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Tuesday, May 7, 2013
Q: I went to a sleep lab and was diagnosed with borderline sleep apnea. The doctor said I could get the CPAP machine, but it was up to me. I chose to get it, and I use it every night. Now, when I nap, I wake myself up gasping.
Could the CPAP be making my muscles weaker so I need it more?
A: Obstructive sleep apnea (OSA) is a condition of not sleeping properly at night. The problem in OSA is that the tissue in the back of the throat relaxes during sleep and can close the airway completely. Snoring is very common, since that indicates a partial closure of the airway. Continuous positive airway pressure, CPAP, blows air through a tight mask that fits over and around the nose.
OSA can cause damage to the heart and lungs over the long term, and almost always causes sleepiness during the day. Treatment of OSA can prevent damage and improve quality of life. Being overweight is a major risk factor for OSA, but not everybody with OSA is overweight.
I don’t think CPAP makes OSA worse, since it’s not acting on muscles. I think it’s more likely that either your OSA is worse than it was, or you are now able to pay more attention, having been on treatment.
Q: At age 15, my son had surgery to remove his left testicle due to a cyst that was growing. The cyst was not cancerous. He is now 31 and has no energy, is depressed, has no resolve to complete tasks and considers himself a “freak” due to the surgery results and negative reactions from women he dates due to his disfiguration.
His doctor diagnosed him as having half of the normal testosterone level for a man his age. If he had the other testicle, would that increase his testosterone to normal?
A: Removal of a testis (the male gonad, which makes sperm, two of which reside in the testicles) can have both physical and psychological effects on men. Most often, the aesthetic consequences are not obvious, but nonetheless still may have significant effects on self-image. The physical effects of loss of a single testis usually are not great. Fertility and sexual function are preserved. The other testis generally compensates, making normal or nearly normal amounts of sperm and testosterone in the same way that, if a woman loses an ovary, the remaining ovary does the work of both.
However, your son has lower-than-expected testosterone levels. Because the range of normal is so large (350 to 1,200 in my lab), making the diagnosis of low testosterone needs to be done carefully, keeping in mind his age, as you mentioned. I agree that the symptoms your son has could be low testosterone; however, the symptoms could be depression, and it’s entirely possible he has both. It’s worth discussing testosterone replacement, which can be done through the skin or by injection.
A saline prosthetic is inserted into the scrotum, usually through an incision in the groin. Testicular prostheses have been proven to improve feelings of satisfaction, self-esteem, physical attractiveness and positive feelings during sexual activity. These need to be balanced against the risks of infection, contraction and extrusion of the prosthetic (about 10 percent have at least one complication).
Dr. Keith Roach’s column runs in Tuesday’s Extra.
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