Dear Dr. Roach: My urologist’s receptionist asks every person to leave a urine sample for testing. They ask without knowing the reason for the visit. I would not be surprised if they ask the UPS delivery person. My reason for most appointments is for a follow-up of BPH urination frequency, not any kind of infection, etc. When I ask if the test is medically indicated, the receptionist has no good response. So I say no. When I see the doctor, he never brings up that the test should be done.
I’m all for testing when medically indicated. But to me, this pervasive urine testing by this office is nothing but a money grab by the physicians. Am I wrong?
I strongly disagree with this practice.
I do understand why they ask. In a urologist’s office, the likelihood of an abnormal urine test is very high, and knowing these results early can be a time saver. Even in men with BPH (benign prostatic enlargement), urine infections are common and need to be ruled out as a cause for those men who note worsening symptoms. However, not everyone needs them, and it doesn’t save that much time.
Perhaps I’m naïve, but I do not think the underlying rationale is greed. I think the urologist wants to avoid missing any unsuspected urine infections. However, I think tests should be driven by symptoms (and by screening in a few, selected cases, such as preoperatively). I agree with your refusal with the testing. If your urologist needs it, the onus is on him to explain why.
Dear Dr. Roach: My husband stated that every day he soaks some toilet tissue with 91% rubbing alcohol and shoves it up his nose. What’s your opinion about that practice? Is it a good or a bad idea, and why?
That’s a bad idea.
The first reason is that it isn’t helpful: I imagine he is doing so to reduce infection risk, but it is ineffective at doing so.
The second reason is its toxicity. Rubbing (isopropyl) alcohol is irritating to the mucus membranes of the nose, its vapour is irritating, and it is modestly toxic if swallowed. I would also be concerned that toilet tissue could fall apart in the nose, leaving soaked tissue behind, further subjecting the nose to irritation and the sinuses and lungs to alcohol vapours.
If he really wants to rinse his nose, normal saline solution would be ideal, but even that is not necessary for most people.
Dear Dr. Roach: I take 500 milligrams of valacyclovir daily to prevent outbreaks of ocular herpes. Since this antiviral drug is used to treat shingles, does that mean I don’t need to get the shingles shot? I’ll be 65 years old this year.
It’s a reasonable thought, but I would still recommend you get the shingles shot.
Your dose of valacyclovir (Valtrex) is insufficient to prevent shingles, and there is resistance to anti-viral drugs (such as Valtrex) among herpes viruses like varicella-zoster virus, which causes shingles.
You may have a lower risk of shingles because of the Valtrex, but in my judgment, the benefits of the shot still outweigh the risks.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu