#15 Warning: Some Drugs Make You Floppy in the Worst Way

This one is a little obscure, but it's a side effect of a common drug and completely avoidable. Read on:

Dear Dr. Tumoriffic,

I'm afraid my iris has gone all floppy. Why did this happen?

Signed, 
Mr. Floppy


Dear Mr. Floppy,

I'm so glad you brought up this subject! Readers, did you know that there is a truly scary way men (and women) can go floppy? And no, it's not polka music. It's drugs. In fact, it's a class of drugs*. And what gets floppy? It isn't your little friend, guys. It's your iris. And in the wrong situation, that can make you blind.

Let me introduce you to FLOPPY IRIS SYNDROME. Floppy iris syndrome--more correctly, intraoperative floppy iris syndrome (IFIS)--is when the muscles of the iris go slack. For most people, it doesn't matter. You won't know you have it, and it won't affect your vision. But cataract surgery could make you go blind.

Patients with IFIS are at high risk of going blind from cataract surgery. However, this is almost always preventable if your ophthalmologist (eye surgeon) knows that you have had certain drugs. Then, they can take precautions. So listen up!

The guilty class of drugs is the alpha-1 antagonists (you don't have to remember that phrase). These are drugs that are sometimes used to treat high blood pressure (which is why some women get IFIS from them), but, usually, they are used to treat benign prostatic hypertrophy (BPH).* This is a very common condition in men over 60.

One of these drugs is much more likely than the others to cause IFIS. It's tamsulosin (Flomax) and probably Silodosin (Rapaflo), because they are very similar. Even a single dose of tamsulosin in a lifetime forever puts you at risk for IFIS. Other common members of the class include alfuzosin (Uroxatral), doxazosin (Cardura), terazosin (Hytrin), and prazosin (Minipres)***. These others may do it, but they're much less of a problem.

Why am I telling you this? Because I saw a patient who had IFIS from tamsulosin and cataract surgery. His ophthalmologist didn't ask about it, and now, he is almost blind in one eye. So, remember this: if you have EVER taken tamsulosin or silodosin, make sure your eye surgeon knows this before you get cataract surgery.

Or, let's be real. Who will really remember these specifics? If you have EVER been treated for BPH, make sure your eye doctor knows before you have cataract surgery, and make sure they know your blood pressure meds! If your parent, aunt, uncle, etc. is having cataract surgery, make sure they tell them. Yes, I am sure almost all eye surgeons remember to ask, but not all of them do.


Oh, and guys, if you have that other kind of floppiness, don't worry. You don't have to tell your ophthalmologist about it. They really don't want to know.

Be well,

Dr. Tumoriffic




* The prostate gland is an organ that produces some of the ingredients of semen, so only guys get to have one.) It is shaped like a doughnut with a very small hole. The prostate is located just at the exit from the bladder, and, through the little hole runs the urethra. Unfortunately, the prostate, like the ears and the nose, continues to grow throughout the lifetime.** Sadly, the hole in the middle does not grow, but shrinks as the prostate grows in on it. That's what alpha-1 antagonists treat.

** As I always tell my patients that if we find the pill that will allow us to live forever, men are all going to look like caricatures of Ross Perot but with basketballs between our legs. Some have proposed that the first person who will live to be 150 has already been born. If that person is male. . .

*** Prazosin is the real weirdo of the bunch. In addition to BPH, it can also treat PTSD and the sting of the Indian red scorpion!

This cat is bored.

#14 A Sacrifice to the Goddess Hernia

Hello readers! I have had the worst writer's block. I have tried every literary laxative in the book (legal ones, that is), and still, I strain to write. But, here is a new one at last.

Dear Dr. Tumoriffic,

I have something bulging in my groin that I can't push back in. Should I come to see you right away, go the emergency room, wait until after my vacation to Newark?

Signed, 
Mr. Bulgepants

Dear Mr. Bulgepants,

Quick answer:

If your hernia is painful, or if it is difficult to push back in, you need to see your primary care doctor or a surgeon right away. If you cannot push it back in, go to the emergency room.

Long answer:

It really depends on what that bulge is. This is a family-friendly blog, so there are some kinds of groin bulge I simply refuse to discuss. However, I will assume that is not where you're going with this. In that case, it sounds like a hernia.

Hernias are one of the oldest diagnosable health conditions. They were known to doctors as far back as ancient Egypt. Hippocrates bestowed the name 'hernia' on the condition in honor of the goddess Hernia, who was the goddess of buds or shoots. Unlike Athena, who burst forth wholly formed from Zeus' head (in the mother of all hangovers), Hernia burst forth from Zeus' left groin during a weight-lifting contest with Atlas.*

A hernia is the extrusion of one part of the body through the tissue containing it. The ones we usually talk about involve the intestines pushing through fascia, the leathery tissue that wraps nearly all of the body and keeps what belongs inside inside. Hernias are extremely common, affecting nearly a quarter of all men at some point over their lifetimes and about 3% of women.

Examples of these kinds of hernia include the ventral (front) hernia, in which the abdominal fascia splits down the middle, and the intestines bulge out, creating a tall, narrow bump in from the middle of the abdomen. Many older men have these, and you can see them if you look for them at the beach. These are usually harmless, though disfiguring.

Another common one is the unmbilical hernia, in which the little weakness of the fascia created by the belly button expands to let out a bump of gut.

Finally, there is the inguinal hernia. Inguinal hernias form because of original sin. Specifically, during fetal development, the testicle must migrate from outside of the abdomen so that it can travel upwards to form most of the male brain. Wait. There is something wrong about that. What I meant is that the gonads are formed in the abdominal cavity.** If the fetus is male, if all goes normally, the gonads migrate out of the abdominal cavity and into the scrotum through a tube of fascia about 4 inches long called the inguinal canal.***

An increase in abdominal pressure from, for instance, trying to lift something heavy like a planet, may push the bowels through the opening of the inguinal canal and even into the scrotum, leading some men to become inappropriately proud of their new anatomy.****

Hernias can be harmless. If it doesn't hurt, and you can easily push the herniated tissue back where it belongs. It can be something to do if you're bored. Some people get them repaired at this stage. That's perfectly reasonable, but usually not necessary.

However, if the herniated tissue becomes stuck (the technical term is 'incarcerated'), it's an emergency. The blood supply to the tissue may be blocked, and the tissue will die very quickly.  The gut is filled with bacteria that are usually quite friendly, but if a piece of gut dies, those bacteria escape into the rest of your body, and you can die in hours.

A hernia can usually be repaired with a very quick procedure. Depending on the type of procedure, patients can often go home within 6-24 hours. They usually can return to light exercise in 1-21 days but have to refrain from heavy exercise (like wrestling a minotaur) for 2-6 weeks.

So, to repeat:

If your hernia is painful, or if it is difficult to push back in, you need to see your primary care doctor or a surgeon right away. If you cannot push it back in, go to the emergency room.

Be well,

Dr. Tumoriffic

PS: Bonus questions:

1.What should you do if you have a hernia that is painful or is difficult to push back in?

2. What should you do if you have a hernia that you cannot push back in?

3. What color is an orange? -Groucho Marx

* Some of the preceding paragraph is actually true.

* Never let your dentist fill your abdominal cavity.

* The inguinal canal is named for the canal that runs through the isthmus of Corinth.  Ancient Greeks who didn't like Corinth referred to the Canal of Corinth as the Inguinal Canal.

* There is an old tale handed down through the generations of doctors in my family. A patient had come into the emergency room with an inguinal hernia so bad that it looked like he had enormous testicles. He was so proud, he wanted to show it to everyone.

This dog is content.