Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
How Does Tamsulosin And Finasteride Help In Treating Enlarged Prostate?
Question: From :xxxxxx XXXXXXX XXXXXXX
Dear Dr,
1.How do Tamsulosin,Finasteride & Beta sitosterol compare in treating enlarged prostate ??
2. My abdomen sonology in Lab A done in March 2014 has these details
Urinary bladder -- Prevoid vol 455ml postvoid residual urine 151 ml (significant)
Prostate enlarged in size ( grade 1 ). 38x 3x38 mm 25ml.
Urimax 0.4 mg taken for 9 months.
=======
Sonology done this week ( 9.5 months later) in Lab B says
U Bldr --prevoid vol 238 cc ( so low -- insuff collection ??)
postvoid Nil ( !!! in spite of substantial incr in prostate size )
Prostate is massively enlarged in size. 4.9x4.7x4.1 cm ( vol 49.6 cc)
=========
Could this be an error & due to 2 diff labs ??
But, I'm able to pass urine without much difficulty, though little slow. No increased disability in the past 9 months.
Why prostate size has increased fast in spite of Urimax ??
Is Beta sitosterol better for me ?? Or Finasteride ??
YYYY@YYYY Mob XXXXXX
Dear Dr,
1.How do Tamsulosin,Finasteride & Beta sitosterol compare in treating enlarged prostate ??
2. My abdomen sonology in Lab A done in March 2014 has these details
Urinary bladder -- Prevoid vol 455ml postvoid residual urine 151 ml (significant)
Prostate enlarged in size ( grade 1 ). 38x 3x38 mm 25ml.
Urimax 0.4 mg taken for 9 months.
=======
Sonology done this week ( 9.5 months later) in Lab B says
U Bldr --prevoid vol 238 cc ( so low -- insuff collection ??)
postvoid Nil ( !!! in spite of substantial incr in prostate size )
Prostate is massively enlarged in size. 4.9x4.7x4.1 cm ( vol 49.6 cc)
=========
Could this be an error & due to 2 diff labs ??
But, I'm able to pass urine without much difficulty, though little slow. No increased disability in the past 9 months.
Why prostate size has increased fast in spite of Urimax ??
Is Beta sitosterol better for me ?? Or Finasteride ??
YYYY@YYYY Mob XXXXXX
Brief Answer:
Finasteride is the drug of choice for BPH.
Detailed Answer:
Hi XXXXXXX XXXXXXX
I understand your query and concern.
1.Finasteride prevents the growth/hypertrophy of prostate.
2.Tamsulosin helps to increase the urinary flow rates by relaxing the urinary sphincter.
3.Beta Sitosterol has no documented clinical effects on enlarged prostate,whats so ever.Its only meant for historical importance.
4.Urimax is meant for antispasmodic action,relieving pain associated with BPH.
5.Pre void 238 ml on scan in lab B could be insufficient collection.
6.There is a possibility of Nil post voided urine inspite of massively enlarged prostate due to action of tamsulosin over 9 months.
7.This could not be a lab error as per your conviction.
8.BPH is progressive disorder,inspite of all drugs created to arrest its growth,it still grows and hence,ultimately requires surgery.
9.Finasteride is the drug of choice and not Beta sitosterol on any day.
post your doubts if any.
thank you
Finasteride is the drug of choice for BPH.
Detailed Answer:
Hi XXXXXXX XXXXXXX
I understand your query and concern.
1.Finasteride prevents the growth/hypertrophy of prostate.
2.Tamsulosin helps to increase the urinary flow rates by relaxing the urinary sphincter.
3.Beta Sitosterol has no documented clinical effects on enlarged prostate,whats so ever.Its only meant for historical importance.
4.Urimax is meant for antispasmodic action,relieving pain associated with BPH.
5.Pre void 238 ml on scan in lab B could be insufficient collection.
6.There is a possibility of Nil post voided urine inspite of massively enlarged prostate due to action of tamsulosin over 9 months.
7.This could not be a lab error as per your conviction.
8.BPH is progressive disorder,inspite of all drugs created to arrest its growth,it still grows and hence,ultimately requires surgery.
9.Finasteride is the drug of choice and not Beta sitosterol on any day.
post your doubts if any.
thank you
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr Heijebu,
Thanks for yr pointed reply.
One of my doubts of lab errors was, can the size of the prostate
increase from 29 ml to 49.6 ml in 9 months, in spite of taking Urimax 0.4 daily ?? Is it possible that the latest reported size of 49.6 ml is wrong, as I'm reasonably comfortable in passing urine ??
==========================================
Since my present concern is reg prostate, I did not tell you abt my other longtime existing,but, hopefully less serious renal /abdominal
ailments ; which are --
1. Kidney cysts -- slowly growing over 25+ years
a. Right --13x 9 cm cyst in the middle polar calyx extending into the hilium with a focus of peripheral calcification(Bosniak II ).
b. Right --Large exophytic simple cyst measuring 8x7 cm in the upper pole of the right kidney(Bosniak I ).
c. Left -- A 5.7x3.7 cm bilobed cyst in it's upper pole with a thin hyperdense septa within it(BosniakII).
Kidneys are otherwise normal in size,position,axis and contour wth no calculi or hydronephrosis.
======================================
2. I had my both hernias operated 25 years ago.Now it shows as bilateral inguinal omental hernias,left larger than right.
I seek yr advice on the above.
Rgds,
XXXXXXX
Thanks for yr pointed reply.
One of my doubts of lab errors was, can the size of the prostate
increase from 29 ml to 49.6 ml in 9 months, in spite of taking Urimax 0.4 daily ?? Is it possible that the latest reported size of 49.6 ml is wrong, as I'm reasonably comfortable in passing urine ??
==========================================
Since my present concern is reg prostate, I did not tell you abt my other longtime existing,but, hopefully less serious renal /abdominal
ailments ; which are --
1. Kidney cysts -- slowly growing over 25+ years
a. Right --13x 9 cm cyst in the middle polar calyx extending into the hilium with a focus of peripheral calcification(Bosniak II ).
b. Right --Large exophytic simple cyst measuring 8x7 cm in the upper pole of the right kidney(Bosniak I ).
c. Left -- A 5.7x3.7 cm bilobed cyst in it's upper pole with a thin hyperdense septa within it(BosniakII).
Kidneys are otherwise normal in size,position,axis and contour wth no calculi or hydronephrosis.
======================================
2. I had my both hernias operated 25 years ago.Now it shows as bilateral inguinal omental hernias,left larger than right.
I seek yr advice on the above.
Rgds,
XXXXXXX
Brief Answer:
A TRUS can eliminate all your doubts beyond conviction
Detailed Answer:
Hi Sir.
I understand your concern.
1.As already read,Urimax is used only as an antispasmodic to prevent pain experience while urinating,in presence of hypertrophied prostate.
2.As such Urimax has no action on controlling the growth of prostate, there is still a very practical possibility of attaining an increased size to 49.6cc considering the due nature of the course of the disease of BPH.
