The Prostate Controversy: Should I get tested?

“Most men are going to their graves with prostate cancer instead of from prostate cancer.”

-Dr. Oubre

 

The prostate cancer testing controversy has raged on for over a decade.  The prostate controversy parallels the mammogram controversy (see the Harms of Mammography blog) although mammograms look stellar when compared to PSA testing.  Before we get started, I want to state a few key terms, so that we are all on the same page.

Key Terms:

PSA – Prostate Specific Antigen testing. This is a simple blood test that has been routinely checked in men over the age of 50 for many years.

dreDRE – Digital Rectal Exam is the examination of a patient’s rectum with a finger.  The test assesses for rectal cancers, hemorrhoids, and prostate abnormalities.  The small amount of stool present in the rectum is tested for blood after the exam which can be an early sign of colon cancer.

Screening Test – A screening test is a test that is performed on the general population when they are without symptoms and are at average risk.  A screening test does NOT apply to high risk individuals or patients with symptoms.  For instance, if your father had fatal prostate cancer at a young age, then you are not considered to be in a “screening” population.  You are at high risk and need more aggressive testing than others at average risk.  Or, if you are having trouble urinating or have noticed blood in your semen, then a PSA test is not considered a screening test.

Synopsis:

Since the PSA test was discovered, it has been the subject of numerous studies.  In 2006, a group of scientists combined all of the data from previous studies and analyzed the results.  There were a total of about 350,000 men who were between the ages of 50 and 74.  All men were followed for 7 – 15 years.  The patients were divided into “PSA Testing Groups” and “Control Groups.”  The PSA Testing Group received annual PSA levels and subsequent diagnostic tests needed.  The control group did not have any PSA levels drawn nor did they get any further studies or interventions performed on them.

End Result:  Both groups lived the same amount of time and died at the same ages.

This is a real head scratcher.  We all thought that getting tested regularly meant that you are healthy and being responsible.  Not according to this data.

There is a hidden and added harm to the shocking results listed above.  Not only did the group that got yearly PSA tests live to the same age as the control groups, but they had further testing and interventions performed that were apparently unnecessary.  If their PSA was abnormal, then they would get a Transrectal Ultrasound and 14 (or more) biopsies of their prostate.  As you can imagine, an ultrasound probe inserted through your rectum is uncomfortable to say the least.  On top of that, 14 biopsies of the prostate are taken since prostate cancer can hide in any portion of the prostate.  The false positive rate of these biopsies is as high as 75%, and as many as 50% of men are over-diagnosed with prostate cancer from the transrectal biopsies.

If the biopsies return as abnormal or cancerous, then the male undergoes radiation therapy or radical prostatectomy (removal of the prostate).  After all of these interventions, the likelihood of death was the same as without any testing or intervention!  How can this be if they were saving lives by removing prostate cancer, and the other group was not even tested?  The reality of it is that surgery and interventions can be harmful.

For example:  Consider that one person is saved by prostate cancer treatment.  In the same group, another person who was going to be saved by surgery gets hospitalized because of a surgical complication like rectal bleeding.  The hospitalization leads to a drug-resistant pneumonia which in an elderly person who just underwent radical prostate surgery turned fatal.  This adverse outcome negates the person who did manage to live longer.

This example illustrates why both groups lived the same length of time.  For every person that was saved, another died early.

More ways to look at the same data:

One life is saved for every 37 cancers detected and treated.  How would you like to be 1 of the 37 that underwent radiation or radical surgery for no reason in order for someone else to live longer?

For every 1,000 men screened, 0.1 life is saved.  Yikes!  In other words:  You must screen 10,000 men before one life is saved.  That is more men than I have in my practice!  So, if I screen all of the men in my practice, none of them might benefit?  Scary!

Over the years, many of the physician organizations have changed their position statements and recommendations regarding PSA testing.  It is not surprising that the Urological association has the most aggressive approach to PSA testing despite their lack of evidence.

  • USPSTF (United States Preventive Services Task Force):
    This federal organization is supposed to be immune from bias since it is a panel of physicians from multiple specialties that evaluate all aspects of a test, including effectiveness, harm, benefit, and cost.  They drive many of the guidelines that physicians live by.
    Statement:
    The USPSTF organization recommends AGAINST PSA testing on men of any age.  Through their analysis, they have determined that more people are harmed than they benefit.
  • ACP (American College of Physicians):
    Men aged between 50 – 69 years of age should be informed of the LIMITED POTENTIAL BENEFITS and the SUBSTANTIAL HARMS of screening for prostate cancer.
  • ACS (American Cancer Society):
    “The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their healthcare provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.”
  • American Urological Association (AUA)
    “For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences.”

