The Case of the Reluctant Patient: A True Story
By Marcel J. Hernandez, N.D.
Ron was 64 years old when he sat across from me in my office and first told me his story. His wife, Amy, sat quietly beside him as he began to speak.
Ron started off by saying that he didn’t like going to doctors and was only there because his wife had insisted that he see me. He said he had done a lot of reading about prostate conditions and he knew exactly what was going on with himself. He was absolutely certain that all of his symptoms were due to BPH (Benign Prostatic Hyperplasia), a non-malignant enlargement of the prostate that most aging men experience.
When I asked him what symptoms he was referring to he answered, “the usual.” I then prompted him to elaborate and he told me that he was getting up several times at night to urinate, had a marked decrease in the strength of the flow of his urine and a feeling that he had not voided all of the urine in his bladder, even after standing at the urinal for what seemed like several minutes. At times he also had difficulty starting a stream. He quickly added that his the symptoms had gotten somewhat better after he started taking saw palmetto extract and some other supplements that he had read about on-line as being helpful for reducing the symptoms of enlarged prostate. In his mind, his positive response to natural supplements was proof that he had BPH. He felt that an office visit was an unwarranted expenditure of time and money.
I asked him if he had ever had a prostate evaluation and he answered that starting at age 55, he began to get an annual PSA (Prostate Specific Antigen) blood test. He said that although his PSA had risen from an initial result of 0.7 eight years ago to 2.4 last year, the rise had been gradual and the results consistent with what he understood about BPH. He was due for another PSA in the next couple of weeks. I suggested that I order the test for him and we could then discuss the results. He nodded his assent.
I asked him if anything else was going on that he wanted to bring up and he replied that there wasn’t, that he had told me everything. Amy piped in for the first time and said that Ron had forgotten a few things: his libido was very low and he seemed to be tired all the time. After more questions and answers about this new information, the visit with Ron and Amy ended and they departed with lab requisition in hand. Two weeks later, the results came back.
Ron’s PSA had risen to 4.5, a rapid rise for one year. This is not indicative in itself of prostate cancer. However, his free PSA percentage was very low – an indication that further evaluation was necessary. A biopsy revealed that Ron had an aggressive form of prostate cancer and is currently following a program I designed for him and is also under the care of a urologist. Ron’s prostate cancer was discovered in time for him to have a number of treatment alternatives.
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Finding out exactly what is going on when the prostate is involved can be a challenge because the symptoms of a number of condition overlap. This is especially true when it comes to BPH and prostate cancer. Like Ron, many of my male patients have been literally pushed into my office by their partners. Men, in general, tend to ignore subtle changes in function that occur over time. Please look at the questions in the box. Your answers could save your life.
It is important to note that the entire field of prostate evaluation, diagnosis and treatment is presently under intense scrutiny and debate. However, we DO have the tools to make a positive difference in your experience of life.
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Dr. Hernandez is happy to address your health-related questions in his column. He may be contacted at HawaiiND@BigIsland.net.