The prostate cancer test is for PCA3 which is elevated only in cancerous prostatic tissue and is also named the Progensa test.

This new prostate cancer test that has recently been developed is better than the current PSA test which is elevated in some benign conditions as well as in patients with prostate cancer. In men with enlarged prostates the PSA level can rise leading to a possible diagnosis of cancer. Very often these men have to undergo a prostatic biopsy. PCA3 levels weres not associated with enlarged prostate glands unlike the PSA test. Also as the level pf PCA3 rose so did the likelihood of a diagnosis of prostate cancer. In men with levels over 100,  69% men had a positive prostatic biopsy for cancer. 

This  test offers an alternative to painful prostatic biopsies which sometimes miss the cancer. Only those patients with a positive PCA 3 test will now need to undergo prostatic biopsies.

The test is expensive at around £200 but its value may be in targetting those patients that have a strong family history of prostatic cancer or an abnormal prostate gland on rectal examination.

• For sneezing and itching in the nose or nasal blockage
• Nasal spray – Beconase - £5.00 or Nasonex - £11-00 or
• Antihistamine – Chlorpheniramine (Piriton) 2 mgs three times a day (£5.00 for 56 tabs) or
• Cetirizine (Zirtek) one a day (£6.00 for 60 tabs) or
• Loratidine ( Clarityn) one a day (£6-00 for 60 tabs )
• For itching of the eyes or constant watering
• Sodium chromoglycate eye drops – one drop each eye up to four times a day (10 mls = £3.50) or
• Antihistamine – Chlorpheniramine (Piriton) or Cetirizine or Loratidine
• If you have both eye and nose problems, You may need a combination of Sodium chromoglycate eye drops and Beconase or Nasonex nasal spray or Antihistamine with either a nose spray or eye drops
• If you wish to try and prevent or reduce hayfever symptoms before they occur, this can be done by having a long lasting steroid injection. This needs to be given at least 1-2 weeks before your hayfever symptoms begin ie. if you usually have symptoms at the beginning of June then the injection needs to be given mid May. The cost of this injection would be £15-00.

The above question is often asked by patients.  But is there an easy way of finding out how many puffs are roughly left in an inhaler?

Well the answer is yes. 

Get a bowl of water. Take the inhaler canister out of its plastic coating be it blue, brown, green or orange and place the inhaler in the bowl of water as per diagram. The inhaler will now float in a number of ways as shown in the diagram demontrating the rough number of puffs left in your inhaler so you know when to renew your prescription.

Under the new guidelines to GP's all patients over 75 are being given statins to prevent them having heart attacks or strokes, especially if they suffer from dIabetes, have hypertension or suffer from heart disease. The question that needs to be answered is, does this prolong their lives?

Answer is I'm afraid-NO. A study with over 5000 patients were either given a statin or nothing at all to reduce their cholesterol and then followed up for several years. Overrall the statins did prevent some heart attacks over this period but to do this 48 patients needed to be treated to prevent a heart attack. What was worse was that this only applied to men and not women ie. women taking these drugs had no benefit whatsoever.

What is even more depressing is that both groups lived the same amount of time ie. the statins did not increase your life expectancy. Finally even more depressing was the fact that those taking the statins died of cancer more than those not taking the statins. This does not mean that the statins gave you cancer, although this is not ruled out, but that instead of having your heart attack and dying you developed cancer instead and died.

What does this all mean

• Statins in over 75's does not prolong  life expectancy
• Statins may prevent some heart attacks in men but not in women but at the expense that you then died of cancer

The question then is should we stop wasting vast amounts of money giving statins to over 75's as well as the vast amount of medical time wasted in monitoring and prescribing these drugs?

The answer is yours to make but money like this could be put to better use by improving the quality of life of the elderly by providing better hearing aids, more cataract surgery as well as joint replacements because we know that these do improve a patients life although not prolong it! What is more important?

There is now increasing evidence that Vitamin-D prevents the development of both breast and colon cancer. Two studies looked at Vitamin-D levels in healthy people and then followed them up for up to 25 years.

In the Breast cancer study 1760 patients were studied and those with the lowest levels of Vitamin-D were more likely to develop breast cancer. They were able to calculate that by taking in 2000 international units of Vitamin-D per day was able to give you a 50% reduction in developing breast cancer. To obtain the 2000 units of Vitamin-D / day they calculated you would need to spend at least 15 minutes in the sun / day. To ingest this quantity of Vitamin-D / day was difficult as there are only 400 units in a pint of milk although oily fish has a high content. It was suggested that you may need to take vitamin-D supplements to reach this level of intake if you were not able to get out in the sun.

In the Colon cancer study 1448 patients were studied and followed-up for up to 25 years. Again by taking 2000 units of Vitamin-D / day they calculated that colon cancer was reduced by 66% in the patients studied.

In summary you need to take 2000 units Vitamin-D / day which needs to be obtained by using a combination of means such as going out in the sun for 15 minutes / day and ingesting food known to be rich in Vitamin-D such as dairy produce and oily fish. If either of these cannot be achieved adequately then a Vitamin-D supplement needs to be taken daily.

Many patients with sciatica that is not resonding to therapy such as physiotherapy are or can be offered an epidural steroid injection into the back to not only help their pain but also prevent surgery.

Does it work? The simple answer is NO unfortunately.

Over 200 patients with sciatica not resonding to therapy were divided into 2 groups those that had an epidural with steroid and those that just had an injection in their back. Even at 3 weeks post injection only 13% of patients in the steroid group had responded as opposed to 4% in the salt injection group. When you analysed the patients from 3 months onwards there was no difference between them. The more worrying thing was that at 1 year only 33% or 1 in 3 patients were 75% better in either group.

What does this mean. I have never understood how a steroid injection can relieve sciatica when the disc prolapse is obviously pressing on the nerve. I have also never understood why surgeons do not operate early on these patients when with keyhole surgery they claim to obtain 90% patients get complete relief from sciatica.

What this study shows is that unless you begin to get relief from sciatica within 3- 6 months then it is unlikely you will get any further improvemennt in pain relief and maybe we ought to be more forceful in saying to neurosurgeons  get keyholing on my back and stop sticking needles into my spine!

Update May 2007

American Doctors have now come to a definite decision on the use of epidurals in patients with back pain in association with sciatica. They have concluded after looking at many scientific studies that they may improve pain only for two to six weeks after the epidural has been given. After this period no benefit was seen in terms of pain, day to day activity and the subsequent need for surgery to relieve the sciatica pain described above.

By the way they also found that epidurals carried a risk of infection and non-infectious meningitis in some patients. My thoughts on this have been outlined above and now have been strengthened. So patients you have now been told so act accordingly when offered this procedure.

Drinking spearmint tea may be beneficial at reducing excessive or unwanted hair growth in women. It appears that extracts of the spearmint plant can reduce androgen or male hormone levels. We know that certain women are more sensitive to male hormone than others leading them to suffer from acne and hair growth on the face.( See article on Vaniqua) http://www.abbeypractice.co.uk/default.asp?id=22&mnu=22&ACT=5&content=80

To achieve lower androgen levels you need to drink at least 2 cups of spearmint tea / day.

This may be a more natural way for women to control hair growth on the face and / or may increase the benefit of using the vaniqua cream.

This may also be a more natural way of putting bromide in the tea!!!!

Acupuncture has been suggested to be of use for the treatment of hypertension. No matter what method of acupuncture I used, I never managed to make any difference to patients blood pressure and abandoned this trial of treatment many years ago.

However many acupuncturists, of which the majority are non-medical, continue to advocate its use for hypertension. Well at last a good clinical trial has been undertaken in America looking at this type of treatment for hypertension. Well what do you know - utter waste of time. No difference was detected in those receiving genuine acupuncture and rubbish acupuncture.

So please patients do not continue to receive treatment that does not or will not work.  I f you honestly believe it has reduced your blood pressure I would suggest you go for a massage instead and you will find that this is just as effective and more pleasurable because the likelihood is you did not need any  treatment in the first place.

The following is a summary of the Heathcare Commission visit this year. The full document can be found by clicking on the following link http://www.healthcarecommission.org.uk

This inspection took place on 8th December 2006, and was announced.