Why is the medical field changing its opinion?  Routine PSA testing used to be the healthy thing to do.

The medical field is changing its opinion because the PSA test has not demonstrated that it is helping the general population.  We (physicians) knew in the beginning during its release that it was not perfect.  We did not however have enough data to suggest everyone to get it annually.  We marched ahead performing the test routinely anyway because we thought we were going to save lives.  “We put the cart before the horse,” and it did not turn out as expected.

Is this change being forced upon doctors because of Obamacare?

No, this change has nothing to do with Obamacare, and this issue has been under controversy for many years even before President Obama was elected.

My PSA has always been normal.  Should I keep getting it?

This is a difficult question to answer.  You fall into the same category as everyone else.  The trouble with PSA testing is not “What do I do if it is negative (normal)?”  The real trouble is, “What do I do when it is positive (abnormal)?”

A positive test can cause you to lose sleep at night worrying about prostate cancer.  A positive test could mean that you have a mild case of prostatitis (prostate gland infection) that you will need to take antibiotics for 4-6 weeks in order to “fix.”  However, was a “fix” really needed for something that was not bothering you until the PSA was abnormal?  A positive test may trouble you enough that you go see a Urologist and get a rectal ultrasound of your prostate with biopsies.

My PSA has always been normal, but it was abnormal this year.  Now what?

psaThe answer to this question is the same as the question above.  You can take your chances, but it only takes one abnormal PSA to scare you into a Urologist’s office.

My PSA was abnormal, and I was diagnosed with prostate cancer and received treatment.  Now, I am as healthy as a horse!  The PSA test saved my life!  What do you say about that, Dr. Oubre?

You are the 1 in 10,000 that was saved.  I am happy that modern medicine was able to help you extend your life and enjoy many more great years with your family and loved ones.

The real question is whether you actually had aggressive prostate cancer that would have been fatal or a mild cancer that may not have ever metastasized or caused problems.

Most men are going to their graves with prostate cancer instead of from prostate cancer.

What about being on testosterone therapy?  Do I need to get my PSA checked every 6 months or yearly?

This is an area that is also under controversy.  There are studies on both sides of the aisle, so I will defer the answer to the physician prescribing you testosterone.  One study showed that men with testosterone deficiency had higher rates of prostate cancer.  Thus, if the testosterone levels were replaced, then the prostate cancer risk lowered.

Do I still need a DRE or rectal exam even though I am not getting my PSA tested?

This is also debatable.  However, the data regarding rectal exams saving lives is worse than the PSA test.  In fact, it is not recommended for physicians to do regular rectal exams unless there is a reason.  After reading that, I bet many men breathed a sigh of relief.  Men, you do not have to be scared to come to the doctor after you turn 50!

My Concerns:

If physicians are not doing yearly prostate checks, then we are not performing a DRE (rectal exam).  One of my concerns is that we are missing an opportunity to test the stool for blood (FOBT) which may indicate colon cancer.  However, if you are getting your colorectal cancer screening routinely, this should not be an issue.  There are currently 3 forms of colorectal cancer screening:  Colonoscopy, Flexible Sigmoidoscopy, and Fecal Occult Blood Testing (FOBT).  None of these screening exams rely on the physician’s yearly DRE or FOBT.

I did not screen my patient, and he was 1 of the 10,000 that had aggressive prostate cancer that turned out to be fatal.  Would I have caught it if I had tested his PSA level?

This has to be the worst situation for a healthcare provider:  a missed opportunity to save a life.  Unfortunately, it happens and will continue to happen.  It is sad, and it always causes regret.  The part that I have to remember is how many people I would have harmed in the process to save that one person.

#DrOubre

#PSA #MensHealth #Physical #Prostate #ProstateCancer #BPH #Men #AAFP #DRE

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This week decided to take a little break from writing about digestion and gut health to address a very important topic that I confront day in and day out, body image.   It does not seem to matter who they are or what they look like, most women I confront feel they need to look better. It saddens me to think that so many women feel that they are never good enough, no matter what.   I am not different. I constantly wish I could change my body, my legs, abs, face, arms, you name it, I feel that I need improvement, although I have an 80% better body image than I did when I was younger.

 

One of my goals is to help women feel good about themselves, not just good, but great!  I feel that it is imperative to address negative self image and help women feel confident, strong and powerful. I honestly wish that I could step outside of my body and view myself as others do.  There is not a day that goes by that I do not receive one or more compliments and am often told by patients and clients that they will be happy if I can help them look like me.  