3.Regarding your query of still able to pass urine comfortably,i would like to tell you that urine passing tube called urethra passes through the central/median lobe of the prostate.This is liable for compression in BPH(Where only median lobe is involved) causing retention and difficulty in passing the urine.This is only a theoretical possibility.
But having said that,Tamsulosin is particularly very effective in overcoming the resistance/compression offered by enlarged median lobe of BPH to a certain extent/limit thereby facilitating good urine flow inspite of significantly/massively enlarged prostate.Hence its very much possible to have good urine flow in presence of 49.6 cc Prostate.
Its always not to perceive this as a lab error.
4.One more thing i would like to tell you which can eliminate the confusion and offer belief in the issue concerned-I advice you to have a TRUS/transrectal ultrasonography which can accurately determine the size and dimensions of prostate.This investigation is very superior to the routine abdominal ultrasound in evaluating prostate pathology.
5.Regarding the cysts in both Kidneys -You probably have Acquired Cystic Renal Disease/ACRD.
This needs a regular follow up in the form of Multiphase CT/Contrast enhanced CT/MRI particularly in Bosniak stage 2 lesions,which have propensity to turn into malignancy/cancer.
Stage 2 does not require any special therapy.Occasionally antibiotics are needed only if there is cyst infection.
6.Bilateral omental hernias at this stage does not require any special treatment except watchful waiting,as they generally do not pose any significant risks.
Thank you.
A TRUS can eliminate all your doubts beyond conviction
Detailed Answer:
Hi Sir.
I understand your concern.
1.As already read,Urimax is used only as an antispasmodic to prevent pain experience while urinating,in presence of hypertrophied prostate.
2.As such Urimax has no action on controlling the growth of prostate, there is still a very practical possibility of attaining an increased size to 49.6cc considering the due nature of the course of the disease of BPH.
3.Regarding your query of still able to pass urine comfortably,i would like to tell you that urine passing tube called urethra passes through the central/median lobe of the prostate.This is liable for compression in BPH(Where only median lobe is involved) causing retention and difficulty in passing the urine.This is only a theoretical possibility.
But having said that,Tamsulosin is particularly very effective in overcoming the resistance/compression offered by enlarged median lobe of BPH to a certain extent/limit thereby facilitating good urine flow inspite of significantly/massively enlarged prostate.Hence its very much possible to have good urine flow in presence of 49.6 cc Prostate.
Its always not to perceive this as a lab error.
4.One more thing i would like to tell you which can eliminate the confusion and offer belief in the issue concerned-I advice you to have a TRUS/transrectal ultrasonography which can accurately determine the size and dimensions of prostate.This investigation is very superior to the routine abdominal ultrasound in evaluating prostate pathology.
5.Regarding the cysts in both Kidneys -You probably have Acquired Cystic Renal Disease/ACRD.
This needs a regular follow up in the form of Multiphase CT/Contrast enhanced CT/MRI particularly in Bosniak stage 2 lesions,which have propensity to turn into malignancy/cancer.
Stage 2 does not require any special therapy.Occasionally antibiotics are needed only if there is cyst infection.
6.Bilateral omental hernias at this stage does not require any special treatment except watchful waiting,as they generally do not pose any significant risks.
Thank you.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear Dr. Heijebu,
Thanks a lot for crystal-clear comments, infmn & recomm's.
Since massively enlarged prostate & Nil postvoid appeared non-
compatible, the lab agreed & redid the U/S scan today & the
results were :--
Prevoid 380 CC Postvoid 75 CC
Prostate size 45.6 CC
============================
Now that you hv comprehensive infmn abt my prostate & kidney
cysts, I seek yr recomm's on the folwg : --
1. Medicines & dosages
2.Do I hv to go for surgery on prostate now ??
3. For Bosniak stage 2 kidney cysts, last CT was a plain and
contrast enhanced scan on 128 slice MDCT scanner with oral &
IV contrast.For future,which one out of the 3 forms of CT/MRI
you suggested should I go for ??
4. How often should I get the CT/MRI done to keep a watch on
development of possible malignancy/cancer in the cysts ??
Rgds,
XXXXXXX
Thanks a lot for crystal-clear comments, infmn & recomm's.
Since massively enlarged prostate & Nil postvoid appeared non-
compatible, the lab agreed & redid the U/S scan today & the
results were :--
Prevoid 380 CC Postvoid 75 CC
Prostate size 45.6 CC
============================
Now that you hv comprehensive infmn abt my prostate & kidney
cysts, I seek yr recomm's on the folwg : --
1. Medicines & dosages
2.Do I hv to go for surgery on prostate now ??
3. For Bosniak stage 2 kidney cysts, last CT was a plain and
contrast enhanced scan on 128 slice MDCT scanner with oral &
IV contrast.For future,which one out of the 3 forms of CT/MRI
you suggested should I go for ??
4. How often should I get the CT/MRI done to keep a watch on
development of possible malignancy/cancer in the cysts ??
Rgds,
XXXXXXX
Brief Answer:
Surgery on prostate is taken up if the said criteria meet.
Detailed Answer:
Hello Sir,
Good Morning,and i apologise for my delayed response.
Its good to know that your doubt regarding the zero postvoidal urine has been cleared by rescan.
1.Standard drugs and dosages for BPH are as follows.
Tamsulosin-0.4 mg once daily 30 mins after meal each day.If the response is inadequate after 2-4 weeks,it can be increased to 0.8 mg once daily.
Finasteride-5 mg PO once a day.Response is assessed after 12 weeks to 6 months.
2.Stage 1 Bosniak have to be followed once annually.
Stage 2 have to be followed once in 6 months.
Since you have both stages in both kidneys ,it advisable to have a follow up every 6 months.
3.The order of priority,superiority,and acceptability of various investigative modalities for follow up keep your age under special consideration is
MRI>>CECT>MDCT>CT PLAIN.
Hence i advise you to have a serial follow up with MRI,provided there are no contraindications to it.
4.The indications of surgery in case of BPH are.
1.Difficulty in voiding urine
2.Recurrent Gross passage of blood in urine.
3.Recurrent urinary tract infections.
4.Any form of Renal function insufficiency shown on Renal Function tests.
One needs to think of surgery if the above criteria meet,or else watchful waiting is preferred through serial scan.
Thank you.
Surgery on prostate is taken up if the said criteria meet.
Detailed Answer:
Hello Sir,
Good Morning,and i apologise for my delayed response.
Its good to know that your doubt regarding the zero postvoidal urine has been cleared by rescan.
1.Standard drugs and dosages for BPH are as follows.
Tamsulosin-0.4 mg once daily 30 mins after meal each day.If the response is inadequate after 2-4 weeks,it can be increased to 0.8 mg once daily.
Finasteride-5 mg PO once a day.Response is assessed after 12 weeks to 6 months.
2.Stage 1 Bosniak have to be followed once annually.
Stage 2 have to be followed once in 6 months.
Since you have both stages in both kidneys ,it advisable to have a follow up every 6 months.
3.The order of priority,superiority,and acceptability of various investigative modalities for follow up keep your age under special consideration is
MRI>>CECT>MDCT>CT PLAIN.
