thyroid replacement therapy.
•    Rifampin, barbiturates, carbamazepine, St. John’s wort, and other drugs that stimulate the liver to break down drugs may reduce estrogen blood levels.
•    Estrogens may interfere with tamoxifen and bromocripline.
•    Women, especially those ova. 35, who smoke cigarettes and take estrogen have a much greater risk of developing stroke, hardening of the arteries, or blood clots in the lungs. The risk increases with age and tobacco use.
•    Estrogens interfere with many diagnostic tests. Make sure your doctor knows you are taking estrogen before conducting any blood tests or other diagnostic procedures.
Food Interactions
Estrogens may be taken with food to reduce nausea and upset stomach. Avoid drinking grapefruit juice if you are taking this drug.
Usual Dose
Dosage varies. All of these products, including the transdermal skin patch, may be taken continuously or on a cyclic schedule of 3 weeks on, 1 week off.
Tablets
Chlorotrianisene: 12-200 mg.
Conjugated estrogens: 0.3-30 mg.
Conjugated estrogens, synthetic: 0.625-1.25 mg. Esterified estrogens: 0.3-30 mg.
Estradiol: 0.5-30 mg.
Estropipate: 0.625-7.5 mg.
Ethinyl estradiol: 0.02-3.0 mg.
Estradiol Transdermal Patch (0.025, 0.0375, 0.05, 0.075, or 0.1 mg) Alora, Estraderm, and Esclim: 1 patch twice a week: or use 1
patch twice a week for 3 weeks, stop for 1 week, then start again. Climara and Fempatch: 1 patch every week; or use 1 patch once
a week for 3 weeks, stop for 1 week, then start again.
Estradiol Transdermal Spray: 1-3 Sprays (1.53 mg estradiol in each spray
face of the forearm, starting near the elbow. Do not allow the sprays to overlap each other. Allow the spray to dry for about 2 minutes and do not wash the arm for 30 minutes. Do not apply the spray to any other part of the body.
3Wkw1 Onext to each other every morning on the inner sur-Estradiol Gel: Spread 1 pumpful of the gel as thinly as possible over the entire area on the inside and outside of your arm from wrist to
shoulder, once a day at the same time every day.
Vaginal Cream
Conjugated estrogens: 0.52 g a day for 3 weeks; stop for 1 week,
then start again.
Dienestrol: 1 applicatorful 12 times a day for 12 weeks, half the
original dosage for another 12 weeks, then 1 applicatoviO 13 times
a week.
Estradiol: 24 g a day for 2 weeks, half the starting dosage for an-
other 2 weeks, then 1 g 13 times a week.
Estropipate: 24 g a day for 3 weeks; stop for 1 week, then start again.
Estradiol Ring
Insert once every 3 months.
Overdosage
Symptoms may include nausea and vaginal bleeding in adult women. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop breast pain or tenderness, swelling of the feet and lower legs, rapid weight gain, chest pain, breathing difficulties, pain in the groin or calves, unusual or persistent vaginal bleeding, missed menstrual period, lumps in the breast, sudden severe headache, dizziness or fainting, disturbances in speech or vision, weakness or numbness in the arms or legs, abdominal pain, sudden severe vomiting, depression, yellowing of the skin or whites of the eyes, or jerky or involuntary muscle movement.
Women taking estrogens or combined estrogen and progestin therapy should have yearly lamasN exams, perform monthly breast self -Paw i)26ions, and have regular mammograms.
Talk to your health care provider about ways to reduce risk factors for heart disease (blood-pressure control, improving your diet, stopping tobacco use) and osteoporosis (an appropriate diet, vitamin D and calcium supplements, weight-bearing exercise).
Tell your doctor if you are having surgery or require bedrest: your doctor may have you stop taking estrogen 4-6 weeks beforehand to prevent the risk of blood clots.
Your doctor should reevaluate your need for estrogen vaginal cream every 36 months. Do not stop using the drug suddenly because this may increase your risk of developing unpredicted or breakthrough vaginal bleeding.
Women using the cream who develop breast tenderness, start to bleed, or have other vaginal discharge should contact their doctors at once.
Estrogen skin patches should be applied to a clean, dry, non-oily, hairless area of intact skin, preferably on the abdomen. Do not apply it to your breasts or waist, or to any area where tightfitting clothes may loosen the patch from your skin. The application site should be rotated to prevent irritation, and each site should have a patch-free period for 7 days.
Good dental hygiene is important while taking estrogen because estrogen may increase your risk of oral infection. Dental work should be completed prior to starting estrogen, if possible.
Vaginal estrogen cream should be inserted high into the vagina, about 2/3 of the length of the applicator.
Press the vaginal ring into an oval and insert as deeply as possible in the upper 1/3 of the vagina.
Some of these products contain tartrazine (a commonly used orange dye and food coloring). If you are allergic to tartrazine or have asthma, check with your pharmacist to find out if your estrogen product contains this coloring agent.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Authorities note that the risk of serious complications for an individual woman taking hormone replacement therapy is very small. Thus, you may decide to take hormones but your decision should be based on a complete discussion of the facts and your individual situation with your doctor. Continue to talk with your doctor regularly about weighing tt% i1%’Ks against the benefits of taking estrQ(;e5\.
Special Populations
Pregnancy/Breast-feeding: Estrogens harm the fetus and should never be used during pregnancy for any reason.
Estrogens pass into breast milk and reduce its flow. Nursing mothers who must take them should use infant formula.
Seniors: The risk of side effects increases with age, especially if you smoke. Women age 65 or older taking estrogens may be more likely to develop a stroke, blood clot, or dementia, a condition where people suddenly or gradually lose normal mental function and intellectual capacity.

