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WHAT EXACTLY IS A PSA AND WHAT IS THIS BLOOD TEST I’M GETTING | Jan 24, 2013
PSA = Prostate Specific Antigen. This is a protein that is made in the prostate that normally circulates in minute amounts in the blood stream. Women don’t have a prostate and, therefore, they will not have any measurable amount of this protein that is specific for the prostate, hence, the term “Prostate SPECIFIC Antigen”. Young people have small prostates and low levels of this protein circulating. Old people have bigger prostates and higher levels of PSA. We don’t really know why but the prostate is one of the few glands/organs that grows as we get older. Your height shrinks, your kidneys shrink, etc. etc.
The PSA test is just a measurement of this protein in your circulation.
It slowly goes up as you age. The normal range is 0-4. Some experts say you should age normalize the results and use a bigger range as you get older. So, up to 4.0 is okay if you are younger than 60 but over that age maybe a top score of 6 is still normal. The actual number is less important than how it changes over time and it’s easy to measure. When the level is elevated or jumps a lot from the last test, there is a reason. There is always a reason but only sometimes is it cancer. Sometimes the level is elevated and it’s just the prostate getting bigger over time. Sometimes it’s an infection and more of this protein leaks out due to the inflammation/infection. But, sometimes, elevation of the PSA is associated with cancer.
There is no perfect test. I have had patients with PSAs under 4 who had cancer and patients with PSAs over 30 who did not have cancer. Cancer can only be determined by a biopsy. Prostate cancer is treated differently depending on the stage, your age, the aggressiveness of the cancer itself. But if you don’t find it when it’s still small, it greatly limits your choices and the PSA offers the only hope of finding the cancer before it has spread from the gland.
So an elevated PSA doesn’t necessarily mean you have cancer BUT a big jump in the PSA (over 1.5 increase) and every number over the current cutoff of 4 should get checked out. This means either having the test repeated within 6 months or talking about a trial of antibiotics or possible prostate biopsy. What do I do with my results. Your results will be sent to me by the method you selected at the time of the blood draw. This will be done by Dr. Barry directly for each and every sample. It will be Dr. Barry who sends you the email, mails the result or calls you…your preference. You should be notified whether the results are normal or abnormal. You should be notified within 10 days or you should call 559-9936 and let me know. You should share your results with your doctor. Tell him you had a free screening done and the results are xyz. It should be a number hopefully less than 4. If it’s over 4, it doesn’t mean you have cancer, but it does mean you should get it checked out.
There is some controversy over the PSA test. Although I don’t know a doctor seeing men who doesn’t order the test, there is one specific government panel that suggests that people shouldn’t be tested. This makes no sense to me. Little the government does lately makes any sense to me including but not limited to the health care field. Just drop dead already will you. Dropping dead is cheap, chemotherapy is not. The PSA is just like the mammogram…not every abnormal mammo is cancer…not every high PSA is cancer. But, the PSA has still revolutionized prostate cancer because before this test was available prostate cancer was usually diagnosed after it had widely spread to the bones. You could do things to slow the cancer down but this was usually a death sentence and prostate cancer was a top 5 cancer for men. Now with the PSA the cancer is found when it’s still inside the prostate and you have options…watchful waiting if you’re 85 but robot surgery or radiation therapy etc. if you are younger. The technical meaning of younger being having a 10 year life expectancy.
I set up this screening because I am an optimist. I’m not looking for new business. Like Scrooge learned… “Mankind is my business.”
Here Piggy Piggy Piggy… | Sep 25, 2012
That’s right…I’m talking about the State Fair…..A chance to get up close and personal with livestock of all shapes and sizes and breeds. By the time you are reading this the Fair has been open for at least a week already. Hopefully you have checked it out. If not, there’s still time to get out there and I will give you plenty of reasons why you should. I love the Fair! The sights. The sounds. The smells! I have a strange soft spot in my heart for the multicolored chicks in the bird house. Who thought that up? Why? Having personally raised pigs and sheep (don’t ask!) I do like to check out the squeaking and squealing piglets and watch the sheep shearing. To watch the cascading waves of wool come off the lamb at the hands of a good clipper is almost magical. In the end you a pretty big pile of wool and a lamb ready to enlist. How’s that for sustainable energy!
Speaking of sustainable energy, you have to have one of those lemonades made from fresh squeezed in front of you lemons and a quarter bucket of puro cane sugar. (I have watched a few too many crime shows, I can’t say pure, it has to be “puro”, the Mexican way, like you are talking about blue crystal meth), at least it’s not the dreaded high fructose corn syrup. The pucker factor mixed in with the ice cold sweet jolt is a real pick me up. I, of course, always bring my cup from last year because you get a discount, I keep it in my day pack on my back, having taken kids to the fair for years you a have to have something to hold all the small junk and you should have a stroller/wagon for all the really small kids, say under 15. Most kids these days are weaklings. Yes that’s right, I have a day pack, at least it’s not my fanny pack, but that’s another article. Yes, you can pick up some type of freebie bag from Nimo or Keybank to carry your junk, but I prefer the small backpack because I like to keep my hands free. I must be unencumbered if I am to save that baby falling off the tilt o whirl. I only hope it’s a toddler or smaller or I’ll get crushed! Oh what’s that? Not this time? Ok, just saying I am ready is all. Should a horse get away from its handlers I am prepared to wave it away from the twins in the stroller, that right, because my hands are free. And you know there are plenty of opportunities for the Heimlich maneuver to come up, there are too any sausage selling places to have an EMT crew stand by at all of them , but that’s where the action is. I don’t think anyone is choking on the walk away Sunday, and I do like to end my fair visit with one, where they start with the brick ice cream on a cone and then dip it in chocolate and then thrust it, still dripping of excess chocolate into the nuts and end with a cherry on top! Here my health related suggestion, enjoy the ice cream etc., but ditch the cone, you have had carbs aplenty already. I go to the one near the taffy store where you see the taffy get pulled and pulled in the machine, so, of course, I recommend getting a box of that salt water taffy to go. Sure it’s a stress test for your fillings, and you can enjoy them for weeks after the Fair. An edible memento. A Fairmento.
The Fair is expansive enough (that’s right, expansive, not expensive; you can do the Fair on the cheap if you have to). It’s expansive enough to wear out the kinder, the teens and the elders alike, it’s an agricultural, entertainment, and gustatorial triathlon. Between the rides and the exhibits and the stands selling almost everything, but bath salts, the fair can be a draining and exhausting day. That’s why I love it and encourage all my patients to go. Precisely because it is a challenge, it is absolutely a different experience each time you go, if you do it right. Can we be honest here? I think most of you don’t have the strength for a full day at the fair. Admit it. It’s too much walking. Too much exposure to the outside at one time. There are bathroom issues. The crowds. The parking. I hear it every day. Along with all the excuses about why you can’t exercise. That’s a defeatist, I hear. That’s a negative attitude and I can’t tell you how bad that is for your health. No! Rally, I say! Do not go gently into that dark night!
Ok, you can’t take a full day. So what, do a couple of hours. Take one of those buses from the nearest mall, etc. Are you worried about eating unhealthy? I worry about your unhealthy eating the rest of the year. If you are eating right a few indulgences at the fair are meaningless. That’s ok. You know you are going to overindulge in something. Blooming onion? Mystery meat on a stick? Don’t delude yourself, own that pizza fritz, but own the work it’s going to take to get that junk out of your system. Maybe now that I think of it, you shouldn’t own the fritz, rent it, or nibble one fritz between the bunch of you. You do go to the fair as a group, don’t you? That’s a part of the fun. Who will break down first? Will it be Grannie’s knees or Dad’s temper? I like to go with a group of 8 people and play those water games where you squirt the target. If you have 8 people you can own the whole row of seats and someone from your group is guaranteed to win. It’s a blast to go with a little kid this way because all the other adults and older kids can blast away all around the target, but not hit it and the little kid thinks he beat everyone. It’s good to build up the spirits of the little kids before life’s brutal realities grind them down. Of course one of the other kids will be jealous, how come he gets to win because he is the smallest, you never let me win like that, then they have to reveal the secret to the now quivering tot and all the others have to nay say it and there’s the part with Dad’s temper.
