Archive for June 5, 2008

MAKING THE MOST OF YOUR VISIT TO THE DOCTOR

 

MAKING THE MOST OF YOUR VISIT TO THE DOCTOR

Prepare for your visit by writing down:

The signs and symptoms you are experiencing

Any background information you think might be important

All the questions you want to ask.

Take the piece of paper along with you and don’t be afraid to refer to it
during the consultation.

Ask your doctor about the treatment options for your condition. Often there
are different ways to treat the same illness and some may suit you better
than others.

If your doctor prescribes medication, ask about the expected results, the
possible side-effects and exactly how to take it.

If you don’t understand something your doctor has told you, ask for
clarification. If you are worried you might forget information or
instructions, ask your doctor to write it down or write it down yourself.

If your doctor recommends a test, always chase up the results. Don’t assume
that no news is good news.

If you have any doubts about your doctor’s diagnoses and treatment, don’t be
afraid to seek a second opinion. It’s your right.

To avoid any embarrassment for both yourself and your doctor, always ask
about the costs of consultations, tests and treatments in advance.

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Men and Interstitial Cystitis

Men and Interstitial Cystitis
Interstitial cystitis is diagnosed far less often in men than it is in women.
Estimates indicate that about ten percent of all diagnosed IC patients are
men. Symptoms are similar to those experienced by women —urinary frequency
and urgency, often accompanied by suprapubic pain. Men may also experience
scrotal and/or anal pain. Many males who actually have IC are inappropriately
diagnosed as having chronic prostatitis, and the actual number of men with IC
may not be as low as previously thought.

The Male IC Experience
Like women,men have often experienced difficulties in obtaining an accurate
diagnosis of IC, but for somewhat different reasons. The symptoms of IC in
men closely resemble those of non-bacterial prostatitis or prostatodynia.
Although, in recent years, awareness of IC has increased markedly in the
urologic community, IC is often thought to be a “women ’s disease,” and
urologists do not always consider performing diagnostic tests that would
confirm IC in a male patient.

Even when IC is diagnosed, it is sometimes difficult for a man to accept
that he has this condition and that almost everyone who has the disease is a
woman. In a survey one urologist made of 50 male IC patients, he found that
men had seen an average of 3.3 physicians before their diagnosis was made.
This was disturbing because, while women will usually see a general
practitioner or gynecologist before going to a urologist, men ordinarily see
a urologist first.

How Do I Know if I Have IC?
If a man has chronic lower urinary tract symptoms including urgency,
frequency, painful urination, decreased urine flow, or a sense of incomplete
emptying, as well as suprapubic pressure and chronic bladder pain, and does
not respond to standard therapies such as antibiotics, analgesics,
anti-inflammatory drugs, or alpha blockers, he may actually have interstitial
cystitis.

It is very important for male patients to have a thorough diagnostic workup,
including hydrodistention and cystoscopy under general or regional
anesthesia. This workup will rule out other medical conditions that can exist
in males, and will confirm the presence or absence of IC. An additional
benefit is that in more than half of patients who undergo the procedure,
hydrodistention can provide relief of symptoms for as long as 4 to 6 months.

Other conditions that may have symptoms similar to IC must be ruled out.
These include: urinary tract infections, bacterial prostatitis, bladder
cancer, kidney problems, tuberculosis, sexually transmitted diseases,
radiation cystitis, neurogenic diseases and benign prostatic hypertrophy
(BPH).

IC and Erectile Function
IC has not been shown to cause erectile problems. However, IC can contribute
to painful ejaculations, and normal sexual response can certainly be
adversely affected by pain or the anticipation of pain. Anecdotal evidence
suggests that men treated successfully for IC usually experience normal
erections and ejaculations.

IC and Prostatitis
Recent studies at the University of Washington and Tufts New England Medical
Center suggest that many men who are diagnosed with non-bacterial prostatitis
or prostatodynia might actually have IC, and if they are treated specifically
for IC, tend to do better than if they are treated as if they have
prostatitis.

