Archive | December, 2010

Kidney Stone Tutorial

The searing pain associated with the passing of kidney stones is unforgettable.  And what is worse, these stones often reoccur if the condition is not properly treated.  In fact, without treatment, calcium stones recur in 10% of patients within one year of the first attack, and in half of patients within five to seven years.

Several treatments are now available for kidney stones.  Among these modern treatments is Ureteroscopic Stone Removal, or USR.  Uretoscopy is often used for stones located in the middle or lower ureter.  This procedure is minimally invasive and requires little to no time spent in the hospital.  General or regional anesthetic is used with no incision.  The surgeon passes a ureteroscope, which is a small fiberoptic instrument, through the urethra and bladder and into the ureter in order to locate the stones.  Small forceps are then used to remove or grasp the stones, or a laser device is used to break up larger stones.  After the stones have been successfully removed, the surgeon may decide to leave a stent inside the ureter for a few days to help the lining heal.  With this type of procedure, complications are few.  The complication rates range from 5% to 10%, and only 3% of patients experience major problems.  Some common problems may include the inability to break the stones up into small enough pieces.  The removal of these pieces may then require additional surgery or treatment.

Another stone removal procedure is called Cystolithotripsy, or CLT.  CLT is the removal of bladder stones through crushing or destruction of the stones.  The major benefit of CLT is that it is very safe and effective to treat the bladder stones.  Further, no cut in the body is necessary and the patient can be discharged the next morning.

Although modern medicine has developed less invasive treatments, sometimes complications do arise, requiring open surgery.  In Open Stone Surgery, or OSS, incisions through the patient’s abdomen into the kidney or ureter, depending on the location of the stone, are made.  The stone is then removed by the surgeon, and any blockage in the affected area is corrected.  The healing time of OSS is much longer than the other treatments, and the patient may need to stay in the hospital for 4-8 days.  The wound takes about 10-12 days to heal.

Preventative medicine is quickly gaining momentum, especially in America.  In order to prevent kidney stones from occurring or recurring, the most important recommendations are to increase fluid intake, restrict sodium, and reduce protein intake.  Fluids should be mostly pure water, although water with a small amount of lemon juice is allowable.  Your fluid intake should produce at least 2500 mL of urine every day.  Grapefruit, apple, and cranberry juices are to be avoided.  Cranberry juice has actually been found to increase the risk for calcium oxalate and uric acid stones.  Further, cola drinks should be avoided, especially those that contain phosphoric acid as they can severely reduce citrate levels in the urine.  Beer and other alcoholic beverages contain purines, which may increase the risk for uric acid stones; however wine may have properties that protect against kidney stones.

A diet high in salt significantly increases the amount of calcium in the urine.  For this reason, doctors recommend that patients with calcium stones limit their sodium intake to 3 grams or less a day.  Sodium also increases levels of urate, which is a crystalline substance that leads to the formation of calcium oxalate stones.

Doctors recommend that patients with kidney stone problems increase their intake of fiber.  Fiber rich foods such as phytate found in legumes, wheat, and rice bran help protect against kidney stones.

The most common stones are made up of calcium oxalate; however, oxalate-rich foods should not be avoided unless specified by your doctor.  Oxalate binds with calcium in the intestine, reducing calcium absorption.  Further, oxalate-rich foods are very important for good health.  Foods high in oxalic acid include beets, soy, black tea, chocolate, cocoa, dried figs, ground pepper, lamb, lime peel, nuts, parsley, poppy seeds, sorrel, and spinach.  Foods with moderate amounts of oxalates include beans, carrots, celery, roasted coffee beans, raisins, gooseberries, lemon peel, okro, green onions, oranges, green peppers, and sweet potatoes.

Because different types of kidney stones exist, several specific dietary changes may need to be made.  Patients should work with doctors to form an individualized plan.  Consultation with an expert is necessary as unattended stones may lead to more serious problems such as recurrent urinary tract infections, kidney damage, or even kidney failure.

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Diet High in Fish May Decrease Prostate Cancer Mortality

A recent study dispelled the idea that a diet high in fish prevents men from developing prostate cancer.  However, a new review of the medical literature reveals that a fish-filled diet may reduce the risk of dying from the disease.

“In the United States, one in six men will be diagnosed with prostate cancer over their lifetime,” noted Dr. Konrad M. Szymanski of McGill University Health Center in Montreal, one of the study’s authors.  “One in six of these men will die of prostate cancer.  Our study findings suggest that the number of men who die once diagnosed is lowered by more than 50 percent among men eating lots of fish.”

