Good Health and Good Posture

September 8, 2014

As physicians, we talk or are supposed to counsel patients about exercise and smoking cessation. That’s a given. But do we talk to patients and do we, as physicians, practice good posture? Poor posture can be the source of so many maladies and is one problem that is reasonably easy to fix. Developing good posture is much easier than a diet and a smoking cessation program. This blog will discuss the importance of good posture and how we can improve our own posture and the posture of our patients.

Good Posture…just how important is it? 
Posture ranks right up at the top of the list when you are talking about good health. It is as important as eating right, exercising, getting a good night’s sleep and avoiding potentially harmful substances like alcohol, drugs and tobacco. Good posture is a way of reducing stress and fatigue.

The good news is that most everyone can avoid the problems caused by bad posture…and you can make improvements at any age.

Why Good Posture is Good Health

We’re a health conscious society today and good posture is a part of it. Even for younger people, how you carry yourself when working, relaxing or playing can have big effects. Poor posture can result in lethargy and poor performance at work.

Today, posture-related problems are increasing for two reasons:
1. As we become a society that watches more television than any previous generation, this often leads to poor posture
2. As we become a more electronic society with more and more people working at sedentary desk jobs or sitting in front of computer terminals, we are at risk for improper posture

Suggestions For Good Posture
1. Control your weight. Strive for a BMI <25.
2. Develop a regular program of exercise – regular exercise keeps you flexible and helps strengthen your muscles to support proper posture and
3. Be conscious of your work place – Raise your computer screen to eye level so you are looking straight ahead and not with your head down putting a strain on your neck and back. Then get up from your chair every hour and stretch if you sit at a computer for long periods

Bottom line: Of course a healthy lifestyle includes proper nutrition, a regular exercise program, moderate use of alcohol, no use of tobacco or tobacco products, and I am suggesting that good posture also be added to that list.

Any woman, no matter what her age, can help reduce the sag in her breasts by nearly 50% by simply standing tall.
Improving your posture 


PSA Screening-What You Need To Know Before Being Tested

September 8, 2014

Prostate cancer is the 2nd most common cancer in men in the US, affecting about 1 in 6 men in his lifetime. It is the 2nd leading cause of cancer death in men, and almost 2 out of every 3 prostate cancers are found in men age 65 or older.

Screening can help find prostate cancer early.
Most insurance providers cover annual PSA tests for men ages 50 and older. A PSA test is a simple blood test that may help find prostate cancer early before it has spread. Talk to your doctor about when you should begin screening. Some organizations recommended men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45.

The US Food And Drug Administration (FDA) first approved prostate-specific antigen (PSA) testing to screen asymptomatic men for prostate cancer in the early 1990s. In the decade prior to this approval, 5-year survival rates from the cancer stood at around 70-75%. By 1998, it had increased to 98.2%.

Although some health care experts have hailed PSA testing as the best available method to screen men for prostate cancer, there has been long-standing debate surrounding its use in routine testing.

PSA testing can lead to many false-positive results, meaning men can be alerted to cancers that are not actually present. Furthermore, critics argue that the test can lead to over-diagnosis, causing many men to undergo treatment they do not need.

September is National Prostate Cancer Awareness Month. So what is the evidence for and against PSA testing for prostate cancer?

PSA is a substance made by cells in the prostate gland. During a PSA test, a clinician will take blood from the patient and send the sample off to a laboratory, where levels of PSA are measured by nanograms per milliliter (ng/mL).

High levels of PSA – usually 4.0 ng/mL or higher – can indicate the presence of prostate cancer, and a man with such levels is likely to need a biopsy to determine whether he has the cancer.

However, high PSA levels can also be a sign of less harmful conditions, such as prostatitis or infection of the prostate gland – or enlarged prostate or benign enlargement of the prostate gland, a condition that can cause urination and bladder problems. Furthermore, the PSA test is unable to determine the difference between aggressive and benign prostate cancers. This is where concerns about the test’s accuracy come into play.

Past research has estimated that between 17-50% of men diagnosed with prostate cancer through PSA testing have tumors that would not have resulted in symptoms throughout their lifetime.