Treatments
Standard IC treatments for males are similar to those used for women. There
is also an array of self-help strategies that can provide relief for both
male and female IC sufferers. At this time there is no cure for IC nor is
there an effective treatment which works for everyone, yet a vast majority of
IC patients are helped by one or more of the following treatments.

Oral Medications

ELMIRON® (pentosan polysulfate sodium): Elmiron received FDA approval in
1996. It is the only oral medication approved specifically for use in IC. It
is believed to work by repairing a thin or damaged bladder lining.

ANTIDEPRESSANTS: Tricyclic antidepressants such as Elavil® (amitriptyline)
have been shown to help with both the pain and frequency of IC. In IC, these
medications are used for their anti-pain properties, and not as a treatment
for depression.

OTHER ORAL MEDICATIONS: These include anti-inflammatory agents,
antispasmodics, antihistamines and muscle relaxants.

Bladder Instillations

BLADDER DISTENTION: The bladder is stretched by filling it with water under
general or regional anesthesia. This is part of the diagnostic procedure for
IC, and is therapeutic as well.

DMSO® (dimethyl sulfoxide)1: This medication is instilled directly into the
bladder. It is believed to work as an anti-inflammatory agent and therefore
reduces pain. DMSO can be mixed with steroids, heparin, and/or local
anesthetics to form a bladder “cocktail.”

BCG (bacillus Calmette-Guerin): This promising experimental treatment is
currently in the clinical trial phase and is not yet approved by the FDA. It
appears to work by boosting the immune system.

CYSTISTAT® (hyaluronic acid): This medication is also in clinical trials and
is not yet approved for use in IC by the FDA. It is thought to work by
replacing the defective lining of the bladder. Efficacy is not known at this
time.

OTHER BLADDER INSTILLATIONS: Heparin, Silver Nitrate, Clorpactin®
(oxychlorosene sodium).

Other Treatments

DIET: Eliminating certain foods (acidic, spicy) may decrease the severity of
IC symptoms. Also, smoking, drinking coffee or tea, and alcoholic beverages
may aggravate IC.

SELF-HELP: Self-help techniques can improve the quality of life and reduce
the incidence and severity of flare-ups. These include changes in diet,
stress reduction, visualization, biofeedback, bladder-retraining and
exercise, among others.

ELECTRONIC NERVE STIMULATORS:
Transcutaneous Electrical Nerve Stimulation (TENS):
This device, which is worn externally, relieves bladder pain in some people.

Sacral Nerve Stimulation Implants: These surgically implanted devices are
approved for use in treating urinary incontinence, urgency, and frequency,
and are undergoing testing for use in treating IC pain.

SURGERY: For a small minority of patients whose symptoms are severe and who
do not respond to other IC treatments, bladder surgery may be considered.
Several types of surgery have been used to treat IC, including bladder
augmentation and, in severe cases, urinary diversion.

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Interstitial Cystitis diet Do’s and Don’ts

Diet Suggestions: Do’s and Don’ts
The idea behind managing your diet is to avoid foods that may irritate your
bladder. Here is a list of some of the suggested items to restrict, followed
by foods that a number of IC patients have noted do not cause them problems.

Milk/Dairy Products

aged cheeses, sour cream, yogurt and chocolate

white chocolate, non-aged cheeses such as cottage or American, frozen yogurt
and milk

Vegetables

fava beans, lima beans, onions, tofu, soy beans and tomatoes

other vegetables and home grown tomatoes (which may be less acidic)

Fruits

apples, apricots, avocados, bananas, cantaloupes, citrus fruits, cranberries,
grapes, nectarines, peaches, pineapples, plums, pomegranates, rhubarb,
strawberries and juices made from these fruits

melons (other than cantaloupes) and pears

Carbohydrates and Grains

rye and sourdough bread

other breads, pasta, potatoes and rice

Meats and Fish

aged, canned, cured, processed or smoked meats and fish, anchovies, caviar,
chicken livers, corned beef, and meats which contain nitrates or nitrites

other poultry, fish and meat

Nuts

most nuts

almonds, cashews and pine nuts

Beverages

alcoholic beverages, beer, carbonated drinks such as sodas, coffee, tea,
cranberry juice and wine

bottled or spring water, decaffeinated, acid-free coffee and tea, and some
herbal teas. Call 1-800-TEALEAF for information on coffees and teas.