Fish has been known for its many health benefits, including its capabilities of reducing the risk of heart disease and stroke.  But the question of whether or not it could protect against prostate cancer has been “a bit controversial,” explains Szymanski.

Dr. Szymanski and his colleagues investigated 31 studies which involved hundreds of thousands of patients.  The findings are reported in the American Journal of Clinical Nutrition.

Seventeen of the studies compared eating patterns among people with prostate cancer and matched controls without the disease.  The remaining 14 studies followed men over time and compared diets of those who developed prostate cancer to the diets of the men who remained free from the disease.

The investigation found no link between a diet high in fish and men’s risk of developing prostate cancer.  But the team did find that men who ate more fish were 44 percent less likely to develop metastatic prostate cancer, or cancer that has spread beyond the prostate gland.  High fish consumption also was associated with a 63 percent lower risk of dying from prostate cancer.

Because the studies used in Szymanski’s investigation included a number of different measurements of fish intake, the researchers explained that it is impossible to say how much fish one would need to eat in order to get a protective effect.  “All we can say is eating more fish can have some benefit.  How many servings of fish or how many grams needed a day, unfortunately, we cannot say.”

One of the team’s theories suggests that fish may reduce prostate cancer mortality by reducing men’s likelihood of developing metastatic disease.  Fish oils have a natural anti-inflammatory effect that may actually help fight cancer progression.

Previous studies indicate that omega-3 fatty acids in oil fish and fish oil supplements may slow cancer progression by reducing inflammation and by a variety of other mechanisms.  Szymanski’s study did not include fish oil supplements in its analysis.

Findings such as these continue to encourage men to choose fish more often.  Szymanski predicts this could have a major impact on public health.

“Prostate cancer is a very common disease,” he added.  “If we can possibly introduce a relatively cheap and easy-to-implement policy that could have even a small impact on how this disease affects men, we could make a very big impact overall.”

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Hormone Replacement Therapy May Lead to Kidney Stones

New research suggests that women who take hormone replacement after menopause are at increased risk of developing kidney stones.

“It doesn’t mean that women should stop taking hormone therapy based on this fact, but it does need to be taken into account when deciding to take the hormones or not,” explained Dr. Naim M. Maalouf of the University of Texas Southwestern Medical Center in Dallas, one of the study’s authors.

Between 5 to 7 percent of postmenopausal women in the U.S. suffer from kidney stones, noted Maalouf and his colleagues.  In addition to being extremely painful when passed out of the bladder, these stones, if severe and recurrent, may lead to more kidney damage.

Maalouf and his colleagues reviewed data from the Women’s Health Initiative, which is a randomized, controlled trial of hormone therapy for postmenopausal women.  The analysis included 10,700 postmenopausal women who had undergone hysterectomy and were randomly assigned to take estrogen or placebo, and another 16,600 who had not had hysterectomies and were put on either estrogen and progestin or placebo.  The first group was followed for six years and the second group was followed for seven years.

Women in the group who were taking the estrogen-progestin combination were 21 percent more likely to develop kidney stones during the follow-up period.  If the results were adjusted to not include women who stopped taking the medication during the study, the risk was 39 percent greater with these hormones.

The baseline risk for developing kidney stones in women is just 7 percent.  The study’s results indicate a significant increase in kidney stone risk for postmenopausal women when taking hormone therapy.

The propensity for kidney stones is “complex,” note the researchers.  Environmental and genetics do play a part.  Estrogen may also be a player.

White women are at a greater risk of developing kidney stones than women from other ethnicities, explains Maalouf.  In addition, obesity has been associated with an increased tendency to form the stones.  Too much salt or protein may increase kidney stone occurrences.  In order to prevent kidney stones, eat a healthy, balanced diet and drink plenty of fluids.

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Men Fight with their Biological Clock, too!

Most people think of menopause and women when they hear “biological clock.”  True, women experience drastic physical and emotional changes once they enter the menopause stage of life as hormone production significantly decreases.  But men also have a clock that starts winding down around the age of 35.  Around this time, men begin experiencing a decrease in hormone production, a decrease in fertility potential, and even an increase in the risk of genetic problems in children born to men who are older.