Hence i advise you to have a serial follow up with MRI,provided there are no contraindications to it.
4.The indications of surgery in case of BPH are.
1.Difficulty in voiding urine
2.Recurrent Gross passage of blood in urine.
3.Recurrent urinary tract infections.
4.Any form of Renal function insufficiency shown on Renal Function tests.
One needs to think of surgery if the above criteria meet,or else watchful waiting is preferred through serial scan.
Thank you.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. Heijebu,
I thank you once again for accurate & clear answers &
guidelines. As I want as much vital infmn reg all my abdomen &
pelvis problems from a high calibre Dr like you, I hv recharged
my acct for further queries.
1.Is there any med or supplement to slow the possible onset of
malignancy in my kidneys' Bosniak2 cysts ? If so, what should be
the dosage for my age ??
I hv hypertension for 25 years & diabetes for 14 years under
control to near normal levels with meds ; no cholesterol & no
history of heart trouble & reasonably good physique for a 4 mile
(6.4 km) 45 min brisk walk.
2. One other condition of mine, I hv not referred to you so far, is
abt a tumour at one place in urinary bladder. First symptom was
hematuria just once in Aug 2013. As routine blood & urine tests
were normal within 2 days after the event,I took it lightly & did not
go for suggested U/S scan & CT.
8 months later, in April 2014, the hematuria repeated, but, again
stopped immly. U/S & CT scans revealed a tumour of 25 ml size.
TURBT was done in Apr 2014. It has been rated as non-invasive,
very slow progression, low-grade carcinoma.Subseq cytoscopies
in the past 9 months incl one last week, hv found the bladder
clean.
Based on the very mild nature of the tumour & the bladder being
clean for 9 months, is it sufficient for me to get U/S scan of
bladder & high resolution microscopic cytology of urine for
malignant cells, done every 6 months, instead of flexible
cytoscopy every year ??
Is there any med or supplement to reduce the possibility of it's
recurrence ??
Rgds,
XXXXXXX
I thank you once again for accurate & clear answers &
guidelines. As I want as much vital infmn reg all my abdomen &
pelvis problems from a high calibre Dr like you, I hv recharged
my acct for further queries.
1.Is there any med or supplement to slow the possible onset of
malignancy in my kidneys' Bosniak2 cysts ? If so, what should be
the dosage for my age ??
I hv hypertension for 25 years & diabetes for 14 years under
control to near normal levels with meds ; no cholesterol & no
history of heart trouble & reasonably good physique for a 4 mile
(6.4 km) 45 min brisk walk.
2. One other condition of mine, I hv not referred to you so far, is
abt a tumour at one place in urinary bladder. First symptom was
hematuria just once in Aug 2013. As routine blood & urine tests
were normal within 2 days after the event,I took it lightly & did not
go for suggested U/S scan & CT.
8 months later, in April 2014, the hematuria repeated, but, again
stopped immly. U/S & CT scans revealed a tumour of 25 ml size.
TURBT was done in Apr 2014. It has been rated as non-invasive,
very slow progression, low-grade carcinoma.Subseq cytoscopies
in the past 9 months incl one last week, hv found the bladder
clean.
Based on the very mild nature of the tumour & the bladder being
clean for 9 months, is it sufficient for me to get U/S scan of
bladder & high resolution microscopic cytology of urine for
malignant cells, done every 6 months, instead of flexible
cytoscopy every year ??
Is there any med or supplement to reduce the possibility of it's
recurrence ??
Rgds,
XXXXXXX
Brief Answer:
FISH and Immunocytology Of Urine can offer better results.
Detailed Answer:
Hi Sir.
I understand your concern.
1.To begin with, I am sorry to say that, there is no clinically proven drug or supplement that exists and which can delay the onset of malignancy in Bosniak stage 2.
So far you have maintained your cardiovascular status in an excellent condition in presence of diabetes and hypertension.I wish you carry this good work.
2.In presence of past history of low grade ,non invasive ,squamous cell carcinoma,being clear on follow up Cystoscopy.,It extremely important to screen for any relapse effectively.
As per your conviction,Urine cytology plus Bladder Ultrasound semiannually as a substitute to annual cystoscopy seems quite a good scientific alternative since low grade tumor recurrences are hardly discernible by routine cystoscopy.
But you need to make certain modifications pertaining to Urine Cytology.
1.Routine/Conventional Urine cytology cannot detect low grade cancer cells effectively due to their strong attachment to their native tissue.
The sensitivity can be improved by Using Immunocytology which uses Cytokeratin 20 target molecule to detect recurrence of the cancer cells with great sensitivity.
Also Similar advantage can be offered by FISH/fluorescent in situ hybridization,which has additional capacity to detect recurrences of cancer in individuals with past history of bladder cancer as well as gross hematuria.
As a alternate to Cystoscopy which is quite embarrassing to the patient,MRI scan as well as Renal ultrasound can offer better alternatives to cystoscopy.
Overall currently followed imaging procedures for detection bladder cancer recurrences however small, are in the given order- Blue light Cystoscopy(very superior to conventional flexible cystoscopy)>MDCT>RENAL ULTRASOUND>IVP>MRI.
Recently in the year 2011/2012 European Association Urology Guidelines,over 30 Urine tumor Biomarkers care commercially available which can detect recurrences very effectively.
2.Intravesical BCG therapy is currently offered to patients with bladder cancers to prevent bladder tumor recurrences.
3.Overall I would like to sum up as follows:
In the event of past history of treatable bladder cancers,there exists a high risk of cancers arising elsewhere in the urinary tract especially the Stage 2 cysts in the kidney.
Hence I advise you to have periodical follow up every 3 months through MRI-FAST SPIN ECHO to detect any new cancers changes.
4.Specific surgical procedures like Endoscopic marsupialization and fulguration and laparoscopic resection will help to eliminate the possibility of developing cancer in the cysts.
Hope I have answered all your queries,
Post your further doubts if any.
Thank you.
FISH and Immunocytology Of Urine can offer better results.
Detailed Answer:
Hi Sir.
I understand your concern.
1.To begin with, I am sorry to say that, there is no clinically proven drug or supplement that exists and which can delay the onset of malignancy in Bosniak stage 2.
So far you have maintained your cardiovascular status in an excellent condition in presence of diabetes and hypertension.I wish you carry this good work.
2.In presence of past history of low grade ,non invasive ,squamous cell carcinoma,being clear on follow up Cystoscopy.,It extremely important to screen for any relapse effectively.
As per your conviction,Urine cytology plus Bladder Ultrasound semiannually as a substitute to annual cystoscopy seems quite a good scientific alternative since low grade tumor recurrences are hardly discernible by routine cystoscopy.
But you need to make certain modifications pertaining to Urine Cytology.
1.Routine/Conventional Urine cytology cannot detect low grade cancer cells effectively due to their strong attachment to their native tissue.
The sensitivity can be improved by Using Immunocytology which uses Cytokeratin 20 target molecule to detect recurrence of the cancer cells with great sensitivity.
