DEAR DR. ROACH: I’m 67 and male. When I had a male doctor, he did a yearly testicle and prostate exam during my physical. Now the practice has been taken over by female doctors, and for the past three years, this has not been done. Is this new? Is there a correct way to ask why the change? Believe me, this exam is not one I look forward to, but with a family history of prostate cancer and other cancers, the bloodwork I get each year alone does not seem to be enough. — Anon.
ANSWER: There has indeed been a change in the way prostate and testicular screening tests have been considered in recent years, and recommendations by advisory groups have changed as well. The current recommendation by the most influential group in the U.S., the Preventive Services Task Force, is against routine screening for prostate cancer and testicular cancer. However, there are some situations, such as with a strong family history, in which screening for these conditions is appropriate, and it is always appropriate for your doctor to listen to your concerns and preferences.
As far as male doctors versus female, most studies have shown that women physicians tend to spend a bit more time with their patients and tend to be more in compliance with practice guidelines. However, differences between individuals are more important than differences between the groups. Just tell your doctor, male or female, that you would like to further discuss prostate and testicular cancer screening.
READERS: The new booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roach — No. 1001W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: have had episodes for many years where I am shocked, like an electric shock, which wakes me from sleep. I jump out of bed, then my legs and feet tremble rapidly, and I need to sit down or I will fall. I have been diagnosed as having “night terrors,” but it is not that. I had a normal MRI.
It used to happen twice a week, then dwindled to monthly. Lately, I have it pretty much under control. I wonder if there is some diagnosis out there for me. I hope you have an answer. It would make me feel like less of an idiot! — J.N.
ANSWER: I don’t think you are an idiot at all, and I do think I know the cause of these episodes. You have a pretty severe case of nocturnal myoclonus (which sounds like I know what I am talking about, but it just means muscle jerks at nighttime). These are very common and usually are normal, but are sometimes associated with epilepsy. Since yours aren’t getting worse over time and you haven’t had seizures, you are almost certain to have the “physiologic” type. Occasionally, there is a family history. I don’t think you will need any treatment.
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