Know this about screening for prostate cancer

Dr. Joseph Sonstein

Dr. Joseph Sonstein

A hot topic in the news this year has been prostate cancer screening and the associated PSA (prostate specific antigen) test. There have been multiple recommendations from multiple sources in the past year or two, and it can be quite confusing to the public as to what to do. And there is controversy.

But as a urologist, I see men with prostate cancer or elevated PSA every day, and I feel that the newly released guidelines by the American Urological Association can help to address some of these controversies.

Since the late 1980s, the PSA test has been used to screen men for prostate cancer. Since that time, we have seen a steady decrease in the death rate from the disease, in part because the PSA test allowed us to find the cancer early enough to treat it. But last year, the U.S. Preventive Services Task Force recommended a wholesale abandonment of prostate cancer screening in men with no symptoms. Continue reading

Our Bodies, Our Lives – Pregnancy brain: Is it fact or fiction?

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and Catherine Hansen

Our Bodies, Our Lives

I know I opened my calendar to add something to it … but what was it?” An exhausted and exasperated Julia, who is 7 months pregnant, finds that words escape her, and on occasion, she heads into a room only to forget what she is looking for. Is this “pregnancy brain” — also called momnesia or pregnesia?

Women, and men, often joke about the memory lapses caused by pregnancy. But is it true? What are the changes that take place? Are the changes all bad?

First of all, we can assure you that there are some very real changes that occur in the brain during pregnancy. Hormone levels of estrogen and progesterone (hormones produced by a woman’s ovaries) increase 30 to 70 fold. The brain is responsive to hormonal changes. But do these hormones alter cognition? Continue reading

Home cooking and family time

Drs. Victor & Michelle Sierpina

Drs. Victor & Michelle Sierpina

In his recent book, “Cooked,” food author Michael Pollan laments the passing of home cooking.

He notes that this has paralleled the rise in obesity rates as we paradoxically spend less time cooking, eating together, and grab more fast food to eat on the run and alone.

I marveled watching a man gobbling down some kind of cheesy pasta dish while standing up in a moving train at the Denver Airport. Is that really all food is, fuel? Can eating like that really be healthy?

Pollan notes that the fast food culture had undermined the institution of the shared meal.

“The shared meal is no small thing. It is a foundation of family life, the place where our children learn the art of conversation and acquire the habits of civilization: sharing, listening, taking turns, navigating differences, arguing without offending. “ Continue reading

Healthy Grilling: Barbecue can be good for you

Drs. Victor & Michelle Sierpina

Drs. Victor & Michelle Sierpina

Down here in Texas, barbecue is pretty much a religious ritual. You name it, from shrimp and seafood to the basic beef, pork, chicken and game meat, there is rarely a person who doesn’t love the smoky smells, social conviviality, and opportunity for creative cookery that grilling brings.

We love to soak wood chips, mesquite, cherry, apple or hickory and put them in a tray inside our gas-fired grill. The smoke smells so nice we usually open the screen to let it blow into the house for a “barbecue incense” experience!

Grilling is a fun, inexpensive form of home cooking, keeps the house cooler in the summer than cooking indoors, and can be a great time with family and friends. Sometimes, these intangible benefits are more important to our health and well-being than any other factor related to the foods themselves. Happiness and joy are good for our health. Continue reading

Hormone replacement therapy — not so scary after all

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and Catherine Hansen

For menopausal women who have symptoms related to a lack of estrogen such as hot flashes, night sweats and vaginal dryness, hormone replacement therapy can offer great relief.

A decade ago when the Women’s Health Initiative famously announced that menopausal women who took hormones had higher rates of coronary heart disease, stroke, blood clot formation and breast cancer, women abandoned their hormones in droves. But now, newer research has shown that wholesale elimination of hormone therapy for all menopausal women may not make sense.

All women taking any type of hormone need to be aware there can be risks. Even custom-compounded or bio-identical hormones function in basically the same way that traditional hormones do on hormone-sensitive tissues within the body.

Despite the fear and terror experienced by patients and physicians alike after the WHI announcement about the dangers of traditional hormone replacement therapy, more recent information and re-analysis of the data has revealed that it is not really so dangerous after all — at least for some women. Continue reading

Surviving cancer… then what?

Drs. Victor & Michelle Sierpina

Drs. Victor & Michelle Sierpina

The good news is that the numbers of people who have survived cancer is estimated to be more than 13 million in the U.S. alone.

 This is because of improved surgical and medical therapies, advanced radiation treatment and increasingly sophisticated imaging, genetic and molecular testing.

Early detection, screening, as well as increased understanding of how lifestyle factors can prevent and contribute to cancer prevention and survival also serve to prolong life after cancer.

Likely, most of you reading this either have a friend or family member who overcame cancer or you experienced a personal encounter with cancer.

The question is how are future health care needs met for these survivors? Once a patient has been diagnosed with cancer, the primary care physician’s role moves immediately to the background.

