Two women pick up the hard-to-treat infection, and a European party destination is one line of inquiry.

Drugs may already exist that could help patients with bipolar, schizophrenia and severe mental illness.

We often leave our doctor’s rooms with a script, and head over to the chemist who magically translates the often messy scrawl and issues us with the medication we need.

But what happens when the chemist gets it wrong and cannot actually read what your doctor has written? Or mistakenly dispenses the wrong medication?

For a woman in Glasgow it meant a trip to the emergency room after she suffered from chemical injuries to her eye. The BBC reports that her doctor had prescribed an eye lubricant called VitA-POS that is used to treat severe dry eyes and corneal erosions. However, the chemist misread this and dispensed Vitaros, an erectile dysfunction cream, instead.

After she used the erectile dysfunction cream, she suffered from eye pain, blurred vision, redness and a swollen eyelid. Fortunately the mild chemical injury was treated in hospital with topical antibiotics, steroids and lubricants. The injury cleared up after a few days and she didn’t lose her sight.

Prescribing errors

According to Dr Magdalena Edington, from Glasgow’s Tennent Institute of Ophthalmology, “Prescribing errors are common, and medications with similar names and packaging increase risk. However, it is unusual in this case that no individual, including the patient, general practitioner or dispensing pharmacist, questioned erectile dysfunction cream being prescribed to a female patient, with ocular application instructions.”

Dr Edington wants to raise awareness that medications with similar spellings exist, and she encourages prescribers “to ensure that handwritten prescriptions are printed in block capital letters (including the hyphen with VitA-POS) to avoid similar scenarios in the future”.

What you can do

According to the Center for Advancing Health, you as the patient must understand your prescription medication. Before you leave your doctor’s office, make sure you know the following:

• The name of the medication you’ve been prescribed
• Why you need to take it
• When and how you need to take it
• How long it will take before you see results from the medication
• What to do if you notice any problems or side effects

Dr Brent Ridge admits there have been times when he has been less than thorough in his explanations. “On these occasions, my patients called my office afterward, as they should have.”

He says when you pick up your prescription, make sure the label matches what you thought you were getting. “If you notice a discrepancy, tell the pharmacist. If you’re familiar with the prescription you’re picking up, such as a refill, you might notice changes. The shape and colour of some pills, as well as the engravings that appear on some tablets, can change from one refill to the next, especially if the pills are generic. But if you have any doubts, ask the pharmacist.” 

^{Image credit: iStock} 

Mandy Freeman

It all began with what I had expected to be a routine telephone call from Dr Grant, my medical doctor, following my annual check-up in September 2018. He calls me every year after conducting the extensive medical check-up during which, among other tests, blood samples are drawn and taken to the laboratory for analysis. Over the years, Dr Grant would simply call to assure me that all was well; but not in 2018.

“Your PSA (Prostate Specific Antigen) is rather elevated”, he told me in a calm, yet concerned, voice, “I need you to arrange to see a urologist for a prostate exam and biopsy, just to be sure that there is nothing to be worried about”. He gave me the name of the suggested specialist whose offices I promptly called to make an appointment.

The two weeks that I had to wait for the appointment seemed the longest I’d ever had to wait. When the time came, Dr Moolman turned out to be a relatively young, affable man who was reassuring in his manner. To be sure, I had also done a bit of reading about him and what he does before I went to see him.

Moolman conducted the dreaded and notorious “finger test” that many men loath, for its invasiveness and promptly suggested a biopsy. Fortunately, the finger test lasted just a few quick seconds and was done before I realised it. The biopsy is done under general anaesthetic during which random samples are taken from the prostate gland and taken to the laboratory for testing.

Of the sixteen that were taken from mine, ten returned with positive indications of the presence of prostate cancer. The highest Gleason Score – which indicates the level of aggressiveness of the cancer – was eight. Ten is the highest score. I consider myself lucky to have gone for regular tests and had the cancer diagnosed before it could spread to other parts of the body.

Some good news

So, the bad news was confirmed; but there was also what I’ll describe as some good news under the circumstances. The good news was that all indications at that time pointed to the cancer being concentrated in the prostate gland and none of it having metastasised into the neighbouring tissue and bone.

Further blood tests, a bone scan and MRI scan, were done over the next few weeks to ascertain these facts. Dr Moolman also took the time to explain available treatment options to me. 

