Dear Dr. Roach: My urologist prescribed Elmiron for my interstitial cystitis (IC), and it worked well. But the cost became prohibitive, so he suggested Zyrtec at bedtime. While it’s not quite as good as Elmiron, Zyrtec is working for me. My question is, how safe is it to stay on Zyrtec indefinitely?
Anon.
IC is a chronic pain syndrome whose underlying cause is uncertain. Most people feel pain when the bladder is filling, then relief when it empties. Like many pain syndromes, it can sometimes be treated with antidepressant drugs at low doses, which work at the level of the nerve cells that transmit pain signals. Drugs like amitriptyline are worth trying, as they are safe, inexpensive and relatively free of side effects at a low dose.
Elmiron is another commonly used treatment for IC, but it isn’t perfectly effective for most and has the potential for a serious side effect of damage to the retina after long-term use.
Antihistamines like Zyrtec have been used in people with IC, especially those who have other types of allergies or have an allergic response in the bladder that might be partially responsible for IC. My experience with this is limited, but if you are getting the same results you did with Elmiron, that is great news. Zyrtec is very safe; it is an over-the-counter medication, tends to be very inexpensive and has a very low risk of serious side effects.
I’m publishing this letter because I have seen many patients (10 times more women than men are affected by IC) fail to get a diagnosis of this chronic painful condition of the bladder for years, and any chance to bring attention to this condition is important, especially when there are safe and inexpensive medicines that can bring help to many. Unfortunately, many people with IC require additional treatments to get the disease under control, and some continue to have symptoms despite all the treatments we have.
Dear Dr. Roach: I am 77 and have had PSA exams throughout the years with good results, all less than 1.0 ng/mL. My family practitioner, who has practiced for almost 25 years, says that a digital rectal exam (DRE) is a thing of the past; nevertheless, I would prefer that he examines me this year. I just feel that a DRE is thorough.
Does he have an obligation to render such an exam if I request it? My last family practitioner, who is in his 80s, always performed a DRE without my having to ask for one.
M.A.R.
The evidence is strong that a DRE adds little information to the PSA test as a screening test for prostate cancer, but it does add something. There are cases where the PSA is normal, but a skilled examiner still found cancer. However, that situation is very infrequent.
I don’t try to talk my patients out of a DRE if they really want it. The harm of a DRE is very low. The harm done to a relationship between a physician and a patient by arguing probably outweighs all other considerations.
There are times when a physician can — and should — refuse to order tests if they really feel that their patient will likely be harmed by it. Your physician has expertise that comes from their education and experience, so it is wise to listen to them.
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 [email protected]