So why go to the Fair?
Point 1. It’s Exercise. That’s right, capital E Exercise. Plain and simple, even if you skip the Indian village you have to walk a ton to take in the whole Fair. Don’t skip the Indian village. It’s probably the lone space at the Fair that is quiet and peaceful and less crowded. You go from the hustle and bustle of the midway to this tree trimmed area that seems both cooler and slower, you know how often I say that to feel good, o get your mind and body right you should spend time outdoors in nature, this is a natural oasis amidst the ice cream of the future and the carnie that will guess your weight or zodiac sign. Sure I pick on the carnies, they are easy targets and they probably can’t or don’t read so I don’t fear reprisals. Now listen, just because they are illiterate doesn’t mean they can’t safely and responsibly put those vomitoriums together, never mind that reference to babies flying off rides earlier.
Why do you let me go off on tangents? Let’s get back to the Indian Village…You have a moment away from the din. Enjoy the natural oasis and then once more into the breach as you thread your way back into the midway in search of a candied apple and a henna tattoo. So just coming to the Fair can be a bit of a physical challenge, the heat, the humidity, the crowds, etc. This is a good thing. You know I think you should challenge yourself. Grow or grow old, my father has said many a time. Or did I read that in a fortune cookie.
Point 2. Try something new. You know that’s also one of my mantras, not motto, I am sensitive because I have been accused by my closest friends and allies of exceeding my motto allowance, who know!! So my mantra has been to challenge yourself, try a new ride or new game, some new food, actually sit and watch a show being put on by talent from all over the state. Ok, every act may not be worthy of America’s Got Talent, but just the experience of seeing someone perform live? That does something good for you.
Point 3. Support the local businesses. Ok, the guy selling the Sham Wow isn’t local, but many local merchants make their presence known at the Fair. Jobs going overseas. Local plants closing or downsizing. Here is a chance to make a difference. How often can you say that? How often can you actually do that? You go, you meet up with someone. You spend a little money, you keep people working, and that’s got to be a good thing in the long run.
Point 4. Sheer entertainment and education. I’m not talking about just the sheep, with so many venues and activities the only way you can be bored at the Fair is if you are a teenager with a dead smart phone, Ewuh, what’s that smell? Where are we? Why is the Center of Progress building selling sham wows? I know you wouldn’t willingly and knowingly do to it, but if you actually give it a chance there are many interesting shows each and every day. How can you not enjoy watching the Frisbee catching dogs, the high divers, the guy that uses a chain saw to sculpt logs, the livestock judging, the exhibits, the shows from the grandstand to all the little venues? I am not much for the grandstand shows or the free court shows, but they also have multiple smaller venues and I have seen great talent there for free and in the shade. I’m talking about local greats, Nancy Kelly and Joe Whitting, to name just a few.
Point 5. People watching. I don’t care what a wreck you have made of your life or your physique there is bound to be someone at the fair that makes you feel better about yourself. You could be a 400 pound, bath salts loving, no underwear wearing, bad tattooed, unemployed drunk and still find someone to look down on at the Fair. I’m not saying that looking down on others is a good thing, but we all compare ourselves to our surroundings don’t we? Is it only me? Ok, so I have hair only in places I don’t want it and my mug would fit right in on a most wanted poster and I could lose a few pounds and dress nicer, etc., at least I have more teeth that that guy! Is that shirt two or three sizes too small. Ok, I admit it; I can’t tell if that person is a man or a woman. (Those people frighten me) I’m just saying!
