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St. Mary Parish officials, educators and health-care workers gathered Friday in Morgan City and heard that Gov. John Bel Edwards is expected to make a major midday announcement about the state's coronavirus responses.

State officials on a conference call said school closures and event cancellations have been under consideration.

The local officials met at the Emergency Operations Center to hear from state homeland security and public health officials.

"This is happening so fast that it's hard to tell what the governor will do in an hour," St. Mary Homeland Security Director David Naquin said during the meeting, which started at 10 a.m.

"This is doable," said Dr. Jimmy Guidry, the state health officer. "We just have to be smart about it."

The local officials heard that test priorities have been changed because the current threat is more from community spread than from exposure to travelers who have been in affected areas.

Personal protective equipment for health care workers is in short supply, but officials said suitable gear currently used in mining, woodworking and other trades is now being directed toward health care.

Other developments:

--Louisiana Secretary of State Kyle Ardoin announced that Louisiana's presidential preference primary, scheduled for April 4, has been postponed for at least two months.

--St. Mary Sheriff Blaise Smith said all visiting at the Law Enforcement Center in Centerville is suspended, a decision that will be reviewed every 30 days.

"We are working with our phone and tablet providers to expand access to telephone services to ensure you have continued connection to family and friends during this time," Smith said.

--LSU is asking that on-campus events and LSU-sponsored off-campus events of 30 attendees be be canceled through May 30.

A decision about commencement will be made at a later date.

--Cleco is temporarily suspending service disconnects and late fees on customer accounts effective Friday until further notice.

“The well-being of our customers, contractors, employees and the general public is our primary concern as the coronavirus has now reached Louisiana and was recently declared a global pandemic by the World Health Organization,” said Ron Smith, director of customer experience. “We don’t want our customers to have to worry about losing electricity and incurring late fees given the importance of electric power in preventing the spread of the virus.”

Cleco offers multiple payment options that don’t require customers to physically go inside a Cleco customer service office or visit an authorized pay agent, including paying bills online, by phone, by mail or dropping payments in the night deposit box located at each customer service office.

