1. Treatment of Men’s common Health Issues
Dr. Robert J. Anderson
Squires and Stags
February 3, 2017

2. Benign Prostatic Hypertrophy (BPH)
Incidence: 10% per year starting at age 50
Prostate gland pinches the urethra=urinary Sx
Frequency
Urgency
Hesitancy
Weak Stream
Incomplete Bladder Emptying
Straining, Dribbling, etc.
Symptoms mimic Prostate Cancer (DRE), Overactive Bladder

4. Treatment of BPH Control > Cure; Rx based on Severity
Non-Pharmacological
avoiding caffeine, alcohol and limiting any fluid in the evening;
avoiding drugs that can aggravate symptoms such as antihistamines, decongestants, pain medication, antidepressants and testosterone;
double voiding to overcome incomplete bladder emptying.

5. Treatment of BPH Alpha blockers (Terazocin, Tamulosin)
MOA: relax smooth muscle to inc urine flow
SE: initial dizziness, hypotension
5-Alpha Reductase Inhibitors (Proscar, Avodart)
MOA: decrease DHT to shrink prostate gland (6-12 months)
SE: sexual dysfx
Low dose PDE5 Inhibitors (Cialis)
Combo Rx: Jalyn, Flomax plus Proscar

7. Low T—dec 1-2% per year > age 40 years
T needed for muscle mass, BMD and sex drive
Rx for hypogonadism: Sx + low T blood levels
Sx: fatigue, loss of energy/sex drive, depression, etc.
Rx inc 10X in last decade; benefit vs. risk? vs. PDE5 prn drugs?
Available in many formulations
SE: liver disease, aggression, personality changes, aggravate BPH, 30% inc risk of strokes, MI, death

8. Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack
The risk assessment tool below uses information from the Framingham Heart Study to predict a person’s chance of having a heart attack in the next 10 years. This tool is designed for adults aged 20 and older who do not have heart disease or diabetes. To find your risk score, enter your information in the calculator below.
Age:
___ years
Gender:
Female/Male
Total Cholesterol:
____ mg/dL
HDL Cholesterol:
Smoker:
No Yes
Systolic Blood Pressure:
____ mm/Hg
Are you currently on any medication to treat high blood pressure.

9. 10 Year CVD Risk 13.8%! Demography Cholesterol Blood pressure
Risk factors
Age: 68
Total: 169
Systolic: 120
Diabetes: no
Gender: male
HDL: 59
Diastolic: 76
Smoking: no
Race: not African-American
On medication: yes

10. Aspirin Use for Primary Prevention? USPTF Recommendations June 2016
Indicated in high risk pts for CVD and CRC
Moderate benefit taking low dose (81 mg) age years who have at least a 10% risk of CVE, low bleeding risk and life expectancy of at least 10 years; adequate evidence that aspirin use reduces the incidence of CRC in adults after 5 to 10 years of use
Age years case by case basis
< Age 50 insufficient data to support use
> Age 70 insufficient data to support use

12. US Preventive Services Task Force Recommendations
All adults aged should be screened for high cholesterol even w/o history of heart disease
Age Rx with elevated risk (>10%) of MI
With new guidelines—13M more need a statin!
Are statins overprescribed? Risk > Benefit??
Dose-related inc risk (46%) for diabetes due to insulin resistance and dec insulin secretion
Statins may inc risk of cataracts by 27%

13. Use of Statins for High Cholesterol Benefit vs. Risk
Patients with CVD
High dose in those < age 75 years
Moderate to low dose in those > age 75 years
Patients with high LDL (> 190 mg/dl)
Patients with DM and LDL > 70 mg/dl
High dose with 10 year risk of > 7.5%
Moderate dose with 10 year risk of 5-7.5%
Patients with 10 year risk >7.5%, LDL >100 mg/dl
Patients > age 75 dec risk of MI and stroke?

14. Use of Vitamin D? Natural sources: fish, fortified foods, sun
RDA: 600 I.U per day
Supplements reduce risk of fractures?
The USPSTF has previously concluded in a separate recommendation that vitamin D supplementation is effective in preventing falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.