 

I get compliments on my body, hair, skin, muscle tone, posture, positive attitude, you name it,  yet, in my head, I still feel that I am not good enough.   This is one example:  A few weeks back,  I was using the cable cross at the gym to work my shoulders and back.  As I am doing reps, my thoughts are focused on having too many drinks over the weekend, not exercising enough the week prior and my lack of desired muscle tone and strength.  As I am in the middle of the reps, a women walked by and told me that I had done an amazing job sculpting my body, which completely took me off guard.  I though wow, how amazing is it that two people can have such different prospectives of the same situation.

 

I usually find that positive self image starts young.  I know that my negative self image started very early, maybe even eight or nine years old.  I grew up in a very small town where being different meant that you were abnormal.  This may seem crazy to you, given that so many women now color their hair red, however, growing up with red hair and freckles was not easy. My red hair and freckles became characteristics that I despised.  I  felt like an out cast, like I was less of a person.  Adults wanted to touch my hair;  Others called a witch, a freak or just ugly, and weird.  To add fuel to the fire I went from being under weight and skinny to over weight and puffy when puberty started.   Unfortunately, the taunting never seemed to endfrom the kids on the school bus,  in the halls and in town, to my father and even negative comments from  doctor.  Sadly, my doctor told me he did not know what was  causes all of my symptoms and that I was overweight and needed to go on a diet.  I know know that my symptoms were stemming from auto-immune thyroid.

 

At the age of 15, I decided to take my doctor advise and lose weight. My diet of choice was a starvation diet, only eating very small portions at dinner and skipping breakfast and lunch.   The crazy thing was that amazing things started to happen when I stopped eating, my brain fog resolved, I had more energy, I could go to the bathroom, and I just felt better, not to mention the weight was coming off.   Not eating became addicting because I felt so much better, however unaddressed emotions also caused me to binge at times, sending me into an emotional whirlwind of anxiety, lethargy and constipation.

 

I spent the next 15-20 years on journey through binge eating followed cutting my calories to sometimes only one can of tuna per day or nothing at all.  At one point in my early 20s  I weighted just under100 pounds and could nearly touch my fingers when I placed them around my waist.

 

Making a career change into nutrition helped me get out of this yo-yo eating disorder and develop life-long healthy eating habits.  I also addressed difficult situations from my past.  It was not easy, however working thorough it has been one of the most powerful things that I have done.  I now feel stronger and healthier than ever and want to continue on this journey to developing a more positive body image.

 

Its time ladies, lets work together to concur  unhealthy body images to pass healthy body image on to younger generations.  

 

Here are a few tips to help improve your self image:

 

 

  • Start talking positively about yourself.  We constantly compliment others on their skin, hair, body, clothing, shoes, etc.  Give yourself a little love.  Be that strong, confident woman that you want to be.  Every day, instead of critiquing the things that you do not like about yourself, choose something that you do like and focus on that for the day.
  • Exercise not only creates feel good neuotransmitters, it helps you tone and bun fat.  Try a combination of strength training exercises to help you firm, tone and build lean muscle.
  • Don’t strive for perfection:  Perfection does not exist. We are humans, meant to make mistake and learn from them.  If things do not of your way today, then blow it off and aim to reach your goals tomorrow.
  • Hang out with positive people: Nothing can bring you down quicker that surrounding yourself with negativity.  Surround yourself with people who make you feel uplifted and good about yourself.
  • Practice kindness:  Be kind to others.  You never know who is going thorough struggles.  Helping someone with small children at the grocery store or mowing your neighbors lawn when they are overwhelmed will bring positivity to your day.  Exuding kindness will brighten everyones day, including yours.
  • Celebrate the little things:  If you lost five pounds, went to the gym three times this week or just chose to avoid the bread at lunch, be happy, you are making positive changes to help reach goals.
  • Focus on things you can change:  You will waste energy by focusing on things out of your control.  If you can not change it, accept that and move forward.
  • Don’t self sabotage:  I see this time and time again.  You are having a bad day, then decide   since things are not going your way, then you might as well have pizza and ice cream, then feel guilty afterwards, leading to an even worse day.  If you are having a bad day, go for a walk outside, call a positive, supportive friend or practice medication or deep breathing instead of reaching for things that will make you feel worse.
  • Set realistic expectations:  Nothing can kill our self image faster than setting unrealistic expectations.   If you are 5’2, you will never be 5’7, so don’t waste time wanting things that have not ability to become reality.
  • Deal with skeletons in the closet:  Past trauma such as abuse, death, rape  and other traumatic experiences can hinder positive body image.  Seek a professional to help you work though experiences that prevent you from moving forward and being at peace.
  • Eat a well-balanced diet:  You know that I could not leave this one out.  Eating a diet full of lean proteins, healthy fats, color fruit and vegetables and whole grains will help with mood, energy, body composition, over all health and positive body image.