The term “mid-life crisis” may be a result of this significant change in a man’s life.  If women undergo a major decrease in hormone production, which leads to noticeable physical changes, then it is not far-fetched to believe that men can go through a similar change.  We know for sure that the slowing of the biological clock in women is due to a drop in estrogen production, causing moodiness, hot flashes, loss of sexual interest, osteoporosis, and the cessation of menstruation.  Why can’t a drop in testosterone levels in men cause symptoms as well?

Nearly six to ten million men suffer from male hormone deficiency.  Most of these men have extremely low testosterone levels in their bloodstream.  And only one out of six of those affected will actually seek and receive treatment to resolve the problem.

Modern families are beginning to develop at much later ages in life than in previous decades.  Now, men and women are waiting until their education is complete and they are financially stable.  Due to this wait, the number of children born to fathers older than 35 has dramatically increased in the past few decades.  Yet men experience a decrease in fertility as they age, making it longer and more difficult to achieve pregnancy.  In fact, the likelihood of taking over a year to conceive doubles when the man is over 35.

Further, the quality, both genetically and physically, of an older man’s sperm is lower.  According to the Centers for Disease Control and Prevention, the number of babies born to parents older than age 35 more than doubled from 1970 to 1999, from 6 percent to 13 percent.  With this trend we have seen a significant rise in the rates of infertility, the number of miscarriages, and the number of babies born with Down Syndrome (as well as other genetic abnormalities).

Andropause, or male menopause, is not as clearly defined for men as it is for women.  Common complaints due to the decrease in testosterone production in aging men include diminished sexual drive, difficulty in getting or maintaining an erection, lack of energy, irritability and grumpiness.  Men may also experience a reduction in height, which is caused by bone loss and osteoporosis.

Experiencing any or all of these symptoms does not necessarily mean you have a testosterone deficiency.  A physician must be consulted and evaluations including blood tests and questionnaires may be given.  These allow physicians to rule out other diseases such as depression or diabetes, which also may affect testosterone levels.

The questionnaire often used is the Androgen Deficiency in the Aging Male, or ADAM.  This questionnaire asks you to assess the following symptoms:

  1. Decrease in sex drive
  2. Lack of energy
  3. Decrease in strength and/or endurance
  4. Loss of height
  5. Decrease of “enjoyment of life”
  6. Sad and/or grumpy feelings
  7. Increase in number of weak erections
  8. Deterioration in sports ability
  9. Falling asleep after dinner
  10. Decrease in work performance

Testosterone replacement therapy may be used to treat several symptoms, including loss of morning erections, depression, tiredness, memory loss, decreased muscle mass and increased weight, more fragile bones, or a diminished sex drive.  Testosterone replacement therapy may be accomplished through injections of testosterone or patches placed on the skin to transmit medication from the skin to the blood stream.  Topical gels are also available for application to the upper arm or lower abdomen to quickly restore a man’s libido.

If you think you are experiencing symptoms associated with the loss of testosterone production due to old age, then seek out the advice of your physician.  A complete medical examination with laboratory work will help determine the source of the symptoms and put you on the right path toward clearing them.  Hormone replacement therapy may be prescribed, and if it is, you will not have to wait long before it starts to work.

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The Crucial Vitamin—Vitamin D

Vitamin D is one of the very few vitamins (biotin is the other) that humans can make themselves.  Yet this essential, non-essential vitamin is responsible for dozens of medical conditions.  Vitamin D’s responsibilities include the growth and stability of bones as well as the prevention of stroke, depression, asthma, high blood pressure, heart attacks, prostate cancer, and osteoporosis.

We make vitamin D ourselves.  The two innermost strata in the skin contain 7-dehydrocholesterol, which absorbs UVB rays from exposure to the sun.  Once the rays are absorbed, vitamin D is produced via a photochemical reaction.  Just 10-15 minutes of sunlight twice a week is enough exposure to produce the amount of vitamin D the body needs.  Excessive exposure to sunlight, however, increases risk of skin cancer.  And as people age, the skin is not as effective at making vitamin D, making supplements necessary.

Fish is a good source of vitamin D.  The vitamin is available in cod liver oil, fatty fish such as salmon, mackerel, sardines, and tuna fish.  In addition, egg yolks and some cereals naturally contain the correct source of vitamin D.  The U.S. also fortifies milk and other products with vitamin D to help Americans maintain adequate levels.  If you have difficulties achieving the recommended 1000-2000 international units of the vitamin daily, supplements do exist.  You should take these supplements with the largest meal of the day as food helps absorb vitamin D.

A simple blood test may be conducted by your physician to check your vitamin D levels.  If less than 20 ng/mL is found, then a deficiency is determined and supplementation is required.

