David Vigder
Chronic cough is a common presenting symptom. It can be caused by many different conditions ranging from relatively benign post nasal drip from chronic sinusitis to a danger of lung cancer. It is critical that he gets a thorough evaluation starting in a primary care clinic. There, he will be directed to get certain tests if indicated. And, if there are any alarming findings, he might be sent to a specialist who can look at the upper airway and lungs more closely. It is usually best to start with an appointment with an internist who can start the evaluation. Thank you for your question.

David Vigder
So far, as of this date, no new imaging techniques have been successful in screening for early heart disease in young, healthy asymptomatic individuals. I think we are getting closer to some promising tests like CT scans, MRIs and other noninvasive tests, but the results so far have led to more questions than answers. For now, try to focus on maintaining good blood pressure (120/80), low cholesterol (below 200), ideal body weight, and yearly check-ups with your primary care provider.

David Vigder
Testosterone does go down with age and there is no way to stop this. However, there are ways to modify your lifestyle to combat the changes that come with decreased testosterone. Make sure you are exercising regularly with cardiovascular and weight training to combat loss of strength, energy and bone mass. If your testosterone is very low, treatment with testosterone replacement is an option but this requires a heart to heart discussion with your internist to discuss the pros and cons.

David Vigder
IBS can be quite disruptive or just mildly annoying. Most patients can control their symptoms by eating healthy foods in moderate amounts at regular intervals. Some patients will notice that certain foods trigger their symptoms and they will need to avoid these foods whenever possible. Another trigger of IBS symptoms is stress. Stress avoidance, meditation, good sleep habits and regular downtime for fun and socializing can greatly help. If needed, a gastroenterologist can prescribe medication that can help decrease symptoms in severe cases.

David Vigder
Varicose veins, even large ones, are generally not harmful and do not need to be treated. The two types of patients who usually get treatment are: A. The patient who has pain most of the time and cannot tolerate it, and B. the patient who doesn't like the appearance of it and would like to have it removed for cosmetic reasons. A simple, nonsurgical treatment of mild to moderate varicose veins is compression stockings. These provide external support to the venous system of the leg and can provide comfort and may even stop the process from getting worse. Compression stockings can be purchased without a prescription at most pharmacies.

David Vigder
An enlarged prostate is really only as bad as the symptoms it causes. There is no reason to avoid alcohol or caffeine unless these make your symptoms worse. If you already have bad symptoms, such as urinary hesitancy or very slow urine stream, it might be best to avoid these substances. If you have no symptoms and just an enlarged prostate, these substances will not cause your prostate to get larger.

David Vigder
High blood pressure is one of the most common causes of heart disease and other problems due to the disruption of the arterial system that feeds all of the vital organs. The short-term and long-term tips are basically the same. Medications work and are mostly well tolerated. A once daily dose can decrease the blood pressure to normal in most patients. But the best short- and long-term solution is lifestyle modification. Many patients have been able to stop or reduce their medication by losing weight, exercising regularly, eating healthy natural foods, and reducing stress.

David Vigder
Yes. This is one of the most common changes in men as we age. It is likely due to a slowly enlarging prostate. Treatment is usually not necessary. Most men over 50 will wake up 1-2 times per night to urinate. If you are getting up 3 or more times per night, you might want to check in with your doctor to see if you qualify for medication that can decrease the size of your prostate and thus decrease the number of times you urinate at night. Other successful techniques at reducing the number times you urinate at night are: 1. reduce your fluid intake around 5 p.m. and do not drink anymore after 7 p.m. 2. Reduce your caffeine intake after Noon. 3. Reduce or eliminate all alcohol intake. If you wake up at night to urinate, and you are able to go back to sleep and generally feel well rested the next day, no action needs to be taken.

David Vigder
I get this question a lot and I wish that I could be supportive of the patient's will to improve the health of a person who is in good health already. Unfortunately, I have not yet found any good evidence in the literature or my practice that supports supplements of any kind. In fact, I worry that my patients taking supplements might be causing more harm than good, or they might just be wasting their money. I try to remind my patients that the best substitute for supplements is healthy, natural foods. Eat plenty of fruits, vegetables, and non-processed meats and bread. You should get all the nutrition you need from the food that is available in almost every grocery store.