Also Similar advantage can be offered by FISH/fluorescent in situ hybridization,which has additional capacity to detect recurrences of cancer in individuals with past history of bladder cancer as well as gross hematuria.
As a alternate to Cystoscopy which is quite embarrassing to the patient,MRI scan as well as Renal ultrasound can offer better alternatives to cystoscopy.
Overall currently followed imaging procedures for detection bladder cancer recurrences however small, are in the given order- Blue light Cystoscopy(very superior to conventional flexible cystoscopy)>MDCT>RENAL ULTRASOUND>IVP>MRI.
Recently in the year 2011/2012 European Association Urology Guidelines,over 30 Urine tumor Biomarkers care commercially available which can detect recurrences very effectively.
2.Intravesical BCG therapy is currently offered to patients with bladder cancers to prevent bladder tumor recurrences.
3.Overall I would like to sum up as follows:
In the event of past history of treatable bladder cancers,there exists a high risk of cancers arising elsewhere in the urinary tract especially the Stage 2 cysts in the kidney.
Hence I advise you to have periodical follow up every 3 months through MRI-FAST SPIN ECHO to detect any new cancers changes.
4.Specific surgical procedures like Endoscopic marsupialization and fulguration and laparoscopic resection will help to eliminate the possibility of developing cancer in the cysts.
Hope I have answered all your queries,
Post your further doubts if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Heijebu,
Thanks a lot once again.
I hv the folwg doubts.
1. As I said erlr, I don't hv much prob in passing urine. In fact,
there is no further improvement in it after starting Tamsulosin 9
months ago,eventhough my prostate size is big now. I wonder
whether I need the med.
Can I stop for a week or so & see if I find any difficulty ??
I suppose, I should start Finasteride 5 mg straightaway ??
I don't u'stand "PO" reg this med in yr erlr reply. When is it
to be taken daily ??
2. The CT Lab report of Apr 2014 has rated one ea cyst in both
the kidneys as Bosniak II.
From the description of these cysts in my erlr query, are both to
be classified as Bosniak II or Bosniak IIF ??
I u'stand II has zero malignancy chance & IIF has 5% chance.
If they are stage II only, do I need imaging every 3 months or with
longer gap ??
3. It would appear that my constitution, by nature, has resistance
to spread of bladder cancer ; my first symptom of just once
hematuria was 17 months ago. I took it lightly & let go.Non-
invasive low-grade carcinoma was diagnosed only 7 months later.
It had not spread to more tumours till then.
An alternate therapy med for bladder / kidney /uterus cancers is
a few drops daily orally of Frank-incense oil daily. I hv been
taking this daily for the past 8 months.
Now, I don't know if non-recurrence of tumour in bladder for the
past 17 months is due to the nature of my consttn or the oil or
both ?? I seek yr opinion on this. Before that,if you hv the time &
inclination,kindly peruse the folwg URLs.
http://www.biomedcentral.com/1472-6882/9/6/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
http://sett.com/mynaturepedia/frankincense-essential-oil-to-fight-cancer
=======================================
For all cancers
Amazing results of baking soda therapy….
http://phkillscancer.com/cancer-success-stories-from-others-some-links
Lemon Drops and Sea Salt Formula
http://phkillscancer.com/cancer/natural-gentle-cancer-protocol-dropped-into-my-lap-lemon-sea-salt-oxygen-no-baking-soda-or-ph-paper
=============================================
4. My last query
I suffer from Erythromelalgia - The Syndrome of Red, Hot Feet
for 3 decades.
After the onset of diabetes 14 years ago, it has become worse.
It is said to be an incurable one.
I seek yr advice on this.
Best Rgds,
XXXXXX
Thanks a lot once again.
I hv the folwg doubts.
1. As I said erlr, I don't hv much prob in passing urine. In fact,
there is no further improvement in it after starting Tamsulosin 9
months ago,eventhough my prostate size is big now. I wonder
whether I need the med.
Can I stop for a week or so & see if I find any difficulty ??
I suppose, I should start Finasteride 5 mg straightaway ??
I don't u'stand "PO" reg this med in yr erlr reply. When is it
to be taken daily ??
2. The CT Lab report of Apr 2014 has rated one ea cyst in both
the kidneys as Bosniak II.
From the description of these cysts in my erlr query, are both to
be classified as Bosniak II or Bosniak IIF ??
I u'stand II has zero malignancy chance & IIF has 5% chance.
If they are stage II only, do I need imaging every 3 months or with
longer gap ??
3. It would appear that my constitution, by nature, has resistance
to spread of bladder cancer ; my first symptom of just once
hematuria was 17 months ago. I took it lightly & let go.Non-
invasive low-grade carcinoma was diagnosed only 7 months later.
It had not spread to more tumours till then.
An alternate therapy med for bladder / kidney /uterus cancers is
a few drops daily orally of Frank-incense oil daily. I hv been
taking this daily for the past 8 months.
Now, I don't know if non-recurrence of tumour in bladder for the
past 17 months is due to the nature of my consttn or the oil or
both ?? I seek yr opinion on this. Before that,if you hv the time &
inclination,kindly peruse the folwg URLs.
http://www.biomedcentral.com/1472-6882/9/6/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
http://sett.com/mynaturepedia/frankincense-essential-oil-to-fight-cancer
=======================================
For all cancers
Amazing results of baking soda therapy….
http://phkillscancer.com/cancer-success-stories-from-others-some-links
Lemon Drops and Sea Salt Formula
http://phkillscancer.com/cancer/natural-gentle-cancer-protocol-dropped-into-my-lap-lemon-sea-salt-oxygen-no-baking-soda-or-ph-paper
=============================================
4. My last query
I suffer from Erythromelalgia - The Syndrome of Red, Hot Feet
for 3 decades.
After the onset of diabetes 14 years ago, it has become worse.
It is said to be an incurable one.
I seek yr advice on this.
Best Rgds,
XXXXXX
Brief Answer:
Finasteride can be started in your case.
Detailed Answer:
Hi Sir,
I understand your concern.
I apologise for my delayed response.
1. Tamsulosin is very useful to improve urine flow rates especially in presence of enlarging prostate size. This drug is very useful in individuals with enlarging prostate size who run the risk of sudden urinary obstruction which may prove hazardous.
Hence I recommend you not to resort to these provoking tests by stopping tamsulosin and adopting a waitful procedure.
2. PO means per oral. This is the mode of drug administration. Finasteride is mainly taken at bedtime daily.
3. Its the right time to start finasteride in your case. Its advantages are
a. It reduces the risk of symptomatic progression of BPH.
b. It reduces the prostate size by 20-30%
c. Reduction in prostate size is sustained for 5 years following treatment.
d. It improves urine flow rates by 2ml/s.
4. Regarding the Bosniak staging, the cyst in the right kidney in the middle polar calyx, belongs to Stage 2F, due to foci of calcification.
The cyst in the left kidney is in stage 2.
The risk of malignancy in stage 2----0 to 14%
2F----upto 20%.
Hence it is recommended to have periodical follow up every 3 months for early diagnosis and treatment.
