Dr. Aruna Narasimman, MD

Medication can relieve mild to moderate symptoms of BPH, such as frequent urination, incomplete bladder emptying, a weak urine stream, and straining while urinating. However, other forms of treatment may be more appropriate if an individual has pain with urination, frequent urinary tract infections, or is unable to urinate. The size of the prostate and the severity of their symptoms will determine the type of treatment they need. If the prostate is not very large, doctors will likely recommend a transurethral procedure. This minimally invasive technique involves the insertion of a scope into the urethra. The most common transurethral procedures for BPH are:

• Transurethral incision of the prostate or TUIP, where the surgeon uses the scope to make small cuts in the area of the prostate that meets the bladder. These cuts will open up the pathway for urine and allow it to flow with more ease.
• Transurethral needle ablation or TUNA, where needles are inserted through the scope and into the prostate. The needles use radiofrequency waves to destroy excess prostate tissue.
• Laser prostate ablation, where lasers pass through the scope to melt away the part of the prostate causing urine blockage.
• Transurethral resection of the prostate or TURP, where the inside of the prostate is trimmed and removed one tiny piece at a time using the scope.

If the prostate is too big for a transurethral procedure, an individual may need a simple prostatectomy, which can be done in one of three ways: laparoscopic, robotic, or open. During a laparoscopic simple prostatectomy, a surgeon makes several small incisions on the belly. Then they insert a long tube with a camera into one of the cuts and surgical instruments into the others. Using the camera to see inside the belly, they carefully removes the enlarged part of the prostate. Robotic simple prostatectomy uses the same techniques as the laparoscopic method, but the surgery is done with the help of a robot. For men with very large prostates, open simple prostatectomy may be the best treatment option. This surgery differs from the other approaches in that it requires a much larger incision.

Most transurethral treatments for BPH, like TUIP, TUNA, and laser prostate ablation, are done in the doctor's office or outpatient surgery center. TURP and simple prostatectomy, however, need to be performed in the hospital and require an average stay of one to three days. Patients should wait a week before doing any strenuous activities after a TUIP, TUNA, or laser prostate ablation, and about four to six weeks after a TURP or simple prostatectomy. Although these treatments improve BPH symptoms for most patients, it is important to be aware of the risks involved, such as urine control issues, tightening of the urethra, and erectile dysfunction.

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.