No-Scalpel, No-Needle Vasectomy-The Prime Cut

December 8, 2014

Most practices are impacted at the end of the year by the rush of patients who have met their deductibles. In Urology, aside from patients wanting to get stones busted (Lithotripsy), scrotal issues addressed, and an occasional prostate; by far and away, the number of vasectomies that are done in December is at least 4-5 times the number that our offices perform during any of the other months. The following is intended for any questions that you may have regarding vasectomy and is based on more than 5,000 vasectomies I have performed over 30 years of urologic practice.

Vasectomy Facts

1. Average time for the procedure is 6-8 minutes.

2. Patients are not given any narcotics as Aleve or Advil are sufficient for any discomfort. Less than 1 in 100 patients require a narcotic prescription.

3. Patients are offered the option of Valium 20 mg. to take prior to the procedure with instructions to have a driver.

4. 95% of the men who come in for a vasectomy consult go on to have the procedure.

5. The biggest fear is of someone they do not know holding sharp instruments and working on their scrotum while they are awake. Because of proper education, including an article given to all patients prior to have the procedure, men need not worry about the vasectomy impacting their sexual function.

6. The sperm make up only 5% of the ejaculatory volume so no noticeable change in the semen volume.

7. Rarely men will be seen following the procedure for some discomfort and typically, it is related to some inflammation or small hematoma and Tylenol or Advil are more than adequate.

8. Because of the way the procedure is performed, it is very rare to see a scrotal hematoma, which can occur and creates a small swelling of the scrotum. This occurs most often in men who do not heed the advice of going home, lying down and keeping ice on the incision.

10. Occasionally, a question is asked regarding sperm banking and this can be done in a facility in one of the infertility clinics in the area.

11. Vasectomy reversal is a formal surgical procedure that can take anywhere from 1-1/2 to 2 hours to perform. Through a scrotal incision, the testicle and spermatic cords are brought into the surgical field. The ends of the vas identified, freshened up and scar tissue removed and an operating microscope is used to perform a surgical closure using typically anywhere from 7-0 to 9-0 permanent suture. Success rates for vasectomy reversal is approximately 75% within the first 10 years and drops to about 30% after 10 years.

Anatomy

The vas deferens is a small tube approximately 3 mm (1\8 inch) in diameter that carries sperm from the testicle up into the body where it unites with the seminal vesicles and stores the sperm until ejaculation when the semen is deposited in the vagina in order to fertilize an egg and start the process of conception.

No Scalpel Procedure

Following anesthetizing the skin in the mid-section of the scrotum with a device that deposits the anesthetic without the use of a needle. Then a single puncture is made about 1\4 of inch in length in the middle of the scrotum. Each vas is occluded with very small titanium clip. No sutures or stitches are required. The patient lies on the table for a few minutes and then goes home and lays flat in bed for a few hours using ice over the scrotum for 45 minutes out of every hour until going to sleep.

Office visits

A vasectomy consultation is always performed before the procedure for a number of reasons:

1. To explain the procedure to the patient.

2. To allay fears, address misconceptions, and put the patient at ease.

3. To ensure anatomically that there are no problems with performing the vasectomy which include an extremely large patient with small scrotum, prior evidence of infection, and to screen for extremely anxious patients who probably would not tolerate the procedure being performed in the office under local anesthesia.

4. Pre-procedure instructions are given including the need to shave all the hair on the scrotum preferably the night before.

5. Men are given a prescription for Valium, which they should take 30-45 minutes before the procedure. If the man takes the Valium pill, then he will need a ride home as he should not drive a car after using Valium.

6. Post-procedure instructions are given including the need to go home and stay off his feet and keep ice on for two days. Sexual intercourse can begin typically 3-4 days post- procedure. Additionally the men are instructed to return for a follow-up visit. It takes approximately 15 ejaculations to clear all sperm from the portion of the vas above the legation of the vas.

6. Typically, a man makes a follow-up appointment at 6-8 weeks although the record is one week, but he wasn’t married! They are also informed of the 1 in 1500 chance of reconnection of the vas.

Summary

The majority of men have the procedure performed on Thursday or Friday, spend the weekend resting with ice, return to work on Monday and are back to regular activity including intercourse by Wednesday or Thursday of the following week.

Bottom Line: Having done more than 5,000 vasectomies, I can think of very few men who would not be willing to undergo the procedure again or recommend it to a friend. Certainly, in comparison to tubal ligation, which requires general anesthetic, it is a much simpler, less costly and less painful form of sterilization.
Don’t hesitate to give me a call if you have any questions about vasectomy or go to my website to view a video on vasectomy: http://neilbaum.com/videos/vasectomy

Bladder Symptoms-Stop Depending On Depends!

November 28, 2014

Millions of American women suffer from urinary bladder problems. Unfortunately, they suffer in silence as women feel too embarrassed to discuss their symptoms with their physicians. This article will discuss the common symptoms of bladder control and what can be done about it that doesn’t require a diaper or Depends.
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The involuntary leaking of urine is a distressing symptom which is associated with loss of confidence, self esteem, relationship difficulties and sometimes depression. Some women deal with the situation by avoiding socializing with family and friends, wearing dark clothes and frequently changing their clothing, using scents, sanitary pads and even diapers.
Bladder difficulties can affect all age groups, but are more common in middle age and older women. It is likely that as many as one in five women experience incontinence at some stage in their lives. Approximately 70 per cent of urinary incontinence sufferers tolerate the symptoms and those who seek medical help wait for an average of four years because of embarrassment, shame and stigma.

Talking about these symptoms is difficult but women do not need to feel reluctant about seeking help as so many women can be effectively treated without surgery.

The biggest risk factor for women is damage to the pelvic floor especially related to pregnancy and child birth. Other conditions include extreme sports, chronic coughing and heavy lifting. Contributing causes include obesity, smoking and drugs that affect the bladder or the muscle that holds urine inside the bladder.
There are two main types of incontinence: stress and urge. Urine loss in the stress type is preceded by increasing the pressure within the abdomen such as occurs with laughing, sneezing, or coughing. Women experiencing urge incontinence have a compelling urge to pass urine, which is impossible to control and causes leaking.

Treatment can start with measures, which do not involve medication, but can be followed by pharmacotherapy if the conservative measure are not effective.

Initially patients are advised to decrease the intake of caffeine and carbonated drinks, smoking and avoiding constipation.
Pelvic floor exercises or Kegel exercises, are the recommended first line treatment for stress, mixed and urgency incontinence and result in significant improvement in up to 80 per cent of cases. Bladder training and electrical stimulation are other effective ways of treating incontinence.

Bottom Line: Wearing a diaper to staying at home because of the loss of urine, is not acceptable to most women who suffer from incontinence. It doesn’t have to be that way. See your doctor and he\she can often find a solution that will make you dry, comfortable, and lead you to a healthy lifestyle.

What Every Woman Should Know….About Her Man

November 26, 2014

Men live 5-7 years less than women and often have poorer health than their female counterparts. This may be due to many factors but certainly one is that men seek out preventive healthcare much less often than women. This blog is intended to give you an overview of the unique healthcare problems of men and what women can do to help their men lead happier and healthier lives.

ED\Impotence
ED is a common condition that affects as many as 30 million American men. Most men are uncomfortable discussing their sexual problems with either their partners or their healthcare providers. As a result men feel embarrassed and women often feel that the man in their life doesn’t find them attractive.

About 70% of the time, ED is caused by an underlying health problem, most often diabetes, high blood pressure, high cholesterol levels, or heart disease. The remaining 30% of men suffer from ED caused by stress, anxiety, depression, the side effects of medication, or drug and alcohol abuse.

In most cases, ED is treatable, which means that it doesn’t have to be a natural or inevitable part of growing older. Treatments include drug therapy (Cialis, Levitra, or Viagra) vacuum devices, injections, or penile implants. If your partner is suffering from ED, encourage him to seek medical care as certainly this condition can be effectively treated.

Testosterone
Testosterone is one of the most important hormones for the normal growth and development of male sex and reproductive organs. It is responsible for the development of male characteristics such as body and facial hair, muscle growth and strength, and deep voice.

Men’s testosterone levels naturally decrease as men age. But if the levels drop below the normal range, some uncomfortable and often distressing symptoms may develop, including:
Decreased libido or sex drive
Importance or ED
Depression
Fatigue or loss of energy
Loss of muscle mass

As many as 10 million men suffer from low testosterone (low T) but only 5% are being treated.

The diagnosis is made with a simple blood test that measures the blood level of testosterone. If the T level is decreased and the man has symptoms of low T, then replacement therapy with injections, topical gels, or pellets can be prescribed.

Prostate
The prostate is a walnut-sized gland that manufactures fluid for semen. It is located at the base of the bladder and surrounds the urethra or the tube that transports urine from the bladder through the penis to the outside of the body.

Prostatitis is a condition often caused by a bacterial infection or an inflammatory response similar to that seen with allergies and asthma. Symptoms may include a discharge, discomfort, pain in the area underneath the scrotum or testicles, frequent urination, and burning with urination. Treatment usually consists of medication and medications t decrease the inflammatory response in the prostate gland.