People trot out that old shibboleth, I have been to the Fair ten times, nothing changes, and it’s always the same. I used to go when the kids were in the house, but why go now? I can’t get around that well, that should set off a red flag, unless you are 80 years old and beyond, and speaking of Seniors, did you catch my Mother’s dance group performance? How many of you can say your parents are still alive in their 80’s? How many are dancing at the Fair? Way to go Momma! Or would you rather stay home and watch reruns of Little House on the Prairie and wonder about the butter sculpture.
So, nothing changes at the Fair? Well obviously some things are the same, we call those traditions, like Christmas and Easter, and no one says, I did Christmas for 10 years, nothing’s different. I would say there is always something different to a person that really takes a look, to a person that is still growing, to a person that still has some life left in them. So, get to the Fair and have your own experience.
Hot Fun In The Summertime | Sep 25, 2012
Miss me last month? Did you think the outrage was over? Had I finial been kicked out / shut down? Not yet anyway! Apparently my article was too long and I have revised it accordingly.
It’s August already and therefore I should be writing about staying hydrated and about how dangerous fireworks can be. But I know you…you will interpret this to mean have another beer and to let Junior set off the bigger fireworks because he’s already missing half his thumb. Not from last year’s party…that happened over the winter with the snow blower.
Besides, people only usually die from heat exhaustion in France where the pensioners go off on vacation in August and leave gramper in the attic for the month. Google it if you don’t believe me. Hydration it turns out is a timely topic as they recently changed the running of the Corporate Challenge Race into a fun run. Really ?!? I understand the rationale being peoples safety but really…isn’t that part of the endeavor to be able to exercise, to know your limits, to test your limits both in terms of speed but also in your ability to perform in the rain, the heath, the cold etc.?
In the Lafayette High school they have posted for the parents attending sporting events in the gym, “Let the coaches coach, let the referees referee, let the players play.” I like this and would add for this occasion “Let the runners run”.
I say let them run. It is after all the Corporate CHALLENGE. All the runners have signed the gobbledygook waiver that no one reads but everyone knows will be used to hold no one accountable. What are the criterion for halting a race? Who will decide? A race official? One of our many trusted government officials? Will it be Wayne Mahar? Will it be the biggest sponsor? Is it based on heat? Is it based on humidity? Will more races be prevented by heat or humidity or cold or rain? Will this become a standard for other sports? Will high school football, lacrosse, baseball games be stopped if it gets too hot? Speaking of high school sports, when are they going to start letting girls really play lacrosse and at the same time outfitting them for proper safety. Concussions from football problem? Check out the concussions in girls lacrosse. It’s not getting hit with the sticks that’s causing the concussions it’s getting hit by the ball. These girls should be wearing helmets like the boys…perhaps with a bit a sporty plumage to close the deal.
Let’s get back to me…I tell you I somehow look forward to someone collapsing at the event. When I do some event, the Boilermaker for instance, if no one collapses, it devalues the event for me. Okay, my time wasn’t that great but at least I beat those people who collapsed from heat exhaustion. Ok you beat me to the finish line but I see you over in the tent getting hydrated with an IV. When I finish I’m ready to form up columns like the ancient Spartans and prepare for the chariot charge. See? That’s me third from the left.
Notice my shield is lined up perfectly?! Yes my spear is wobbling a little but give me some wine and a minute and does anyone know if I beat Crixus. I know I didn’t beat Annette.
