Fw: Broccoli helps (Dr. Casey)
Dr. A. N. Feliciano
> From: Akakan <NOSPAM...@ZIPLINK.INVALID.REPLACE.INVALID.WITH.NET>
> To:
> Subject: Re: Broccoli helps (Dr. Casey)
> Date: Friday, August 06, 1999 8:33 AM
>
> Austin Powers <Anonymous...@See.Comment.Header> wrote in article
> <1999080515...@berlin.neuropa.net>...
>
> > In your case, where bacteria are present, the massage+abx treatment
> > may make sense. Although cure rates are also quite high in bacterial
> > prostatitis even without massage, just using targeted abx.
>
> Is this true?
>
> Everything I've read on the Web in this last panicked week has led me to
> believe that there is no cure, ever, especially if a urine test is
> negative.
>
The cure rate of chronic prostatitis with antibiotics given without massage
is less than 20 to 40% and recurrences are high. Dr. Shoskes who is
experimenting on antibiotics+massage has reported more than 40% cure rate
among his patients. Although Dr. Casey has not publish his cure rate among
his patients, I am sure he will not continue the massage+antibiotics
protocol if his results are no different from the standard antibiotic given
alone.
Antonio Novak Feliciano, M.D., F.P.C.S.
Visit my website
http://web.idirect.com/~ino
http://www.qinet.net.user/dr.anf/chronic.htm
Austin Powers
> The cure rate of CP with antibiotics
> given without massage is less than 20 to
> 40% and recurrences are high. Dr. Shoskes
> . . . [with] abx+massage has reported more
> than 40% cure rate among his patients.
Wrong again. Actually the figure is 38% at 4 months. Not much
different to the abx alone figures. And the abx cures mostly relapse
with time.
> Although Dr. Casey has not publish his cure
> rate among his patients, I am sure he will
> not continue the massage+antibiotics
> protocol if his results are no different from
> the standard antibiotic given alone.
I don't think he's that keen on abx+massage, but I'll let him answer
for himself.
Jonathan E. Miller
I recall that he'll do it if the patient wishes (Latin: "placebo": I
will please), but doesn't believe it helps very often. I hope he'll
correct me if I'm wrong.
Dr. Casey's interest in prostatitis seems to be a concern for his
patients, and not a concern about prostatitis per se. He's posted an
addition to his web site asking us not to travel long distances to see
him. He has a great bedside manner, but he doesn't know any more about
prostatitis than many other urologists (or, for that matter, many
non-doc posters and readers here).
Jon
David L. Casey, MD
>
> Austin Powers wrote:
>
> > "Dr. A. N. Feliciano" wrote:
> >
> > > Although Dr. Casey has not publish his cure
> > > rate among his patients, I am sure he will
> > > not continue the massage+antibiotics
> > > protocol if his results are no different from
> > > the standard antibiotic given alone.
> >
> > I don't think he's that keen on abx+massage, but I'll let him answer
> > for himself.
I haven't seen any magical benefit from this protocol. More and more
I'm moving away from even empirical antibiotics alone...
I think it's probably wise only to treat for definite bacteriologically
proven disease at present.
>
> I recall that he'll do it if the patient wishes (Latin: "placebo": I
> will please), but doesn't believe it helps very often. I hope he'll
> correct me if I'm wrong.
>
That's about right. I really don't mention massages anymore unless the
patient has heard of it or requests it. I'm not sure if I would call it
a placebo, as it may have some benefit as an adjunctive treatment in
some due to its "physical therapy" actions in relaxing pelvic floor
muscles...I don't really know. I do not believe it is possible to
scientifically post "cure rates" in my practice setting as there's no
standardization or selection of patients, and many men have different
conditions that have similar symptoms--ergo it's impossible to state a
"cure rate" when we don't know if we're treating the same type of
patient from one to the next. Some men have benefitted from massage,
but others haven't. In my opinion, not enough have benefitted to
warrant this as standard therapy.
> Dr. Casey's interest in prostatitis seems to be a concern for his
> patients, and not a concern about prostatitis per se. He's posted an
> addition to his web site asking us not to travel long distances to see
> him. He has a great bedside manner, but he doesn't know any more about
> prostatitis than many other urologists (or, for that matter, many
> non-doc posters and readers here).
>
> Jon
Well, I actually am interested in CP/CPPS/IC, but this doesn't mean I
should be a reference clinic for the syndrome(s). Does anyone really
"know" about "CP"...I've said this a hundred times, and it is still
true: "CP" (read CPPS) is NOT JUST one disease. (that's a period)
Until we can understand this syndrome better, no one is going to have
all the answers. I certainly don't, and have no problem admitting
that. I discourage long-distance travelers because chronic
prostatitis/cpps is a _chronic_ disease requiring continuing followup
and long-term care, and this is next to impossible when the patient
lives a long way away.
Frankly, the only reason some people have ever visited me is because I'm
internet-active. It makes me chuckle when men have travelled from areas
close to major metropolitan medical centers to see me...it really is due
more to my openness and willingness to listen than anything else. Yes,
I do pay attention to the CP/CPPS/IC literature more than others (I
suspect), but no, I do not have any special expertise and/or training in
these areas, and probably have about as much success as many other
urologists if the truth were told. I will toot my own horn just a
smidgen, though (though I do not like to do this). I have had some
successes directing patients to Quercetin or other therapies that they
wouldn't have heard about if I hadn't been active in the group. In
addition, another patient who had been treated for 2-3 years for CP
clearly had IC, and I made the diagnosis, and with proper treatment,
this guy is much improved. I really think that everyone with CPPS
should learn as much about IC as possible, as I believe many CPPS
patients may actually have this condition, but since most of the
literature out there is about and for women, many men don't take enough
time to learn about IC and contemplate whether they indeed may have
this...I'm not saying everyone with CPPS is actually an IC'er, but it
wouldn't surprise me if a substantial number are.
