unicorn

Live together in a loving relationship and support each other, but not married.

I'm 60 and my domestic partner is 29. We introduce each other as domestic partners. I'm not sure it's wise to visit Russia these days, but if you were to do so, I'd be more careful and say he's your nephew.

Yes, that's correct. If it's been a week since you tested positive, you're no longer contagious (in fact, you're no longer in danger of becoming contagious, so in an extra-safe group).

I got it.... I clicked on my Avatar, then saw the symbol in the upper left. Thanks!

Well, when I try to click on profile, there doesn't seem to be anything clickable. It just says that my profile is 100% complete....

I've looked at my profile for a way to change my avatar, but haven't been able to figure it out. How does one change one's avatar here?

The crazy Chinese policy has caused havoc not only for China's economy, but for most of the planet. Supply chain problems have lowered supply, thereby increasing prices in most countries, leading to inflation.

I would strongly caution you, for your own sake, to be wary of any seminar or "check-up" offered by someone with a financial incentive to find trouble. Of the tests you mentioned, none is generally recommended by unbiased professional recommendation groups, especially the USPSTF, other than that there's a "C" recommendation for PSA screening in men from 55 to 69 ONLY. The "C" recommendation means there's little evidence for benefit, or benefits and risks are pretty balanced, but might be reasonable per patient preference after a thorough discussion of risks and benefits. Although it seems counter-intuitive that more information can lead to worse outcomes, this fact often appears to be the case in medicine.

Yikes! You should strongly consider getting a new GP. First of all, there's NO evidence gay men have higher PSA levels, whether they bottom or not. In fact, studies have shown that ejaculating more frequently seems to LOWER the risk of developing prostate cancer (which makes sense, intuitively, because you're clearing out your prostate more frequently): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040619/ "...These findings provide additional evidence of a beneficial role of more frequent ejaculation throughout adult life in the etiology of PCa...". Also, if a person, knowing the risks and modest benefits of prostate cancer screening, still wishes to undergo this screening, a blood PSA level is the only way to do it. This screening cannot be done with any urine test.

I can tell you 100%, that the strong implication of the article (which, again, has no scientific references) that active surveillance is almost never a good idea is absolute NOT what I got out of it, but that's because I have more information. However, any lay person reading that article would probably conclude (incorrectly) that active surveillance is usually a lousy alternative. For example, it states "If you have other health problems that limit your life expectancy, active surveillance for prostate cancer may also be a reasonable approach....". Well, any national guideline will tell you that if a man has health problems that limit his life expectancy, PSA screening is entirely inappropriate in the first place. The USPSTF gives it a "D" recommendation which means "Don't do it because there is strong evidence that it's harmful." Another obvious way that article is misleading (very obvious, in fact) is that it list "Risks" of active surveillance, but not the "Benefits"! Any competent physician should be able to explain the risks and benefits of alternative treatment options, and not just sway the patient with one-sided information. In fact, it's the law (at least in the US)--that's why it's called INFORMED consent, not just "consent." Mind-blowing to me, it actually lists as one of the "risks" of active surveillance as "Frequent medical appointments. If you choose active surveillance, you must be willing to meet with your health care provider every few months." As if other treatment options don't involve lots of other medical appointments?? WTF?? Warning patients about having to meet with his health care provider 3 times a year (and get a blood draw), but not mention the many risks of surgery or radiation? Yes, obviously these decisions are personal. However, decisions with such major potential consequences should be made with all of the facts well laid-out, in a manner most patients can understand. In making such important decisions, patients deserve information given in a factual and unbiased manner, not in a clearly one-sided and leading article. The fact that the Mayo clinic is well-rated doesn't mean they can't put out articles which fail to accurately describe risks and benefits (clearly the case for this article). These articles don't factor into the ratings of hospitals/medical centers.

