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Answers to questions about cortisone, finasteride & PSA, and functional foods.

Is there a limit to the number of cortisone injections I can have for knee osteoarthritis

A Cortisone injections are generally reserved for patients who no longer gain ample pain relief from oral medications, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve).

The shots are generally effective, but the benefits usually last only a month or two. And, animal studies have raised concerns that overuse of the injections can destroy cartilage, rupture tendons near the joint, and damage blood supply to the underlying bone. Consequently, most experts recommend that the injections be given no more frequently than once every three or four months and no more than four times in any given joint with osteoarthritis.

Another option is visco supplementation, a series of injections using hyaluronic acid to improve the synovial fluid in the knee. More effective for mild-to-moderate arthritis, the treatment eases pain for three to six months. If your pain continues or worsens despite these treatments, consider knee-replacement surgery.

What effects can finasteride have on prostate cancer screening

A Finasteride (Proscar) and dutasteride (Avodart) belong to a class of drugs known as 5-alpha reductase inhibitors (5-ARIs). The medications are used to shrink the prostates of men with benign prostate enlargement (BPH), and research suggests they also can improve the diagnostic accuracy of the prostate-specific antigen (PSA) blood test, the cornerstone of prostate cancer screening.

But the drugs also reduce PSA levels by about 50 percent in men who take them. So have a PSA test before starting on a 5-ARI, again at six months, and then regularly as your doctor recommends. And, your doctor must take into account the effects of the drugs when assessing your risk of prostate cancer.

The issue of whether the 5-ARls can reduce a man's risk of prostate cancer remains controversial. The U.S. Food and Drug Administration (FDA) rejected a request by the makers of Proscar and Avodart to include an indication for prostate cancer prevention. However, guidelines from the American Urological Association and American Society of Clinical Oncology encourage men to talk to their doctors about 5-ARIs for prostate cancer prevention if they have a PSA of 3.0 ng/mL or lower, undergo yearly PSA testing and have no signs of prostate cancer, or if they already use a 5-ARI to treat BPH. Men at higher risk of prostate cancer--African-Americans, those with a family history of the disease, men over age 60 with a PSA above 1.5 ng/mL and negative biopsy results, and men in their 40s with a PSA above the population mean of 0.7 ng/mL--also may want to have this discussion.

What are "junctional' foods

This term refers to foods and their components that provide health benefits beyond what's necessary for survival, such as reducing the risk of disease. For example, the antioxidants in plants may protect against free radicals, unstable molecules believed to contribute to conditions such as cardiovascular disease, cancer, and arthritis.

Functional foods include fortified products--such as margarines and other spreads with added omega-3 fatty acids, juices and dairy products fortified with calcium, and breads and cereals fortified with folate--or simple whole foods, such as whole grains, fruits, vegetables, legumes (e.g. beans, peas and lentils), and nuts.

The labels of many products contain health claims on their labels, but their functionality beyond basic nutrition isn't always clear. My advice is to stick to whole foods as much as possible and eat a balanced diet rich in fruits, vegetables, whole grains, and legumes, and low in fat, added sugars, and processed foods.

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Editor-in-Chief Richard S. Lang, M.D., M.RH., EA.CR

Vice Chairman, Cleveland Clinic Wellness Institute
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:ASK DR. LANG
Author:Lang, Richard S.
Publication:Men's Health Advisor
Article Type:Interview
Date:Feb 1, 2012
Words:651
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