Antibiotic resistance: prevention is better than cure

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Understanding the impact of stigma

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Prostate cancer: Your need-to-know

Prostate cancer is the second most common cancer among men. A positive diagnosis can mean the patient needs to make significant lifestyle changes, but with early detection there is hope for a full recovery.

What is the prostate?

The prostate is a walnut-sized gland positioned below the bladder outlet, with the urethra (the tube that carries urine from the bladder) running through it. It secretes seminal fluid and is responsible for about 80% of the ejaculate volume.

Cancer risks

Dr Bradley Wood, a urologist at Life Fourways Hospital in Johannesburg, outlines the risks for developing prostate cancer:

  •  Genetic predisposition
  • Smoking
  • Obesity
  • Low testosterone levels
  • A diet high in fat
  • Ageing – but that doesn’t mean prostate cancer affects only older men

If detected early, there’s a 98% chance of survival beyond 5 years, while late detection statistically offers a 26% survival rate over the same period.

In terms of prevention, Dr Wood says that a healthy lifestyle is key. ‘Regular exercise and a balanced, low-fat diet of fresh fruit and vegetables contribute to lessening your chances of developing the disease,’ he says. ‘Increased intake of anthocyanins (red pigments) from foods such as tomatoes, berries and grapes also helps, and a Harvard study showed a marked reduction in prostate cancer in men who had more than 21 ejaculations per month.’

Prostate cancer signs

The proximity of the prostate gland to the bladder and urethra often means that cancer presents with urinary symptoms, especially in the early stages. Depending on its size and location, a tumour may inhibit the flow of urine. Other symptoms include:

  • Burning or pain during urination
  • Difficulty urinating, or trouble starting and stopping while urinating
  • More frequent urges to urinate at night
  • Loss of bladder control
  • Decreased flow or velocity of urine stream
  • Blood in the urine (hematuria)
  • Blood in semen
  • Erectile dysfunction
  • Painful ejaculation

Screening is key to early detection

Regular screening remains pivotal to early detection. ‘Early detection means Stage 1 disease or prostate cancer confined to the prostate,’ says Dr Wood.

  • Annual routine prostate-specific antigen (PSA) testing is recommended for men from age 40 onwards – and twice a year, beyond the age of 50.
  • Those at high risk (men with first-degree relatives who have been diagnosed with prostate cancer), require an annual digital rectal exam from the age of 40 – but in others, starting at age 50 should be fine.

Dr Wood says that the presence of symptoms is often too late a warning sign, as the cancer is often already relatively advanced by the time secondary symptoms like backache, blood in the urine or semen, or loss of weight present.

Treatment options vary

Medical interventions for prostate cancer are determined by the progress of the disease and whether it has spread or not. Prostate cancer is slow-growing and may not require surgery: options include active surveillance, prostatectomy, radiotherapy, hormone therapy and chemotherapy.

While a prostate cancer diagnosis is stressful, it’s not necessarily a death sentence. ‘Find a urologist with whom you’re comfortable, who can walk you through all the potential treatment options and the side effects of each,’ Dr Wood says. ‘It’s important to advise your male relatives that they should get screened, too.’

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE.

References:

  • Adapted from Life Healthcare magazine (2019). Prostate Cancer is Not a Death Sentence by Crighton, T. p.52. Adapted with permission.

A new way to treat chronic back pain

The extreme pain of a herniated disc can be difficult to live with, but a new, minimally invasive spinal-surgery technique called an endoscopic discectomy is increasingly providing relief to South African patients.

Traditionally, disc herniations are treated with open discectomy surgery, but endoscopic discectomy offers a valuable alternative. It has many advantages, including that it doesn’t traumatise your spine the way open surgery does. ‘In fact, you’ll come away with a less than 1cm cut and just one dissolvable stitch, and should be able to walk within an hour of the operation,’ says Dr Riaan Jacobs, an orthopaedic and spinal surgeon at Life Bay View Private Hospital in Mossel Bay, Western Cape.

Here’s all you need to know about this innovative procedure.

What is endoscopic discectomy surgery?

During surgery, an endoscope – a long, thin, flexible tube 5–6mm in diameter that has a light source and tiny camera on one end – is inserted through a small incision in your back so that images of the disc damage can be assessed on a TV monitor by a surgeon. ‘With special instruments, we then remove the problematic disc, with the least amount of damage or trauma to the surrounding tissue and structures,’ explains Dr Jacobs.

How does it differ from traditional spinal surgery?

  • It’s minimally invasive. Traditional surgery has larger incisions and involves the detachment of muscles and other tissues, spinal fusions and implants, for example. Endoscopic surgery only uses a small incision and there’s no disruption of the muscles, or a spinal fusion or implants.
  • Local anaesthetic and sedation are used. ‘Patients are awake enough to let their surgeon know if, for example, the surgeon is touching a nerve – this is called intraoperative patient nerve monitoring,’ explains Dr Jacobs. ‘This fact does put some people off, but patients generally have amnesia of the procedure, as they’re barely awake. However, if patients prefer, a general anaesthetic can be administered.’
  • Shorter duration. Generally, it takes only an hour if all goes according to plan.
  • Reduced post-operative pain. ‘The pain level pre-operation is 10 out of 10, but an hour after the operation, it’s often 0 or 1 out of 10. An hour after the procedure, you get a patient to walk to the bathroom, and then they can go home,’ says Dr Jacobs.
  • Shorter hospital stay. It can be performed as a day or overnight procedure, unlike traditional surgery, which sees patients hospitalised for much longer.
  • There are fewer complications when compared to traditional surgery, for example bleeding and infection.
  • Earlier return to work. ‘Some patients have gone back to work after only 3 days following their endoscopic back operation, although a recovery period of 2 to 4 weeks is advised,’ says Dr Jacobs. Traditional surgery advises 2–6 weeks.
  • Relatively easy revision surgery in the future, if needed, because of minimal scar formation. ‘With traditional surgery, you always get hard scar tissue. If, for example, another herniation occurs, then a surgeon has to fight against this scar tissue. But with endoscopic surgery, there are hardly any signs of scar tissue,’ says Dr Jacobs.