It's interesting to read that article (which doesn't have references). Although it's not apparent to those who are unsophisticated in these matters, it quietly discourages active surveillance. For example, it states "Active surveillance may be best suited if you have a low Gleason score (usually 6 or lower), which indicates a less aggressive, slower growing form of cancer." That statement implies that a Gleason score of under 6 is possible, which it is not. Urologists may dishonestly imply that the Gleason score is a range of 1 to 10. However, the lowest possible score is, in fact, 6, and a score of 7 is actually fairly favorable: https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/gleason-score-isup-grade/ "...Theoretically, Gleason scores range from 2-10. However, since Dr. Gleason’s original classification, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer...". While it is true that a score of 6 means the cancer is highly unlikely to metastasize, the Mayo Clinic article implies that a score of 7 is dangerous and not suitable for active surveillance. That's simply not true.

Just to bring in some science into the discussion, most of the prostate cancers detected by screening (as opposed to those which appear due to symptoms) will never affect the life of the person who has that cancer. Screening asymptomatic men for prostate cancer has NO effect on overall mortality. There is a minimal improvement in prostate cancer mortality, but this is balanced by increased deaths caused by unnecessary treatment. This is probably true because once diagnosed, few men choose the wisest course, which, in many cases, is watchful waiting. The immediate response usually comes as "Aaack! Get it out!", often spurned by financial interests of the urologist or radiation oncologist. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#bootstrap-panel--5 "Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population."

Again, please get your information from public health professionals and professional advisory guidelines, not from forum posts. If you're using colonoscopy as the screening tool for colon cancer, the evidence shows screening should be every 10 years, not 5. Colon cancer screening is the most effective cancer screening there is, precisely because there is a very long period from polyp to pre-cancerous polyp to cancer to invasive cancer, which is why 10 years is the official recommendation. While it may feel you're being "more clever" by doing it every 5 years, colonoscopy has a pretty high rate of serious complications (about 1 in 1000 result in perforation), which is why 10 years works out best. "Intuition" is not what one needs to make these decisions. Guidelines come from statistics and hard facts: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening Direct visualization tests Colonoscopy Every 10 y Evidence from cohort studies that colonoscopy reduces colorectal cancer mortality Harms from colonoscopy include bleeding and perforation, which both increase with age Screening and diagnostic follow-up of positive results can be performed during the same examination Requires less frequent screening Requires bowel preparation, anesthesia or sedation, and transportation to and from the screening examination And, again, with prostate cancer screening, the facts are known and well-summarized for anyone who cares to look into the details of the previously-provided link. While it may intuitively feel as if knowing if you have prostate cancer is useful information, it's a statistical fact that this knowledge does NOT increase lifespan. The vast majority of prostate cancers discovered by prostate cancer screening will never affect the life of the person with said cancer. Discovery of these cancers is more likely to harm the patient than help the patient. This is absolutely a matter of fact, and not a matter of opinion. Now, if you see the statement "PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened" and you feel it's better to take the chance on being one of those 1.3 per 1000, rather than in the overwhelming majority who will be harmed (and even have his lifespan shortened) due to the screening, now that is a matter of personal values and opinion. But it's best to make such decisions fully informed, and with one's eyes wide open, because the consequences are serious.

Of course, it's rude to go to another country and criticize the hosting country. However, I've seen countless people on this and other boards criticize US policies, which I don't have a problem with (for example, I've seen a lot of Canadians criticize US policies regarding the virus, or gun laws, or what have you). As a very well-traveled person, I also see Canadians, definitely more than any other citizens of any other country on the planet, wear their flags on their clothing or accessories without the flag of the country they're visiting, which I find quite rude. I have sometimes worn my flag along with the hosting country's flag in tandem as a pin, in a show of friendship, but never my own only. I realize that in many cases, Canadians are only brandishing their flag to portray the message "I'm not American." In my opinion, that's doubly rude, as a direct insult to both the hosting country and to the US. Although I'm personally grateful I'm American and not Canadian, I would never think of traveling outside the US brandishing an American flag without that flag being joined by the hosting country.

