To Your Good Health: Non-Treatment Can Be a Treatment Plan
Dear Dr. Roach: What advice do you have for a man in his mid-90s who has just found out that he has ureter cancer and does not want to have an operation? He is not in any pain and is in good physical condition for his age. Would it be OK for him to take supplements for his immune system? — J.C.
Answer: The ureter is the tube that carries urine from the kidney to the bladder. Cancers of the ureter are identical to bladder cancers, since the cells lining the ureter are the same as those lining the bladder. Ureteral cancers usually are treated surgically, often endoscopically. The surgery usually is well-tolerated; however, I can understand why a man in his mid-90s might not want to have an operation.
I believe everyone has the right to not treat their own condition, even if their doctor disagrees, if they truly understand what the consequences are. In the case of the man with ureteral cancer, that might mean not being cured of a potentially curable cancer. On the other hand, these cancers can be slow-growing and might not be bothersome for months or even years.
As far as the immune system goes, I am skeptical of any supplement that claims to boost it. Certainly, the immune system can be damaged by poor diet, stress and lack of sleep, but you don’t need a supplement to fix those. Finally, there is a treatment used for bladder cancer and sometimes for cancer of the ureter that does work by enhancing the immune system. It’s called BCG, and it’s a weakened bacteria that is instilled into the bladder. He can ask his urologist whether that might be a way to treat the cancer.
Dear Dr. Roach: I have a question about Aspercreme. It contains an ingredient called paraben. I also use Biofreeze, and it is paraben-free. What is paraben? Is it something to worry about? The Aspercreme gives me better pain relief. — M.I.T.
Answer: Paraben is a preservative. It is generally considered to be safe; however, there recently has been some concern about a possible association with breast cancer. Although there is no direct evidence, the manufacturers of Biofreeze wanted to make a product without a controversial chemical preservative.
Aspercreme, as its name implies, contains a form of aspirin that is absorbable through the skin, and that probably is why it is working better for you as a pain reliever. I think both are good products.
Dear Dr. Roach: My 76-years-young wife recently was diagnosed with giant cell arteritis. Would you please explain what this is, and if it is curable? — R.G.
Answer: Temporal arteritis, also called giant cell arteritis, is an inflammatory condition of the artery that lies directly over the temple. It occurs in people over 50. It often is associated with another condition, called polymyalgia rheumatica, which causes morning stiffness and fatigue.
Temporal arteritis causes symptoms of headache and aching in the jaw that are often worse after chewing. However, its most feared complication is vision loss, which can be permanent. Any vision changes in someone with new-onset headaches should be considered an emergency and should be evaluated immediately. In people in whom temporal arteritis is suspected due to symptoms, often a swollen temporal artery, the diagnosis is strongly supported by a very elevated ESR (erythrocyte sedimentation rate) or C-reactive protein, both markers of inflammation. A biopsy is necessary to confirm the diagnosis. It is treated with high-dose steroids such as prednisone, tapered slowly over a year or so. Many experts recommend aspirin as well. Temporal arteritis can’t be cured, but usually is well-managed with medication.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.