In the past, the total PSA value over 4.0 was considered suggestive of prostate cancer. Subsequent experience has shown this to be inadequate as an absolute cut-off.

Among the ways we have changed our analysis of the PSA is looking at PSA velocity (change of PSA over time) with a rise in PSA over 0.5 per year as suggestive of cancer.

In this recent paper in the Journal of the National Cancer Institute the usefulness of the PSA velocity has been called into question. The PSA velocity, is itself inadequate and can be misleading.

With this information it is difficult to know the exact usefulness of this test, but still I think it is reasonable to use this test on interval basis (typically at a yearly physical), and then to put this number into perspective, with retesting, comparison with prostate exam, and cautious observation.

PSA’s are imperfect, but used as a general guide, and not an absolute arbiter, I will continue to use this test, as it has proven useful in too many instances in patients that I’ve cared for.


A new large prospective study has cleared the use of Plavix & PPI medications (Prilosec, Protonix, Aciphex, Nexium, Dexilent). This is a reassuring finding and means that there is no need to worry or adjust medication for patients with stents who also require treatment for GERD.

This issue has been a hot topic of late and has caused much consternation among internists and cardiologists. Now, with this new study, we can feel confident in combining these medications without hesitation.


Coumadin may be a thing of the past….but not just yet.
A recent study in the New England Journal of Medicine, looked at Apixaban (a medication like Pradaxa…the new Coumadin replacement).
The new Coumadin-replacement was superior to aspirin in preventing stroke, and had a similar safety profile after 1 year of study in 5000 patients.
This medication will likely replace Coumadin as it will not require monitoring of blood levels, but the fact still remains that there is no ‘antidote’ for Pradaxa, while Coumadin has 2 antidotes (Vitamin K and plasma)
As a result, I am suggesting that patients continue to wait on the data, before switching away from Coumadin. Safety will be a major consideration, beyond convenience.
So…..don’t close the buggy whip factory just yet. Coumadin will be around for a while, but should Pradaxa prove safe (it is certainly effective)…..we’ll say good-bye to Coumadin and all that money that goes to University of Wisconsin (WARFARIN….Wisconsin Alumni Research Foundation)


Dizziness is commonplace and when persistently bothersome or severe, leads patients to see the doctor or go to the emergency room.
I see approximately 2-3 people each week of the year with this complaint and fortunately it is rarely a sign of something serious.
A recent study of 30,000 patients with this symptom, who presented to the Emergency Room, found that very few people had anything serious wrong or developed serious issues over the ensuring several months.
This is consistent with my experience here in the office. Although vexing, dizziness rarely is a sign of something serious and treatment is generally supportive, with symptoms resolving spontaneously.
Treatment consists of Meclizine (medication for symptom relief) that can be obtained as a prescription or over-the-counter (Bonine is the product name.)
Beyond this, using head turning exercises can often be helpful.
For more information on this topic, you can read my write up in the PATIENT RESOURCES SECTION, in the Medical Library section under VERTIGO.


Natroba Topical Suspension (spinosad 0.9%) has just been approved for treating lice. It’s easy to apply and does not require combing. In addition, it works better than Permethrin (the topical treatment we generally use.)
You may not realize this, but lice is very common nowadays and is rampant in the Scottsdale School District and in private schools as well. It’s nice to have a more effective, safe, and easy to apply treatment.
If you want to see a ‘nit picker’ in action, Mike Rowe of Dirty Jobs fame did a great piece on the topic….enjoy.


A recent study suggests that fosamax and other bone building medications (called bisphosphonates) have the ability to prevent colon cancer.
A 50% reduction was seen in patients on medication vs. those not taking these medications. The connection is unclear and there will be further study, but for now, it is encouraging to see some positive news about this group of medications.
Recently concerns have been raised about the long-term safety and benefits from the medications. Concerns have included problems with the esophagus (and esophageal cancer), reduced bone strength after many years or treatment, and issues with dental health (osteonecrosis of the jaw).
None of the issues are ‘deal-breakers’ as regards taking the medication, but it does indicate the need to be selective as to who is taking them. The benefits must be there. You need to know that your bones really do require some help with medication.
So….for now, there is some encouraging news about Fosamax and we will continue to monitor for more news (good and bad)

News Flash about HOT FLASHES!

A new research study in JAMA, using Citalopram (an inexpensive generic medication) shows promise in reducing hot flashes in approximately half the women in the study.
Taking 20-40mg of Citalopram was effective and safe. This medication is an ‘anti-depressant’, but is being used for broader indications.
If you are having problems with this issue or know someone who is, and who does not want any hormone therapy, this is a worthwhile consideration. That said, it is not as good as hormone therapy in preventing hot flashes.


Taking the shingles vaccine reduces your risk of getting shingles by 50%…a large amount. This is reassuring and confirmatory information indicating the benefits of this immunization and I recommend it to everyone over the age of 50 who is interested in it.

This data is based on a recent study of more than 300,000 people.

There has been some issues with obtaining the vaccine due to production problems, but it has become more generally available now, and we can put you on a list to get the vaccine if you wish.

The vaccine costs a bit over $200 through our office (due to the high cost of the vaccine itself). It is safe and effective and I’ve not seen any reactions or side effects from it.
Do call us if you are interested in getting your shingles vaccine.


Yes….I said Bully (I love TR!)
A recent study from England shows improved strength and muscle function after a stroke if patients are given 20mg of Prozac( standard dose) in the days following a stroke and for the 3 months after that.
Very interesting. We commonly use anti-depressants after strokes, as depression is a common chemical accompaniment to stroke, due to the alteration in brain chemistry from the injury. Now, we will have even more reason to begin medication early.
I presume that other anti-depressants would work similarly, but that said, we will likely try Prozac as our ‘first line’ therapy in such settings.


Of late, the generaly tenor of medical recommendations on hormone replacement are that it is generally a negative as regards increased cancer risk (breast in particular), increased heart disesae, and increased risk of dementia. These latest thoughts are completely opposite to recommendations only 15 years ago.
This remains a confusing topic, but a recent report on dementia and hormone use shows the complexity of the associations.
In this study 5000 woman using hormones and assessing for dementia they found:
If you use hormones immediately when you go into menopause, they reduce your risk for dementia
If you wait to use hormones until several years after menopause, there is an increased risk of dementia.
If you use hormones immediately and for the long term, there is no difference in dementia as compared to women without hormone therapy.

This research suggests a ‘window’ of opportunity for hormone benefits, and explains why there is such contradictory information on hormone use more generally.
Based on my analysis of the research data I believe that:
Estrogen use alone (Premarin or similar) should be started after menopause and will lead to reduced heart disease, reduced breast cancer, reduced osteoporosis, and reduced dementia.
Estrogen + Progesterone combined will lead to reduced heart disease, a slight increase in breast cancer, reduced osteoporosis, and no effect on dementia.

The balance needs to be analyzed in each woman’s situation and is very specific. There is no ‘pat’ answer for everyone.