5. Body constitution and inherent resistance are not clinically implicated in delaying the onset of bladder cancers. The late presentation of cancer after 7 months of hematuria could only be related to the low grade nature of the tumor.
6. I have gone through your uploaded URL's as well.
Frankincense oil, Baking Soda, Lemon drops and sea salt are never documented clinically to prevent, halt or delay cancers. Please do not invest your belief in such.
7. You seem to have Primary Erythromelalgia, for which there is no documented cure in any literature.
Thank you.
Finasteride can be started in your case.
Detailed Answer:
Hi Sir,
I understand your concern.
I apologise for my delayed response.
1. Tamsulosin is very useful to improve urine flow rates especially in presence of enlarging prostate size. This drug is very useful in individuals with enlarging prostate size who run the risk of sudden urinary obstruction which may prove hazardous.
Hence I recommend you not to resort to these provoking tests by stopping tamsulosin and adopting a waitful procedure.
2. PO means per oral. This is the mode of drug administration. Finasteride is mainly taken at bedtime daily.
3. Its the right time to start finasteride in your case. Its advantages are
a. It reduces the risk of symptomatic progression of BPH.
b. It reduces the prostate size by 20-30%
c. Reduction in prostate size is sustained for 5 years following treatment.
d. It improves urine flow rates by 2ml/s.
4. Regarding the Bosniak staging, the cyst in the right kidney in the middle polar calyx, belongs to Stage 2F, due to foci of calcification.
The cyst in the left kidney is in stage 2.
The risk of malignancy in stage 2----0 to 14%
2F----upto 20%.
Hence it is recommended to have periodical follow up every 3 months for early diagnosis and treatment.
5. Body constitution and inherent resistance are not clinically implicated in delaying the onset of bladder cancers. The late presentation of cancer after 7 months of hematuria could only be related to the low grade nature of the tumor.
6. I have gone through your uploaded URL's as well.
Frankincense oil, Baking Soda, Lemon drops and sea salt are never documented clinically to prevent, halt or delay cancers. Please do not invest your belief in such.
7. You seem to have Primary Erythromelalgia, for which there is no documented cure in any literature.
Thank you.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
XXXXXXX 18 8.58 PM
Dear Dr. Heijebu,
Thanks a lot once again.
I seek yr advice on the folwg, if I'm not mistaken as exploiting the
provisions reg Q&A.
1. I was suffering from cramps occuring allover the body daytime
& nighttime from teenage for the past 50 years. Tried so many
supplements like Ca, Mg,Potassium,eating more tomatoes,
vitamins etc, but it did not work.
For the past 6 months I'm taking Zy Q 200 quinine hydrox 200mg.
Almost from the first day there was relief which is still sustaining.
Am I on the right track in this ?? Will there be any side effects over
a long run ??
2. My elder brother of age 75 is heart-healthy & has no diabetes
nor cholosterol nor hypertension. He has BPH with opposite
symptoms viz., incontinence of bladder & rectum.
He is taking Urimax 0.4 mg as per prescrpn but no relief. He is
living in a small town in T Nadu, where there is not much choice of
specialists.
I seek yr advice for his case.
Rgds,
XXXXXXX
Dear Dr. Heijebu,
Thanks a lot once again.
I seek yr advice on the folwg, if I'm not mistaken as exploiting the
provisions reg Q&A.
1. I was suffering from cramps occuring allover the body daytime
& nighttime from teenage for the past 50 years. Tried so many
supplements like Ca, Mg,Potassium,eating more tomatoes,
vitamins etc, but it did not work.
For the past 6 months I'm taking Zy Q 200 quinine hydrox 200mg.
Almost from the first day there was relief which is still sustaining.
Am I on the right track in this ?? Will there be any side effects over
a long run ??
2. My elder brother of age 75 is heart-healthy & has no diabetes
nor cholosterol nor hypertension. He has BPH with opposite
symptoms viz., incontinence of bladder & rectum.
He is taking Urimax 0.4 mg as per prescrpn but no relief. He is
living in a small town in T Nadu, where there is not much choice of
specialists.
I seek yr advice for his case.
Rgds,
XXXXXXX
Brief Answer:
Avoid Zy Q 200
Detailed Answer:
Hello Sir.
1.Zy Q 200 contains hydoxychloroquine sulphate which is not safe on long term use.
This drug is also not used for such an indication.
This drug is known to cause Retinal damage,skin and musculoskeletal system pigmentation,corneal damage,reduction of blood cell counts.
Hence I advise you to refrain from its use.
2.Pertaining to your brother,its more apt to replace the term incontinence with urinary frequency,urgency and dribbling.
The need for surgery is high in your brother's case due to the refractory symptoms to medical therapy.
Thank you.
Avoid Zy Q 200
Detailed Answer:
Hello Sir.
1.Zy Q 200 contains hydoxychloroquine sulphate which is not safe on long term use.
This drug is also not used for such an indication.
This drug is known to cause Retinal damage,skin and musculoskeletal system pigmentation,corneal damage,reduction of blood cell counts.
Hence I advise you to refrain from its use.
2.Pertaining to your brother,its more apt to replace the term incontinence with urinary frequency,urgency and dribbling.
The need for surgery is high in your brother's case due to the refractory symptoms to medical therapy.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
XXXXXXX 19 9.17 PM
Dear Dr. Heijebu,
Thanks a lot once again. I hv recharged again.
1.As I said erlr, I hv been suffering from unbelievably severe
cramps from teenage ; tried many remedies with no success.
Occuring day & night & disturbing sleep & leading to headaches.
Imagine from teenage not able to sit in the pillion of a bike, hv to
spring out of bed in odd hours & jump up & down for 10 mins ;
constant residual pain in thighs & legs ; sometimes lockjaws etc,
etc. It subsides after rubbing painbalms.
Could you suggest safer drugs for these severe cramps ??
2. My wife ( age 68) who has Osteoarth in left knee for 10 yrs &
symptoms of Rh arth in many joints for 4 years, has been
prescribed HCQS 200 mg daily in 2011 by a reputed conservative
Ortho Dr. Also another strong drug methotrexate 5mg, 3 times on
any one day once every week. She is still on those drugs. She has
hypertension & Cholesterol, under control with drugs, but has no
diabetes.She's very bulky,115 kg. No heart or hormonal probs.
I seek yr comments & advice on her health.
Rgds,
XXXXXX
Dear Dr. Heijebu,
Thanks a lot once again. I hv recharged again.
1.As I said erlr, I hv been suffering from unbelievably severe
cramps from teenage ; tried many remedies with no success.
Occuring day & night & disturbing sleep & leading to headaches.
Imagine from teenage not able to sit in the pillion of a bike, hv to
spring out of bed in odd hours & jump up & down for 10 mins ;
constant residual pain in thighs & legs ; sometimes lockjaws etc,
etc. It subsides after rubbing painbalms.
Could you suggest safer drugs for these severe cramps ??