 

 

If you find yourself struggling and need help, then call me.  Together we can work through obstacles and help you feel your best.

 

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We have all heard the term “you snooze, you lose”. For some reason most people think that sleep is more of a privilege than a necessity. We are so busy with the demands of our jobs, families, friends, chores and other obligations that we tend to rush around and skimp on sleep, just to get our daily duties complete.

The fact is that we all need sleep, as it is imperative for optimal function. Most people need and average of eight hours of sleep, according to the National Sleep Foundation, to detoxify and regenerate cells . When you don’t get adequate sleep, your brain cannot function properly, which affects your cognitive ability and emotional state. Lack of sleep can also compromise immune function, increase hunger and increase risks for chronic diseases such as diabetes, heart disease, and obesity.

Let’s face it, life is stressful. We have all had those nights where are minds are racing making it difficult to fall and stay asleep. Hopefully those nights are few and far between, however if this is your norm, you need to take action and address underlying causes of dysfunctional sleep.

Some of the underlying causes of sleep dysfunction include:

Stress: Stress causes excess cortisol to be released which in turn disrupts our normal circadian rhythm.
Elevated cortisol effects production of other sleep neurotransmitters including Melatonin.

Eating too late: If you tend to eat within two hours of bedtime, your liver will be too busy with sugar regulation to be able to detoxify effectively. This tends to cause you to wake over and over again.

Too many electronics in the bedroom: Keeping electronics, even wifi routers in the bedroom can cause brain activity and alertness, which causes increased periods of awakening.

Genes: Specific gene SNPs(single nucleotide polymorphisms) Like MTHFR and COMT MTHFR can interfere with proper sleep pattern. Schedule an appointment to find out if you carry the MTHFR and/or COMT gene SNPs.

Bad mattress: Make sure your mattress is comfortable and supportive. It is recommended to replace your mattress every eight years.

Too much caffeine: Some people are slow metabolizers of caffeine, allowing the caffeine to stay in your system longer, leading to difficulty falling asleep.

Too much alcohol: A glass of wine may calm you down initially then act as a stimulator, making for a restless night of sleep.

Snoring or apnea: If your partner is complaining of snoring or period of time when you stop breathing, it is time to make an appoint to discuss your symptoms with your doctor.

Follow these tips to get more restful sleep:

Stop eating two or more hours prior to bed.
Eat a nutrient dense diet avoid refined carbohydrates, processed foods and sugar.
Put electronic devices away 30-60 minutes prior to bed time
Incorporate deep breathing, meditation or yoga to help decompress from the day.
Try aromatherapy such as lavender to help induce relaxation.
Stick to a schedule
Limit caffeine in the afternoon and evening
Write out your task for the next day so that you can relax your mind.
Exercise daily
Maintain an optimal weight

If you are still struggling with sleep after following the recommended tips, then it is time to make an appointment for evaluation. Oubre Medical can evaluate your sleep issues and make appropriate recommendation based off of your uniqueness.

Happy sleeping!

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Day in and day out we are assaulted by toxic substances that can interfere with our body’s biochemical processes that allow us to function optimally, preventing disease.   An array of conditions including genetics, stress,  inadequate sleep, poor diet, a compromised immune system, dysfunctional digestion and total toxin exposure all determine how much toxic load our bodies can handle, before damage and dysfunction begins to occur.

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Have you ever found yourself in the middle of your pantry shoving food in your face, even when you were not hungry?  I bet your answer is YES!!!  I have contemplated this blog for weeks, as I, yes, the nutritionist, found myself in my pantry over eating on multiple occasions recently and felt the need to help other avoid stress eating.

 

The idea for this blog started on a Monday evening after engulfing the fourth snack in less than 10 minutes.  The day started off great, nothing unusual.  An early workout, a morning full of patients that I love and and afternoon with my  17 month old grand daughter, one of my favorite people in the world.  After she went home for the day, I decided that I had to make this phenomenal paleo bread with the berries that I had in the refrigerator.   As I went into the pantry to retrieve ingredients, I spotted some plantain chips, which I promptly opened and shoved a handful into my mouth, then returned to the kitchen to make the bread.  As I added ingredients, I realized that I had forgotten the orange extract and entered the panty again.    