Who is an ideal candidate for this surgery?

Not all disc herniations can be treated with endoscopic surgery. ‘The ideal candidate is someone who has experienced acute back and leg pain for a short duration. It must be a fresh injury several days or weeks old, that is, not someone who’s been walking around for months with a herniated disc,’ explains Dr Jacobs. ‘It’s also a safer option for older patients who are too sick to have open surgery.’

What diagnostic tests have to be done to determine a candidate’s suitability?

‘Other than blood tests to determine whether a patient is fit for surgery, the main diagnostic test used is a magnetic resonance imaging (MRI) scan. X-rays alone don’t show the disc itself, whereas an MRI does,’ explains Dr Jacobs.

How safe is endoscopic back surgery?

This is a spinal operation where surgeons work close to, and on, the nerves, cautions Dr Jacobs. ‘There’s definitely not a 0% chance of nerve injury, but compared to traditional surgery, the risk is smaller for nerve injury, as well as infection and bleeding.’ The main precaution you need to take is stopping any medication that makes you prone to bleeding – for example, Aspirin or blood-thinning medication like Warfarin – at an appropriate time before surgery, he advises.

WORDS BY CARLA HÜSSELMANN

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE.

References:

  • Adapted from Life Healthcare magazine. (2018). 6 Things You Need to Know About Endoscopic Back Surgery by Hüsselmann, C. p.38. Adapted with permission.

Dealing with bipolar mood disorder

Bursts of energy and goal-driven activity with very little need for sleep sounds like a recipe for go-getter success. But when it’s accompanied by inflated self-esteem and irrational decisions and, after a few weeks, a mood swing to the other end of the spectrum, it’s time to get help.

‘These extremes of a manic or hypomanic high followed by a depressive low represent the two poles of bipolar mood disorder, formerly called manic depression,’ says Dr Theshenthree Govender, a specialist psychiatrist based at Life Entabeni Hospital and Life St Joseph’s in Durban. It is a mental illness, not a character flaw, she emphasises. ‘The brain is an organ and, like any other organ in the body, it can malfunction.’

Who gets bipolar mood disorder?

Bipolar mood disorder can affect anyone, inhibiting their ability to function. In particular, for those with a genetic predisposition, psychological and environmental stressors – even something positive such as the birth of a child – could precipitate the onset of symptoms. Although it can’t be cured, the disorder can be managed.

There are 3 types of the disorder

The type of disorder depends on the symptoms.

  1. Bipolar I: manic highs and depressive lows. From being euphoric, feeling invincible and energetic, a patient sinks into despair, feeling useless and unable to manage life. The manic phase can lead to psychosis.
  2. Bipolar II: hypomania, and usually more depressive episodes. Hypomania is more subtle than mania and doesn’t lead to psychosis.
  3. Cyclothymia: hypomanic and depressive cycles occur over a two-year period, but the symptoms are not full-blown.

A clinical diagnosis is made by a psychiatrist, based on symptoms, history and genetic predisposition. Dr Govender says it’s essential to rule out that symptoms are caused by a medical condition such as a brain tumour or stroke, medication prescribed for other illnesses or drug abuse.

Dr Rani Samuel, a clinical psychologist who consults at Life St Joseph’s, says when the symptoms are tracked back, it’s usually clear that there’s been ‘a persistent emotional unravelling’ for at least a few weeks. ‘Anyone can have mild mood fluctuations, but in bipolar disorder the mood changes are quite marked,’ she says.

How is bipolar disorder treated?

The type of bipolar disorder and the phase a patient is in dictate the appropriate treatment. ‘If a patient is in a manic episode, there’s a risk of suicide, so we need to stabilise them. If they’re psychotic, sedation might be necessary,’ says Dr Govender.

If a patient is in a depressive phase, a picture of behaviour over time is key because if depression is diagnosed and antidepressants are prescribed, these could precipitate a manic episode.

Long term, a mood stabiliser is the mainstay for managing and controlling the disorder. ‘The medications are optimised according to clinical response, so monitoring, patient compliance and follow-up are essential,’ says Dr Govender. ‘If a patient defaults on prescribed medication and relapses, they are more likely to have an extended episode with increasing episode frequency that becomes progressively destructive,’ she adds. Dr Samuel says that alongside medication, psychotherapy for bipolar mood disorder is fundamental to managing the condition.

Nurse Grace Maleka, Clinic Manager at Life Carstenview, advises that family members of those affected seek out help too. ‘It helps everyone understand and cope with the illness, and the family learns how they can best support their loved one,’ she says.

What is electroconvulsive therapy?

While electroconvulsive therapy (ECT) is controversial due to perceptions based on the old-fashioned technique, it is now safe, effective and done in a theatre with an anaesthetist, says Dr Govender. Small electrical currents are passed through the brain, triggering a brief seizure, which changes the brain chemistry and controls symptoms. A possible side effect is short-term memory loss.

ECT may be used for patients who can’t take medication (such as pregnant women), if the standard treatment isn’t working, or if a patient is manic and highly suicidal or severely depressed and catatonic, says Dr Govender.

WORDS BY GILLIAN WARREN-BROWN

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE.

References:

  • Adapted from Life Healthcare magazine (2018). Taking charge of bipolar disorder by Warren-Brown, G. p.24. Adapted with permission.

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