Benign prostate gland enlargement affects most men after age 50. The symptoms consist of frequent urination, getting up at night to urinate, and a decrease in the force and the caliber of the urine stream. Treatment consists of oral medication to reduce the size of the prostate gland, or medication that can relax the prostate and improve the urine flow. Now there are minimally invasive treatments such as microwaves, lasers, and even a new treatment, UroLift, that pins open the prostate gland in a 15 minute procedure in an outpatient setting.

Prostate cancer is the most common cancer in men. Nearly 240,000 new cases are diagnosed every year and causes 30,000 deaths each year making it the second most common cause of death due to cancer in men. The diagnosis is made by a digital rectal exam and a blood test, PSA test. If prostate cancer is caught early, it is often curable and nearly always treatable.

In the early stages, prostate cancer usually causes NO symptoms. However, as the disease progresses, so do the symptoms such as hip or back pain, difficulty with urination, painful or burning on urination or blood in the urine.

Every man should consider a baseline PSA test and a digital rectal examination at age 40. Additionally, African Americans and men with a family history of prostate cancer see a physician annually beginning at age 40.

Treatment options for prostate cancer include surgical removal of the prostate gland, radiation therapy, hormone therapy, immunotherapy or cryosurgery. Some men with localized, low risk prostate cancer might select active surveillance or watchful waiting which closes monitors the cancer to see if it progresses or becomes aggressive. If the cancer progresses, then treatment is usually instituted.

Testicular cancer
Cancer of the testicle is the most common cancer in men between the ages of 15-35. Although, there is nothing to prevent testicular cancer, if the cancer is diagnosed early, there is a high cure rate. Early detection is the key to success.

Symptoms of testicle cancer include:
Lumps or enlargement of either testicle
A feeling of pulling or unusual weight in the scrotum
Pain or discomfort in the testicle or scrotum
Dull ache in the lower abdomen
Enlargement or tenderness of the breasts

The best way to diagnose testicle cancer is be doing a testicle self-examination. Men\boys should examine themselves once a month just as women are recommended to do a monthly breast self examination. If a man experiences a lump or bump on the testicle or in the scrotum, contact your physician as soon as possible.

So what do I recommend?
In your 20s
A physical examination every three years
Check blood pressure every year
Screening for cancers of the thyroid, testicles, lymph nodes, mouth, and skin every three years
Cholesterol test every three years
Testicular self-exam every month

In your 30s
All of the above and a physical exam every two years

In your 40s
A physical exam every two years
A PSA test and a digital rectal exam if you are in a high-risk group
A stool test for colon and rectal cancer every year

At age 50 and above
A colonoscopy every 5 years or as recommended by your physician
A PSA and digital rectal exam every year

Bottom Line: Women can be so helpful in guiding men to good health. If you love your man, encourage him to follow these guidelines.

In the next blog we will discuss what men need to know about women’s health.

Testosterone Replacement In Men Who Wish To Continue Family Planning

November 24, 2014

Testosterone Replacement In Men Who Wish To Continue Family Planning

Millions of men have testosterone deficiency. Most of the men are middle age and older and, therefore, family planning is not an issue. However, if younger men have a low testosterone level and wish to continue family planning, the usual replacement with testosterone injections, gels or pellets is contraindicated because testosterone can reduce the sperm count making fertility difficult or impossible. This blog will discuss treatment of low T in younger men who wish to continue to have a family.

Function of Testosterone

Testosterone is the most important sex hormone or androgen produced in men. The function of testosterone is primarily the producing the normal adult male characteristics. During puberty, testosterone stimulates the physical changes that constitute the attributes of the adult male.

Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass. Testosterone is produced in men by the testes and in the outer layer of the adrenal glands.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Symptoms of Low Testosterone

The failure of the testes to produce a sufficient level of testosterone in the adult male results in a low testosterone level. Physical signs of low testosterone in men may include:

Declining sex drive,
Erectile dysfunction (ED),
Low sperm count
Decrease in lean muscle mass
Insomnia or sleep disorder
Depression
Chronic fatigue.
Conditions Causing Male Testosterone Deficiency

Testosterone deficiency can be caused by different conditions: 1) effects of aging; 2) testes based conditions; 3) genetics; and 4) conditions caused by the pituitary and hypothalamus.

