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Your Good Health: Radiation therapy raises fear of side-effects

Dear Dr. Roach: I recently have been diagnosed with early prostate cancer. My Gleason score is 7. My urologist has informed me that he doesn’t think I am a good candidate for surgery, due to having atrial fibrillation. My radiation oncologist has recommended traditional radiation therapy. However, I am worried about the possible side- effects. I am 72 and in otherwise good health.

I am considering proton therapy and wonder if you have any thoughts. My research indicates that this has far lower risk of incontinence andimpotence.


Prostate cancer can be a challenging diagnosis, and I hope I can help clarify things a bit.

You have what would be termed intermediate-risk prostate cancer, based on your Gleason score, a measure of how aggressive the cancer appears on pathological slides. Most experts would recommend radiation or surgery. Atrial fibrillation itself is not necessarily a reason NOT to get surgery; however, the side effects probably are less with radiation compared with surgery. Depending on the exact findings of your cancer, experts would recommend radiation in addition to surgery in some cases similar to yours. The radiation is combined with hormone treatment in some people.

Radiation may be delivered from the outside, either with X-rays (traditional) or protons, or from the inside via internal radiation “seeds” implanted surgically, called brachytherapy. Cancer cells are more sensitive to radiation than surrounding healthy cells, so radiation has been an effective treatment for prostate cancer for decades. Unfortunately, healthy cells of the bladder and rectum still can be affected by radiation, so side-effects of radiation include urinary complaints and rectal bleeding, pain and urgency. Sexual function also can be affected; however, modern X-ray radiation techniques (called intensity-modulated radiation therapy) are much better at avoiding the structures that can lead to these complications.

The research data has shown that there is not a survival difference comparing radiation and surgery. When comparing IMRT and proton-beam treatment, there is no convincing evidence that proton-beam therapy is more effective, but there is weak-to-moderate evidence of MORE side effects with proton beam, especially more GI symptoms (34 per cent higher in the proton beam group). A head-to-head trial would be needed for definitive data. Proton beam is much more expensive. Brachytherapy, on the other hand, seems to have similar side effects and at least as good outcomes; again, there are not head-to-head trials to confirm this. Decreased sexual function is common in all treatment modalities.

All three options (X-ray, proton beam and brachytherapy) are reasonable, have similar effectiveness and relatively low side effect rates in the bladder and bowel, and higher in sexual function. However, I don’t see a reason to prefer proton treatment at the present time over IMRT.

Dear Dr. Roach: I had a terrible reaction to a tetanus shot 30 years ago — arm swollen, fever, body aches. Now I need the Tdap vaccine to protect a future grandchild. Can I get just a pertussis vaccine?


There is not a vaccine only for pertussis, and it’s worthwhile to get the booster for tetanus and diphtheria if you haven’t had one in 30 years.

The vaccine is different now from the one you had 30 years ago, and you are less likely to get a reaction. Some people do get a sore or swollen arm, low-grade fever and aches that generally last less than 24 hours. While I hope you don’t get a reaction, I do want to stress that it is certainly safest for your new grandchild and for yourself.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to

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Your Good Health: Aneurysm requires close monitoring

Dear Dr. Roach: I am a 68-year-old male in good health with a 3.3-centimetre aneurysm in my internal iliac artery. I have no symptoms. It was 1.9 cm eight years ago. My physician says that an aneurysm measuring over three cm requires surgical intervention. I have looked at recent studies that say an aneurysm measuring less than four cm can be safely observed because a rupture under this size is extremely rare. I welcome your opinion on this matter.


The internal iliac artery is one of the main blood vessels in the hip. The aorta branches into two common iliac arteries, left and right, which in turn branch into the internal and external iliac arteries. An aneurism is a dilation of the artery, and the big concern is a rupture, which is immediately life-threatening (about 15 per cent of people will die in the first 30 days). Thus, repair is recommended before there is a significant risk of rupture.

The current standard of practice is to repair any aneurism that is over three cm, symptomatic or rapidly expanding. Although yours has expanded slowly over the past eight years and you have no symptoms, the aneurism is still over three cm.

A study presented in Finland in 2015 has challenged the current standard of practice. The author of the study said that elective treatment of an internal iliac aneurism could “quite safely be increased to 4 cm.” The average person in the study was 77 years old.