2. My wife ( age 68) who has Osteoarth in left knee for 10 yrs &
symptoms of Rh arth in many joints for 4 years, has been
prescribed HCQS 200 mg daily in 2011 by a reputed conservative
Ortho Dr. Also another strong drug methotrexate 5mg, 3 times on
any one day once every week. She is still on those drugs. She has
hypertension & Cholesterol, under control with drugs, but has no
diabetes.She's very bulky,115 kg. No heart or hormonal probs.
I seek yr comments & advice on her health.
Rgds,
XXXXXX
Brief Answer:
Primary RLS could be possibility.
Detailed Answer:
Hi Sir.
I understand your concern.
1.As per your symptoms,you probably seem to have Early Onset(before 45 years of age)Restless leg Syndrome/RLS.
This is primarily a distinct neurologic(central nervous system) movement disorder with all the criteria/symptoms you mentioned.
This is most cases is idiopathic/primary,Idiopathic cases have a familial tendency in 25-75% cases.Such patients tend to have earlier age of onset and slower disease progression.
Only few cases can have a cause attributed to RLS.These cases are termed as Secondary RLS.Hence its very important to first rule out secondary causes,before proceeding to therapy .
Common causes include:
1.Iron deficiency-hence full panel of iron studies testing is required.
2.Folate,B12,Magnesium deficiency- hence their testing is required.
3.Diabetes mellitus-Blood glucose test.
4.Rheumatoid Arthritis-Anti CCP antibodies and RF testing .
5.Thyroid disorders.
6.MGUS-Monoclonal gammopathy of undetermined significance-Very important as far your age is concerned.
7.Any known long term renal disease.
Certain drugs particularly psychotropic medications are also known to cause/aggravate RLS.Eliminating them would control the symptoms quite easily.
Hence I request you to give a complete list of daily medications in your follow up to identify any offending drug that is known to cause RLS.
Some non pharmacological measures which I would like to suggest are:
1.Sleep hygiene measures.
2.Avoidance of caffeine,nicotine and alcohol if any.
3.Discontinuation of all the medications that are known to cause RLS.
4.Regular exercises like daily brisk walk.
5.Physical modalities like hot or cold bath,whirlpool bath or limb massage.
Vibratory/electrical stimulation (with a device called Relaxis)of the feet and the toes.
Pharmacological therapy of Primary RLS is largely symptomatic.
Gabapentin Enacarbil,an USFDA approved drug for Primary RLS.The usual dosage is 600 mg PO once a day with food at 5:00 pm.
Additionally Iron salts are needed in presence of their documented deficiency.
Its safe to use the drug for possible short periods of time.
Please note this drug has to be taken only under strict medical supervision.
2.Regarding of your wife-She is currently receiving a standard therapy for RA and OA.
Its always better to take Methotrexate on any fixed day of the week.
She need to get a Liver function test on semi annual basis ,since Methotrexate is potentially hepatotoxic drug.
She has to cut down in weight.This is extremely important to maintain weight around 60-65 kgs in presence of hypertension and hypercholesterolemia.
Its extremely important that she is started on anti lipid medications to normalise her lipid profile.
Its mandate that she gets her routine heart check in the form of ECG,2D ECHO,Lipid Profile semiannually.Any abnormalities have to be promptly corrected.
Blood pressure has to be measured twice weekly.Its important to keep the BP under 130/80 mm of Hg always.
Thank you.
Primary RLS could be possibility.
Detailed Answer:
Hi Sir.
I understand your concern.
1.As per your symptoms,you probably seem to have Early Onset(before 45 years of age)Restless leg Syndrome/RLS.
This is primarily a distinct neurologic(central nervous system) movement disorder with all the criteria/symptoms you mentioned.
This is most cases is idiopathic/primary,Idiopathic cases have a familial tendency in 25-75% cases.Such patients tend to have earlier age of onset and slower disease progression.
Only few cases can have a cause attributed to RLS.These cases are termed as Secondary RLS.Hence its very important to first rule out secondary causes,before proceeding to therapy .
Common causes include:
1.Iron deficiency-hence full panel of iron studies testing is required.
2.Folate,B12,Magnesium deficiency- hence their testing is required.
3.Diabetes mellitus-Blood glucose test.
4.Rheumatoid Arthritis-Anti CCP antibodies and RF testing .
5.Thyroid disorders.
6.MGUS-Monoclonal gammopathy of undetermined significance-Very important as far your age is concerned.
7.Any known long term renal disease.
Certain drugs particularly psychotropic medications are also known to cause/aggravate RLS.Eliminating them would control the symptoms quite easily.
Hence I request you to give a complete list of daily medications in your follow up to identify any offending drug that is known to cause RLS.
Some non pharmacological measures which I would like to suggest are:
1.Sleep hygiene measures.
2.Avoidance of caffeine,nicotine and alcohol if any.
3.Discontinuation of all the medications that are known to cause RLS.
4.Regular exercises like daily brisk walk.
5.Physical modalities like hot or cold bath,whirlpool bath or limb massage.
Vibratory/electrical stimulation (with a device called Relaxis)of the feet and the toes.
Pharmacological therapy of Primary RLS is largely symptomatic.
Gabapentin Enacarbil,an USFDA approved drug for Primary RLS.The usual dosage is 600 mg PO once a day with food at 5:00 pm.
Additionally Iron salts are needed in presence of their documented deficiency.
Its safe to use the drug for possible short periods of time.
Please note this drug has to be taken only under strict medical supervision.
2.Regarding of your wife-She is currently receiving a standard therapy for RA and OA.
Its always better to take Methotrexate on any fixed day of the week.
She need to get a Liver function test on semi annual basis ,since Methotrexate is potentially hepatotoxic drug.
She has to cut down in weight.This is extremely important to maintain weight around 60-65 kgs in presence of hypertension and hypercholesterolemia.
Its extremely important that she is started on anti lipid medications to normalise her lipid profile.
Its mandate that she gets her routine heart check in the form of ECG,2D ECHO,Lipid Profile semiannually.Any abnormalities have to be promptly corrected.
Blood pressure has to be measured twice weekly.Its important to keep the BP under 130/80 mm of Hg always.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
XXXXXXX 22 10.32 PM
Dear Dr. Heijebu,
Thanks a lot once again.
Thse are my followup queries.
1. As described by me erlr,for severe, ever-present & daily occuring many times, cramps from teenage which caused misery to me @ home & workplace , which did not abate in spite of trying for a few years Gabapentin, Folate, Mg etc., etc.,will Vitamin D 5000 IU daily help instead of the bad HCQS ??
2. Is Mg supplement of one Milk of Magnesia in tabletform daily good for the heart & general health ??
3. I had a BP shootingup to 182 / 110 episode on Tuesday 20th XXXXXXX night.Nearby friendly Dr gave sublingual 5 mg of calcigard liquid in softcapsule & it subsided. I used to hv this abt 4 times a year for abt 4 yrs 2000--2004 ; only now after that. Though my routines are same, this occurs, though very rarely.
a) Can there be any particular cause ??
b) Is this the correct way of dealing with this emergency ??
c) My regular BP meds are Telmisartan H & Amlobet 50+5 twice a day. Is this OK ?? Or any Nifedepin also desirable ??
d) Are Lowcost equivalent BP drugs by Mankind & Bluecross dependable ??