I'm happy for you, but as a recently-retired physician, I can tell you that a major chunk of my practice, especially during Fall/Winter, was evaluating just such people. It's extremely common, I'd guess more than 4.5% of those who get colds. If the patient had symptoms suggestive of a sinus infection, I'd usually just treat for a sinus infection for another 10 days, but symptoms would often persist, and further evaluations such as a chest X-ray, sinus CT's, tests for tuberculosis, etc., were usually negative. I'd then prescribe inhaled steroids (asthma meds), and in most cases symptoms would go away by 6 weeks. The percentage of coughs which lingered beyond 4 weeks was far more common, of course, in asthmatics and/or smokers, but could be seen even in non-smokers and non-asthmatics. The study cited above didn't exclude asthmatics or smokers, so the 4.5% figure is not at all surprising.

Well, at least this study did include some omicron cases, although it looks as though they define long Covid as 28 days, although the WHO defines it as 3 months of symptoms. Even with that 28-day definition, "...Among omicron cases, 2501 (4·5%) of 56 003 people experienced long COVID and, among delta cases, 4469 (10·8%) of 41 361 people experienced long COVID. Omicron cases were less likely to experience long COVID for all vaccine timings, with an odds ratio ranging from 0·24 (0·20–0·32) to 0·50 (0·43–0·59). These results were also confirmed when the analysis was stratified by age group...". So from your originally quoted 20%, we go to 10.8% in November 2021 to 4.5% in March of 2022. Do you see a trend? And I personally have had lots of colds in which my symptoms lasted over 28 days (though none 3 months). WHO definition of long-Covid: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.

Well, if anyone would bother to actually read the study referenced in that New York Times article... The NYT article was published in May, but the study was quite upfront in using pre-omicron data: "...A retrospective matched cohort design was used to analyze EHRs during March 2020–November 2021, from Cerner Real-World Data,* a national, deidentified data set of approximately 63.4 million unique adult records from 110 data contributors in the 50 states..." . https://www.cdc.gov/mmwr/volumes/71/wr/mm7121e1.htm?s_cid=mm7121e1_e&ACSTrackingID=USCDC_921-DM82414&ACSTrackingLabel=MMWR Early Release - Vol. 71%2C May 24%2C 2022&deliveryName=USCDC_921-DM82414#contribAff In other words, the data stopped well before the appearance of the current omicron strain. There is no data to refute my contention that long-Covid has not been a problem associated with the virus we're dealing with now. Yes, it was a major problem. It doesn't seem to be any longer. Almost all Americans have probably been exposed to the virus (probably almost everyone in the world). Fortunately 1 in 5 of us haven't had long Covid. Obviously, people are being hospitalized and dying--but not from this virus. The percentage of people testing positive for the virus in hospitals is usually about the same as that in the general public. Obviously, contracting the virus will not make a person immortal. People will still die. The virus, however, generally has nothing to do with the deaths.

Well, we were told that completing the ArriveCAN app was required. Once we were approved, we received a QR code, which we were told we'd need. However, there were no checks whatsoever on arrival (or on board). We even had to get tested the day before departure in Reykjavik, but that was a waste because it was never checked. There was only one test center in just about the whole country of Iceland, since almost all countries have dropped pre-testing requirements, with the exception being cruise ships going to Canada. More than likely, the only reason that singular requirement is still around is that Canadian authorities banged their fists on the table in May, pronouncing that under no circumstances would they revisit the policy before the Fall. The thought that the additional time on the cruise ship makes a difference also doesn't make a whole lot of logical sense. Should one be more concerned about 2000 cruise ship passengers which go to one or two ports and stay for a few hours? Or more thousands of people coming in by plane, train, car, or ferry, and staying for 10 days and going all over Canada? Or the 2% of the Canadian population that's probably already walking around with the virus? As our cruise demonstrated, one could test negative on stepping foot in the country, but be in the incubation period, and be highly contagious 2 days later.

A sore throat has not been described as a symptom of long Covid: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html I would look for an alternative diagnosis, seeing an ENT doctor if necessary.

