DEAR DR. ROACH: I lived in England in 1985-1986, during the mad cow disease outbreak. Since then, I have been ineligible to give blood. It is one of the few questions they ask. This has been 35 years and, obviously, I don’t have and have never had the disease itself. Is this still a valid reason to rule me out as a blood donor? — B.R.
ANSWER: Variant Creutzfeldt-Jakob disease was epidemic in the United Kingdom (and to a lesser extent, Ireland and France) from 1981 to 1996. By preventing blood donation from people who lived in the U.K. for more than six months during that time period, it is estimated that 90% of future vCJD could be prevented in the U.S.
Incubation periods of 40 years have been reported for a similar disease, kuru, which is why the prohibition against blood donation remains. However, the absolute risk is very low, both to you and to the blood supply.
Blood banks must make decisions based on not only improving the safety of the blood supply, but also to improve people’s confidence that the blood supply is safe. They have also considered how many potential donors they are turning away.
DEAR DR. ROACH: A recent CAT scan to measure my aortic aneurysm (4.1 cm) showed that my prostate is 5.1 cm. That’s somewhat larger than normal. I’m 68 years old and do have some mild symptoms — only at night. Due to the pandemic, I don’t want to go to my doctor right now, and he is not seeing patients unless they are ill. Is there a standard medicine for this? Years ago, I would have tried an OTC medicine, but I have read that they do not really help (except placebo effect). What do you recommend for this, other than consulting with my primary care physician? If I call him and ask him to prescribe a standard medicine for my case, I’m sure he will. — R.O.
ANSWER: Most men will develop an enlarged prostate (medically called benign prostatic hypertrophy) as they get older, but the severity of symptoms varies widely, from minimal to severe. A few men will be unable to urinate at all and require medical intervention to protect the kidneys.
Men with mild symptoms may still choose to try treatment. The standard medical therapy is called an alpha blocker. One commonly used one is tamsulosin (Flomax), but there are many. Tamsulosin is less likely than most others to cause dizziness on standing, which is a common side effect of alpha blockers. This class of medicine is generally safe, but it still requires a physician’s prescription, as there are potential interactions with some other medicines and with some heart problems.
Although many men will try herbal therapies, the evidence for their use is mixed. Probably the most commonly used supplement for BPH is saw palmetto, but a 2012 evaluation of the published studies showed that it was no better than placebo, as you said. Two other agents, beta-sitosterol and Pygeum africanum, showed relief that was better than placebo, but long-term safety has not been well studied. As always, I caution that over-the-counter supplements are not well-regulated in the U.S, and some brands do not contain what is listed on the label, as determined by independent laboratories.
The international prostate symptom score is a useful tool to grade the severity of symptoms and monitor response to therapy. It is found easily on the Internet
Finally, a PSA test should have been done to help stratify risk for prostate cancer. Hopefully it was done for you and the result was low.