This means many men may receive treatment for prostate cancer – such as surgery, radiation or hormone therapy – that they do not need, which can lead to serious side effects, including urinary incontinence and erectile dysfunction.

Reasons Not To Test or Screen For Prostate Cancer
Such factors have fueled recommendations against routine prostate cancer screening. In 2012, the US Preventive Services Task Force (USPSTF) led the way by issuing a recommendation against PSA-based screening for prostate cancer for men of all ages who do not have symptoms.

Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms.

The American Cancer Society (ACS) does not provide guidelines that back routine PSA testing for prostate cancer. Instead, they state that “men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer.”

ACS suggest that a patient’s discussion with their health care provider about prostate cancer screening should start at age 50 for men who are at average risk of the disease and who are expected to live 10 years or more, while the discussion should take place at age 40 for men at high risk of prostate cancer.

The American Urological Association and the American College of Physicians have similar recommendations.
But despite recommendations against routine prostate cancer screening for men with no symptoms, many health care professionals believe PSA testing is crucial for preventing deaths against the disease.
Since PSA screening became routine in the 1990s, prostate-cancer mortality rates have declined by nearly 40%. I think PSA testing is the most likely explanation.

Without routine PSA testing, an additional 17,000 men every year would be diagnosed with advanced prostate cancer. We know that not all these men would be cured if detected earlier but PSA testing dramatically improves the odds that prostate cancer will be found before it becomes incurable.

Many men with prostate cancer feel that having a PSA test meant their cancer was diagnosed at a stage when it could be treated, and they would like all men to be able to benefit like they feel they have. As a result there have been calls for a screening program for prostate cancer using the PSA test to be introduced.

The European Randomised Study of Screening Prostate Cancer (ERSPC), launched in 2003 to determine the effect of routine testing on prostate cancer death rates.

Routine screening can lead to over diagnosis in around 40% of cases, which can lead to overtreatment and common side effects.

The results of another study – the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial – found that between 1993 and 2001, PSA-based screening for prostate cancer appeared to have no mortality benefits compared with a digital rectal examination.

With such conflicting studies on PSA testing for prostate cancer, it is no wonder that health organizations appear to be sitting on the fence when it comes to recommendations for such screening.

Dr. Otis Brawley, chief medical officer at the American Cancer Society stated that the majority of individuals are unaware of what the current recommendations are when it comes to prostate cancer screening.

Virtually every organization recommends men be informed of the documented harms and potential benefits of screening and be allowed to make a decision about being screened. Some may reasonably choose screening and make the decision about treatment after diagnosis. Even the USPSTF statement – which starts out recommending against routine screening – is consistent.

By looking at all available evidence for and against PSA testing for prostate cancer screening, it seems impossible to reach a firm conclusion about whether the test should be routinely offered to men or not.
If the test could distinguish between aggressive and harmless prostate cancers, routine screening would not be an issue, as the risk of overtreatment would be reduced. But of course, more research is needed to reach this point.

The US Food And Drug Administration (FDA) first approved prostate-specific antigen (PSA) testing to screen asymptomatic men for prostate cancer in the early 1990s. In the decade prior to this approval, 5-year survival rates from the cancer stood at around 70-75%. By 1998, it had increased to 98.2%.

Although some health care experts have hailed PSA testing as the best available method to screen men for prostate cancer, there has been long-standing debate surrounding its use in routine testing.

PSA testing can lead to many false-positive results, meaning men can be alerted to cancers that are not actually present. Furthermore, critics argue that the test can lead to over diagnosis, causing many men to undergo treatment they do not need.

I suggest that each patient being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.

They say a patient’s discussion with their health care provider about prostate cancer screening should start at age 50 for men who are at average risk of the disease and who are expected to live 10 years or more, while the discussion should take place at age 40 for men at high risk, i.e., if you have a close relative with prostate cancer or if you are of African-American.

The American Urological Association and the American College of Physicians have similar recommendations.

Bottom line: PSA screening isn’t for every man. However, every man should have a discussion with his doctor and see if PSA testing is appropriate for him.