There's a designated gay-friendly bar (about 50% gay). We've socialized with mostly gay couples, but to a lesser extent with straight couples. This virus isn't spread with fomites/shaking hands, as proven by a study which came out almost exactly 2 years ago. If you don't shake hands, do so for viruses other than Covid (Norovirus almost certainly can be spread this way, possibly rhinoviruses as well--though that hasn't been studied). As I'm sure you're aware, there's a huge number of illnesses one can get from sucking dick and eating as... 😉

That's actually the most intelligent counter-argument I've heard. I guess if people are still getting "long Covid" with the current strain, that would be the one way in which the current strain is worse than any other colds we've had to deal with all of our lives (and will also never eradicate, at least not in our lifetimes). That being said, I haven't heard of anyone getting long Covid (over 3 months) with the latest strain (since January 2022 in the US). I've had a lot of colds which have kept me with a cough for weeks (I have asthma), but I haven't heard of people getting long Covid over the last several months.

My domestic partner "Chris" and I have been on a cruise ship trip from Iceland to Boston for the last 2 weeks. We're amazed to see that many people, though not a majority, seem unwilling to adapt their views and behavior as new data and statistics become available. The week before we left, we heard the pubic health statistics from our chief medical officer for Los Angeles County on the radio. In our county of over 10 million people, there were 1100 (0.01% of the population) in the hospital who tested positive for the virus (despite an overall prevalence of 2% of people who were testing due to being in jobs which required routine testing). Of those testing positive, the vast majority had NO symptoms compatible with the virus, and were clearly there for other reasons (heart attack, stroke, kidney infection, broken hip, etc.). Of the fewer than 500 there with the virus and compatible symptoms, only a handful were in the ICU, ALL of them with serious underlying illness predating the virus. No reported deaths attributed to the virus. In other words, it's LESS serious than a common cold at this point. Yet we were warned that the Canadian government had decided in May that all cruise ship passengers had to be both vaccinated and tested within 48 hours prior to boarding, while we were still touring Iceland. Since I'm a physician, I prescribed Paxlovid for both of us, which we took for 4 days in my case and 3 days in his case prior to boarding, just so we wouldn't get infected just prior to boarding (analogous to PrEP before sex to avoid getting HIV). The Canadian government had made that decision in May and had vowed, at that time, that no way no how would they re-visit their policy prior to the Fall, no matter what! Strangely, that rule applied only to cruise ship passengers, but not to planes, trains, automobiles, or multiple ferries that ply the waters between the countries (for example, Bar Harbor ME to Yarmouth NL, Seattle WA or Port Angeles WA to Victoria BC, or across Lake Erie). I would imagine that most of the guests (our line markets to older people, so I'm suspecting the average age was around 65-70, though "Chris" and I are younger) apparently weren't worried about the virus much, as most didn't wear masks. One of the (gay) couples we met, however, wore KN-95 masks scrupulously, taking them off only when actively eating or drinking. Two days ago, I met one of the couple, and sure enough, one of them had a mild cough and tested positive (the other repeatedly tested negative). We had 3 days of Paxlovid left from our "PrEP," so I offered it for the positive symptomatic one, since he's 68. Sure enough, although studies have shown a 90% reduction in symptoms, he refused to take the Paxlovid (we gave it to his husband, who said his sick partner "couldn't explain" why he wouldn't take the pills), but his symptoms have already turned the corner without even taking the Paxlovid. (6 weeks ago, my 91 year-old step-mother also declined taking Paxlovid and got better quickly when she got her cough as well) Also, as it turns out, Canada didn't enforce their law, and no one's vaccination status or test results prior to boarding were checked. I'm guessing that in the coming weeks, they'll update their laws to reflect their current practice. I will say that as new facts have emerged, I've changed my behavior and views immensely, but it looks as though a number of people haven't. I'd be curious to hear the perspective of anyone on the board who still wears masks, for instance. Why have a heightened worry about a virus which seems extremely mild? What, if anything, would convince those who are still masking to stop? Do they imagine that the virus will eventually be completely eradicated? (It won't, BTW) Would the virus have to be even less virulent? At this time, it seems the only harm from the virus is potential over-reaction of others to positive test results, so wrecked travel plans are the only potential consequence of infection...