This can be true not only during active cancer therapy but also in the post-treatment period of surveillance.

After cancer therapy, patients may have a variety of residual issues like decreased function in the kidneys, heart, lungs or other organs.

The patient may also suffer from fatigue, pain, nausea, hypertension, gastrointestinal problems, bone and joint problems.

Some of these problems are best managed by cancer experts, but many may also fall into the realm of the primary care physician — the PCP. Continue reading

In search of ‘natural’ hormone replacement therapy

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and Catherine Hansen

Our Bodies, Our Lives

For women going through menopause, current popular advice about the safety of different kinds of hormone replacement therapies can be confusing.

It’s important that every woman trying to make a decision about hormone replacement find a knowledgeable health-care provider with whom to discuss this important issue.

Your menopause is yours. Don’t let entrepreneurs and celebrities determine what you put into or onto your body.

Historically, women have used hormonal therapies long before they even lived long enough to experience menopause. Thinking that it would promote youthfulness and vigor, women used preparations made from female or male urine, crushed tissue or fluid from animal ovaries.

Eventually, commercial preparations became available. The first “bio-identical” hormone, extracted from the urine of pregnant women, was discovered in 1928 by a German chemist, earning him a Nobel Prize. Mass production of hormone medication made from the urine of pregnant mares began in 1942.

Major advancements in hormone production began in the 1950s and 60s, culminating in a new treatment for menopause symptoms — estrogen replacement therapy. Continue reading

Develop a personal plan if still fatigued

Dr. Victor Sierpina

Dr. Victor Sierpina

I took a look at the common medical complaint of fatigue in last week’s column.

Frequent causes of chronic fatigue are poor sleep hygiene, lack of exercise, depression, boredom and lack of motivation.

To those, I would add poor nutrition. Without the essential energy provided by a healthful diet, the body’s cells can’t get the fuel they need to function optimally, resulting in just feeling tired a lot.

Eating sugary, highly refined carbohydrates and saturated fats might give you an energy burst, but it is like a rocket going up, then quickly falling down like a stick.

Without sustained energy provided by whole grains, lean proteins, fruits, vegetables and healthy fats, the body is quickly starved of reliable, steady sources of energy.

It is like a fuel pump in your car that is partially blocked or works on and off. It is hard to get much distance without the right amount or kind of fuel.

If you suffer from chronic fatigue and it doesn’t seem to be from any clear cause, you definitely need to have your physician do a comprehensive history and physical examination including blood work plus other tests as needed.

Fatigue can come from multiple causes and as a result of problems with any organ system. Continue reading

For some men, it’s “T” time – test or no test. Dr. Baillargeon explains.

Prescriptions for testosterone therapy have increased significantly during the last 10 years, according to a study in the current issue of JAMA Internal Medicine conducted by researchers at the University of Texas Medical Branch.

About 50 percent of the men in the study who had received testosterone therapy had been diagnosed as having hypogonadism, a condition where a man is unable to produce the normal levels of testosterone.

But the study also found that, among new users of a prescription androgen product, about 25 percent did not have their testosterone levels tested before starting the treatment.  In addition, it’s unclear what proportion of the 75 percent who were tested had a low level of testosterone.

Dr. Jacques Baillargeon, lead author of the study and an associate professor in preventive medicine and community health at UTMB, said that he believes this is the first national population-based study of testosterone-prescribing patterns.  

(See video of Dr. Baillargeon explaining main findings of the study) Continue reading

One-Third of Women Undergo Unnecessary Breast Biopsy Surgery

By Molly Dannenmaier | UTMB at Galveston

MINIMUM INTRUSION, MAXIMUM RESULTS— Jennifer Thomas, a mammographer at The University of Texas Medical Branch at Galveston, shows the needle used to extract breast tissue in minimally invasive breast biopsies.

Jennifer Thomas, a mammographer at The
University of Texas Medical Branch at Galveston,
shows the needle used to extract breast tissue in
minimally invasive breast biopsies.

Roughly a third of Texas women with a breast lump end up having an old-fashioned surgical biopsy to determine whether the lump is cancerous.

Yet since 2001, the American Society of Breast Surgeons, the American College of Radiology, and the National Cancer Center Network have recommended nonsurgical, minimally invasive biopsies as the first course of action for women with breast lumps or masses. These less invasive methods of sampling breast tissue provide results that are as accurate as surgical biopsies, the organizations say.

“We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of a breast mass,” said Taylor Riall, M.D., associate professor of surgery at the University of Texas Medical Branch at Galveston.

Riall is a lead investigator of new research performed by UTMB researchers and published in the Journal of the American College of Surgeons, which reveals that despite national recommendations, invasive and expensive surgical breast biopsies were the first diagnostic step for 35 percent of Texas women diagnosed with a breast mass between 2000 and 2008. The findings were based on an exhaustive analysis of Texas Medicare data during that six-year period which gleaned information on a total of 87,000 breast biopsies. Continue reading