Erectile Dysfunction and Heart Disease

September 6, 2014

There is no doubt that there is a connection between heart disease and erectile dysfunction or ED. The blood supply to the penis is through blood vessels that are less than half the size of the blood vessels to the penis and therefore are problems with erections are often preceded prior to problems with the heart.

Patients with heart disease who have severe erectile dysfunction should receive more ‘aggressive’ cardiac rehab care because they have such a poor prognosis relative to other patients with more normal sexual function, researchers reported at the European Society of Cardiology annual scientific meeting this week.

A study looking at the outcomes of 373 patients undergoing cardiac rehabilitation over 30 months found that the 62 patients with severe erectile dysfunction had a three fold higher risk of adverse cardiac events and death than the rest of the patients, even after accounting for their greater risk from other factors.

The researchers concluded: ‘Presence and severity of erectile dysfunction is a strong determinant of coronary heart disease prognosis, independently of age, functional capacity and other cardiovascular risk factors.
Routine assessment of sexual function is therefore warranted in cardiac rehabilitation programs and presence of severe erectile dysfunction may determine a more aggressive and holistic approach to cardiac rehabilitation in coronary heart disease.’

In another presentation, researchers found patients with chronic heart failure need to undertake high-intensity aerobic exercise to help regain sexual function.
Among 20 patients with stable heart failure, aged on average 53 years, a 12-week high-intensity interval training program led to increased erectile function, desire and sexual satisfaction as well as improved quality of life, whereas a moderate intensity continuous training program only improved patients’ quality of life.

Bottom Lline The researchers concluded: In patients with chronic heart failure, only high intensity aerobic training improved sexual function, while quality of life improved with both intensities of exercise.

The Relationship Between Tomatoes and Prostate Cancer

September 5, 2014

There has been media attention to the role of lycopenes found in tomatoes as a possible prevention of prostate cancer.

A study from England showed that men who eat over 10 portions a week of tomatoes have an 18% lower risk of developing prostate cancer.

Researches examined the diets and lifestyle of 1,806 men between the ages of 50 and 69 years with prostate cancer and compared them with 12,005 cancer-free men.
The study is the first study of its kind to develop a prostate cancer dietary index consisting of dietary components—selenium, calcium, and foods rich in lycopene—that have been linked to prostate cancer.
The results showed that men who had optimal intake of these three dietary components had a lower risk of prostate cancer, researchers found.

Tomatoes and tomato products, such as tomato juice and baked beans, were shown to be most beneficial, with an 18% reduction in risk found in men eating over 10 portions a week. This is thought to be due to lycopene, an antioxidant that fights off toxins that can cause DNA and cell damage.

The findings suggest that tomatoes may be important in prostate cancer prevention.

Bottom line: Men should still eat a wide variety of fruits and vegetables, maintain a healthy weight, and stay active.

Preventing Prostate Cancer

September 4, 2014

Prostate Cancer is a disease of aging and at this time there is no vaccine or sure fire way to completely prevent prostate cancer. However, there are steps you can take to reduce your risks.

• Advanced age increases your risk. Despite this, prostate cancer is not an “old man’s disease:” 35 percent of those affected are younger than 65.
• Family history may play a role. A strong family history of prostate cancer can increase your chances of developing the disease. While these factors are beyond our control, having awareness of increased risk can motivate us to focus on the areas we can affect.
• If there are factors that put you at higher risk, it’s important to be vigilant in areas you can control, including regular screenings. Talk with your doctor about the pros and cons of prostate screening. For African-Americans or those with a family history of prostate cancer, ask if screening should begin earlier.
1. Eat healthy. Avoid foods high in sodium, saturated fat, cholesterol, refined sugar and trans fat, which contribute to cancer risk. Instead, choose foods high in Omega-3 fatty acids (salmon, almonds) and monounsaturated fats (olive oil, peanuts) as well as fruits, vegetables and whole grains. Eating right doesn’t just lower your risk for prostate cancer, but prevents weight gain and improves your overall health.

2. Be active. Participate in 75 minutes of vigorous activity, or 150 minutes of moderate activity, weekly. This can include walking, swimming, biking or any exercise your doctor recommends.