4. For type 2 diabetes( for 14 years ), my med now is Janumet 50/500 + Metformin 500 twice daily. Is this OK ?? My fasting value is 110 & PP 145.
5. Warts in neck & chest front & back is another 25 year condition in me. They are totally silent ; no inflammation, nor wetness nor bleed nor pain. Any remedy ??
6. My wife, whose health probs I hv stated erlr, has bulky uterus.The lab has suggested Biopsy, eventhough she has no discharge problem nor any pain. What further diagnosis & treatment are desirable, taking her health condition into acct ??
7. Is bariatric surgery to reduce wt & bulk safe & effective for my
wife's health condition ??
Rgds,
XXXXXX
Dear Dr. Heijebu,
Thanks a lot once again.
Thse are my followup queries.
1. As described by me erlr,for severe, ever-present & daily occuring many times, cramps from teenage which caused misery to me @ home & workplace , which did not abate in spite of trying for a few years Gabapentin, Folate, Mg etc., etc.,will Vitamin D 5000 IU daily help instead of the bad HCQS ??
2. Is Mg supplement of one Milk of Magnesia in tabletform daily good for the heart & general health ??
3. I had a BP shootingup to 182 / 110 episode on Tuesday 20th XXXXXXX night.Nearby friendly Dr gave sublingual 5 mg of calcigard liquid in softcapsule & it subsided. I used to hv this abt 4 times a year for abt 4 yrs 2000--2004 ; only now after that. Though my routines are same, this occurs, though very rarely.
a) Can there be any particular cause ??
b) Is this the correct way of dealing with this emergency ??
c) My regular BP meds are Telmisartan H & Amlobet 50+5 twice a day. Is this OK ?? Or any Nifedepin also desirable ??
d) Are Lowcost equivalent BP drugs by Mankind & Bluecross dependable ??
4. For type 2 diabetes( for 14 years ), my med now is Janumet 50/500 + Metformin 500 twice daily. Is this OK ?? My fasting value is 110 & PP 145.
5. Warts in neck & chest front & back is another 25 year condition in me. They are totally silent ; no inflammation, nor wetness nor bleed nor pain. Any remedy ??
6. My wife, whose health probs I hv stated erlr, has bulky uterus.The lab has suggested Biopsy, eventhough she has no discharge problem nor any pain. What further diagnosis & treatment are desirable, taking her health condition into acct ??
7. Is bariatric surgery to reduce wt & bulk safe & effective for my
wife's health condition ??
Rgds,
XXXXXX
Brief Answer:
Few excursions in Blood pressure can be stress related
Detailed Answer:
Hi Sir,
I understand your concern.
Before starting any form of therapy for RLS,one needs to have a documented proof of deficiency of the above mentioned minerals/vitamins in the body.
Vit D supplementation needs prior Vit D serum testing.Unusual intake of this vitamin can elevate your blood pressure.
For similar reasons Mg needs testing in the blood,since milk of magnesia when taken without a clear cut indication can cause,neuromuscular disturbances and renal stones.
The usual recommended intake of Vit D for your age is 600 IU this is equivalent to 1500 mcg of Calcitriol(active form of vit D).
Hence any VIt D supplementation should not exceed these numerals,unless there is a specific indication.Primary RLS is certainly not an Indication.
4 such episodes of elevated blood pressure to 180/100 mm of Hg,for about 4 times a year for 4 consecutive years may not significant in view of new organic disease progression.This elevation can usually be considered benign or reactive to daily stressors.
Calcigard retard is often a good option in such situations,but is not always the management of choice.I advise you to have an ECG every time you shoot up your blood pressure to such levels.
Its always safe and secure that you receive such monitoring and care in an emergency cardiac setting in events like elevated blood pressure or chest discomfort.
Telmisartan plain is preferable to Telmisartan H in individuals who are above 65yrs,since "H" component is known to cause serious electrolyte disturbances like Na and K loss from the body.
Amlobet 5mg is good enough for you.
Low cost dependable drugs by Mankind and Bluecross are absolutely not advised.NEVER go for them since large differences in oral bioavailability of the drugs.
Metformin and Janumet are relatively safe drugs in diabetics in your age.But its important that you take adequate intake of Vit B12 ,since Metformin 0n long term can cause B12 deficiency.
For this I prescribe tab Matilda ER 1500 mcg one tab every alternative day for 3 months.This regimen will create enough reserves of this vitamin in the body.
Its always safe to maintain the levels of FBS and PPBS under 110 and 130 mg% respectively.
The warts in your case are probably benign,Verruca Vulgaris.This does not need special treatment.For cosmetic purposes,you can apply Salicylic acid Oint 17% along with Imiquimod Cream 5 % Will help.
A bulky uterus in your wife's case always needs histological examination to rule out malignancy.Biopsy is a must.Treatment largely depends on the results of the Biopsy.
Bariatric surgery is not really a good option in your case.Its only indicated in in cases with BMI greater than 40 with associated serious gastrointestinal disturbances and those who failed with exercise and diet regimen.The Brunt of surgery over long term can be a problem for elderly age group.
Thank you.
Few excursions in Blood pressure can be stress related
Detailed Answer:
Hi Sir,
I understand your concern.
Before starting any form of therapy for RLS,one needs to have a documented proof of deficiency of the above mentioned minerals/vitamins in the body.
Vit D supplementation needs prior Vit D serum testing.Unusual intake of this vitamin can elevate your blood pressure.
For similar reasons Mg needs testing in the blood,since milk of magnesia when taken without a clear cut indication can cause,neuromuscular disturbances and renal stones.
The usual recommended intake of Vit D for your age is 600 IU this is equivalent to 1500 mcg of Calcitriol(active form of vit D).
Hence any VIt D supplementation should not exceed these numerals,unless there is a specific indication.Primary RLS is certainly not an Indication.
4 such episodes of elevated blood pressure to 180/100 mm of Hg,for about 4 times a year for 4 consecutive years may not significant in view of new organic disease progression.This elevation can usually be considered benign or reactive to daily stressors.
Calcigard retard is often a good option in such situations,but is not always the management of choice.I advise you to have an ECG every time you shoot up your blood pressure to such levels.
Its always safe and secure that you receive such monitoring and care in an emergency cardiac setting in events like elevated blood pressure or chest discomfort.
Telmisartan plain is preferable to Telmisartan H in individuals who are above 65yrs,since "H" component is known to cause serious electrolyte disturbances like Na and K loss from the body.
Amlobet 5mg is good enough for you.
Low cost dependable drugs by Mankind and Bluecross are absolutely not advised.NEVER go for them since large differences in oral bioavailability of the drugs.
Metformin and Janumet are relatively safe drugs in diabetics in your age.But its important that you take adequate intake of Vit B12 ,since Metformin 0n long term can cause B12 deficiency.
For this I prescribe tab Matilda ER 1500 mcg one tab every alternative day for 3 months.This regimen will create enough reserves of this vitamin in the body.
Its always safe to maintain the levels of FBS and PPBS under 110 and 130 mg% respectively.