Generic Name
Eszopiclone (ess-oh-PIK-lone)
Brand Name Lunesta
Type of Drug Sedative.
Prescribed For Insomnia.
General Information
Eszopiclone is a nonbenzodiazepine sleeping pill that is believed to work in much the same way as the drug zolpidem and as benzodiazepine-type sleeping pills and sedatives. Unlike the benzodiazepines, however, eszopiclone has little muscle-relaxing or antiseizure effects. This drug is rapidly absorbed and usually starts working within a few minutes. Eszopiclone causes little or no “hangover,” and there are no rebound effects after stopping the drug. In studies of eszopiclone, tolerance to its effects did not develop even after 6 months of continued use. Eszopiclone is broken down in the liver, and the level of this drug in the body does not increase after you take it for several days.
Cautions and Warnings
Do not take eszopiclone if you are allergic or sensitive to any of its ingredients.
People With severe liver disease should use eszopiclone with caution and must take less of this medication than those with normal liver function or mild liver disease.
Sleeping problems often result from a physical or psychological illness. Eszopiclone does not affect the underlying causes of
insomnia. It should be taken only with your doctor’s knowledge. If you cannot sleep even after 7-10 days of taking eszopiclone, con-
tact your doctor.
Eszopiclone has caused amnesia (memory loss), but this happens mostly at dosages larger than 2 mg per night.
Suddenly stopping eszopiclone after having taken it for some time may produce drug withdrawal (symptoms include fatigue, nausea, flushing, lightheadedness, crying, vomiting, stomach cramps, panic, nervousness, and general discomfort).
People with a history of substance abuse may be more likely to develop drug dependence on eszopiclone. Eszopiclone doses of 612 mg are similar to 20 mg of diazepam in their potential for abuse.
Eszopiclone is a nervous system depressant and may cause loss of coordination and concentration. It should be taken just before bedtime. People taking sleep medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, or cooking with no memory of the event. Eszopiclone may also interfere with normal activities the next day, especially if taken with alcohol.
Eszopiclone should be avoided by people with severe depression, severe lung disease, and sleep apnea (intermittently stopping breathing when you are asleep). You should not take this drug if you are drunk.
Possible Side Effects
Adults
Some side effects are more likely with larger doses (viral infection, dry mouth, dizziness, hallucinations, infections, rash, and unpleasant taste).
♦    Most common: headache, drowsiness, unpleasant taste, and lung infections.
✓    Common: dry mouth, dizziness, and nausea.
✓    Less common: nervousness, vomiting, viral infections, anxiety, confusion, depression, hallucinations, reduced sex drive, rash, male breast e”k-aigement and/or pain, painful meR%k5UMlrjn, chest pain, migraines, and swelling of the arms or legs.
♦    Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Mixing eszopiclone with olanzapine can affect your coordination and ability to perform tasks.
•    Mixing eszopiclone with ketoconazole more than doubles blood levels of eszopiclone. Other drugs that may have a similar interaction include itraconazole, clarithromycin, nefazodone, troleandomycin, ritonavir, and nelfinavir.
•    Rifampin can be expected to drastically reduce the effectiveness of eszopiclone because it increases levels of liver enzymes that break down eszopiclone.
•    Avoid combining eszopiclone with alcohol and other nervous system depressants, including sedatives, narcotics, barbiturates, antidepressants, and antihistamines.
Food Interactions
For the most rapid and complete effect, take eszopiclone on an empty stomach at least 2 hours after a meal. It will take longer for eszopiclone to work if you have had a high-fat meal immediately before taking it.
Usual Dose
, abnormal dreaming, nery
Adult (q% 1% and over): 2-3 mg immediately before bedtime or after you are in bed and have trouble falling asleep. Eszopiclone can act very quickly.
Child (up to age 17): not recommended.
Senior: 1-2 mg immediately before bedtime.
People with liver disease: 1 mg.
Possible Side Effects (continued) Seniors
Some side effects are more com    the cluding dry mouth, pain, and unpleasant easant
♦    Most common: headache.
♦    Common: pain, dry mouth, diarrhea, rrhea, and upset
♦    Less common: accidental injury,
ousness, nerve pain, itching, and urinary• Rare: Rare side effects can occur in almost any part body. Contact your doctor if you
ou experience any side ef fect not listed above.
infection. of - , mon with larger doses in
Overdosage
Overdose can result in nervous system depression, from unconsciousness to light coma. Combining eszopiclone with alcohol or other nervous system depressants may be fatal or affect other body organs. One person took up to 36 mg of eszopiclone and fully recovered. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Eszopiclone may cause tiredness, drowsiness, and an inability to concentrate. Be careful when driving or performing any task that requires concentration on the day following a dose. Make sure you get 7-8 hours of sleep after taking eszopiclone.
People taking eszopiclone on a regular basis may develop a drug withdrawal reaction if the medication is stopped suddenly (see “Cautions and Warnings”).
Do not take a double dose of this medication.
Special Populations
Pregnancy/Breast-feeding: Some animal studies with doses of eszopiclone up to 800 times the human equivalent showed it did not affect a developing fetus, and other studies showed some modest effects. However, there is no information on the use of eszopiclone in pregnant women. If your doctor considers eszopiclone crucial for you, its potential benefits must be carefully weighed against its risks.
It is not known if eszopiclone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, who are likely to be more sensitive to eszopiclone and its side effects, should start on a 1 -mg dose and take the lowest effective dosage.
Generic Name
Etanercept (eh-TAN-er-sept)
Brand Name Enbrel
Type of Drug
Immune system modulator.
Prescribed For
Rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis.
General Information
Etanercept binds to a specific protein in the body known as tumor necrosis factor (TNF) and blocks it from interacting with cell surfaces. TNF is involved in normal inflammatory and immune responses and the inflammatory processes of rheumatoid arthritis, juvenile rheumatoid arthritis, and other conditions. Etanercept can also interfere with biological actions that are either caused or regulated by TNF.
Cautions and Warnings
Do not use etanercept if you are allergic or sensitive to any of its ingredients.
Serious infections and malignancies are possible in people using etanercept because of its ability to suppress the immune response. This may be more common in people with other conditions that predispose them to infections such as advanced or uncontrolled diabetes.
Levels of blood platelets and some white blood cells may be reduced in rare cases, leading to persistent fever, bruising, bleeding, and pale skin. Contact your doctor if any of these symptoms develop.
Etanercept may increase the risk of some nervous system disorders including multiple sclerosis.
Etanercept may cause or worsen congestive heart failure.
In rare cases people taking etanercept have developed a lupus-like syndrome which may disappear when the drug is discontinued.
People taking etanercept should not receive any live vaccines, because the body may not be able to respond as expected to the vaccine.
Possible Side Effects
RPndmt may develop at the site where etanercept is injected. Injection sites should be rotated among the thigh, abdomen, and upper arm to avoid excessive bruising or other skin damage.
Possible Side Effects (continued)
♦    Most common: infection, injection-site reactions, upper respiratory infection, headache, and runny nose.
♦    Common’. nausea, dizziness, sore throat. cough, weak-
ness, abdominal pain, rash, and respiratory problems.
♦    Less common: upset stomach, sinus irritation, vomiting.
swelling in the legs or feet, mouth sores, and hair loss.
✓    Rare: malignancy, stroke, seizure, tingling in the hands or feet, nervous system irritation similar to multiple sclerosis, eye inflammation, joint pain, generalized pain, appetite loss, blood vessel inflammation in the skin, dry eyes, lumps under the skin, fever, flu-like symptoms, weight gain, chest pain, flushing, diarrhea, taste changes, difficulty breathing, worsening of existing lung conditions, itching, and skin reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Do not mix etanercept in the same syringe as another drug.
•    Using etanercept with anakinra increases the risk of serious infections.
Food Interactions None known.
Usual Dose
Adult: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis-50 mg a week. Plaque psoriasis: 50 mg twice a week, reducing to 50 mg a week after 3 months.
Child (age 4-17): 0.36 mg per lb. of body weight, up to 50 mg a week, 3-4 days apart.
Child (under age 4): not recommended.
Overdosage
In one study, ‘A patient accidentally self-administered 62 mg of etanercept twice a week for 3 weeks with no ill effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Etanercept is taken by injection under the skin. Be sure you understand how to measure the proper dose of etanercept and how
to self-inject it.
To mix and inject etanercept: Withdraw all the water supplied with the medicine into a syringe and slowly inject it into the vial containing etanercept. Swirl the mixture gently to avoid excess foaming in the vial. Do not shake the vial.
Do not combine etanercept with any other injectable drug. Etanercept may be stored in a refrigerator for up to 14 days after it is mixed.
Single-use pre-filled syringes must be refrigerated. Do not use past the provided expiration date.
If you forget to administer a dose, do so as soon as you remember. Remember that etanercept doses must be administered at least 3 days apart. Call your doctor or pharmacist if you have any questions about how to time your etanercept doses.
Special Populations
PregnancylBreast-feeding. The safety of using etanercept during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if this drug passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors are more likely to develop infections while using etanercept.

