Q: A bunch of foods are promoting health benefits beyond simple nutrition, like those yogurts that help digestion. Is this just marketing? Or do these things actually work?
A: These products are probably not harmful, and there is research that shows probiotics—the beneficial bacteria or yeasts being used in some yogurts—can help people with diarrhea, immune problems, even skin disorders. When people hear the word "bacteria," they naturally think of something that is bad or harmful, but bacteria can be beneficial, as there is an ongoing battle in the body to balance bacteria. The concept of eating products like yogurt with added probiotics—yogurt naturally has bacteria—is that you will have more of the good bacteria to fight the bad.
But whether products with added probiotics could help people who are already healthy is unknown. How healthy is more healthy? And although the FDA does regulate these biological therapy products, they fall in a gray zone between chemicals such as drugs, which are also regulated, and supplements like vitamins, which are not. In general, these foods appear to be safe; I don't think people are going to hurt themselves by eating yogurt. At worst, though, these products may be ineffective, and you should talk to your doctor to make sure that the extra money you are spending on these products really benefits you. —Dr. Daniel Bessesen, Endocrinology, Diabetes, and Metabolism; Denver Health Medical Center, University of Colorado Hospital
Q: I'm a 35-year-old male, and my father is a prostate and colon cancer survivor. When should I start having screenings for these diseases?
A: There's a lot more known about colon cancer and heredity than there is with prostate cancer, though both can be due to an inherited predisposition. People who have a first-degree relative with colon cancer have an increased risk. The standard screening test for colon cancer is the colonoscopy, which is typically done at age 50. However, because you have a family history, I would recommend having the procedure done 10 years before the age that your father was diagnosed. Some families have a hereditary predisposition to colon cancer, such as Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer), which raises the risk for colon cancer much higher than it would from just having a first-degree relative who'd had the disease. To be considered for genetic testing for hereditary causes of colon cancer, you or your father would meet with a genetic counselor, and your family history would be further analyzed to see if testing would be warranted.
As for prostate cancer, again, men routinely have the prostate-specific antigen, or PSA, blood test at age 50, but for those who have a strong family history of the disease, you'd want to have the test done at age 40. Prostate cancer is a slow-growing cancer, but if you're diagnosed with it when you're young, you'll have to discuss with your physician how best to treat the cancer. In older men that develop prostate cancer, the likelihood is that they'll die with prostate cancer rather than die from it. —Dr. Allen Cohn, Medical Oncology; Presbyterian/St. Luke's Medical Center, St. Joseph Hospital
Q: My doctor suggested I have "microfracture" surgery to repair the cartilage in my left knee. I hear about all these NBA guys getting the surgery, with mixed results. Would I still be able to ski if I decide to have the procedure?
A: Skiing after microfracture surgery? That's a definite maybe. Unfortunately, our solutions for injuries of articular cartilage—think of that white, glistening stuff on the surface of the end of a chicken bone—are far from perfect. While articular cartilage is an ideal joint-bearing surface in terms of its low friction (it's 10 times slicker than an ice skate on ice) and numbness (cartilage has no nerves), it has limited, if any, ability to heal or regenerate. In the microfracture procedure, the surgeon uses a small ice-pick-like tool to make a series of tiny puncture holes (fractures) in the exposed surface of bone. These puncture marks bleed, and, if the procedure is successful, that bleeding coagulates and hardens into a layer of scar tissue that covers and protects the area of injury.
While this all looks great on paper, in real life the scar-tissue "patch" that we try to achieve with microfracture isn't as numb, slick, or durable as the original articular cartilage, and patient satisfaction with the procedure is only about 70 percent. A much better solution would be to invent a pill, shot, or surgical procedure that would stimulate the body into resurfacing the defect with the original material. While I don't have that solution to offer my patients today, some of our country's top bioengineers (including the University of Colorado's Dr. Kristi Anseth) are working to get us there. —Dr. Ted Parks, Orthopedic Surgery; Presbyterian/St. Luke's Medical Center, St. Joseph Hospital
Q: I'm pretty stressed out between work, the economy, and paying my mortgage. What can I do to ease my stress levels?
A: A good technique is to list major stresses and prioritize those that can be most easily dealt with. In so doing, you gain a sense of accomplishment and mastery. For those stressed by a large mortgage, now is a time to look at the feasibility of refinancing and possibly consolidating debt to be more manageable. If your career seems to be getting you down, now may be the time to reconsider increasing your education and looking at careers that are showing growth potential. Take a look at what is positive about your current job, and assess if there are ways to enhance these aspects. Now is a time to focus on the present rather than the distant future. Volunteer your time. Give to others: It provides a sense of well-being and a sense of altruism as you focus on something for others rather than your own concerns. Reorganize your own environment, and donate what you no longer need. Most important: Take time to "feed the soul," and be thankful for what you have. —Dr. Robert House Jr., Psychiatry; Denver Health Medical Center, University of Colorado Hospital
Q: I have chronic lower back pain and have had a couple of specific disc injuries (one bulging, one herniated). How do I weigh the cost-benefit of having surgery versus rehab?
A: At least 85 percent of the population will experience some type of back pain in their lifetimes. But even if you've had a couple of injuries and chronic pain, it would potentially be of great benefit to try a course of physical therapy. Unless you are having weakness and/or some other nerve-type issue from the bulging and herniated discs, I would not recommend pursuing surgery as the first line of treatment. Many people have back and disc injuries, including herniations, that can be treated successfully with nonoperative management.
If you have tried physical therapy and continue to have problems, then it might be time to consider surgical options. However, despite the potential benefits surgery has, there still are risks, including injury to the nerves, infection, and lingering pain from surgery. Before deciding to have surgery, it would be wise to see if there are other alternatives, such as an epidural injection to reduce the inflammation around the discs and the nerves. Also, getting a second opinion from a fellowship-trained back surgeon would be appropriate. —Dr. Eric McCarty, Sports Medicine; Boulder Community Hospital, University of Colorado Hospital