Hey, middle-aged men. You know who you are. Is your prostate the size of a baked yam? Do you dribble like the Harlem Globetrotters? Have you gotten a rent bill for spending so long at a urinal?
If so, you’d better read this. Dr. David Kaufman, a Manhattan urologist and specialist in a new procedure called Rezum, has agreed to let us know about a minimally invasive procedure that can help.
JB: Benign prostatic hyperplasia is a common problem in men as they age. Can you give us a rough idea of its incidence at ages 50, 60 and 70?
DK: After the age of 30, pretty much all men have pathological evidence of benign hypertrophy of prostate cells which increases in volume as men age further; however, more importantly just because there are cells exhibiting benign hypertrophic growth, doesn’t mean men are symptomatic with lower urinary tract symptoms. In general, as the prostate enlarges, there tend to be more urinary symptoms.
JB: How often is BPH accompanied by difficulty in urination at these ages?
DK: Very often. About 50% of men between 60-70 experience urinary symptoms, and 90% of men over 70. Of course, I see plenty of men in their 40s and 50s with lower urinary symptoms caused by BPH. It’s a quality of life decision which determines whether a man elects to treat or not — I typically try to convince the patient to try medication for a few weeks and then decide whether the treatment is worth it.”
JB: If difficulty in urination persists over time what kinds of problems can result?
DK: There are a number of problems, all bad.
Progressive bothersome lower urinary symptoms … frequency, urgency, hesitancy, sense of incomplete bladder emptying, and need for multiple voids to empty.
Increasing risk of UTIs, due to incomplete bladder emptying and inability to wash out bacteria that enter via urethral meatus, mostly as a result of sexual contact.
Risk of permanent bladder decompensation (the bladder no longer contracts). The longer a bladder is stretched beyond its normal capacity due to incomplete bladder emptying and large chronic post-void residual urine, the more likely that bladder will be damaged so that it loses its contractile functions. This is a major issue for which there no good treatment. These patients are relegated to self-catheterization to empty their bladder 3-4 times per day.
Renal failure — long term bladder decompensation results in high pressures in the bladder which eventually extend up the ureters to the kidneys, blowing out the kidneys and causing permanent renal damage necessitating dialysis and transplant. This was more common in the past, due to inaccessible medical care and lack of understanding of the pathophysiology of “post-renal failure”
JB: What drugs can help? How effective are they and what kind of side effects can be expected?
DK: There are three classes of drugs in this category:
Alpha blockers (Flomax/tamsulosin, Uroxatral/alfuzosin, etc.) were originally used to treat high blood pressure. It was observed that the original bp drugs in this class (prazosin, Hytrin, Cardura) also facilitated voiding in treated patients. I was one of the clinical investigators in the original Hytrin study — in the late 1980’s — that established this benefit. This was because similar alpha receptors were found in the prostate gland as in blood vessels. Eventually, we discovered that a subtype of alpha receptors were more specific to the prostate, and effected bp less (fewer side effects of light-headedness) leading to the development of prostate-specific alpha-blockers, which are all still first-line drugs for BPH. They result in clinical improvements within days of starting therapy due to relaxation of smooth muscle within the prostate, allowing for a “relaxation” resulting in a wider opening of the prostatic urethra.
The 5-Alpha reductase inhibitors (Proscar, Avodart) block part of the metabolism of testosterone to its metabolite, dihydrotestosterone. There are receptors for dihydrotestosterone on the prostate and in hair follicles. These cause prostate growth and loss of hair, respectively. I was also an investigator in the original Merck Proscar study that helped establish clinical improvement (and also had one of the original patients who unexpectedly observed hair grow). These drugs generally take 2-3 months to improve symptoms and result in approximately 25% decrease in prostate size.
Phosphodiesterase inhibitors (PDE5) — (Cialis, others)— I don’t know if anyone understands exactly how these drugs improve voiding. Perhaps men are so happy with their erections that they don’t care anymore about their urinary issues.
JB: There are countless claims from the dietary supplement industry pushing herbs, etc., that “support prostate health.” Any advice here?
DK: As far as I am concerned, they are all BS, for example, saw palmetto. When this stuff was tested in a placebo-controlled study it showed no measurable advantage over placebo. Remember, the placebo effect is about 25% improvement.
JB: If patients don’t respond well to medication or have unacceptable side effects what are the options, for example, surgery?
DK: There are a number of options:
Thermotherapies (use of heat): Microwave, Transurethral needle ablation, Rezum using heat to destroy prostate tissue resulting in gradual (over 2-3 months) sloughing of prostate tissue and opening of the prostate channel.
JB: Well, those sound absolutely delightful! Is there anything else?
DK: Yes, Urolift uses staples placed transurethrally to compress prostate tissue opening the urethral channel. All of the procedures I’ve mentioned so far are office-based and generally done under local anesthesia.
JB: I’m guessing you have some more lovely-sounding options, right?
DK: I sure do.
There are ablative procedures using various energy sources (monopolar electricity, bipolar electricity, various laser energies, water pressure) to remove or vaporize obstructing prostate tissue
The gold standard for 100 years is called TURP (transurethral resection of the prostate). This method uses electricity to cut prostate tissue which is pushed into the bladder and then washed out at the completion of the procedure.
Open prostatectomy is a major surgical procedure and is rarely done now; it is reserved for the largest of prostates. This operation can be done robotically, although it requires a significant skill set to do this.
JB: TURP doesn’t sound like a whole lot of fun. How often does it work? What’s it like for patients?
DK: These days, TURP or “laser TURPs” are fairly well tolerated but they do require general or spinal anesthesia and are performed in a hospital. They are typically done as outpatient surgery where the patient goes home on the same day, usually with an indwelling catheter. They are so routine now, that there are rarely any significant complications or side effects other than “retrograde ejaculation” where a lower volume (or no) ejaculate comes out during orgasm.
JB: You now use a relatively new, minimally invasive procedure called Rezum where steam is used to remove portions of enlarge prostates. It sounds downright terrifying. How does this work?
DK: It’s about as terrifying as sitting on a bench in a steam room. Rezum is a simple outpatient procedure that takes only several minutes in the doctor’s office, with only moderate discomfort that is well managed with local anesthesia. The procedure involves the injection of water vapor (steam) into several areas of the enlarged portion of the prostate gland (usually three to five nine-second injections) under camera guidance through the urethra. There are no reports of erection or ejaculation issues from the thousands of procedures done in this county. The only downside, common to all thermal therapies, is that the full benefit requires at least 3-4 months of healing.
JB: Is there a risk of permanent complications from the procedure?
DK: There have been none yet reported.
JB: Can you compare Rezum to TURP in terms of ease of the procedure, efficacy, patient recovery time, and potential risk?
DK: Rezum is done in the urologist’s office, under local anesthesia and takes about 3 minutes; you are in and out in about an hour. Four-year data show comparable benefits to TURP, though full benefit takes a few months vs. a few weeks with TURP. There is certainly less anesthetic risk with Rezum — less bleeding risk and no risk of erectile, ejaculatory and urinary control issues (although rare in TURP) with Rezum.
JB: Anything out there we men can “look forward to”?
DK: Yes, there are studies going on involving a second generation of balloon dilation of the prostate gland which shows some promise
—David Kaufman, MD is a board-certified urologist treating patients throughout New York City at Maiden Lane Medical in Midtown East. He completed his medical degree at the State University of New York at Stony Brook Schools of Medicine. He went on to serve his general surgery internship at the Mount Sinai Hospital and his urology residency at Columbia Presbyterian Medical Center. Kaufman is board certified by the American Board of Urology and is a member of the American Urology Association. In addition to treating patients at Maiden Lane Medical, Kaufman is also an assistant professor of Clinical Urology at the Weill Cornell Medical School. He often speaks on breakthroughs in urology including diagnostic techniques at medical conferences and seminars across the country.

St. Mary Parish Sheriff Blaise Smith Announces the Coronavirus (Covid-19) Plan for the St. Mary Parish Law Enforcement Center
Following the directive set forth from Secretary James M. Leblanc of the Louisiana Department of Public Safety & Corrections, Sheriff Blaise Smith is announcing that the St. Mary Parish Law Enforcement Center will be adhering to the plan that will be put into place starting today, March 13, 2020, in all state prisons.

To ensure we are protecting staff and our prison population at the L.E.C., we are adopting the following measures:

1. Effective immediately, all visiting is suspended at the L.E.C. We will review the decision on visitation restriction every 30 days until the threat subsides.

2. We are working with our phone and tablet providers to expand access to telephone services to ensure you have continued connection to family and friends during this time.

3. Effectively Friday, March 13, 2020, we are discontinuing off-site non-emergent (non-life threatening) trips.

Please understand that none of these decisions have been made lightly or in haste. Similar to nursing homes, our operations are extremely vulnerable to contagious illnesses and we are taking steps to keep our staff and prisoner population protected.