Valley urologist suggests steps to better health

Dr. J. Nevin Smith suggests steps to take maintain urinary health.
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At the start of a new year, we often decide to pay more attention to our health. With that in mind, the Sun contacted Dr. J. Nevin Smith, a urologist who graduated from Stanford Medical School, completed his urology training at UCSF and has practiced in Sonoma since 1967. He raised two daughters and a son here and was a member of the Sonoma Valley Hospital board for 12 years. And like many other Valley residents, Smith makes red wine from his own grapes.
To be clear, urology is the specialty that treats the urinary systems of both women and men, as well as men’s reproductive systems.
Men, Smith notes, are concerned about prostate cancer. He said the best prevention is to eat a heart-healthy diet, also called the Mediterranean diet. That means reducing animal protein and processed foods (like white rice) in your diet and eating more vegetables and whole grains. He says we should eat like the Chinese, who traditionally use meat as an accent for vegetable dishes, instead of making meat the primary ingredient.
Being overweight is another risk. “If your primary care doctor tells you to lose weight, you should do it,” Smith said. He recommends several hours of exercise a week, preferably low-impact aerobics like walking, biking and swimming. And because men’s testosterone levels start dropping in their 20s, Smith suggests including some weight-bearing exercise, which raises testosterone and contributes to a feeling of well-being.
After age 50, men should have annual prostate screenings, which consist of a blood test for the prostate-specific antigen (PSA), a possible indicator of cancer, and a physical exam. A high PSA score requires further investigation, but doesn’t automatically mean cancer is present, Smith explained. One factor doctors consider is whether the score got high quickly, or over a longer period.
Most men over 90 will have prostate cancer, Smith noted, but it will be slow-moving and doctors will treat it conservatively, with “watchful waiting.” For younger men, the choice is between surgery to remove the prostate and radiation therapy.
A new outpatient procedure in which radioactive seeds are implanted in the prostate is effective, with fewer side effects, Smith said. Dr. Stephen Doggett, a radiotherapist in Tustin, travels to Sonoma Valley Hospital once a month to treat patients.
Testicular cancer is another concern for men, from about age 16 until they reach their mid-40s. Smith recommends that men perform periodic self-exams, looking for lumps or swelling. Most cases are treatable; Tour de France winner Lance Armstrong is a well-known example of success.
For women, Smith recommends Kegel exercises, especially after childbirth, to tone pelvic muscles, which can reduce bladder control problems that at least one third of women experience after menopause. Being overweight adds to the problem. There are also surgical and drug therapies.
Increasing fluid intake can help women reduce bladder infections by washing out bacteria. In general, Smith said, “drink what your body tells you, when you feel thirsty.” He doesn’t recommend cranberry juice to prevent infections. It can work, he explained, if consumed 24 hours a day to keep urine properly acidic at all times. But this is impractical and means you’ll be consuming a large amount of sugar in the juice. Cranberry capsules are a better substitute, but also must be taken around the clock to maintain a constant high acid level.