3. Get screened. The National Comprehensive Cancer Network recommends baseline PSA screening for healthy men ages 50 to 70 every one to two years, and a majority of the panelists recommend baseline testing for men ages 45 to 49, too especially for men with a family history of prostate cancer or are of African American heritage.

Bottom line: Prostate cancer affects 250,000 men each year and causes 40,000 deaths making it the second most common cause of cancer death in men. Eating a healthy diet, exercising regularly and getting tested with a digital rectal exam and a PSA test on a regular basis is the best prevention strategy available today.

Losing Your Urine? It May Be Due to Your Medications

September 4, 2014

Urinary incontinence impacts millions of American men and women. Often times the solution may be to have your doctor check your medications and see if the medications may be the culprit.
There are four groups of medications doctors commonly recommend that can cause or increase incontinence. If you are taking any of these, you should let your doctor know about your incontinence and discuss your medications (both prescription and over-the-counter) to see if there is another approach to control or eliminate the problem.
The most common incontinence problems arise from medications in the following four categories:

1. Diuretics to reduce excess fluid
Diuretics, also known as “water pills,” stimulate the kidneys to expel unneeded water and salt from your tissues and bloodstream into the urine. Getting rid of excess fluid makes it easier for your heart to pump. There are a number of diuretic drugs, but one of the most common is furosemide (Lasix®).
Approximately 20 percent of the U.S. population suffers from overactive bladder symptoms which consists of urgency of urination and loss of urine when the man or woman cannot reach the toilet in a timely fashion.
Many of those patients also have high blood pressure or vascular conditions, such as swelling of the feet or ankles. These conditions are often treated with diuretic therapies that make their bladder condition worse in terms of urgency and frequency.
A first step is to make sure you are following your doctor’s prescription instructions exactly. As an alternative to water pills you might try restricting salt in your diet and exercising for weight loss. Both of these can reduce salt retention and hypertension naturally. Also, if you take diuretics, use them in the morning so you have frequency during the day and not at night after you go to sleep.

2. Alpha blockers for hypertension
Another class of drugs used to reduce high blood pressure or hypertension by dilating your blood vessels can also cause problems. These medicines are known as alpha blockers. Some of the most common are Cardura®, Minipress® and Hytrin®.
Men typically take these to treat an enlarged prostate (benign prostatic hyperplasia or BPH) which can restrict urination by putting pressure on the urethra. By relaxing the muscles in the bladder neck, alpha blockers allow smoother urine flow for those patients but may result in incontinence.

3. Antidepressants and narcotic pain relievers
Some antidepressants and pain medications can prevent the bladder from contracting completely so that it does not empty. That gives rise to urgency or frequency or voiding dysfunction. They can also decrease your awareness of the need to void.
Some of these drugs can also cause constipation. Constipation, in turn, can cause indirect bladder incontinence because being constipated takes up more room in the pelvis that the bladder needs to expand. Also, a full rectum can press on the bladder and result in stimulation of the bladder to contract and result in urgency and frequency as well as incontinence.

4. Sedatives and sleeping pills
Using sedatives and sleeping pills can present a problem, especially if you already have incontinence. They can decrease your awareness of the need to void while you are sleeping.
The best way to address this situation is to take other steps to relax and improve your sleep. Getting more exercise earlier in the day to make you tired, for example, can help. It’s also important to maintain a regular bedtime and wake-up schedule. Try to find other ways to relax before bed — meditation, reading a book or listening to soothing music or sound effects (e.g., rain or waves) — can also help you sleep better.

Bottom line: the side effects of medication can result in urinary incontinence. If you think this is a problem, check with your physician.

Urinary Incontinence-When It Gets Wet Down There

September 4, 2014

Urinary incontinence affects millions of American men and women. It is a condition that is a source of embarrassment, depression, and lead to social isolation. This blog will review urinary incontinence and what can be done to help those who suffer from this condition.

People suffering from urinary incontinence — loss of bladder control — have been advised to seek prompt medical advice as simple lifestyle changes or medical treatment can cure some men and women with the problem and most can have improvement in their voiding symptoms.



Some patients may feel uncomfortable discussing incontinence with their doctor. But if incontinence is frequent or is affecting their quality of life, it is important to seek medical advice because urinary incontinence may also indicate a more serious underlying condition. 