The warts in your case are probably benign,Verruca Vulgaris.This does not need special treatment.For cosmetic purposes,you can apply Salicylic acid Oint 17% along with Imiquimod Cream 5 % Will help.
A bulky uterus in your wife's case always needs histological examination to rule out malignancy.Biopsy is a must.Treatment largely depends on the results of the Biopsy.
Bariatric surgery is not really a good option in your case.Its only indicated in in cases with BMI greater than 40 with associated serious gastrointestinal disturbances and those who failed with exercise and diet regimen.The Brunt of surgery over long term can be a problem for elderly age group.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
XXXXXXX 26 6.42 PM
Dear Dr. Heijebu,
Thanks a lot once again.
These are my final followup queries in the order of yr above reply.
1. I'll get Vit D serum testing done. Pl adivse if the 25(OH) test is
the right one.
2.Are the supplements calcitriol,cholecalciferol & alfacalcidol one
& the same,pl ?? Cholecaciferol is priced 4 to 8 times the others.
3.You hv recomm'd dosage of 600IU of calcitriol as 1500mcg ;
whereas all brands of it sell it in .25 to 1 mcg. Pl clarify.
4.In calcitriol/alfacalcidol which is the best brand viz., a) Qtr Alpha
by Walace b) Vitalpha of XXXXXXX Antibiotics.c) GR Alpha of
Zydus/German Remed d) Calcit SG of Zydus Cadila
5.Cholecalciferol is avlbl only in 60000 IU. If that's yr choice, at
what freq'cy should it be taken, pl ?? Which is the best brand
among a)D More of Medzer Pharma b)Hira D3 by Hira Labs c)
Quente D3 by XXXXXXX
=================================
6.For hypert'n I'll take only plain Telmisartan 40mg in future. Is
Newtel 40 of Systopic reliable ?
7.For Amlodip 5mg+ Atenolol 50mg, is Amodep AT by FDC ok
?? or Tenodepin by Abbott better ??
8.For plain Atenolol, is Ziblok by FDC ok ? Or, BP Nol by Elder
better ??
Bye,bye & Rgds,
XXXXXX
Dear Dr. Heijebu,
Thanks a lot once again.
These are my final followup queries in the order of yr above reply.
1. I'll get Vit D serum testing done. Pl adivse if the 25(OH) test is
the right one.
2.Are the supplements calcitriol,cholecalciferol & alfacalcidol one
& the same,pl ?? Cholecaciferol is priced 4 to 8 times the others.
3.You hv recomm'd dosage of 600IU of calcitriol as 1500mcg ;
whereas all brands of it sell it in .25 to 1 mcg. Pl clarify.
4.In calcitriol/alfacalcidol which is the best brand viz., a) Qtr Alpha
by Walace b) Vitalpha of XXXXXXX Antibiotics.c) GR Alpha of
Zydus/German Remed d) Calcit SG of Zydus Cadila
5.Cholecalciferol is avlbl only in 60000 IU. If that's yr choice, at
what freq'cy should it be taken, pl ?? Which is the best brand
among a)D More of Medzer Pharma b)Hira D3 by Hira Labs c)
Quente D3 by XXXXXXX
=================================
6.For hypert'n I'll take only plain Telmisartan 40mg in future. Is
Newtel 40 of Systopic reliable ?
7.For Amlodip 5mg+ Atenolol 50mg, is Amodep AT by FDC ok
?? or Tenodepin by Abbott better ??
8.For plain Atenolol, is Ziblok by FDC ok ? Or, BP Nol by Elder
better ??
Bye,bye & Rgds,
XXXXXX
Brief Answer:
Cholecalciferol Is the preferred drug for your age and gender
Detailed Answer:
Hi Sir,
I understand your query and concern.
1.For Serum testing of Vit D,I advise you to go for 1,25(OH)2 Cholecalciferol testing and not 25-OH calciferol.
2.The supplements of Cholecalciferol,Calcitriol are same,and they contain the direct active form of vitamin D-1,25 HYDROXY CHOLECALCIFEROL/1,25hcc.
Whereas Alphacalcidiol/1,hcc is an active metabolite of Vit D with same effects as that of parent compound.It is generally indicated in patients with nutritional deficiency and renal diseases.
Each tab of alpha calcidiol ex Calcit SG 0.25 contain 0.25mcg of Vit D which is equivalent to 10 IU.
Earlier I mentioned 600 IU as 1500 mcg,Its a shear typing error(I am extremely apologetic about it).
Its equivalent to 15 mcg.
Please Note Imcg =40 IU of Cholecalciferol Or Calcitriol/Vit D3.
3.Many brands do sell it in the range of 0.25-1 mcg.
4.Regarding Alpha calcidiol -GR alpha of Zydus alpha/German remedies is best in my opinion.
5.Regarding Cholecalciferol 60000 IU,Hira D3 by HIRA labs seems the best.
I advise you to take Cholecalciferol 60000 one tab every 3 months for 1 year .This has to be supplanted with alpha calcidiol for first 3 months only.
ie-Alpha calcidiol 0.25 mcg one tab daily after dinner for 3 months only.
This is the ideal regimen for your age
6.For Hypertension Newtel 40 of Systopic is enough reliable.
7.For the combination,Tenodepin By Abbott is better.
8.For Plain Atenlol,Zibolok by FDC is better.
Thank you.
Cholecalciferol Is the preferred drug for your age and gender
Detailed Answer:
Hi Sir,
I understand your query and concern.
1.For Serum testing of Vit D,I advise you to go for 1,25(OH)2 Cholecalciferol testing and not 25-OH calciferol.
2.The supplements of Cholecalciferol,Calcitriol are same,and they contain the direct active form of vitamin D-1,25 HYDROXY CHOLECALCIFEROL/1,25hcc.
Whereas Alphacalcidiol/1,hcc is an active metabolite of Vit D with same effects as that of parent compound.It is generally indicated in patients with nutritional deficiency and renal diseases.
Each tab of alpha calcidiol ex Calcit SG 0.25 contain 0.25mcg of Vit D which is equivalent to 10 IU.
Earlier I mentioned 600 IU as 1500 mcg,Its a shear typing error(I am extremely apologetic about it).
Its equivalent to 15 mcg.
Please Note Imcg =40 IU of Cholecalciferol Or Calcitriol/Vit D3.
3.Many brands do sell it in the range of 0.25-1 mcg.
4.Regarding Alpha calcidiol -GR alpha of Zydus alpha/German remedies is best in my opinion.
5.Regarding Cholecalciferol 60000 IU,Hira D3 by HIRA labs seems the best.
I advise you to take Cholecalciferol 60000 one tab every 3 months for 1 year .This has to be supplanted with alpha calcidiol for first 3 months only.
ie-Alpha calcidiol 0.25 mcg one tab daily after dinner for 3 months only.
This is the ideal regimen for your age
6.For Hypertension Newtel 40 of Systopic is enough reliable.
7.For the combination,Tenodepin By Abbott is better.
8.For Plain Atenlol,Zibolok by FDC is better.
Thank you.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