Today, vitamin D deficiency is becoming more common, and more of a problem, than we originally thought.  For decades we have listened to the horrors of skin cancer and our physicians have taught us to be afraid of sunlight.  Although skin cancer is a risk, we still need our weekly dosage of UVB to make our necessary vitamin D.  At the very least, get your vitamin D levels checked annually and take supplements if it is too low.

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Your Guide for Urological Health

Urology is an important field of medicine that often gets overlooked.  It is the study of the urinary tracts in men and women, as well as the reproductive organs of men.  Spanning from expertise on urinary tract infections to kidney stones, the knowledge of medical experts in this field includes anything concerning the kidneys, the bladder, and even the adrenal glands.

When most people think of urology medical services, urinary tract infections first come to mind.  But many circumstances exist that require the aid of a urology specialist.  And many of these problems require incredible professionalism, education, and discretion on the behalf of the specialist as these conditions involve the urinary tract system or the male reproductive system.

Urology field training in the diagnosis, treatment, management, and surgical procedures related to disorders associated with the kidneys, bladder, urethra, and ureters is required for a urologist.  These specialists are also knowledgeable in erectile dysfunction, male infertility, overactive bladder, cancers of the testicles, prostate, penis, bladder, kidneys, and the adrenal gland.  Yet, the main flow of information begins with you: you must know what to look for and what to ask your urologist in order to help maintain urological health.

Your urological system consists of kidneys, which filter out waste products from your blood stream, and ureters that transport liquid waste products to the bladder.  Millions of nerves, dozens of muscles, sphincters, and supporting ligaments all work together to remove wastes from the body.  However, illness, old age, and injuries can cause weakening or damage to the whole system, leading to the need for medical treatment.

Urinalysis is often used as a first test to determine urological health.  The test requires a urine sample that is sent to a lab for further testing.  An additional test, called the urodynamic test, may be conducted.  This test involves a small tube called a catheter, which is inserted into the urethra to allow for visual examination.

In addition to UTIs, some common conditions that may require medical attention include enlarged prostate, painful bladder syndrome, kidney stones, urinary incontinence, stress incontinence, and urinary retention.  Cranberry juice often alleviates symptoms in many instances of urinary tract infections, but a specialist may be needed to treat the underlying causes of the infection in order to prevent future infections and further complications.

The field of urology, like many specializations in medicine, is further broken down into medical services for both surgical and nonsurgical procedures.  Urology includes so many bodily systems and specialties that sub-disciplines are required to improve overall urological health.  Sub-disciplines in urology include:

Endourology—A field of surgery that requires the least amount of invasive treatments.  It uses the urinary tract as an access point for many procedures.

Oncology—A field designed specifically for cancers of the urological system.

Neurourology—The specialty of neurological causes of abnormal urination.

Pediatricics—The specialty of urological disorders in children.

Andrology—A sub-specialty for the male reproductive system.

Reconstructive urology—A field dedicated to the correction, repair, and augmentation of the genito-urinary tract.

Female urology—The specialty that focuses on overactive bladder, incontinence, and prolapsed pelvic organs.

The best way to maintain your urological health is by becoming aware of the many types of urological symptoms, which are warnings of potential future problems.  Further, you must drink plenty of fresh, clean water every day.  And finally, make immediate appointments with your urologist if you suspect a problem.

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Ultrasound Imaging Option for Prostate Cancer Screening

Millions of men in the United States alone suffer from prostate cancer.  But although it is one of the most prevalent diseases, it is also one of the most easily treated, if caught in its early stages.  The rectal exam traditionally aims to discover early stage prostate cancer; however, men often find this form of screening and exam extremely uncomfortable and may opt out of prostate cancer screening.  A new study from European researchers has found that ultrasound testing may be a reliable, non-invasive way to diagnose the disease.

Diagnosis of prostate cancer involves several steps.  First, a man must undergo initial PSA determination to notate the level of prostate specific antigen produced by the prostate gland.  If subsequent monitoring of this level reveals high levels of the antigen in the blood, then men must receive additional testing, which can be invasive and uncomfortable.

The new study, conducted by researchers at the Eindhoven University of Technology in the Netherlands, showed that ultrasound imaging may be a reliable way to detect the presence of prostate tumors.  It may also be able to predict the aggressiveness of these growths.

