Dr. Keith Roach
Dear Dr. Roach: I’m an 82-year-old woman who is in good health. In May of this year, I started suffering from migraine headaches that were preceded by an aura, which lasted from two to three times per week. They’re not as intense than they had been when I was younger however I’ve never experienced more than one or two per year since entering my 40s. I was scanned for my brain during August. However, the results were normal. I’m not able to tolerate anti-inflammatory medications since they upset my stomach. Do you have any ideas on what should I do if concerned , and/or what can I do to alleviate the headaches?
— J.R.
Dear J.R.: New headaches for older adults ought to raise concerns about various kinds of headaches due to migraine, and in particular temporal arteritis. But, the presence of an aura, as well as the fact that you’ve previously experienced these types of headaches is what makes migraine the likely cause .
If you are experiencing greater than 10 headaches each month, I generally suggest medication to prevent headaches as well as medication to prevent headaches from occurring. The medications like sumatriptan are one of the most effective treatments for treatment of acute headaches, while there are a variety of options for preventive therapies, including over-the counter options like magnesium or vitamin B2 and Riboflavin.
Due to your age and the regularity of the headaches and the frequency of headaches, having an MRI is advisable and I suggest that visiting your physician regularly as well as a neurologist who is specialized in headaches to get more treatment.
Dear Dr. Roach: I was recently diagnosed with prostate cancer for the third time and my radiation oncologist said, “We can’t radiate a third time because I don’t want any harm to the colon.”
He has suggested that I try hormone therapy using Orgovyx my Urologist is on board. My main concern is the adverse effects, which are terrifying. Do you have any thoughts or any other suggestions?
— B.H.
Dear B.H. The possibility of recurrence of prostate cancer following treatment is always a scary problem that leaves no simple options. I’m not equipped with enough information about the extent as well as the location and type of cancer in the prostate, to provide you with a definitive diagnosis similar to what your urologist and radiation oncologists have. However, if definitive treatment with surgery isn’t feasible (in the case of your situation 2 rounds of radiation might have rendered surgery unattainable and there could be additional anatomical issues) The best treatment is to stop the body’s ability produce testosterone. The majority of prostate cancers are able to grow when testosterone is present and the presence of a low testosterone levels (ensured by surgery or medication such as Orgovyx) typically stops prostate cancer from advancing.
The adverse effects may be difficult to manage. The loss of bone is a significant problem that can result in fractures, however it can be avoided with treatment. The symptoms of hot flashes can be addressed with nonhormonal treatments. The sexual side-effects are quite common and can be addressed with counseling and advice starting before any medication is taken — ask your physician regarding this. Men who have an history of heart issues must have a plan that includes the treatment of any cardiovascular risk because a deficiency in testosterone can increase the risk of heart issues.
While there are numerous potential adverse effects from the reduction of testosterone by using medicines such as Orgovyx These side effects are manageable, and it is important to take into consideration the fact that treating prostate cancer that has recurred helps patients to live longer and their quality of living could be maintained in large part.
Additionally, there are men who are recurrently diagnosed with prostate cancer who also benefits from chemotherapy based on platinum, however for the majority of males, the biggest benefits with little impact to quality of life stems from lowering testosterone levels through treatment.
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