This is a very complex subject. First of all, there are countless (well, quite a few) conditions which cause an increase in urination, only some which involve the prostate at all. If the prostate is involved in increased urinary frequency, it's because the prostate is preventing you from emptying your bladder completely. The other symptoms which will go along with that are what are called "obstructive symptoms": straining while urinating, a less forceful urinary stream, a sense you aren't completely emptying your bladder, and dribbling after you finish, for example. Other symptoms might point to alternative diagnoses. Irritation and urgency would be more suggestive of infection, for example, and increased thirst and/or volume of urine would be more suggestive of diabetes (of which there are different types, including non-sugar related types). Blood in the urine would suggest either bladder infection or bladder cancer as a cause. Even within the prostate, there are different prostate-related causes, with non-cancerous growth and prostate infection being more common than the (still common) prostate cancer. Getting a PSA level checked is certainly a good idea for men over 45 or so with urinary symptoms, especially if the symptoms are obstructive. That being said, this does NOT mean it's a good idea for men without symptoms to get PSA levels checked on some sort of routine level. I would urge board members reading this to get their health advice from public health officials whose job it is to evaluate all of the scientific facts, instead of relying on emotional stories or discussions. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening Benefits of Early Detection and Treatment The goal of screening for prostate cancer is to identify high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer. Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to assess whether there are benefits to starting screening in these high-risk groups before age 55 years. Adequate evidence from RCTs is consistent with no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older. Harms of Early Detection and Treatment The harms of screening for prostate cancer include harms from the PSA screening test and subsequent harms from diagnosis and treatment. Potential harms of screening include frequent false-positive results and psychological harms. One major trial in men screened every 2 to 4 years concluded that, over 10 years, more than 15% of men experienced at least 1 false-positive test result.5 Harms of diagnostic procedures include complications of prostate biopsy, such as pain, hematospermia (blood in semen or ejaculate), and infection. Approximately 1% of prostate biopsies result in complications requiring hospitalization. The false-positive and complication rates from biopsy are higher in older men.3 Adequate evidence suggests that the harms of screening and diagnostic procedures are at least small. PSA-based screening for prostate cancer leads to the diagnosis of prostate cancer in some men whose cancer would never have become symptomatic during their lifetime. Treatment of these men results in harms and provides them with no benefit. This is known as overdiagnosis, and follow-up of large randomized trials suggests that 20% to 50% of men diagnosed with prostate cancer through screening may be overdiagnosed.3 Overdiagnosis rates would be expected to increase with age and to be highest in men 70 years and older because older men have high risk of death from competing causes. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bothersome bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence requiring use of pads, and 2 in 3 men will experience long-term erectile dysfunction. More than half of men who receive radiation therapy experience long-term sexual erectile dysfunction and up to 1 in 6 men experience long-term bothersome bowel symptoms, including bowel urgency and fecal incontinence.3 Adequate evidence suggests that the harms of overdiagnosis and treatment are at least moderate. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, harms from diagnostic biopsy, and harms from treatment. Before consenting to screening (which is different from testing when there are symptoms), it's important to be aware of both the potential benefits of screening (which, if you read the USPSTF, are quite minimal), as well as the potential harms--which are numerous and much more likely. So, yes, the original poster should probably get a PSA done due to his symptoms (especially if they're obstructive), and I hope he keeps us updated. However, the takeaway message should NOT be that all men over 50 should rush in and get this testing. There are some pretty significant harms that can come from screening, especially since the vast majority of prostate cancers never affect the life of the man who has it. There is a massive amount of science which has looked into this question, and professionals have spent large amounts of time actually reviewing the data.