Essentially, I could go the traditional Brachytherapy route, which consists of the implantation of radioactive seeds into the prostate gland to attack and kill the cancer. But this method offers no immediate guarantees, as I’d have to wait for some nine months to be fully assured if the cancer has been treated.

And anything could happen in the intervening period, including the resurgence of the cancer. Were the latter to happen, the radioactive seeds could not be injected for the second time, as this can only be done once. Treatment would mean possible chemotherapy and a lifelong regular observation.          

The alternative treatment option was to undergo a Da Vinci X robotics surgery, also called the “Robotic assisted laparoscopic prostatectomy”. It is the latest, higher definition, version of the first generation Da Vinci SI Surgery. “This minimally invasive procedure”, Moolman explained, “is performed with the use of a robotic surgical system that is designed to complete procedures with an extremely high level of precision. Six tiny incisions are made to enable the insertion of small surgical instruments and a drainage pipe into the abdomen.

The surgical tools, together with a high-definition camera, are mounted onto the machine’s robotic arms so that the cameras allow the surgeon to see the inside of the body in detail. The flexible instruments can bend and rotate much more than the human hand can, allowing for complete accuracy”.

The procedure enables the surgeon to remove the prostate gland from the urethra, around which it is normally wrapped. This procedure is recommended in cases like mine, where there is cancer inside the prostate gland that hasn’t spread to the surrounding organs and tissue.

For better cure results, Dr Moolman routinely removes the seminal vesicles with the prostate gland. In cases where the MRI scan shows the cancer to have spread outside the prostate, a wider resection margin is performed to make sure that no cancer is left behind after surgery.

If a patient is a good candidate – with very localised cancer like mine – a bilateral nerve sparing prostatectomy will be performed to ensure the return of erectile function after the surgery.

This unexpected personal journey with prostate cancer – no one in my family, including my father who died at the age of 92, is known to have had the cancer – as well as further information from Dr Moolman – opened my eyes to broader, pertinent, societal issues in South Africa:

• Most men either do not know they have to be tested annually (from the age of 40 for African men and 50 for Caucasian men), they’re too scared to go for tests, or they simply underestimate the potential danger of this silent killer of men;

• Most men are not comfortable discussing personal medical issues, especially prostate cancer; possibly because of the stigma associated with it (potential sexual dysfunction or incontinence); 

• Because of the absence of symptoms in the earlier stages of the cancer, most men think they’re fine and do not need to be tested. In reality, when symptoms begin to show – e.g. blood in the urine, difficulty passing urine, pain or a burning sensation when passing urine, or unusually frequent urination, especially at night – chances are that the cancer is already in an advanced stage. This is often the case with those (mostly) African men who live in rural areas and, in many cases, either lack the means, e.g. medical insurance, to get regularly screened for prostate cancer, or simply lack the awareness for it;  

• It’s important to note that 50-60% of African men in state hospitals are diagnosed with metastatic prostate cancer. This means they get diagnosed too late after the onset of prostate cancer and can therefore not be cured with therapy. More awareness is needed to prevent this; 

• Studies have also shown that African men have a bigger risk of being diagnosed with more aggressive prostate cancer than Caucasian men;

• Treatment costs are prohibitive. The Da Vinci Surgery is currently only available in private hospitals and not in the government sector, which only offers open surgery or radiation therapy;• There are currently only six Da Vinci systems in SA, with each machine costing in excess of $1000,000;

Since I’m on a Coastal Core Plan with Discovery Health – also called the Hospital Plan – which paid for the core surgery and hospital stay, I had to find another source to complement the many excess medical costs associated with this treatment. For this, I accessed additional funds through my Life Cover with Old Mutual, which also came to the party when I needed it.    

Thanks to Dr Moolman’s expertise, I was discharged from hospital two days after surgery and a bilateral nerve sparing prostatectomy to ensure a return of erectile function. 70% of his patients leave the hospital after a night following surgery.  None of this is possible with the open and traditional laparoscopic surgery. Once discharged from hospital, patient, loving, support by family and friends makes a huge difference.

Given the vast income disparities in SA, as well as difficult access to medical insurance for the majority of our citizens, there is an opportunity for government and the private sector to form some kind of Private-Public-Partnership in order to bring costs for the more modern Da Vinci X Surgery down and to make it available in the public health sector.