Main findings

Overall, the establishment provides a service that meets the needs of its clients, within an environment that is clean, well maintained, comfortable, and adequately staffed. Equipment and facilities are appropriate to the service offered, and are of a good standard overall, and the registered manager was helpful, professional and courteous at all times during the inspection. The quality of treatment is delivered to a satisfactory standard, in line with accepted protocols. Patients interviewed were very satisfied with the service and commented around their trust of  Dr. Stellon and were grateful for the treatment and support given. The Healthcare Commission would like to take this opportunity to thank the provider for the assistance given in this inspection.

Achievements

The management is very supportive of all staff and in developing the services of The Abbey Practice. They play a key role in the day-to-day running of the establishment and have maintained a high level of compliance since registration. 

Homeopathic medicines are commonly used to treat anxiety but do they work? My own experience suggests that they do not, even in those patients that have the exact symptoms and signs for that homeopathic remedy.

Now someone has reviewed all the clinical trials using homeopathy for anxiety and found likewise that it really does not work for this condition. One can see how taking a homeopathic remedy might work in that the patient believes it is helping and so it does. Anxiety is a symptom that can be manipulated by suggestion, in some mild cases, leading the belief homeopathy works. These studies over a longer period of time show no difference between a sugar pill and the real homeopathic remedy lending support to the notion that homeopathy treatment is all in the mind.

Heavy periods are a common problem in women over the age of forty and many ask for advice on how best to treat this condition. Very often contraception or treatment for irregular bleeding need to be considered when treating this condtion. The following is a summary of treatments that can help this problem:

• Ibuprofen (nurofen) or mefanamic acid (ponstan) Both these drugs are non steroidal anti-inflammatory drugs and can reduce blood loss by up to 30%. The drugs need to be started at the start of menstruation and continued until menstruation finished. 
• Tranexamic acid This is a drug that can also reduce up to 30% blood loss at the time of a period. It works by increasing the clotting ability in the uterus so that blood loss from blood vessels in the uterus is reduced. This drug needs to be taken for the duration of menstruation only.
• Combined contraceptive pill This pill has been shown to reduce the amount of bleeding in both young and older patients with heavy periods. This method is also useful in patients that have irregular as well as heavy menstruation in that it lengthens the time between periods to approximately 28 days and can also be useful in patients that require contraception.
• Depot progesterone injection This is a hormonal form of contraception using a progesterone type compound.This can be given either by injection (every 3 months) or as an implant (Implanon) every 3 years. This works by flattening the lining of the womb such that periods disappear or are reduced to a trickle each month either as a small bleed or as spotting of blood. This can be useful for those patients that have irregular bleeding or need contraception as well as reducing blood loss.
• Mirena coil This coil has some progesterone hormone on it and reduces blood loss by the same action as the depot injection above. This device has reduced the need for hysterectomy in a large number of patients with heavy periods.The device needs to be changed every 5 years.
• Norethisterone This is also a progesterone type hormone but really is useful for irregular periods. Unless it is taken for at least 21 of the 28 days of the menstual cycle it does not reduce blood loss.

Recent evidence suggests that men who develop erectile problems may also have underlying heart disease.

We all know that men who develop erectile problems have an underlying blood supply problem to their attachment. Now we have evidence that this could be a signal that they also have blood supply problems to their heart.  How do we know this? Well when patients who had undergone angiography to the heart were then questioned about erectile problems it appeared that up to 22% men who had one vessel blocked had erection difficulties. However if they had two vessel disease 55% men had erection problems but with 3 vessel disease a massive 66% had erectile dysfunction.

In those with angina and diagnosed with blocked arteries by angiography it was shown that these same men had erection problems upto 2-3 years before they developed their angina and chest pain.

The take home message from this study is that all men who develop erection problems should see their doctor and have a blood pressure check, and diabetes and cholesterol check. If they are smoking they should stop and if overweight lose some. If you have any of these risk factors you may require an exercise ECG to exclude any silent blocking of your arteries. Erection problems are an early warning sign. So men do not lose the opportunity to do something about it otherwise heaven may beckon you before your time.

To quote from an eminent Cardiologist "Just as there is more to sex than an erect penis, there is more to erection problem prevention than simply restoring an erection.”