Based on this study, it appears you could hold off on surgery, for now. However, it is likely that the vessel will keep expanding and you eventually will need repair. Most importantly, the one whose opinion matters most, next to your own, is the surgeon who would be operating on you. I would recommend discussing with your vascular surgeon the advisability of waiting. I should mention that many times, these procedures are now done endovascularly, which means no open surgery.

Dear Dr. Roach: My daughter was only a year old when she was diagnosed with an autoimmune disease — a non-life-threatening disorder that would mean she spent a considerable amount of time in and out of hospitals.

Due to this diagnosis, she was unable to get the measles, mumps and rubella vaccine. She contracted measles in the hospital and, despite the best care available, died three months later. I am writing to educate parents on the benefits of vaccination, as every child deserves to be protected from infectious diseases.


I admire your trying to make something positive out of the worst tragedy a parent can face.

Measles is an exceptionally infectious disease. Ninety percent of people exposed will contract the disease unless they have immunity from a previous infection or vaccination. People with some immune system diseases and those who have had chemotherapy might be unable to take the vaccine. The best hope for people who cannot get the vaccine is that enough people around them are vaccinated so that the disease cannot spread. In several countries in Europe, the level of vaccination has dropped below the critical level, with a result of over 9,000 cases in the previous 12 months, as of the most recent report. About one person per 1,000 with measles will die and another 1-2 per 1,000 will get a serious complication.

Vaccinating yourself and children protects them and others.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to

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Your Good Health: Two sides to low-carb diets

Dear Dr. Roach: I recently had my yearly physical with my primary-care doctor of 10 years. I am a male, 75, who is five feet, 10 inches tall and weighs 152 pounds.

He sent me my lab results and commented: “Your A1c (5.8) was in the prediabetic range of 5.8-6.4. Please remove all grains/ breads/carbs/sugars and processed food from your diet and recheck this level in six months.” I read up on low-carb diets and found that low-carb diets are rich in saturated fat and cholesterol, which might raise bad cholesterol and increase risk of heart disease.

My previous A1c tests with my primary-care doctor have shown my A1c between 6.2 and 6.0 over the past five years. I would appreciate your opinion on all of this.


The advice you received from both sides about low-carbohydrate diets was both right and wrong, in my opinion.

I mostly agree with your doctor, but his answer needs some context. Cutting down greatly on simple sugars and starches, including grains, breads and pasta, is likely to improve your A1c (a measure of blood sugar, over time). You do not need to lose weight, so that isn’t an issue for you. Personally, I don’t “order” people to reduce starches and sugars to zero, as that seems to me to unnecessarily restrictive. Further, by having limited amount of starches in combination with protein and healthy fat, you can limit the rise in blood sugar associated with their consumption.

The information about low-carb diets is, at best, misleading: It’s possible to change a high-starch diet to a much healthier diet without eating much (or any) meat or eggs. There are many plant-based sources of protein to fulfil the body’s needs. People also might eat modest amounts of fish, skinless poultry or lean meat without increasing heart disease risk. Saturated fat comes mostly from animal sources (and to a lesser extent tropical oils, which I do not recommend), and a healthy plant-based diet uses mono- and polyunsaturated fat, which has been shown to reduce cholesterol numbers and heart disease risk.

The largely plant-based diet I recommend is largely carbohydrate, but not starchy. Unlike processed starches such as white rice and white flour, vegetables and legumes are high in fibre, which helps people feel fuller and attenuates the blood sugar response. Similarly, fruits are high in sugar, but whole fruits do not increase A1c the way added sugars do.

Dear Dr. Roach: In a six-month period last year, I was anesthetized six times for various procedures and surgeries. I have had some memory problems, shaky handwriting and spelling problems. Was this too much? Did my symptoms come from the anesthesia? Is this common, and is it permanent?


People sometimes can have a period of time after a surgical procedure where they are not quite themselves, mentally. This is more common in people who already have some kind of impairment, such as mild dementia, that might not have been noted before. It can take months to recover, and multiple procedures would be likely to prolong the time until full recovery. Being in the ICU is also a major risk for developing confusion afterward.