But until this becomes reality, African men need to take their health more seriously and get checked on a regular basis after the age of 40. Only early diagnosis can improve survival and cure rates.  

Solly Moeng

As if the start of a new school year isn’t stressful enough, many teens may find their acne worsening when classes start, a skin doctor says.

During summer holidays, acne often eases because teens have less stress and more sun exposure, but it could flare up now that they’re back in school, explained Dr David Shupp. He’s a dermatologist at Penn State Health Medical Group.

Girls more susceptible

“A teen often feels alone in suffering from embarrassing pimples,” Shupp said in a Penn State news release.

“Because acne is caused primarily by hormone levels, the condition often begins at puberty and clears up by the late 20s,” he added. “Girls are more susceptible than boys to hormone-related acne.”

For teens with mild acne, the first step is to try over-the-counter creams, gels or lotions applied directly to affected areas. Teens with other skin conditions – such as eczema or psoriasis – should consult their doctor before using over-the-counter acne medications, Shupp advised.

The most common over-the-counter acne medications contain:

• Benzoyl peroxide, which kills bacteria, helps remove excess oil from the skin and reduces inflammation.
• Salicylic acid, which dries excess oils and works best for blackheads and whiteheads.
• Adapalene, which prevents plugging of hair follicles and is available over-the-counter in 0.1% strength.

“If over-the-counter medications don’t provide enough relief from acne, it’s time to discuss prescription medications with a dermatologist or family physician,” Shupp suggested.

Prescription acne treatments include:

• Stronger retinoids, such as Retin-A. These are among the most effective topical medications but can be more drying than over-the-counter options.
• Antibiotics, which can be administered orally or via a topical gel or cream to kill excess bacteria. Topical antibiotics are often combined with benzoyl peroxide to maximize effectiveness while lowering the risk of antibiotic resistance.
• Hormonal treatments, which impact the balance of hormones that cause acne and are usually prescribed to supplement topical medications or antibiotics in young women.
• Isotretinoin (Accutane) is a powerful vitamin A derivative used to treat severe acne that does not respond to other medications. Potential side effects include birth defects, so teenage and adult women taking this oral medication must undergo monthly pregnancy tests.

Don’t use acne medications prescribed for someone else, Shupp said.

Along with treatment, there are a number of things teens can do to reduce acne, he added.

Permanent scarring

Gently clean affected skin twice a day. Avoid scrubbing, which can damage the skin and aggravate an acne problem. Do not use abrasive products.

Use oil-free cosmetics, sunscreen, moisturizer and hair products. They’re labelled “noncomedogenic”.

Keep hands and hair away from the face to reduce the transfer of oil. Don’t squeeze pimples. This can cause permanent scarring.

The most common skin condition in the United States, acne strikes close to 85% of people between the ages of 12 and 24, according to the American Academy of Dermatology.

^{Image credit: iStock}

Pelvic floor exercises are commonly targeted at women. But for men, as they age in particular, the exercises can be of massive benefit – especially for a condition such as incontinence.

While pelvic muscles can weaken due to age, there are other factors that can contribute to their deterioration, such as an injury or surgery.

Surgeries like the removal of the prostate (radical prostatectomy), as well as conditions like diabetes can affect the pelvic floor muscles.

Watch for more on pelvic floor exercises.

Neuroscientists at Tufts University School of Medicine, in collaboration with colleagues at Yale University School of Medicine, have discovered a new molecular mechanism that is essential for maturation of brain function and may be used to restore plasticity in aged brains. Unlike previous research that broadly manipulated brain plasticity using approaches that affected the entire brain, this study targets for the first time a specific molecule acting on a single type of neuronal connection to modulate brain function. This restores the brain’s ability to rewire itself.

The reddish-brown varroa mite, a parasite of honeybees and accidentally introduced in the Big Island of Hawaii in 2007-08, is about the size of a pinhead. Yet, its effects there are concerning to entomologists because the mite is found nearly everywhere honeybees are present.

Among the social insects, bees have developed a strong and rich social network, where busy worker bees tend to the queen, who in turn, controls reproduction for the benefit of the hive.

Its name was similar to one for dry eye and was given by mistake to a woman, who was injured as a result.