Also, think if you will, about the ambulance and first aid people. No race means no emergencies. When people go down, the EMS teams jump into action. They love it! They are bored otherwise! Starting the IVs and maybe getting the paddles ready…it’s what they live for. When you don’t allow people to collapse (dare I say their inalienable right to test themselves to the point of collapse) you deprive these dedicated EMS workers a change to do their thing… maybe they won’t involve/hire as many services next year since the number of calls was down this year due to changing to a walk. So collapses means jobs just that simple. That’s right…the occasional collapse means jobs for the ambulance, the dispatcher, the fire dept., the emergency rooms, etc. Please understand I am talking about the dehydrated person, the twisted ankle, the low blood sugar. Heart attacks and strokes are serious medical emergencies and I am not making light of them but they didn’t curtail the Corporate Challenge because of worries about heart attacks but rather dehydration. It’s these low grade oft times self-inflicted injuries that I’m talking about. They are part of the engine of the health care economy. Yes, in their own morbid way heart attacks and strokes both also do their part to stimulate the economy as well. Unfortunately, it’s the funeral homes and nursing home part of the economy in these cases.
To die suddenly is a terrible thing until you think about the alternatives with the chemo and the nursing home and the chronic pain and loneliness. I don’t use the line often because many people just get freaked out but I like to say “you, I like…I hope you drop dead”. Meaning that I hope they are spared much suffering. Some get taken aback by the expression until you explain it, but a quick death is a blessing that fewer people experience in our modern world.
Next month, publisher willing I will return with more summer advice.
Don’t you Remember?
The experts claim that one in three Americans will suffer from Alzheimer’s disease. Suffering is a relative word because honestly most of the suffering done with Alzheimer’s is the suffering of the caregivers as the patient themselves is usually unaware of their condition. You suffer through cancer…you suffer through depression…your family members are the ones that suffer when you have severe memory loss. Alzheimer’s is listed as one of the top 6 causes of death in America but before it kills you it takes a toll on you, your dignity, your family, your bank account, etc. Dementia is probably the #1 diagnosis in the nursing home and therefore at $8,000 a month, per patient, it’s probably one of the most expensive diagnosis to treat on a national level. Maybe one of those wildly expensive chemotherapy agents are more expensive but usually they’re used for 6 weeks or 3 months whereas dementia can persist for decades.
I don’t actually use the term Alzheimer’s much…It’s really a diagnosis that can be made with brain evaluation at autopsy and it’s just a name…I prefer to call it by the more practical and less charged name…memory loss.
That’s what I see and that’s what I try to treat. You could call it Alzheimer’s, you could call it Binswanger’s disease, you could call it Lewy body dementia, you could call it senile dementia, you could call it multi-infarct dementia but the bottom line is the person has a functional problem with their memory, usually short-term more than long-term. They might remember the name of their second grade teacher but they sure don’t remember where they left the car keys or that they wrote two checks to the cable company and one to the gas company. There are some new and up-and-coming brain scans that might help decide whether you have in particular the typical Alzheimer’s changes, but it doesn’t matter much since the treatments are all the same. There is no good reliable blood work to aid in diagnosis. Diagnosing dementia is like diagnosing Parkinson’s. It is best done by the same observer evaluating the patient over time and seeing what changes occur. Unfortunately in the modern doctor’s office the typical patient can get in and get out and be quite demented but not picked up by the doctor if he doesn’t ask the right questions. In an office visit with the doctor checking the blood pressure, checking the meds, checking the cholesterol and attending to any issues with the insurance company it’s hard to step back and ask “by the way can you tell me the name of the last 3 presidents? By the way can you remember these 3 words and draw me o’clock etc.?” It is not particularly hard to do. You just have to have the time and interest… I have seen many people that were really having a lot of trouble with their memory before it was picked up by their healthcare professional because they didn’t think to ask the right questions. You don’t require a psychologist, or a neurologist, or any specialist to diagnose dementia.
So dementia is diagnosed by asking patients questions. You can use formal testing like the Mini-cog, or the MMSE, or the SAGE questionnaire, or you can diagnose it informally. Once you look for it, it’s not hard to diagnose. On the other hand many people have mild cognitive impairment and never go on to dementia and it is hard to determine who will progress and who will not, and that’s why it is best managed over time by the same professional doing serial observations.
Now, the treatment for dementia is unfortunately quite limited. None of the current prescription medications cause significant and sustained improvement in cognition. The best we can say is that these medicines keep the patient as they are, and delays deterioration, but even the most ardent user of these medicines, if they look at the literature, realize they lose their efficacy within a year or year and a half. I wanted to be known as a very aggressive dementia doctor and so when the NIH recommended that we use Aricept and then add Namenda that’s what I did. I happily told patient’s I was following the NIH recommendations proving to them that I was an up-to-date well-informed physician. The only problem was this combination didn’t really work well for the vast majority of patients I treated. There might have been a patient here and there that the family said they noticed some improvement temporarily, but it wasn’t common. Additional experience with these medicines over time has continued to disappoint. Not only did these drugs not make a big difference…they also had side effects. My experience has shown me that in point of fact the benefits are quite minimal and the side effects are real, not dangerous but real. I have had many patients stop these pills and either did not deteriorate further or improved off the medicines, so my view of prescription treatment for dementia has been leavened by experience over time. There are also 2 medical foods/nutritional supplements to treat dementia as well and they include Axona and Cerefolin NAC. I like the idea that there would be some vitamin you could use that might actually have a clinical effect because I think there are less side effects with these prescriptions then there are with the other drugs mentioned previously. Unfortunately these nutritional supplements are not usually covered by insurance because they are considered vitamins but they are not available in GNC or Natur-Tyme as they require a prescription from the doctor. Once again although individual families will say this medicine helped or that medicine helped they have not been overwhelmingly successful. Worth a try: yes. Guaranteed to work: absolutely not. I have absolutely no confidence in any nonprescription supplements that are available in the nutrition stores and vitamin stores. Completely unproven and potentially dangerous! Show me a single study done in America using human beings that show some improvement in a double blinded study and I will happily change my tune. So unfortunately, our current armamentarium is quite limited when it comes to treating Alzheimer’s/memory loss and therefore we are left with trying to prevent it, which I think in the long run is much more important…
There are obvious risk factors for dementia and they include smoking, diabetes, hypertension, and being inactive. There are genetic risk factors as well but there is nothing you can do about your genes so we focus on the modifiable factors. So yes, you can directly diminish your risk of dementia by not smoking, not drinking excessive alcohol, controlling your blood pressure and controlling your sugar. I prefer to focus on the couch potato aspect because the studies show that this is one of the most important modifiable risk factors. Besides exercise helping your cholesterol, your blood pressure, your joints, your mood, your fall risk, etc. physical exercise cuts your risk of dementia. Mental exercises are also touted to prevent dementia but the evidence that supports that is very slim. Physically pumping more blood to the brain works…mentally challenging your brain hasn’t been shown to work. It just makes sense to me that if you can open up the arteries to your brain with exercise you can get a little better blood flow and therefore a little better function from the brain. Studies have not shown that mental exercises have a basic and lasting impact but studies have shown that physical exercise seems to be associated with a lower risk for dementia. The mature patients that I see on a regular basis would benefit from exercise for many reasons not just the dementia component. People may be afraid of a heart attack or stroke in some vague way but the fear of dementia seems to strike a stronger chord. They take it a little more personally because they know someone who’s had the problem. Still, knowing about it and actually doing something about it are two different things. Get up off the couch and take a walk regularly…walk over to the local Nursing Home and that will provide you much better motivation than I can with this article. If walking through the halls of the nursing home doesn’t motivate you to get moving while you still can nothing will!
So memory loss can be a terrible problem with life changing consequences for the entire family…meds so far have little effect…but you are not helpless against this scourge…In fact you don’t need special tools, expensive tests, or exotic supplements to ward off memory loss. You just have to move it or lose it. Move your body to prevent losing your mind. So what or who are you waiting for? Until next month…get well…stay well.