Some procedures are clearly necessary and can improve overall function. However, it is always wise to consider whether surgery is necessary, especially in people at higher risk. That includes older people.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Healthy Living: New cholesterol guidelines

Recently, the American Heart Association updated it’s guidelines to treat and prevent high cholesterol.

Most importantly, the AHA encourages people to working with their health care provider adding that it’s the only sure way to know whether you need treatment for high cholesterol.

The new guidelines focus on lifestyle, including healthy eating and physical activity.  When done together regularly, doctors say both are proven to lower LDL cholesterol.

In addition, they recommend people start monitoring cholesterol early in life.  In fact, they suggest testing kids as young as 2-years-old if there is a family history of heart disease.  People over 20 who don’t have cardiovascular disease should have a risk assessment every 4-6 years.

According to the AHA, people between 40-75 are the most likely to need medicine.  Among the many factors that could further increase risk include:

  • family history of heart disease or stroke
  • high triglycerides
  • metabolic syndrome
  • chronic kidney disease
  • chronic inflammatory conditions, such as rheumatoid arthritis, psoriasis or HIV
  • history of pre-eclampsia or early menopause
  • ethnicity

Remember, while 20% of a person’s risk relates to family history, the other 80% can be controlled through diet, exercise and a healthy lifestyle.   Meaning you can take control of your health.

If you would like to learn more about the new cholesterol guidelines and other heart health topics, visit the American Heart Association


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Healthy Living: Crohn’s, the Silent Disease

While a patient with Crohn’s disease looks healthy on the outside, chronic inflammation in the intestines can be waging war on his or her insides and many patients are too embarrassed to talk openly about it.

In Healthy Living, Courtney Hunter teaches us more about the disease, which often strikes when patients are in their teens or younger. 

Experts say the majority of Crohn’s patients can manage the disease with medication and many do not require surgery.

They’re still not sure what causes the condition, but say genetics and a trigger like a viral infection may play a role.



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6 Healthy Veggies You Can Substitute for Meat

One of the biggest assumptions is that going vegan will automatically improve your health, but those who switch to a vegan junk food diet soon discover a poor vegan diet can ruin your health.

Like on any diet, you need to get all essential nutrients in order to maintain optimal health on a vegan diet. If you’re not keen, your diet might lack some of the essential nutrients found in meat, such as iron, vitamin B12 and omega 3s.

The good news is you don’t need to take supplements to get these nutrients, with the exception of vitamin B12. You just need to eat certain veggies. Below are the healthy veggies you can substitute for meat.

Kale Chips

1. Dark Leafy Greens

There are many reasons to love dark leafy greens, like kale and collard greens. They’re among the best sources of magnesium, and they can give your body the iron it needs. Just be wary of greens like spinach and Swiss chard, which contain a lot of iron but also contain antinutrients that can block iron absorption.

The truth is, you have a higher risk of iron deficiency than you may think. Two percent of men and nine to 20 percent of women in the U.S. have iron deficiency, not just vegans. Plus, it’s the most common vitamin deficiency in the world.

Other vegan sources of iron include fortified bread, beans, raisins and cereals.

2. Eggplant

Most people associate eggplant with a vegan diet because of its meaty texture. Well, you won’t get bored with eggplant! You can prepare it through grilling, stir-frying or baking.

Eggplant is a good source of manganese, folate, fiber, potassium, copper, vitamins B1 and B6, and niacin.

6 Healthy Veggies You Can Substitute for Meat

3. Cauliflower

You don’t have to skip all your favorite recipes that had meat. For some recipes, you can use cauliflower instead of meat. For instance, you can make succulent Cauliflower Steaks smothered in chimichurri sauce.

You may be also happy to find out that cauliflower contains small amounts of omega 3s.

4. Artichokes

Artichokes are the perfect meat substitute for two reasons. One is they have good amounts of protein – a medium bulb contains 4.2g of protein. Second, they’re very filling, thanks to the high fiber content.

You can cook them by boiling, steaming, microwaving, roasting and grilling.

Grilled Artichokes

5. Brussels Sprouts

Brussels sprouts are not as popular as they should be, considering they have good amounts of omega 3s, fiber, and vitamin C and K.

Unlike meat, which increases the risk of heart disease, cruciferous veggies such as Brussels sprouts can lower your heart disease risk by 16 percent, according to research.