Generic Name
Exemestane (ex-eh-MES-tane)
Bnj(kod WaYne Aromasin
Type of Drug Aromatase inhibitor.
Prescribed For
Breast cancer. Also prescribed for prostate cancer prevention.
General Information    Some breast cancers depend on the presence of the hormone estrogen to stimulate their growth. Depriving these cancers of estrogen is an effective way of treating the condition. Exemestane significantly reduces the amount of estrogen in the blood by binding permanently to an enzyme called aromatase, an essential element in the conversion of androgen (male hormones) to estrogen in premenopausal and postmenopausal women. Exemestane does not affect other hormones in the body. Exemestane is broken down in the liver.
Cautions and Warnings
Do not take exemestane if you are allergic or sensitive to any of its ingredients.
Exemestane may be prescribed for men and postmenopausal women only.
Possible Side Effects
✓    Most common: fatigue, hot flashes, pain, depression, sleeplessness, anxiety, nausea, and breathing difficulties.
✓    Common: flu-like symptoms, leg swelling, high blood pressure, dizziness, headache, vomiting, abdominal pain, leg swelling or other fluid retention, sweating, appetite loss, constipation, and coughing.
✓    Less common: increased appetite, diarrhea, fever, weakness, tingling in the hands or feet, broken bones, bronchitis, sinusitis, rash, itching, urinary infection, and swollen lymph glands.
♦    Rare: chest pain; confusion; reduced sensitivity to stimulation; upset stomach; joint, back, or other bone pain; respiratory infection; sore throat; runny nose; and hair loss. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Estrogen-containing drugs reduce the effectiveness of exemestane. Do not combine these drugs.
• Rifampin, phenytoin, carbamazepine, phenobarbital, and St. John’s wort may potentially reduce the effectiveness of
exemestane.
Food Interactions
Take this drug with a meal. The amount of exemestane absorbed into the blood is increased by 40% when taken with a high-fat meal.
Usual Dose
Adult: 25 mg once a day with or just after a meal. Dose adjustment is not needed in people with kidney or liver disease. Child: not recommended.
Overdosage
Doses as large as 600 mg have been well tolerated by women with advanced breast cancer. Overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the prescription bottle or container.
Special Information
If you forget a dose, skip the forgotten dose and continue with your regular schedule. Contact your doctor if you skip more than one dose.
Special Populations
Pregnancy/Breast-feeding: Exemestane is intended only for postmenopausal women. It can cause birth defects and miscarriage and should not be used by pregnant women or women who may become pregnant.
Exemestane may pass into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may take this drug without special precaution.