The condition may restrict their activities and limit social interaction while it also poses an increased risk of falls in older adults as they rush to the toilet at night when the lighting is poor.



Common symptoms of urinary incontinence are occasional minor leaks of urine or wetting clothes frequently. Types of incontinence include stress incontinence, urge incontinence, overflow incontinence, mixed incontinence, and problems with emptying the bladder. Bladder irritants such as alcohol, caffeine, decaffeinated tea and coffee, carbonated drinks, and artificial sweeteners could cause urinary incontinence. 

 Foods high in spices, sugar or acid, especially citrus fruits, as well as medications can act as diuretics, or water pills, and by increasing the volume of urine result in urinary incontinence.



Urinary incontinence may also be caused by some easily treatable medical conditions, such as urinary tract infection, which irritates the bladder, causing strong urges to urinate, and sometimes incontinence. Other signs and symptoms of urinary tract infection include a burning sensation when urinating and foul-smelling urine.



Constipation is another cause as the rectum is located near the bladder and the two organs share many of the same nerves. Hard, compacted stools in your rectum cause these nerves to be overactive and increase urinary frequency and sometimes urinary retention.

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including pregnancy, childbirth, changes with age, menopause, hysterectomy, enlarged prostate, prostate cancer, obstruction and neurological disorders.



Urinary incontinence isn’t always preventable but certain factors can help decrease the risk of having the condition, such as maintaining a healthy weight; practicing pelvic floor exercises, especially during pregnancy; avoiding bladder irritants, such as caffeine and acidic foods; and eating more fiber, which can prevent constipation, a cause of urinary incontinence.


Urinary incontinence could be diagnosed by examining the bladder’s dynamics through an examination conducted with a device that assesses the bladder function. This can be done by taking an X-ray of the bladder at various stages in order to further support the diagnosis.



Bottom line: Don’t let incontinence get you down. See your doctor as you don’t have to suffer in silence

Libido Enhancement For Women-A Few Suggestions That Will Make a Big Differences

August 24, 2014

Want that lovin’ feeling again? We can’t turn the clock back and have the sex drive and desire that we had in our twenties. However, there are some steps that we all can take to boost our sex drive and our relationship with our partners and significant others.

Take a walk at lunch
In a study of women ages 45 to 55, sexual satisfaction correlated directly to fitness. The less exercise they got, the lower their desire and sexual satisfaction.

Read something kinky
Erotic literature can quickly jump-start arousal.
You’d be hard pressed to find someone who hasn’t heard any of the buzz surrounding the erotic novel Fifty Shades of Grey. Based on the life of a college student and her entrepreneur lover, the trilogy has been whipping the nation into a frenzy. It might just whip your sex life into a similar frenzy.
Check out these 8 picks to help you turn up the heat. Oh, and if you can’t see yourself opening up a book featuring a buxom gal being ravished by a Fabio look-a-like on the cover, that’s what e-books are for, ladies. Enjoy!

Fifty Shades Of Grey: Book One Of The Fifty Shades Trilogy, by E L James Even if S&M isn’t your thing, who isn’t curious about it? This book answers all your questions—and ones you’ve never even thought of.

A Groom Of One’s Own, by Maya Rodale Why would an upstanding duke consider jilting his duchess bride for a newspaper writer? One word: Passion. A lot of it.

Lust In The Library, by Amelia Fayer “This novella is a great introduction to erotics,” says Rodale. Plus, the tagline is hilarious: “Some like it hot. Some like it in the reference section.”

The Claiming of Sleeping Beauty, by Anne Rice, writing as A. Roquelaure The first installment of the erotic trilogy of Sleeping Beauty, this fairy tale gives you way more than Disney ever could.

Aqua Erotica, by Mary Anne Mohanraj The first erotic novel Auteri ever read, this page-turner explores sexual satisfaction beneath the waves.

Seducing Sarah (The Madame X School of Sex), by Jinx Jamison For anyone who has wanted to break free from their boring day-to-day life (and who hasn’t?), here’s your chance to live vicariously through a paralegal who enrolls in sex school—trading mundane meetings for ménage seminars.