In addition to increased comfort levels associated with ultrasound screening, the imaging also produces more precise pictures of what is going on inside the prostate.  This precision may lead to a clearer picture for physicians, aiding in a better diagnosis.  With better a better diagnosis comes a more helpful treatment plan that will help more men avoid invasive and potentially harmful procedures that may not have been needed in the first place.

The usage of ultrasound imaging for prostate cancer diagnosis is still in its early stages.  Doctors and researchers have said that their understanding of how to use the technology is still growing, but doctors hope to use it as a standard practice soon.

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Dog Detects Prostate Cancer

At a San Francisco meeting of the American Urological Association, a team of French researchers from Tenon Hospital in Paris presented the preliminary findings of their new study – dog sniffing and identifying urine from patients with confirmed prostate cancer.

After a year of training, the Belgian Malinois – a shepherd breed dog who is also used for detecting bombs and drugs was put to the test.   The dog was presented with six urine samples and was tasked to sit in front of the urine it considers to have come from a man with prostate cancer.  In the 66 tests, the dog was correct 63 times. There were 3 false positives which mean the dog mistakenly identified samples from healthy men as being cancerous. There were no false negatives.  Of the three false positives one might not have been false as the man who provided the urine had another biopsy and turned out to have prostate cancer.

Many tumors release chemicals with distinct odors that can be picked up by dogs whose sense of smell is much more sensitive than that of humans.  Other researchers have reported varying degrees of success using dogs to detect cancers of the skin, lung and bladder.

If developed the test might be more effective as it had fewer false positives than the commonly used PSA test.

Skeptics are concerned that the dogs are picking up on subconscious signals from researchers, among other things.

Although this is a small study and has yet to undergo peer review and withstand scrutiny from outside experts, if this study holds up and researchers can identify which chemical or combination of chemicals the dog is reacting to, it can lead to the development of an “electronic nose” which can more accurately detect prostate cancer.

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Vitamin K2 May Reduce Risk of Prostate Cancer

A recent study conducted by the European Prospective Investigation into Cancer and Nutrition (EPIC) suggests that an elevated intake of vitamin K2 may reduce the risk of prostate cancer by up to 35 percent.

The researchers found that the potential benefits of K2 were more pronounced in those individuals who have advanced prostate cancer.  On the other hand, vitamin K1 intake did not indicate prostate benefits.

These recent findings are based on data from 11,319 men who took part in the EPIC Heidelberg cohort, and are published in November’s issue of American Journal of Clinical Nutrition.  The researchers include Katharina Nimptsch, Sabine Rohrmann, and Jakob Linseisen.

Vitamin K is normally associated with bone and blood health, with a recent linking to improved skin health.  Studies on the potential benefits of vitamin K are on-going as the amount of evidence in support of vitamin K continues to grow.

According to Cees Vermeer, PhD, and leading vitamin K researcher from the VitaK and Cardiovascular Research Institute CARIM at the University of Maastricht, called this most recent study “high quality.”

“The anti-tumor effect of K2 vitamins has been suggested in several other (mainly Japanese) papers; in most cases these papers were based on small numbers, however.  Also, in Japan it is usual to provide very high doses of the short-chain menaquinone-4 (45 mg/day or higher),” explains Dr. Vermeer.  “The elegance of the Nimptsch paper is that the effect is found at nutritional doses of vitamin K.”

According to the European School of Oncology, over half a million new cases of prostate cancer are diagnosed every year worldwide, and the cancer is the direct cause of over 200,000 deaths.  And the incidence of the disease is increasing with a rise of 1.7 percent over 15 years.

The study focused on 268 incident cases of prostate cancer during 8.6 years of follow-up.  The researchers found that an increased intake of all menaquinones (vitamin K2) was associated with a 35 percent reduction in risk.  A strong association was documented when they considered only advanced prostate cancer, with increased intake of menaquinones linked to a 63 percent reduction in risk.

Dietary sources of menaquinones include meat and fermented food products like cheese and natto; however, Nimptsch and colleagues report that those from dairy had a stronger inverse association with advanced prostate cancer than did menaquinones from meat.

“Our results suggest an inverse association between the intake of menaquinones, but not that of phylloquinone, and prostate cancer,” concluded the researchers.  “Further studies of dietary vitamin K and prostate cancer are warranted.”

Dr. Vermeer reported, “I am highly pleased by this paper, which underpins the (widely underestimated) importance of long chain menaquinones for disease prevention.”  He concludes with, “It also supports my opinion that intake of vitamin K2 supplements may have a significant contribution to public health.”

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