Generic Name
Exenatide (ex-EN-ah-tide)
Brand Name Byetta
7Vpe of Drug Incretin mimetic.
Prescribed For Type 2 diabetes.
General Information
Exenatide is a unique drug that improves blood sugar control in people with type 2 diabetes who have been unsuccessful with diabetes pills. It is added to existing therapy and does not replace other treatments. Exenatide has many of the same actions as GLP-1, a natural incretin hormone. It differs chemically and works differently from other diabetes medications, including insulin.
Exenatide begins working about 30 minutes after injection and continues to work for at least 8 hours. It helps the pancreas to release insulin into the blood in response to sugar levels, so insulin rises when blood sugar is high and declines as blood sugar declines. It reduces the production of a hormone called glucagon, which raises blood sugar. Exenatide also keeps food in the stomach longer, which in turn helps reduce the amount of sugar absorbed from dietary sources. Exenatide increases the number of beta cells (that produce insulin) in animals and may have the same effect in humans. This could help reduce the need for other medicines and improve diabetes control.
Cautions and Warnings
Do not take exenatide if you are allergic or sensitive to any of its ingredients.
This drug is not a substitute for insulin. Exenatide has only been studied together with metformin, glitazones, and/or sulfonylureas. It has not been studied with other diabetes pills or insulin.
People with severe kidney disease should not use exenatide.
People with severe stomach or intestinal disease should not use exenatide.
Inflammation of the pancreas can occur with this drug. Symptoms include nausea, vomiting, fever, rapid pulse, and painful and swollen abdomen that may develop slowly and worsen when you eat or may be severe and constant.
Low blood sugar may ziccurit you are taking exenatide with a S\00ny)urea-type antidiabetes drug or with a glitazone.
Antibodies to exenatide may develop, but antibody levels generally go down with time. Most patients who develop antibodies still have good sugar control and similar types of side effects as people who do not develop exenatide antibodies.
Possible Side Effects
♦    Most common: nausea, vomiting, diarrhea, and low blood sugar (when mixed with a sulfonylurea-type drug or metformin plus a sulfonylurea).
♦    Less common: low blood sugar (when mixed with a glitazone), feeling jittery, dizziness, headache, and upset stomach.
✓    Rare: rash, abdominal swelling and pain, constipation, and kidney failure. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Exenatide has been studied with a number of other medications commonly taken by people with diabetes (digoxin, lovastatin, lisinopril, and acetaminophen) and no significant interactions were noted.
•    Combining exenatide with a sulfonylurea-type drug may lead to hypoglycemia (low blood sugar). Your doctor may change your sulfonylurea dose to solve this problem.
•    Take all oral medicines at least 1 hour before you inject exenatide to ensure maximum absorption. If you must take oral drugs with food or meals, take them with a snack or meal when exenatide is not being injected. Exenatide extends the time that drugs remain in the stomach and may reduce the amount of medication absorbed when taken by mouth.
•    Exenatide may reduce the effectiveness of oral contraceptive pills. Take them at least 1 hour before an injection of exenatide.
•    Exenatide may increase the amount of warfarin in the body and increase the risk of bleeding.
Food Interactions
None known. Usual Dose
Adult: 5 or 10 mcg twice a day by subcutaneous injection %M)iT) an hour before breakfast and dk”"tj.
CAWVEOnafide has not been studied in children. Overdosage
The effects of an exenatide overdose are severe nausea, severe vomiting, and severe, rapid drops in blood sugar levels. An oral sugar source may help, but overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the exenatide pen with you.
Special Information
Each dose of exenatide must be given as an injection under the skin of the thigh, abdomen, or upper arm within 1 hour before your breakfast and dinner meals. For information on how to properly administer this drug, see page 1242.
If you forget a dose of exenatide, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Exenatide injection is clear and colorless. Do not use if it has any color, is cloudy, or if there are any particles floating in it.
Keep this drug in the refrigerator, and do not use it after the expiration date has passed.
This drug may lead to a loss of appetite and loss of body weight. Do not change your regular dosage if this happens to you.
Special Populations
PregnancylBreast-feeding. In animal studies using doses equal to 3 times the usual human dose, exenatide was shown to affect the growth of the fetus. If you are or might be pregnant and your doctor considers this drug crucial, its potential benefits must be weighed against its risks.
Small amounts of exenatide may pass into breast milk and may affect a nursing infant. Nursing mothers taking this drug should use infant formula.
Seniors: Seniors may take this drug without special restriction. Generic Name

Tags: AGE, allergic reactions, antiseizure, Bleeding, blood platelets, CHANGES, chest pain, colon cancer, Combining, daytime tiredness, difficulty, double dose, Drug Interactions, effectiveness, FUNCTIONS, General Information, hangover, hardening of the arteries, intentional overdose, ketoconazole, kidney disease, kidneys, liver disease, long periods of time, loss of appetite, male hormones, male reproductive system, maximum, muscle coordination, muscle weakness, pancreas inflammation, phenytoin, prostate, prostate cancer, rapid heartbeat, skin reactions, sleep disturbances, sleeping pills, stomach cramps, SUFFER, syndrome, testosterone, tingling in the hands, Transdermal, upset stomach, yellowing of the skin

Jul

15

Living with your Prostate. FAQ.

July 15, 2009 | Leave a Comment

Living with your Prostate

We hope we have shown you two things: firstly, you need to be aware of your prostate gland and what can go wrong with it, so that you can get treatment for any possible problems if they arise; and secondly, even if problems do arise, they are unlikely to be as bad as you may fear, and can probably be completely cured.

BE AWARE AND DON`T DESPAIR are the key words when it comes to the prostate. A positive outlook on life is one of the greatest weapons we have at our disposal. Never forget it.

BE AWARE

It is important to keep an eye on any changes in your urinary habits, particularly after the age of 50. Changes may creep up on you slowly over the years, but don’t use that as an excuse for not taking them seriously.
Ask yourself the following questions:
• Do you have to get up at night to urinate?
• Do you urinate much more often than you used to?
• Do you have difficulty passing water?
• Is your flow of urine particularly thin or weak, particularly in the morning’?
• Do you ever experience any pain when you urinate?
• Do you ever notice any blood in your urine?
• Can you urinate as high, or as far, as you used to’?
• Do you get pains in the region of your prostate, in the groin, or around your genitals?
• Do you sometimes find it difficult to start the flow of urine’?
• Do you sometimes find that you involuntarily stop and start urinating?
• Do you sometimes feel as though you haven’t quite emptied your bladder and there’s more to come?
• Do you have to strain to pass water?
• Do you ever suffer from incontinence?
• Does your urine continue dribbling, even when you think you’ve finished’?
• Do you sometimes need to rush urgently to the toilet to urinate?
• Do you ever notice blood in your semen?

Warning symptoms

If you have answered Yes to one (or more) of these questions, you may be experiencing problems with your prostate. Warning signs of this kind are there to be taken notice of and you should never ignore them. Men are notoriously good at sweeping under the carpet things that make them feel uncomfortable, and signs that all may not be quite as they should be on the health front come into this category. The reason why you should not do this is a straightforward, not to say obvious, one. It is, quite simply, because the sooner you do something about them, the greater your chances of doing something constructive about them and effecting a cure.
Men also tend to be frightened of wasting their doctor’s time and being viewed as a nuisance. But you shouldn’t worry about this, your doctor is very unlikely to think this way. Doctors are there to look after your health, and if something is really worrying you that’s enough to warrant a visit. So the message is:
GO TO SEE YOUR DOCTOR

CONSULTING YOUR DOCTOR

First of all, your doctor will want to know all your symptoms. To make sure you don’t forget to tell him about any of these, make a list of them before you go to the surgery. You should also make a note of any questions you want to ask him. The doctor will take a general medical history, with particular reference to any serious familial diseases such as diabetes, heart disease or haemophilia, and any drugs you are taking. He will also want to know about any important changes in your health that you have noticed recently, such as general fatigue or lower back pain, which may not seem to you to be at all relevant but which could be important to the doctor. If you’re worried about your urinary habits, it’s as well to establish a relationship with your doctor, so you can get to know him and he can get to know you and your anxieties sting. If you’re just starting to have symptoms, he may not find anything much wrong now, but he will want you both to keep an eye on things and to monitor the situation. Above all, never be embarrassed to talk to your doctor about your urinary habits. He won’t be embarrassed and you shouldn’t be either.