6. Potatoes

You can replace meat with potatoes in so many meals or even use them as the main ingredient in meals. This study shows that replacing meat with potatoes can lower the risk of a heart attack.

Are there other veggies that you substitute for meat? Tell us your favorites in the comments.

Images via Getty

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‘Hangxiety’: What it is, who it affects, and its consequences

'Hangxiety': What it is, who it affects, and its consequences

New Delhi: ‘Hangxiety’ is a term that refers to the coming together of a hangover, and anxiety. In a study published in the journal Alcohol and Alcoholism, it was stated that almost half of the people who were studied, faced agitation the next day after drinking. The study found that apart from just hangover physically – drowsiness, dizziness, fatigue, etc., people experienced feelings of guilt, distress, and worry.

Hangxiety refers to feeling anxious after a night of drinking, fearing what you have said, done, or the after effects of all the fun you had when you were drunk like emotional after-effects, or physical injuries and illnesses that may happen due to it.

Effects of Hangxiety

A study published in the journal Personality and Individual Differences studied the concept of hangxiety to determine who it affects, what effects can it have and what are the long-term consequences of the problem, and the results were as follows.

Emotional effects

Drinking can have adverse emotional effects on the drinker the next day. Emotions of fear, guilt, or embarrassment can follow the next day along with a hangover over things done while drunk- drunk calls, injuries, etc. Emotional effects of hangxiety can be worse than imagined.


Sufferers of hangxiety feel anxious to such levels that they have developed a fear of drinking because they want to avoid getting this anxious. Their normal lives also get affected as panic attacks become common, and they may slip into depression or have anxiety even when sober.

Who does Hangxiety affect?

Hangxiety is most likely to affect very shy people. The study published in the journal Personality and Individual Differences recorded that very shy people are most vulnerable to experiencing hangxiety and may also develop dependence on alcohol because of the same and fall prey to the Alcohol Use Disorder (AUD), a chronic disorder marked by a person’s inability to quit drinking alcohol despite of its adverse effects on his/her social, professional, or personal life. The study has revealed that people who are shy develop more hangxiety as compared to others who are more outgoing and extroverted. Hangxiety is linked to AUD symptoms in highly shy individuals.

Tip of the iceberg

It was understood that hangxiety may only be a symptom of a larger health problem, and also may become the cause of alcohol dependence. People who consume large amounts of alcohol may weaken their nervous system and hence the ability to think and react. This may, in turn, make them more anxious and drink more, causing worse hangovers and more anxiety. The cycle may continue and may need professional medical intervention to stop.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a professional healthcare provider if you have any specific questions about any medical matter.

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For Your Health: Tips to get better night’s sleep

By Blanca Gutierrez

The holidays can be filled with a lot of joy and a lot of stress. Not getting enough sleep can contribute to that stress and may even turn into a serious health ailment, if left untreated. Insomnia is linked to other chronic health conditions, less productivity and even fatal car crashes. Not sleeping enough is an all too common occurrence. According to the Centers for Disease Control and Prevention, one in every three adults report not sleeping enough in the United States. Below are some steps you can take tonight, to ensure a better night sleep and a healthier you!

Establish an easy bedtime routine

Have you been missing out on bedtime routines because you thought they applied only to children? If you are trying to go to sleep earlier, faster and stay asleep throughout the night, you should try establishing a simple bedtime routine, which can help signal your body that it is time to wind-down and relax. Consider the following routine: half an hour before you plan to go to bed turn off televisions, computers and don’t use your phone. The blue light emitted by these devices can interfere with the body’s natural circadian rhythm and slow down the release of melatonin, a hormone produced by the body to help you sleep. If you are not pregnant, try drinking valerian tea, which may help you fall asleep faster. Results may appear after two weeks of drinking the tea regularly. Avoid doing strenuous activities before bedtime and instead try a relaxing activity of your choice. This may range from writing in a gratitude journal or nightly reflections, drawing, meditating, or easy yoga/stretching.

Gradually go to sleep earlier each night until you reach your desired bedtime

It is important to set reachable sleeping goals. If you are accustomed to staying up past 1 a.m., and you decide that tonight you will go to sleep at 10 p.m., you are setting yourself up to fail. You may end up tossing and turning in bed, feeling frustrated and may give up on the idea of getting a better night’s rest. Instead, aim to go to sleep 20 minutes before the time you went to sleep the previous night. Continue doing this until you reach your desired bedtime. Combine this technique with the bedtime routine for maximum efficacy.

