Medical diagnosis required to determine gynecomastia

Q. My wife thinks I have gynecomastia. I may; I do have “man boobs,” but it could be from being overweight.

If I do have gynecomastia, I guess it could be from some of the medications I take and/or the weight. I realize the only way to be positive is a doctor’s exam. I have one scheduled in about two months. Is there anything I can do to test myself and get an idea if I might or might not have gynecomastia?

A. Gynecomastia is the medical term for enlarged male breasts. Some adolescents develop this condition temporarily, but they usually outgrow it within a few years.

Weight can be a contributing factor. So can many medications. Some examples include cimetidine (Tagamet), eszopiclone (Lunesta), leuprolide (Lupron), spironolactone (Aldactone) and finasteride (Proscar).

This condition requires medical diagnosis. Although there is no test you can do yourself for gynecomastia, your doctor will check your hormone levels and rule out various tumors. If a medication is responsible, it might be possible for your doctor to prescribe an alternative less likely to trigger breast enlargement.

Q. No one knows I have this problem. I have been using the laxative bisacodyl every day for 20 years and have steadily increased the dosage.

I’ve stopped taking it for a few days at a time. Not surprisingly, nothing moves.

Are there any studies on this? Might I have done permanent damage to myself? Is it better to cut back slowly or stop altogether and just see what happens?

I know it’s not healthy for waste to back up in my body, so I’m worried about stopping AND I’m worried about continuing.

A. You clearly have developed a laxative habit. Bisacodyl is considered a “stimulant” laxative, which means it triggers intestinal contractions. This can lead to loss of crucial minerals such as magnesium and potassium. Cramping and diarrhea are other possible side effects, along with a “lazy” colon that will not function properly without laxatives.

A gradual phase-off under medical supervision may allow your body to re-establish a more natural rhythm. We are sending you our Guides to Constipation and Digestive Disorders for information on nondrug approaches such as dynamite pumpkin muffins and “Special Constipation Remedy” with bran, applesauce and prune juice.

Q. I am alarmed by recent reports that Vytorin and Zetia are associated with plaque buildup in the carotid artery. My doctor tells me that until more is known, I should continue taking the prescribed medicine. Do you agree? Is it harmful to switch abruptly to another cholesterol-lowering medicine such as simvastatin?

A. In the wake of the ENHANCE study that produced such disappointing results with Vytorin, the American College of Cardiology convened an expert panel to advise their colleagues. These thought leaders suggest that doctors should stick with statin-type cholesterol-lowering drugs, which have a proven track record.

Until there is more convincing data about Vytorin or Zetia, the cardiologists recommend using them only as a last resort. There should be no danger switching to simvastatin since it has been shown to be effective.

X In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of The Vindicator or e-mail them via their Web site: www.PeoplesPharmacy.com.

2008 King Features Syndicate Inc.