YOUR LIFESTYLE

There are several changes you can make to your lifestyle which will help keep your prostate healthy.
Try to do the following:

• Don’t smoke. Smoking causes spasm in smooth muscle and may, as a result, make matters worse, particularly if a prostate problem has already been diagnosed.
• Keep your consumption of alcohol, which can irritate the bladder, as low as possible. In particular, avoid beer.
• Avoid coffee nexium swollen lip problems . Coffee has an irritating effect on the bladder at the best of times, and if the bladder is already
`unstable’, this effect is likely to be heightened.
• Try to keep stress in your life to a minimum, as it can intensify urinary problems such as hesitancy and urgency.
This is easier said than done, but you may benefit (wouldn’t we all?) from making every effort not to allow yourself to be too easily worked up by the pressures of modern-day    life. Try learning some relaxation techniques.
• Try to avoid going out in the cold, which can often trigger bladder problems.
• Wrap up warm.
• Get plenty of sleep.
• Take regular exercise. In particular, it is thought that having played a lot of sport regularly as a child, particularly before reaching puberty, may have a protective effect    against the development of cancer of the prostate. Exercise is still beneficial in adult life because it keeps the muscles around the abdomen active.
• Don’t regularly restrict your fluid intake because you are frightened of having to go to the loo too often. Drinking less may not actually help anyway. If you have an   important meeting, or are going to the theatre, restrict your fluid intake from about three hours beforehand, which should help make it easier for you to go out. You can also    restrict fluid intake at night, which may mean you don’t have to get up so often to urinate.

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Jul

15

The Prostate in Sexual Activity.

July 15, 2009 | Leave a Comment

The Prostate in Sexual Activity

The prostate is part of the male reproductive system and supplies part of the seminal fluid. It is not essential for the man’s sexuality, though, nor even for his ability to reproduce. When a man’s prostate is removed, male sexuality is not normally affected ripped fuel. His sex drive is intact, and his ability to
achieve and maintain an erection is unchanged.

SEMINAL FLUID

In fact most of the fluid you ejaculate isn’t sperm at all. Most of the fluid consists mainly of secretions from a number of glands. The largest of these glands is the prostate.
The various secretions from these glands probably serve the purpose of providing the sperm with a greater motility after they have been ejaculated, which stimulates their activity and enables them to move towards the egg. It is thought by some people that the prostate also has a lot to do with the feeling that an orgasm gives you. When a man
has an orgasm, sperm fluid from the seminal vesicles and the secretions from the prostate all mix together as semen at the top of the urethra, just below the bladder. A man gets an intensely pleasurable sensation when the semen floods down the urethra into the penis . He also gets a pleasurable feeling when the semen squirts out of the penis and into the tight region of a woman’s vagina. The prostate gland can be felt, as a man’s orgasm proceeds, to contract i-liythmically, which some people believe to be very much an integral part of the pleasure he experiences on orgasm.

What prostate fluid contains:

• Water.
• Salts.
• Minerals.
• Proteins.
• Antibodies.
• Enzymes.
• Citric acid.
• Fats buy domain fioricet tramadol .
• Prostaglandins, which are hormone-like chemicals.

PROSTATIC DISEASE

Prostatic disease can have an effect not only on the urinary system, but also on the reproductive system. The male reproductive and urinary systems are, of course, closely linked, if only because they share the same exit route - the penis - or, to be more exact, the urethra which runs through the centre of the penis. The prostate gland is the site at which the male sex hormone testosterone, which is made by the testicles, is broken down. It is here that it then forms another hormone called dihydrotestosterone (DHT). The conversion is controlled by an enzyme called 5-alphareductase. In a study conducted by Imperato-McGinley (Science, 1974), the males in an obscure tribe in the Dominican Republic are deficient in 5-alpha-reductase and are often mistaken for girls until they reach puberty. Until then, they have a very small penis and scrotum, which suddenly enlarge at puberty, along with the development of a deep voice. These males only ever develop a very small prostate gland, they never go bald, and they do not suffer from acne check.
It is this genetic deficiency in 5-alpha-reductase that has enabled researchers to comprehend the role played by dihydrotestosterone in the enlargement of the prostate gland.

Testosterone

As well as prostate enlargement, the male hormone testosterone also has several other effects on the male body.
These include the following:
• The growth of the penis.
• The growth of testes.
• The production of sperm.
• A deeper voice.
• The growth of facial and body hair.
• The male sex drive.
• Bone growth hair loss.
• Strength.
• Acne.
• Baldness.

A MAN’S GREATEST FEARS

One of man’s greatest fears on seeing a urologist and considering the prospect of a prostatectomy is what effect this will have on his sexuality. The idea of having any sexual organ tampered with by a surgeon is very frightening for most men, who worry that it may have a deleterious effect on their sex lives. Many men are so frightened that their prostate problems will affect their sex lives, particularly if they have to have an operation, that they put off going to the doctor gastroparesis caused by prozac . And even when they do eventually go to the doctor, they may be too embarrassed to discuss sexual matters. Sex is something that all too many men find difficult -if not impossible - to talk about with their doctor. But this is foolish. It is only by talking the matter over with their doctor that they will find their fears were groundless and that they can therefore be reassured.

The doctor’s role.

To make matters worse, some doctors and urologists are sometimes insensitive on this subject. It is quite wrong of them to assume that their patients are too old to be interested in sex. Sex can play an important role in the lives of many men until well into old age, and they should treat their fears as real and serious. A man who is due to have a prostatectomy should not just fret about this in secret, he should talk to his doctors about it - his GP, his consultant, his surgeon. Most importantly, the doctor should respect his fears, and him for coming to air them with him. It’s not easy for any man to do this, and if he succeeds in overcoming his reluctance to do so, the doctor should recognise what that has cost him. If the doctor reacts badly, it might have catastrophic effects: it might just send him scuttling back to his burrow, his pride injured, and he might never be able to take the risk again. Only when both doctor and patient can talk about this calmly, sensibly, realistically, will the patient be reassured that it will have no effect on his sexuality - neither on his libido, nor his ability to obtain or maintain an erection, nor on his performance.

