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ASK DR. LANG.

Answers to questions about epididymitis, knee braces, and apolipoprotein B

Q What is epididymitis, and what treatments are available for it?

A The epididymis is a coiled duct on the back of each testicle that serves as a reservoir for sperm while they mature and carries sperm from the testicle to the vas deferens. Epididymitis occurs when the epididymis becomes inflamed, usually as a result of a bacterial or viral infection. Symptoms include pain, pressure, or swelling in and around the affected testicle, a swollen or inflamed scrotum, pelvic pain, urinary symptoms (painful urination or increased urinary frequency), painful intercourse, blood in semen, and fever.

Epididymitis can occur in men of all ages. The condition may result from sexually transmitted infections or occur when bacteria from a urinary tract infection or prostatitis (prostate infection) migrate to the epididymis. Other potential contributors to epididymitis include infections resulting from urinary tract surgery, insertion of a catheter or scope into the urethra, and obstructive urinary disease caused by an anatomical abnormality in the urinary tract or benign prostate enlargement.

Treatment may entail the use of antibiotics (for bacterial causes), analgesic medications, ice packs, elevation of the scrotum, and bed rest to relieve discomfort. Less commonly, surgery may be necessary.

Q I have knee osteoarthritis, and I want to stay active. Should I wear a knee brace?

A Braces can support your knee and reduce excessive loading on an arthritic joint, but it's important to choose the brace that's right for you. For mild knee arthritis, you might try an off-the-shelf, sleeve-type brace made out of elastic rubber (neoprene) that warms and compresses the knee. For more severe arthritis, consider an unloader brace, a semi-rigid device made of plastic, foam, and hinged steel struts on each side to limit lateral movement.

These custom-fit devices are designed to ease pain by keeping your knee aligned and transferring pressure from the inside part of the knee to the outside.

Talk to your doctor or an orthopaedic specialist about knee braces and which type is right for you, and use the brace in combination with other treatments, such as exercise, weight management, and medications. Also, don't wear the brace all the time, but only during activities that stress the knee joint. Overusing the brace can deny the muscles supporting your knee the workout they need to stay healthy.

Q What is apolipoprotein B, and what can it tell me about my cardiovascular risk?

A Apolipoprotein B (apo B) plays a role in lipid metabolism and is the primary protein found in low-density lipoprotein (LDL, "bad") cholesterol. Higher apo B levels correlate with elevated LDL levels and non-HDL cholesterol, and suggest a higher cardiovascular risk.

Testing for apo B may be ordered especially if you have a personal or family history of cardiovascular disease, as well as to evaluate abnormal lipid levels (particularly if you have high triglyceride levels) or further assess your residual risk if your LDL level is near goal. The test also may be used to monitor the effects of lifestyle changes and lipid-lowering therapy. Cleveland Clinic experts recommend an apo B goal of less than 100 mg/dl for people at low or intermediate cardiovascular risk and a goal of less than 80 mg/dl for high-risk patients, such as those with established cardiovascular disease or diabetes.

Your doctor also may order a test for apolipoprotein Al (apo Al), the chief protein in high-density lipoprotein (HDL, "good") cholesterol, and then calculate the ratio of apo B to apo Al. A higher ratio of apo B to apo Al suggests an increased cardiovascular risk.

Editor-in-Chief Richard S. Lang, M.D., M.P.H., EA.C.P

Vice Chairman, Cleveland Clinic Wellness Institute
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Author:Lang, Richard S.
Publication:Men's Health Advisor
Article Type:Interview
Date:Oct 26, 2017
Words:617
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