Dear Dr. Roach:
I had a TIA in July 2016. I had lots of risk factors: morbidly obese, cholesterol of 255, elevated blood pressure, Type 2 diabetes (wellcontrolled, but still) and heavy drinking. Since then, I have lost weight (from 250 pounds to 205, so far), reduced my cholesterol to 172 (with statins and diet), started taking Plavix and stopped drinking. Losing weight helped me control my high blood pressure. I currently take losartan, instead of the four meds I needed when I was heavier. I am, alas, allergic to aspirin/ibuprofen.
I have made a lot of improvement; my doctors are happy, but I am still very apprehensive. Does that ever go away?
Answer: — S.S.
A TIA (transient ischemic attack) is a temporary loss of function in the brain: This may include localized weakness or a loss of speech. A TIA has the same risk factors as a stroke, and as such, a TIA is rightly called a warning sign of a stroke. The risk of developing a stroke is much higher among people with a TIA, compared with those without one. It’s a call to action: time to make a change.
You really have done so, and I am very impressed by your results. Between improved behaviors and medication, you have dramatically reduced your risk for another TIA or stroke, and I understand why you and your doctors are happy. I congratulate you. Anyone can have a stroke. You still have a risk for stroke, despite your outstanding efforts. However, that risk has dramatically decreased, and will decrease further as you maintain your good behaviors. Plavix reduces stroke risk about as much as aspirin does (maybe a bit better, at least in women), and so does a statin.
If your question is about the apprehension, I can’t answer that. For most people, it does wane over time. However, a TIA is a frightening experience, and some people continue to have apprehension about it. In some ways, it is like posttraumatic stress disorder, and can be treated the same way if the apprehension is affecting your daily life. See a mental health professional if that’s the case.
The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Roach, Book No. 902, 628 Virginia Dr., Orlando, FL 32803
Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
Dear Dr. Roach:
Ina recent column on a glomerular filtration rate question, you commented that half of adults over 70 will have a GFR below 56. I am 73 and have noticed the same trend, albeit a small decrease versus five or six years ago. My doctor is watching my medications, as you suggested. I am also a vegetarian and eat a lot of veggies/plant food, as you recommended.
My blood-test results show the normal GFR levels for African-Americans and non-African-Americans. Is there a corresponding number for Asian Indians, or do they fall into the non-African-American category? The reason I ask is that I read somewhere that the red blood cell count is lower for Asian Indians versus Caucasians, and thus, they often get wrongly diagnosed as anemic. — H.Z.
Answer: While normal GFR levels have been created for people living in China and Japan, I could not find specific results for South Asians, including people from India, who should therefore use the non-African-American numbers.
The levels of red blood cells and hemoglobin are very similar in Asian Indian men compared with nonHispanic white men in the U.S.; however, Asian Indian women have hemoglobin levels about 1 point (g/dL) lower than American women. This does have implications when considering whether a level is abnormal.
Prostate cancer is the most common type of cancer among men and is often treated successfully. Onehundred percent of men diagnosed with prostate cancer can expect to survive five or more years. More than 2 million men living in the U.S. today are prostate cancer survivors.
The American Cancer Society recommends men discuss the uncertainties, risks, and potential benefits of prostate cancer screening with their primary care physician before getting screened. Screenings should not take place without having this discussion.
For men who are at average risk of developing prostate cancer and expected to live at least 10 more years, this informed discussion should occur at age 50.
For men at high risk of developing prostate cancer (such as African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65), the informed discussion should take place at age 45.
For men who have more than one close male relative (father, brother, son) with prostate cancer that was diagnosed before age 65, the informed discussion should take place at age 40.
“Screenings include a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE),” says Jorge Arzola, MD, a urologist with Kettering Physician Network’s South Dayton Urological Associates. “The screening is repeated every one to two years, depending on the PSA level. Because prostate cancer often grows slowly, men without symptoms of prostate cancer and with less than a 10-year life expectancy are not likely to benefit from testing.”
Early stage prostate cancer usually has no symptoms. Advanced prostate cancers can cause some symptoms, such as:
Problems passing urine, including a slow or weak urinary stream or the need to urinate more often, especially at night Blood in the urine Trouble getting an erection Pain in the hips, back (spine), chest (ribs), or other areas
Weakness or numbness in the legs or feet, or even loss of bladder or bowel control
Other diseases cause many of these same symptoms. Still, it is important to tell your doctor if you have any of these problems so the cause is found and treated. The treatments for prostate cancer range from frequent check-ups to surgery, radiation therapy, cryotherapy (freezing), hormone therapy, vaccine, and chemotherapy used one at a time or in combination.
Most men find it helpful to discuss all of their treatment options with a team of specialized doctors to make a decision that best fits their needs.
The types of doctors who treat prostate cancer include:
Urologists – Surgeons who specialize in the urinary system and male reproductive system
Radiation oncologists – Doctors who treat cancer with radiation therapy
Medical oncologists – Doctors who treat cancer with medicines such as chemotherapy or hormone therapy
Kettering Health Network is a faith-based, notfor-profit healthcare system.
The network has eight hospitals: Grandview, Kettering, Sycamore, Southview, Greene Memorial, Fort Hamilton, Kettering Behavioral Health and Soin.