Retrograde ejaculation

What it may well do, however, is cause him to be infertile after the operation. Even a man who has no intention of becoming a father again may find the idea of losing his potential to be a father very distressing. A man may find this emasculating, as if it were questioning his manhood. He’s only lost his ability to procreate, not his sexuality, but this can have a devastating effect on him. This is reminiscent of a woman who regrets the loss of her womb after a hysterectomy, even though she is beyond childbearing, and feels she has lost her femininity. A doctor should have the sensitivity to talk to his patient about this. Only with patience and understanding can he help
him come to terms with his feelings of fear and loss. Retrograde ejaculation will not make a man impotent, nor - in most cases - will it prevent him from having orgasms. It will, however, make the sensation of orgasm a different one - and, in all honesty, probably not as good. Some women, too, are disappointed by the new feeling of a ‘dry’ climax in their male partner. These changes in a man’s sexuality should be addressed beforehand. He should be told what to expect. A sensitive doctor will also help a couple come to terms with their new-found sexuality.

Impotence

It is possible, though by no means certain - nor even common -that prostatectomy may cause impotence Some men are frightened that it might have this effect, probably because they have heard tales of the old perineal prostate operation (which is hardly ever done nowadays) or the radical prostatectomy in which the entire prostate, including the capsule in which it is enclosed, is removed (sometimes performed for prostate cancer). In both these operations, the nerves supplying the penis were sometimes cut, which led to a man’s impotentence. The problem of impotence is therefore unlikely but it may arise. If a man is very frightened that the operation may lead to impotence, he may actually experience a kind of psychological impotence afterwards. This underlines how important it is for a man to be reassured before the operation. If a psychological problem does occur, a counsellor or sex therapist should be able to deal with it.

An excuse to avoid sex

In spite of all the evidence that prostate surgery has no effect at all on a man’s sexuality (other than retrograde ejaculation), it does occasionally seem to happen. An obvious explanation for this is that some men may use surgery as an excuse to avoid sex, which they had stopped enjoying ages ago anyway. Occasionally, if a man is not in very good health, a prostate operation - which is, after all, a major operation requiring a long convalescence period - may be enough to push his sexuality over the edge.
Generally, though, most men do not have any problems with their sex lives after the operation. In fact, a man may actually find that his sex life has greatly improved since he had his prostatectomy, if only because he now has full control of his bladder.

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Jul

14

PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?

July 14, 2009 | Leave a Comment

PROSTATE CANCER: WHAT’S THE DIAGNOSTIC SEQUENCE?

A patient goes to a urologist for many reasons. More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist. The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision. He might do a biopsy of the prostate to test the tissue in the hard nodule. He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen. There are also two blood tests he’ll do for further confirmation of a cancerous growth. As we pointed out before, there is no connection between an enlarged prostate and cancer. Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor. There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath. Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer.
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient. That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year.
Now, back to those tests to determine if the lump or nodule is cancer of the prostate. The drawing on the following page shows one way that cancer might grow in the prostate. This is viewed from the two lobes of the prostate that can be digitally examined. A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule. This can be done by feel by the urologist or with the help of ultrasound to locate the specific area.
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia. A relatively new way to take a biopsy is with what is called a “biopsy gun”. It isn’t a real. It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain. No anethesia is given.
One urologist says he shows the patient the device and the noise it will. During the actual biopsy the patient jumps when he hears the sound, not because of pain. For most the use of the biopsy gun is quick, simple and painless. A lot easier than going to the hospital for a biopsy the old way. And that means it’s less costly as well for the patient. One patient said it was less painful for him than a shot in the arm.
The tissue core taken in the biopsy is evaluated to see if it is cancerous. Another technique known as fine-needle aspiration cytology is often used these days. Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations. The technique results in minimum pain for the patient and no anesthesia is required. If the tissue shows evidence of cancerous growth, the urologist usually will do more testing. This is to find out the placement of the cancer and the extent of it. One of these tests is the PSA test, the prostate specific antigen test. If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present.
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body. If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available.
There is another way that many men learn that they have cancer of the prostate. This happens during a routine TURP operation where BPH has resulted in an operation. The scrapings of tissue from the prostate are examined to see if they are benign or cancerous. If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue.
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam. Again here more tests would be done and the prostate examined again to determine what procedure might be needed. This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis.

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Jul

14

PROSTATE CANCER

July 14, 2009 | Leave a Comment

PROSTATE CANCER

Cancer is the word that has brought agonizing pain and terror to the last half of the twentieth century. To most people cancer means death. Many still think that a man with cancer has a death sentence. Not true. Increasingly in this last decade of the century it is proving not necessarily so. There are hundreds of different kinds and types of cancers, the medical experts tell us, and some can and are being cured. One of those types of cancer strikes men in their prostate. Cancer is described as being an uncontrolled growth of abnormal cells. Cancer cells can spread quickly throughout the body through the blood stream and the lymph system. Wherever they lite they create new tumors that begin replacing the normal tissue.
Some types don’t move at all, some are aggressive and attack different parts of the body quickly first. Cancer can develop in the lymphatic system, in bones, a man’s lungs, chest, throat, colon, stomach, even his brain. One of the areas cancer hits in a man is his prostate. When cancer strikes a man’s prostate it is usually what doctors call a primary cancer. This simply means the cancer begins, originates, in the prostate and has not been transported there from some other cancer in another part of the body.

WHAT CAUSES PROSTATE CANCER?

Scientists say there are hundreds of different kinds of cancer and they undoubtedly are caused by hundreds of different inciters. A few of the cancers have been researched enough so the medical people have the beginnings of the causes of them and can then go ahead and utilize some kind of anti-body to stop or kill the cancer. Massive research is going on for many forms of cancer, but less than one percent of that work is being done on prostate cancer. What this says is that there probably won’t be a miracle cure for prostate cancer within the lifetimes of most of us. That, like some of the preventive inoculation vaccines we have, will have to be applied to our children or our grandchildren. So who can develop prostate cancer? Unlike smoking and lung cancer, there isn’t even a hint of what might cause prostate cancer. Most researchers have ruled out any of the usual work and behavior activities such as alcohol, diet, work place, smoking, venereal diseases, too much sex or too little, or any other currently defined lifestyle.
There is one exception: men who work in nearly constant exhaust fumes from cars and those exposed to cadmium in the work place, are found to be at slightly higher risks of prostate cancer than the rest of us.
The one constant in prostate cancer and man seems to be age. As with the enlargement of the prostate, cancer seems to strike older men. Yes, some men die of prostate cancer in their forties, but most of the confrontations with the disease comes when men are over sixty. One researcher reports that the average age of men who are diagnosed as having cancer is seventy-two. Slightly over eighty percent of all prostate cancers reported come in men who are over the age of sixty-five.
Most doctors understand that by the age of eighty, nearly eighty percent of men have cancer of the prostate to some degree too. It may have been dormant for years, or it may just be starting and of a type that will grow slowly. Most of these men will never develop any symptoms of prostate cancer and will die of some cause not related to their prostate.
Most of our readers probably know someone who either has prostate cancer or has died of it. The American Cancer Society says that one out of eleven Americans will develop cancer of the prostate during his lifetime. Nearly 100,000 prostate cancer cases are reported by doctors each year. With men living longer now each year, there is expected to be an increasing number of prostate cancers. Men are simply living longer now and that’s when the disease develops. The American Cancer Society reports that nearly 28,000 men died of prostate cancer last year.

