Oct 16, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"I think I failed my joint test." Recreational cannabis legalization is all over the news. It is early in the morning. I am talking to Emily before her 7:30 am gym class. My mind races a little. I am confused over my 16 year old daughter's statement. Did I sign a marijuana cigarette rolling consent form that I missed? No, the legal age for marijuana is 19 not 16. Hmmm. Maybe take another sip of coffee. Now let's ask Emily to repeat herself and actually listen to what she has to say. "I said the math test went okay but I think I failed my multi-joint test." Okay she sees the blank stare. Don't freak out. "You know... butt joints, 45 degree angle joints, sticking pieces of metal together?" Welding. Yes. The "joints" are welding joints. Not everything this week is about cannabis.

I'm not sure if not understanding Emily was a hearing or an attention problem on my part. But as guys get older, hearing problems do get more common. Trouble peeing is another common complaint as men age. Let's do a quick anatomy review. The urethra is the canal through which urine passes. It starts at the bladder and goes out of the body. The prostate is a walnut sized gland that surrounds the urethra in males. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine.

Symptoms of BPH rarely show up before age 40. As mentioned, as men age the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent of men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven't completely emptied your bladder, and more frequent nighttime urination.

What should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss your treatment options. What treatment options are available for BPH? There is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. BPH treatment will usually start with medication. And don't panic about a BPH diagnosis. Despite what you made have heard, although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.

Just because you go to the doctor and complain about trouble peeing, don't be disappointed if they don't immediately offer you surgery or medication. If your symptoms don't bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.

There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in two weeks to a month. As good as alpha blockers are their benefits don't last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don't shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately, these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy's symptoms.

One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Studies like the Combination of Avodart and Tamsulosin (CombAT) Study have showed that the combination of these two types of drugs works.

Emily is really enjoying her welding classes. One of her latest projects is converting a frame of what was to be a wood stove for an ice fishing shack into the stove and rock holder for a sauna. I have never welded. But when I grew up there were two welders near my house on Lansdowne Ave in Pinawa. Mr. Sterling said he could weld two pieces of foil from a cigarette package together. And our house was full of Bill Dereski creations. We had a wire rack that held my mom's glass coffee pot above the element coil on the stove. There were welded wire puzzles that I wanted to solve. And that there was the ballerina holding a bent barbell while she balanced and spun on pedestal. I always thought Mr. Dereski's creations were cool. It'll be fascinating to see what Emily creates.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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