15. ACIP/CDC Vaccine Recommendations
Flu vaccine every year
Tdap (> Td) vaccine (Boostrix); Td booster q 10 yrs
> age 50 years??: shingles (Zostavax)
Efficacy 50% in prevention
Efficacy 67% in prevention post-herpetic pain
Pneumonia
One time PCV-13 (Prevnar) recommended 1st or >1 yr after Pneumovax
Pneumovax > age 65 years

16. Health Screenings
Blood Pressure: Inc Risk Stroke with Pre-hypertension /80-89 mm Hg; incidence 49 million! lifestyle changes vs. Rx??
Blood Sugar: >50% > age 65 are pre-diabetic; partial remission with lifestyle changes
Colon Cancer: screening starting at age 50 years and continuing until age 75 years
Prostate Cancer: DRE + PSA levels??

17. Minimize Risk/Progression of Prostate Cancer--Lifestyle Interventions
Maintain a healthy weight, avoid tobacco products, physical exercise to keep blood sugar and cholesterol under control
Maintain a healthy diet
Cruciferous veges—dec risk 10%
Flaxseed, soy, coffee, green tea, tomatoes
Avoid/minimize meat, dairy
Foods more important than supplements

20. Lifestyle and Colon Cancer
3rd most common cancer
Diet responsible for 70-90% of all cases
Inc risk red meat > fish, white meat
Dec in intake of saturated fat may dec risk
High fiber diet recommended
Diets rich in folate (dark green veges, beans) are beneficial
Minimize alcohol intake
Calcium/Vit D foods/sun/supplements beneficial
Polyphenols (antioxidants) may be beneficial?

22. Memory Loss Warning Signs Normal Aging
Walking into a room and forgetting why
Having trouble recalling names of unfamiliar people
A change in memory compared to when you were younger
Memory changes similar to other folks your age
Misplacing items but later recalling where you put them

23. Protect Your Telomeres!
Causal relationship between telomere shortening and age-related diseases such as dementia and Alzheimer’s disease
Due to increase in oxidative stress on the body
Solution: “chill out” and increase exercise!!

24. Memory Loss Warning Signs Potential Signs of Cognitive Decline
Getting lost in familiar surroundings
Having difficulty remembering important details of recent events
Difficulty following the plot of a TV program, movie or book due to memory problems
Memory changes that are worse than those in your age group
Misplacing items and being unable to relocate them later

25. Pharmacological Treatment Alzheimer’s Disease
Mild to Moderate disease
Cholinesterase inhibitors—Aricept (donepezil), Exelon, Razadyne
Moderate to Severe disease
NMDA antagonists—Namenda (memantine), Exelon patch, Namzaric (combination Namenda ER/Aricept)
Taper slowly due to side effects (GI, CNS)

26. Impact of ObamaCare Repeal on Consumer-Friendly Medicare Benefits
Health care spending may accelerate again
Less monitoring of waste, fraud and excessive payments
Drugs costs may increase (11 million patients saved >$20B with tapering of “doughnut hole”)
Free preventative services may be impacted
Flu shots
Cancer screenings (mammograms, colonoscopy)
Diabetes screenings (> 8 million undiagnosed)

28. TrumpCare 2017?? Transitional repeal of ACA?
Pledges to keep selective provisions of ACA
Portability of insurance coverage
Adult children covered until age 26
Initiate market vs. government bidding on prescription drugs (i.e. VA, DOD, Canada)??
Decrease regulations, increase drug mfg in US
Adopt/Modify Ryan Proposal—fixed dollar subsidy or voucher system; inc age to 67 yrs?

29. Growth of US Spending on Medications in 2017
Expected decrease from 12% in 2015 to 6-7% in 2017 due to:
Decrease in prescribing of specialty medications especially for Hepatitis C
Increase in patent expiration of brand-name drugs
Increase in dispensing of lower cost generics
Introduction of “biosimilars” to the market—generic equivalents of high cost biotech drugs
Decrease in rate of costs for both generics and brand name drugs
Out-of-Pocket co-pays expected to decrease
Source: Quintile IMS Institute: Outlook for Global Medicines Through 2021