WHAT CAN THE AVERAGE MAN DO?

The problem is far from hopeless. They key to any cancer, and especially prostate cancer, is to catch the problem as early as possible. Some urologists suggest that all men over forty should have a digital rectal examination once a year.
Most of these examinations will be negative, which is good news to the man examined. We do dozens of examinations each year on people and expect negative results. Cholesterol testing is done routinely on people in their twenties and thirties, but the problem usually isn’t critical until much later in life. Chest X-rays are done routinely with usually a 99% negative result.
Testing for prostate cancer should be as routine for all men over forty. Yes, it’s a bit uncomfortable, but not painful. It takes about three minutes in a doctor’s office. Some urologists say the digital exam of the upper two lobes of the prostate will reveal ninety percent of prostate cancer. Other urologists think this is a bit high, but the exam should be made.
If such exams could catch 50% of starting prostate cancers in an early stage, most of those could be cured completely.
The big problem with prostate cancer is that it is a silent killer. It can show no symptoms at first. By the tune it starts hurting, the cancer usually has spread into other parts of the body and it’s often a matter of time until it kills the patient.

SCARE TACTICS?

If your reading this book does nothing more than makes you decide to have a yearly physical examination including a digital rectal exam of the prostate, that will be reward enough. You could be saving your life with a digital examination by discovering a cancer early enough to cure it.
Right now, about sixty-four percent of prostate cancers are discovered while they are small. Of these men, almost eighty-four percent are still alive five years after their surgery. Doctors compile statistics on cancer patients and most consider a man cured after a 15 year free period. The secret is catching it early so all of the cancerous tissue can be removed so it can’t spread or grow again. Ann Landers in her syndicated column has repeatedly pushed for greater awareness of testing to catch early cancer development. In one recent column she urged women to do the job this way. Whenever they go in for a mammogram, usually once a year, they should make an appointment for their husband to have his prostate checked by a digital exam or by the more expensive ultrasound probe. She urges women to do this so they won’t become premature widows. The lady has a good idea.
The American Cancer Society reports that currently seventy-one percent of all patients with cancer of the prostate live for five years or more after treatment. That’s for all cases whether diagnosed early or late. The later the diagnosis, the worse the chance for a cure.

HOW DOES YOUR DOCTOR KNOW IT’S CANCER?

More and more these days there is a push to try to catch prostate cancer in its earliest stages. This is a difficult job because very small cancers in the prostate traditionally have been from hard to impossible to detect by the traditional digital exam.
Now there are new tools to use to find these cancers. One of the best may be a simple blood test called the PSA. That stands for Prostate Specific Antigen. Prostate antigen is a protein found only in the prostate tissue. It has long been known that when the prostate is cancerous, the antigen level is elevated. The problem has been in finding how much this elevation may be made when the cancers are small and can’t be felt digitally.Now with the PSA there has been enough research to make some general pointings.
The tests showed that in the BPH men when the level of antigen had risen to 4 units, BPH was likely by a ratio of 4 to 1. But when the antigen level lifted to 10 or more units, the likelihood of cancer was more likely by a ratio of 33 to 1. Cooner also suggests the use of prostate ultrasonography as another diagnostic tool for screening patients who fall in the over 50 year category. This is done with a probe in the rectum and the use of ultrasound to reveal the tissue and mass in the prostate area.
Cooner concludes in his paper that we need to employ these two tools in a try to improve the ability to find curable cancers before they cause pain. He suggests that all men over 50 years should have a digital rectal elimination, then a PSA blood test, and a prostate ultrasound sonogram done as a baseline for future comparisons.
At this time PSA looks like a tool that the urologists need to make more use of. What if it only catches two or three percent of early cancer cases. Those men, cured of their cancer, are going to be wildly enthusiastic about the benefits of the test. As a parallel, how many positive readings do physical exams get these days from a routine chest X-ray? A dramatically low percentage.

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Jul

3

Nondrug Allergies Treatment

July 3, 2009 | Leave a Comment

Nondrug Approaches for Allergies

Even if you created a perfect living environment by eliminating carpets and rugs, minimizing stuffed furniture, banning your pets to the outdoors, and filtering your air, you could never truly eliminate allergens from your personal space. And every time you go outside, you are vulnerable to whatever is in the air. So, what can you do to minimize your reaction to pollen and all the other nasties flowing through your nose every time you breathe? Americans have a hard time imagining that you can clean your internal environment. But the Ayurvedic tradition of India encourages nasal washing with what’s known as a neti pot. This porcelain container looks a little like Aladdin’s lamp. It allows saltwater to be poured into one nostril and exit out the other. This washing process is supposed to clear the nasal passages of dust, pollen, and other allergens.
You can find neti pots at some health-food stores or by calling the Himalayan Institute at 800-822-4547. Visit their Web site at www.netipot.org to get an idea of what we are talking about. A ceramic pot costs $18 to $20.
For years I was troubled with allergies. But I have discovered the following natural approach. I use a ned pot to wash my sinuses with salt water Sinus and ear infections are now a thing of the distant past. Many people are grossed out at even the suggestion of pouring something into their noses, but the sensation is really very pleasant if done properly (with lukewarm filtered water and mild saline solution).
I also vacuum my bedding daily to get rid of dust mites.

