Anxiety attacks benefit from expert help

Dr. Keith Roach M.D.

DEAR DR. ROACH: My daughter-in-law has anxiety attacks. It gets so bad that she ends up throwing up. She has seen a doctor, but so far it has not helped. Can you give her any advice? -- M.L.

       ANSWER: Anxiety is something that nearly everyone has felt when confronted by a difficult, unexpected or time-consuming problem. An anxiety disorder is different. 

       Generalized anxiety disorder is "excessive and persistent worrying that is hard to control, causes significant distress or impairment, and occurs on more days than not for at least six months." Some physical symptoms are hallmarks: Poor sleep, fatigue, headaches and pain in the neck, shoulders and back are among the most common, but vomiting is possible in people with more-severe cases of anxiety. Panic attacks often co-exist with severe anxiety disorders.

       Many regular doctors, including primary care doctors like me, may not recognize the symptoms of an anxiety disorder or be comfortable providing treatment. A referral to a mental health professional is wise. When the condition is diagnosed, the doctor needs to assess the severity to determine what kind of treatment is best. For many people, that will include psychotherapy, such as cognitive behavioral therapy. This has been shown to be effective, but it may be difficult to find in some areas of the country. Medication treatment is also effective, and the combination of the two is more effective than either separately.

       Since your daughter-in-law is having severe symptoms, I would really recommend she see an expert.

       DEAR DR. ROACH: I am a 92-year-old man who is experiencing frequent urination. I urinate two or three times during the evening and during the day. It seems to be worse when I change from the sitting position. Are there any medications that may help? -- R.T.

       ANSWER: I suspect you have benign prostatic hyperplasia, or enlargement of the prostate gland; however, your doctor will need to do an evaluation before making the diagnosis for sure and discussing treatment. Urine infections can cause these symptoms, and there are other causes of excess urinating, such as new or poorly controlled diabetes. 

       Since the vast majority of men in their 90s will have enlargement of the prostate, I suspect your symptoms are most likely due to this condition. Although you ask specifically about medication treatment, there are some interventions you can try before considering medication. 

       Limiting fluids before bedtime -- especially alcohol, which acts as a mild diuretic -- and bladder irritants, such as hot peppers, can help. Constipation often makes prostate symptoms worse, so that should be avoided. Regular strenuous exercise helps. Weight loss may help for those who are overweight. Men can also learn pelvic floor (Kegel) exercises. Timed urinating helps some men. Going every two hours is a reasonable starting point. Simply urinating again a minute or two after urinating once may have a surprisingly beneficial effect.

       When medications are needed, the usual first treatment is with the alpha blockers, such as tamsulosin. 5-alpha reductase inhibitors, such as finasteride, are slower to take effect, but they have an additional mechanism of action from alpha blockers. Tadalafil, a medicine usually used for erectile dysfunction, has some benefit in BPH and can be used in men who have both prostate enlargement and ED.

       Many people write to me about supplements. Some men get benefit from saw palmetto, Hypoxis rooperi (South Africa star grass) or Pygeum africanum (African plum); however, there is not strong evidence that any of these is better than placebo.