 

This time the organic kale crackers caught my eye and began calling my name. I opened the box,  grabbed a handful and ate them, then reached for more.  Next up was the cashews.  As I started munching on the chews I stopped a moment,  looked around and wondered what in the world was I doing.  Here I was again, shoving food in my mouth!   I stepped back, put the cashew bag down and realized that I was at it again…binge eating.  

 

For many years of my life I struggled with binge eating, but not for quite a long time…maybe even 12 or more years.  As a young adult, I would make myself a cake for dinner, eat the whole thing, then not eat for three days because I felt so bad and guilty,  then I would repeat with homemade cinnamon rolls or other goodie…bread, pie, cookies…you name it, I binged on it. I loved baking from scratch and could do it with no recipes or measuring devices.

 

I thought that I had put binge eating behind me, but realized I needed to reflect on the driving force behind my behavior.  It was STRESS!!   I knew it, I was stress eating, there was no denying it.  I like to pride myself at managing stress and usually do it very well.  Why was this time different??  Maybe it was staring a new business and transitioning another, while working full time at someone else’s practice,  building a web-site(which was like learning a foreign language), learning social media marketing, seeing patients,  moving offices, typical stress with teenagers, trying my hand a graphic design, contemplating my future, all the unknowns…maybe it was deciding to start a health coach class for the next year, all the struggles our country is having, the violence between citizens and police, having a husband who is a police officer and worrying for his safety…the list goes on and on…but enough about me…you get the idea…I have had a lot going on

 

I decided enough is enough. I am stronger than succumbing to stress eating.  I needed time to reflect an get back to my “stress is not going to get me” mentality.  After all, this is what I teach other to do for themselves.  It was time to get back to reflecting on the good, not letting things out of my control and get the best of me and cause stress eating.

 

If you find yourself stress eating and binging in your panty or any other place for that matter, here are a few tips to help get you back on track:

 

  1. Take time for yourself: I know that this seems easier said than done. Remember that you are important. People are counting on you to be your best which requires time to decompress. Hang out with friends, plan date nights with significant others, plan outing with your kids.
  2. Don’t sweat the small stuff: Take time to breath and reflect before blowing a gasket over diry dishes in the sink or laundry on the floor. Getting upset and stress eating is not going to make you feel any better!
  3. Get a good night’s sleep: Falling asleep and staying asleep is imperative for the rejuvenation and repair of the immune system and the organs involved with detoxification. Waking up rested sets you up for the days and helps you manage stress and avoid stress eating due to fatigue.

 

Set yourself up for a good nights sleep:

  • Avoid caffeine
  • Avoid food 2-3 hours before bedtime
  • Keep a regular sleep schedule
  • Control light exposure: Avoid keeping cell phone, computers and other electronic devices in the bedroom
  • Exercise regularly
  • Sleep on a comfortable mattress
  • Spend a few minutes with deep breathing or meditation prior to getting into your bed.

 

  1. Exercise:  Exercise release a feel-good neurotransmitter, dopamine.  Dopamine gives us that “high” that make a difficult workout worth while.  Go ahead, try it and see how you feel.  push yourself through discomfort and reap the benefits to help stop stress eating.

 

  1. Eat a nutrient dense diet full of colorful vegetables and fruits  full of phytonutrients, responsibly raised animal proteins, healthy olds, nuts & seeds, legumes, herbs and spices.

 

I hope you find these tips helpful to end stress eating.  If you feel you need more guidance and coaching to help you identity stress eating triggers, manage stress, sleep better or work through life challenges, I would love to work with you one on one.

 

Contact me to set up a time to find out how health coaching can help you.

 

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Tips from a doctor on how to save money at the pharmacy.
1) GoodRx App
2) Ask for cash price of drug without insurance (before paying copay)
3) Use different pharmacies (1 for cash, 1 for insurance)
4) Generic drugs
5) Ask your doctor to switch you to a generic alternative
6) Ask your doctor WHY you need a brand name drug
7) Shop around at different pharmacies
8) Ask about prices at your compounding pharmacy

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I answer questions about the Oubre Medical membership as well as discuss the benefits of being a member.

Features of membership:
1. Access to me, Philip Oubre, MD
2. Be treated by a physician who values using food as medicine, getting to the root cause of disease, and embracing the growing trend of functional medicine model of practice.
3. Access to special therapies for sports medicine such as vitamin infusions, stem cell arthritis therapy, PRP (platelet rich plasama) therapy.
4. Skip the traditionally crowded waiting rooms an wait times.
5. Be part of an exclusive membership that is strictly limited in membership size.

Find out all about Oubre Medical at http://oubremedical.com/philip-ou…

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