Mystery of the boot-camp urine collection solved
DEAR DR. ROACH: Regarding urine collection in boot camp, I had the same experience in the fall of 1962. As I remember the story, after a few weeks in “captivity,” our systems were cleaned out and our urine had medical value. A nearby drug company used it.
I often have wondered about this, and would be most interested to know more. The military did some strange things with us in the 1940s, ‘50s and ‘60s. -- T.M.
DEAR DR. ROACH: Your recent letter concerning the collection of urine from military personnel caused me to recall my vascular surgery training. The lytic drug urokinase initially was extracted from human urine. This drug was very helpful in a number of thrombotic conditions. -- Dr. James Killeen, professor of surgery, retired
ANSWER: I read up on the history of urokinase and am convinced that T.M. and Dr. Killeen have together solved the mystery. Urokinase is not a waste product; it is secreted into the urine, where it helps prevent kidney obstruction by proteins. It is still used medically to break up (lyse) blood clots, especially in catheters and in people with clots in critical organs. I thank the many soldiers and sailors who wrote in. DEAR DR. ROACH: I am an 81-year-old retired nurse. I have had GERD for as long as I can remember. My surgeon measured my hiatal hernia, and he said it was 5 cm. I am taking Nexium, 40 mg. Due to my age, I do not want to have any kind of surgery. My only problem is this GERD. I recently heard on TV that there is a surgery to repair a hiatal hernia. It is done via endoscopy. Do you know anything about this? -- D.E.
ANSWER: Although most people with GERD, with or without a hiatal hernia, do well with lifestyle modification and medications, surgery has long been an option for people with severe symptoms or those who do not want to (or can’t) take medications. The procedure is called a fundoplication. It ties part of the stomach around the esophagus, preventing both reflux (acid going into the esophagus) and the stomach from going through the hiatal hernia into the chest.
A similar procedure can be done now by endoscopy. However, it isn’t right for everybody. It is not indicated for people with severe inflammation in the esophagus, including a Barrett’s esophagus. After the procedure, most people are unable to belch or vomit. This may not sound bad, but it can lead to bloating and distension.
This is a new procedure, and it’s not clear yet how well it will work in the long run: At six months, about 70 percent of people who had the procedure were satisfied with the results.
DEAR DR. ROACH: I was started on phentermine to help me lose weight, but my blood pressure shot up. The doctor says it isn’t due to the drugs. What do you think? -- J.B.
ANSWER: Phentermine is an appetite suppressant related to amphetamine. However, high blood pressure is a very unusual side effect, with studies finding that the vast majority of people have no increase in their blood pressure.
Pulmonary hypertension, which is an increase in blood pressure of the right side of the heart and the lungs, is a rare side effect. Any new shortness of breath, swelling of the legs or feet, or chest discomfort should be reported. This drug should be prescribed only by experts in weight management.