If you find yourself waking up in the middle of the night, avoid looking at the clock. Calculating how long you have been awake or how many more minutes of sleep you have left before you must get up in the morning may only contribute to stress and make it more difficult to fall asleep. Instead do a relaxing activity and when you begin to feel sleepy again, simply go back to bed.

It is normal to not get enough rest occasionally. Consider these tips and have a good night. If the problem persists, contact your physician.

Blanca Gutierrez is the project coordinator for the Community Clinic Consortium and a partner of Solano Coalition for Better Health.

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Weight loss: 5 healthy egg recipes to lose belly fat

Weight loss: Healthy recipes with eggs to lose belly fat

New Delhi: Proteins are very important for a weight loss diet. Protein boosts metabolism, reduces appetite, and changes several weight-regulating hormones. It specifically helps in losing belly fat. When we talk of protein, the first food item that comes in mind is eggs. Eggs are a very rich source of protein and including egg in your diet in the right ways can help you lose weight incredibly.

Eggs are low in calories and keep the stomach fuller for longer. They also contain protein, iron, phosphorous, and vitamins which are essential for the body. Eating an egg on a weight loss diet means losing weight without making the body weak or depriving it of the required nutrition. Here are some healthy egg recipes you can try and include them in your flat-belly eating plan.

Scrambled eggs

Easiest to make and delicious to eat, scrambled eggs can be a great recipe to make with eggs when targeting weight loss. Scrambled eggs can be eaten with raw vegetables, fresh fruits for a wholesome breakfast.


The most famous recipe made with egg is the omelette. You can make it in your preferred way, with vegetables of your choice or just beat an egg in a mug and make one if you don’t have time in the morning. It is important not to skip your breakfast and an omelette is the least time-consuming recipe to make with eggs.

Eggs with beans

Beans are also a good source of protein and can be clubbed with eggs to make a tasty meal. Eggs and beans can be mixed in sauces and baked together for a meal that fills your stomach. Meals like this one will keep the body from feeling hungry too often, avoiding weight gain.

Healthy deviled eggs

Deviled eggs are boiled eggs eaten with a mixture of egg yolk, mustard, mayonnaise, and spices. Mayonnaise, the only component that is high on fat can be replaced with greek yogurt, which is high on protein and low on fat to make deviled eggs one of the best breakfast choices for a weight loss diet.

Eggs with sprouts salads

Sprouts are a very healthy breakfast or snack option for a weight loss diet as sprouted grains have more protein in them. Sprouts are also believed to have cancer-fighting properties in them. A salad made with boiled eggs and sprouts can be a very healthy choice for a full meal. It is tasty, nutritious, and also calorie-free to keep the weight in check.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.


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Health care town hall covers Fort Knox changes

A town hall is scheduled Tuesday at American Legion Post 113 on Ring Road in Eliza­bethtown with Ireland Army Health Clinic officials to discuss transitioning retirees’ primary care to the civilian health care network, update attendees on progress of the transition and talk about additional changes.

The two-hour meeting is scheduled to begin at 5 p.m.

The U.S. Army is building a new clinic at Fort Knox to replace its current clinic, which operates out of the former hospital, which opened in 1957. The new clinic is scheduled to open in 2020.

Ireland Army Health Clinic leadership, Humana, the Veterans Administration and area network partners also will discuss how to navigate the network and find a doctor, according to a news release. Additionally, they will explain the services each network partner offers, as well as similarities and differences between military and civilian health care processes such as acquiring and filling certain prescriptions. There also will be an opportunity for attendees to ask questions.

The new military treatment facility will be constructed according to U.S. Army Health Facilities Planning Agency clinic construction guidelines and Title 10 Public Law, which allows room for only current active duty soldiers and their family members.

As a result, the clinic on post will no longer be able to provide primary care and some services for retirees. However, retirees still will have access to the pharmacy, the release said.

The Veterans Admin­istra­tion broke ground last week on its Fort Knox clinic to be constructed alongside the Ireland clinic.

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