I hope this helps, and best of luck to all.
--
David L. Casey, MD
Denton Urology
Denton, Texas USA
http://www.dentonurology.com (Homepage)
http://www.dentonurology.com/books.html (Books)
http://www.dentonurology.com/acronym.html (Acronyms)
Check the website often for ongoing changes!
This communication is intended to provide general information, and in no
way is a substitute for face-to-face medical care.
No implication of a doctor-patient relationship should be assumed by the
reader.
Sorry, but no questions or requests answered by private email. Long
distance travel for medical care is strongly discouraged.
gt account1
you say that many CP could be IC.
Can you suggest a "10 minutes" reading to understand the difference?
Thanks and regards
G. Tonal
David L. Casey, MD
David L. Casey
> In article <37B0DB4F...@pol.net>, "David L. Casey, MD" <dlc...@pol.net>
> writes:
>
> >In
> >addition, another patient who had been treated for 2-3 years for CP
> >clearly had IC, and I made the diagnosis, and with proper treatment,
> >this guy is much improved. I really think that everyone with CPPS
> >should learn as much about IC as possible, as I believe many CPPS
> >patients may actually have this condition, but since most of the
> >literature out there is about and for women, many men don't take enough
> >time to learn about IC and contemplate whether they indeed may have
> >this...I'm not saying everyone with CPPS is actually an IC'er, but it
> >wouldn't surprise me if a substantial number are.
>
> Dr. Casey,
>
> What tests do you perform to differentiate IC from CP?
I do a cystoscopy under anesthesia and hydrodistention... There are other
modalities being researched, and a "potassium" test that basically involves
dripping potassium into the bladder of a suspected IC patient, and if severe pain
occurs, in the absence of detectable UTI, then IC is highly suspected.
IC is largely suspected based on history and symptoms, and in a man, I begin to
suspect it when there is little inflammation in the EPS, and a poor response to
standard treatments (whatever that means).
> Also, what percentage of
> men with CPPS have PFD? I was told that 72% of women diagnosed with IC have
> pelvic floor dysfunction by the urologist who has been treating me.
That's a good question that I do not know the answer to. I suspect it is a
substantial percent, but do not have a concete figure for you.
Best of luck.
>
>
> Sincerely,
> Brian
> Elect...@aol.com
Electric87
>In
>addition, another patient who had been treated for 2-3 years for CP
>clearly had IC, and I made the diagnosis, and with proper treatment,
>this guy is much improved. I really think that everyone with CPPS
>should learn as much about IC as possible, as I believe many CPPS
>patients may actually have this condition, but since most of the
>literature out there is about and for women, many men don't take enough
>time to learn about IC and contemplate whether they indeed may have
>this...I'm not saying everyone with CPPS is actually an IC'er, but it
>wouldn't surprise me if a substantial number are.
Dr. Casey,
What tests do you perform to differentiate IC from CP? Also, what percentage of
men with CPPS have PFD? I was told that 72% of women diagnosed with IC have
pelvic floor dysfunction by the urologist who has been treating me.
Sincerely,
Brian
Elect...@aol.com
Electric87
writes:
>in a man, I begin to
>suspect it when there is little inflammation in the EPS
Dr. Casey,
What would you consider "little inflammation in the EPS" to be in terms of
wbc?
According to Dr. ANF^s posts, there are major differences of opinion about the
"normal" level of wbc in ESP.
Brian
David L. Casey
Good question. Probably less than 5 wbc/hpf indicates a low degree of
inflammation...
Classically I believe the number of white cells per hpf considered abnormal is 10,
but as you mention there is no consensus. I have looked at EPS in asymptomatic men
before and found "significant" inflammation...so who knows what it really means.
Daniel Shoskes MD
"David L. Casey" <dlc...@pol.net> wrote:
> Electric87 wrote:
> > What would you consider "little inflammation in the EPS" to be in
terms of
> > wbc?
> > According to Dr. ANF^s posts, there are major differences of
opinion about the
> > "normal" level of wbc in ESP.
> >
> > Brian
>
> Good question. Probably less than 5 wbc/hpf indicates a low degree of
> inflammation...
>
> Classically I believe the number of white cells per hpf considered
abnormal is 10,
> but as you mention there is no consensus. I have looked at EPS in
asymptomatic men
> before and found "significant" inflammation...so who knows what it
really means.
>
I suspect it's a lot like PSA and prostate cancer: You can have prostate
cancer with a PSA under 4 and have benign disease with a PSA in the
20's. What also confuses the picture is the fluctuation over time of the
WBC count in men with CPPS (see Tony Schaeffer's excellent article: J
Urol 1994 Dec;152(6 Pt 2):2300-3). There is no question that EPS from
asymptomatic men who never have had a UTI/STD or CP can have WBC counts
over 10.
We are generating a lot of this data in the NIH study and will be
including asymptomatic volunteers this coming year.
Daniel Shoskes MD
UCLA
http://www.ben2.ucla.edu/~dshoskes
Institute for Male Urology
http://ww
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