MEN'S HEALTH MATTERS:There has been an increase in the number of cases of tuberculosis in Ireland over the past seven years and this must be addressed, writes THOMAS LYNCH.
Q I have had a chronic cough for the past few months and have had a lot of sweating at night.
I went to see my doctor and he referred me to the hospital and I have been diagnosed with tuberculosis of my lungs. I thought this disease had been eradicated. Is it common?
What are the risks of me spreading this disease to others in my family?
How long will I have to take my treatment for and are there any side effects to the treatment?
Are there any long-term problems with having this disease?
ATuberculosis was never eradicated from Ireland and over the past seven years the number of cases has been increasing. This is of concern and needs to be addressed.
A new problem has emerged in that there are now a lot of multiple drug-resistant cases of TB. These cases are especially difficult to treat with lots of side effects.
Yes, it is possible that others may have caught the disease from you and if this is the case then they must be treated. By the time a patient is diagnosed with tuberculosis, members of their families have a 50/50 chance of having caught the infection from them.
Most people who catch the infection never actually get the disease. The infection “goes to sleep” and doesn’t wake up and this is called “latent” TB infection. There is a big difference between having tuberculosis disease and latent TB infection.
People with latent TB infection cannot transmit the infection to other people, however they are treated to prevent them from becoming ill. People with tuberculosis disease in their lungs, however, can transmit it to other people and we find that of each case we see that about 12 other people have become infected.
These other people are contacts, and they can be offered medication to keep them well.
The treatment for tuberculosis disease takes, at the very least, six months but may take longer and the medications do have some side effects. These side effects are usually very manageable and include upsetting the liver.
For that reason we advise patients to avoid taking alcohol and drugs that may upset the liver such as paracetamol for the duration of their therapy. In addition, one of the drugs may cause pins and needles in the fingers and toes and to prevent this, vitamin B6 is given.
If the tuberculosis pneumonia that you suffer from has affected a significant amount of the lung, then you may have some long-term problems once the TB has been eradicated.
These may manifest in a chronic cough productive of sputum because of damage to the tubes in the lungs. In rare cases, these can cause coughing up blood and repeated chest infections. Most patients do not endure long-term problems.
Q I was in a health food shop recently and purchased saw palmetto as I heard that it was good for my prostate. I read more about this herbal remedy and see that it can affect the accuracy of a PSA blood test for prostate cancer. Is this true?
AThere's reason to suspect that saw palmetto might affect prostate specific antigen (PSA) levels, but to date we have little scientific evidence that this herbal remedy interferes with the commonly used cancer screening blood test.
The extract of the saw palmetto plant (Serenoa repens) is often recommended for disorders of the prostate gland. Medical studies have reached different conclusions about this remedy’s effectiveness, but most experts believe that saw palmetto is a safe and reasonably effective treatment, particularly for benign prostatic hyperplasia (BPH).
Very little is known about how and why saw palmetto is useful for prostate conditions. Some research suggests that the extract blocks the effects of testosterone within the prostate, much like the drug finasteride (Proscar). Finasteride, in turn, can lower blood levels of PSA. Since PSA is often used to screen for prostate cancer, men who take finasteride for prostate conditions are often warned that their PSA levels may not be accurate for detecting early stage cancers.
Despite its widespread use, there has been little scientific research looking at how saw palmetto affects PSA levels. A single study that compared finasteride and saw palmetto for chronic prostatitis found that saw palmetto had slightly less impact on PSA levels.
That said, it’s impossible to know whether doctors should use a different PSA cut-off in men taking the herbal extract. There’s also some question as to whether saw palmetto might actually help to prevent prostate cancer, although there’s been little research on this connection, either.
The bottom line is that men who are thinking about long-term treatment with saw palmetto should consult their doctor.
It may make sense to check a PSA level before starting the drug. However, it’s unlikely taking saw palmetto will lead to wildly inaccurate PSA results, or a missed diagnosis of prostate cancer.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Dr Joe Keane consultant respiratory physician, St James’s Hospital, Dublin