Lady Sophie’s Lover, by Lisa Kleypas “You cannot go wrong with a Lisa Kleypas novel. She has a gift for beautiful, passionate writing—especially the love scenes,” says Rodale.

The Dom of My Dreams: A BDSM Novel, by M.F. Sinclair They say never mix business with pleasure, but when a publicist takes on a hot new writer, all the rules go out the window.

Flex your muscles
Flexing your pelvic floor muscles—the ones that stop the flow of urine—instantly increases desire and sexual sensation because you’re mimicking the contractions of orgasm. For more information on Kegel exercises, go to: http://neilbaum.com/articles/pelvic-exercises-for-women-kegel-exercises

Have a massage
The skin-on-skin contact stimulates the sex hormone oxytocin. The more oxytocin released, the more desire a woman will feel.

Slip into something sexy
Putting on a pair of black stilettos or a sheer cami invigorates you sexually because it makes you feel more daring. It stokes your sexual imagination so you can play a role, like a good girl letting her sexy side out.”

Steal his Viagra
Ask your doctor about taking one of those little blue pills. You may be ready to go in an hour. Viagra increases blood flow to the genital area—something women need for arousal just as much as men do. Though the FDA hasn’t approved the pill for women, doctors can prescribe it.

Take a shower—together
Being clean makes you feel sexier and more open to receiving oral sex. And you’re also more likely to want to reciprocate with a clean partner as well.

Vibrate your pelvis
Vibrators bring the circulatory system into play right away and can greatly speed up your arousal time. Don’t worry that pleasuring yourself will turn off your desire for your partner.

Use a lubricant
Sexual intimacy feels better with lubrication. I recommend a water soluble lubricant such as K-Y jelly instead of an oil based lubricant such as Vasoline.

Bottom Line: Sex drive in the tank? Use a few of these ideas to revive your libido. You and your partner will be glad you did.

Exercise and Diet-Two Essentials for Good Health

August 24, 2014

Most American’s, myself included, are looking for methods and ways to be more active an consume fewer calories. There is no short cut to success as you either have to increase your exercise level and calories burned or decrease your consumption of calories to lose weight.
Many people think that if you exercise, you can eat whatever you want. Even though your daily caloric requirement will increase, attention to diet is necessary in order to meet your exercise and fitness goals.

Here are a few guiding points:

• -Meet, but don’t exceed, your caloric requirements. It is easy to overestimate the number of calories burned during exercise and underestimate the number of calories that you consume. Try to modify your diet each day to match your level of physical activity for that same day.
• -Stay fully hydrated throughout the day. Our bodies function poorly with even mild levels of dehydration.
• -Get a daily dose of vitamins. The best sources are always from food. The stress of exercise can increase your need for trace vitamins and minerals that can be found in fruits, vegetables, and nuts.
• -Don’t skip breakfast.
• -Eat more whole grains and less sugar. Think of complex carbohydrates as a “slow release” form of energy to carry you through the day.
• -Eat a power snack one hour prior to exercise. A small cup of yogurt and a handful of nuts would provide the ideal amount of protein and fiber.
• -Minimize alcohol intake.
• -Manage caffeine intake. Consuming caffeine in moderation just prior to exercise can boost performance.

Bottom Line: We all need to be active and increase our activity in order to enjoy good health. For more information go to:

http://www.laparoboticsurgery.com/august-2014-newsletter/#sthash.9TDcdJXg.dpuf

Shocking Your Penis Back to Good Health

August 20, 2014

A technique using shock waves, which have been used for nearly two decades to treat kidney stones, has now being applied to men with erectile dysfunction or ED. Two treatment arms were used to test the technology of shock waves. One arm received low intensity shock waves and the other received a sham or placebo treatment where no shock waves were administered to the penis. The results, which included a small group of only 58 men showed that there was minimal improvement in hardness in the treatment group and the ability to engage in successful sexual intercourse was modestly improved in the group who received shock waves.

Bottom Line : The application of shock waves for the treatment of ED has demonstrated a modest improvement in sexual performance in men who have trouble obtaining and maintaining an erection adequate for sexual intimacy.


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