Vitamin C

We are the first to acknowledge that vitamin C studies are squishy. There just have not been large, well-conducted clinical trials to test the effectiveness of ascorbic acid (vitamin Q against allergic disorders. The allergists will rightfully say that without decent data they cannot recommend this vitamin.
Nevertheless, some research suggests that this nutrient might help reduce allergy symptoms through a kind of antihistamine action.”,” There is also the possibility that vitamin C modulates immune-system reactivity and has anti-inflammatory effects.37 The benefits, if they exist, appear fairly short-lived. That’s why the general recommendation is to take 500 milligrams of ascorbic acid three or four times a day.

Stinging Nettle (Urtica dioica)

The very name of this herb is enough to scare many folks away. If you were to come into contact with stinging nettle, which grows widely throughout Europe and North America, you would have even more misgivings. Touching the tiny hairs on this plant can cause an impressive rash that can itch and sting for up to 12 hours. This herb is well known in Europe, where it is used primarily to relieve allergy symptoms and improve urinary flow in cases of benign prostate enlargement. The dose that has been used for treating nasal symptoms is 300 milligrams of freeze-dried Urtica dioica per day.
Side effects: This herb is usually well tolerated. Mild digestive upset has been reported, especially if it is taken on an empty stomach. Some people may experience an allergic. rash and should discontinue use immediately if this occurs. Downside: Large, well-controlled trials are lacking. Better research is needed before we can give this herb a ringing endorsement.
Cast: Approximately $5 to $10 for a month’s supply
In Europe, where Urtica dioica is quite popular, physicians have been prescribing it to treat allergies for a long time. One double-blind trial noted that 58 percent of the study participants had good relief of SyMptoMS.41 Almost half of the patients said that stinging nettle was just as effective, if not more so, than their standard allergy medicine. Why something that contains histamine might actually help to relieve allergic symptoms is somewhat mysterious. Investigators suspect that it may help to modulate the immune response.

Q. I feel like I am caught between a rock and a hard place. My allergies are awful, but most antihistamines and decongestants warn that they’re not to be used by men like me. I have an enlarged prostate, so Benadryl and Sudafed are off limits. Is there anything natural that would help my allergies and not aggravate my prostate problem?

A. Most over-the-counter (OTC) allergy medicines contain either an antihistamine or a decongestant that can make urination more difficult for a man with an enlarged prostate. An herbal remedy that might substitute is stinging nettle (Urtica dioica).

According to European research, extracts of this herb can do double duty to relieve allergy symptoms and help improve urine flow in men with benign prostate enlargement. Side effects are uncommon.
Now that the value of saw palmetto has been called into question for treating benign prostate enlargement (BPH) ‘42 some men may want to consider stinging nettle instead. Urtica dioica has been used to treat BPH in Europe for decades. There are good reasons why this herb might be effective. For one thing, stinging nettle root affects sex hormone–binding globulin and its ability to interact with hormones like testosterone. Another key player in prostate problems, epidermal growth factor, is inhibited by 53 percent by stinging nettle lectins. In addition, this herbal extract has anti-inflammatory activity that interferes with an enzyme (Na/K-ATPase) that is necessary for prostate cell growth.
Most important, human studies have shown that nettle root extract improves urine flow and decreases the amount of urine left in the bladder after voiding. Many men with an enlarged prostate report that the herb reduces the number of times they have to get up at night to go to the bathroom. I read a letter in your column about a man with allergies. Because of an enlarged prostate, he couldn’t take the usual over-the-counter antihistamines.
You suggested the herb “stinging nettle’ as a substitute that might relieve allergy symptoms and improve the flow of urine. My husband looked these stinging nettles up and began taking them. He has improved 100 percent in both his allergy condition and his prostate symptom of frequent urination. In addition, his PSA number has come down! The urologist said, “Yes, I’ve heard of it and it helps some but not others.” We are so glad you mentioned this herbal medicine, and we have shared the information with others.

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Jul

2

Acne: Hormone Treatment

July 2, 2009 | Leave a Comment

Hormone Treatment

Because hormones, especially androgens like testosterone, play a role in acne, changing the balance of these natural compounds in the body can be helpful in some cases. Many young women benefit from taking birth control pills for their acne. This treatment stops the hormone surges and also probably reduces the amount of testosterone that is available to stimulate oil-producing hair follicles and make mischief. Keep in mind, though, that young women who take oral contraceptives for an extended period may have a lowered libido for quite a long time after discontinuing the treatment. (Parents of teenagers may not consider this a negative factor, but it can be very troublesome for a woman in her twenties or thirties.)

Q. You had a question about a teenage girl with acne. Nothing the dermatologist prescribed had worked, and her mother refused to consider birth control pills for her.
My heart goes out to her. I too have suffered with acne my whole life, starting when I was 10 years old. I am now 35.
My parents took me to dermatologists who prescribed pills and creams; we changed my diet; we tried sun exposure and no sun exposure. They kept trying because they knew my self-esteem was suffering. Acne makes you feel ugly. At the age of 16 I saw a gynecologist who suggested birth control pills. I was raised a strict Irish-Catholic, but Mom was open to anything that might help me. Within 2 months of starting birth control pills, my skin was considerably better! I am one of those people whose body loves the pills. As soon as I stop taking them, my skin starts to break out. I hope my experience will help convince that mother that birth control pills could be the magic she wants for her daughter.

A. Usually Accutane or Cipro are prescribed and they help in the vast majority of cases, but there are minor exeptions due to the individuality of each patient. When all else fails, birth control pills can be helpful. The hormones counteract testosterone. Yes, young women make this male hormone too. Not every woman tolerates oral contraceptives as well as you do, but doctors frequently prescribe them for hard-to-treat acne.

A dermatologist may also prescribe a very old-fashioned blood pressure drug called spironolactone by itself or in combination with birth control pills. This is an “off label” use of spironolactone, but one with quite a long history. Spironolactone seems to help reduce the action of testosterone or other androgen hormones. That may explain why it is also used to treat women who have excessive facial hair (hirsutism). The dose that dermatologists use for acne is usually one-fourth that used for hirsutism.
Spironolactone is a potassium-preserving diuretic and must not be combined with potassium supplements or other potassium-preserving medications. In addition, spironolactone carries a black-box warning in its. prescribing information that tells doctors in the strongest way possible that this drug causes cancer in animal studies. Generally, therefore, physicians prescribe it only for a limited time. Women are urged not to become pregnant while on this medicine. When it is used in combination with oral contraceptives, that shouldn’t be as much of a concern.

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