Seasonings

mayonnaise, miso, spicy foods (especially such ethnic foods as Chinese,
Indian, Mexican and Thai), soy sauce, salad dressing and vinegar

garlic and other seasonings

Preservatives and Additives

benzol alcohol, citric acid, monosodium glutamate (MSG), aspartame
(Nutrasweet®), saccharine, foods containing preservatives and artificial
ingredients and colors

Miscellaneous

tobacco, caffeine, diet pills, junk foods, recreational drugs, cold and
allergy medications containing ephedrine or pseudoephedrine, and certain
vitamins

Although the list of foods to avoid may initially appear daunting, remember
that there are still many foods you can enjoy. Some IC patients report that
they have the least trouble with rice, potatoes, pasta, vegetables, meat, and
chicken. With these foods as a base for your diet, you can create nutritious
and flavorful meals. You can still cook for family and friends and share
meals with them because the foods you can eat are the basic elements of a
healthful, balanced diet. However, you may need to make some minor
adjustments, such as setting your serving aside before adding seasonings. You
may also want to consider adding a source of fiber to your diet to promote
regular bowel movements.

Suggestions
With some imaginative effort, you should be able to come up with
substitutions for your favorite foods and drinks which will not aggravate
your symptoms. Here are a few suggestions:

Add a pinch of salt to carbonated beverages to make them flat.
Try reduced-acid orange juice now available in supermarkets.
Try Prelief® a natural dietary supplement which helps neutralize acidic
foods. Prelief is available over-the-counter at pharmacies and grocery stores
in granulate or tablets. For more information call 1-800-994-4711.
Boil down all sauces containing alcohol.

Dining Out
Once you have determined which foods cause you trouble, you should be able to
eat in restaurants or at social gatherings without too much difficulty. You
will simply need to ask about ingredients or stay away from dishes where
ingredients are hard to discern. Spicy ethnic foods can pose a problem when
dining out because the spices used may cause the release of trouble-making
histamines. The ingredients in these dishes are often difficult to determine
as well. Before ordering, ask your waiter what spices are used in particular
dishes.

Food Allergies
Doctors find that some IC patients have additional symptoms that are caused
by food allergies. Allergies to wheat, corn, rye, oats and barley are common.
Other patients with milk allergies and lactose intolerance may experience a
severe response to these foods. Although the existence of systemic yeast or
“yeast syndrome” remains controversial in the medical community, a number of
IC patients report success with a yeast-free diet which eliminates yeast,
cheeses, molds, alcohol and fermented foods. If you suspect that food
allergies play a role in your IC symptoms, you should consult a doctor or
nutritionist who specializes in food and environmental allergies.

What if I have eaten something I shouldn’t have?
If you have eaten a forbidden food or tried a new dish only to discover
afterwards that it has brought on symptoms, take one teaspoon of baking soda
in a glass of water. This helps to alkalinize the urine and prevent the acids
in urine from irritating the bladder. Some patients take baking soda as a
preventative before consuming problematic foods. Those who have heart
conditions, high blood pressure, or other medical conditions affected by salt
intake should consult their doctors before taking baking soda because of its
high salt content. If you have a flare in symptoms after eating, you should
also drink plenty of water to dilute the urine.

Conclusions
Making the changes necessary in the diet to help control IC is a challenge,
as are so many aspects of this disease. Don’t get discouraged if you do not
discover your ideal diet even after a few weeks of trial and error. The
process takes time and patience, but if you are like many others with IC, it
may pay off in a reduction in your symptoms.

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