The effects of aging on testosterone production
Testes disorder
Pituitary/Hypothalamus disorder
Genetically-based condition
Function of Testosterone Therapy

The function of testosterone hormone replacement therapy is to increase the level of testosterone in the adult male diagnosed with testosterone deficiency (low testosterone) or hypogonadism. Testosterone replacement should in theory approximate the natural, endogenous production of the hormone. The clinical reasons for treatment of testosterone deficiency in men include:

Increased male sex drive
Improve male sexual performance
Enhance mood in men
Reduce depression in men
Increased energy and vitality
Increase bone density
Increased strength and endurance
Reduce body fat
Increase body hair growth
Reduce risk of heart disease
Develop lean muscle mass with exercise
Function of HCG Therapy is to Stimulate the Testes to Prevent Loss of Natural Testosterone Production and Avoid Testicular Atrophy while the Male Patient is Undergoing Testosterone Hormone Replacement Therapy

The hormone HCG is prescribed for men in this therapy to increase natural testosterone production during the course of therapy as a result of the stimulation of the testes by the HCG. No testosterone medication is administered in this treatment. The treatment objective is to cause the male testes to naturally produce a higher volume of testosterone by HCG stimulation of his testes with the result that the patient experiences a continuing higher blood level of testosterone while on treatment. Another treatment objective is to avoid the use of any anabolic steroid and its adverse side effects upon the patient.

HCG Therapy normally increases natural testosterone production by the male testes while HCG is administered to the patient during the treatment period However, HCG Therapy can also result in a continuation of increased testosterone production and a resulting higher level of testosterone in the bloodstream after treatment is completed when the cause of the patient’s low natural LH secretion by the pituitary is not due to the patient’s natural genetics, aging process, injury to or loss of one or both testes; a medical disorder or disease affecting the testes, or castration.

HCG Therapy can result in a continuing higher level of natural testosterone production by the testes after HCG Therapy is completed when the underlying cause of the low LH secretion and resulting low testosterone production (1) is due to the prior use of one or more anabolic steroids by the patient or (2) due to the administration of testosterone in a prior hormone replacement therapy without the required concurrent HCG Therapy to prevent the patient’s endocrine system (hypothalamus pituitary-testes axis) from shutting down the natural production of testosterone by the testes and causing testicular atrophy.

Types of Testosterone Therapy for Men

A good male testosterone replacement therapy produces and maintains physiologic serum concentrations of testosterone and its active metabolites without significant adverse side effects.

The leading types of testosterone therapy for men include:

Testosterone Injection with HCG
Testosterone Transdermal Cream with HCG
Testosterone Transdermal Gel with HCG
Benefits of HCG Therapy for the Male Patient Undergoing Testosterone Hormone Replacement Therapy

Increases natural testosterone production by the testes
Prevents loss of natural testosterone production by the testes while the male patient is undergoing testosterone hormone replacement therapy
Prevents atrophy of testes while male patient is being treated with testosterone replacement therapy
Increases physical energy and elimination of chronic fatigue
Improves sex drive
Improves sexual performance
Improves mood
Reduces depression
Increases lean muscle mass
Increases strength and endurance as a result of exercise
Reduces body fat due to increased exercise
Increases sperm count and therefore male fertility
HCG Therapy can also result in a higher level of natural testosterone production after HCG Therapy is completed when the cause of a man’s current low testosterone production is the prior use of anabolic steroids that shut down or reduced the pituitary gland’s production of LH and decreased testosterone production.
Human Chorionic Gonadotropin (HCG)

HCG is compounded by a compounding pharmacy or manufactured by pharmaceutical company in 10,000 IU (International Units) for reconstitution with sterile water for injections in 10 cc vials.

HCG is a natural protein hormone secreted by the human placenta and purified from the urine of pregnant women. HCG hormone is not a natural male hormone but mimics the natural hormone LH (Luteinizing Hormone) almost identically. As a result of HCG stimulating the testes in the same manner as LH, HCG therapy increases testosterone production by the testes or male gonads as a result of HCG’s stimulating effect on the leydig cells of the testes.

The Decline in Gonadal Stimulating Pituitary Hormone LH (Leutenizing hormone)

The natural decline in male testosterone production that occurs with aging is attributed to a decline in the gonadal stimulating pituitary hormone LH (Luteinizing hormone). As a result of the hypothalamus secreting less gonadoropin-releasing hormone (GhRH), which stimulates the pituitary gland to produce LH, the pituitary gland produces declining amounts of LH. This decrease in the pituitary secretion of LH reduces the stimulation of the gonads or male testes and results in declining testosterone and sperm production due to the decreased function of the gonads. The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

How HCG Therapy Increases Plasma Testosterone Level in Men with Low Testosterone Production

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone. The male endocrine system is responsible for causing the testes to produce testosterone. The HPTA (hypothalamic-pituitary-testicular axis) regulates the level of testosterone in the bloodstream. and . The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release Leutenizing hormone (LH).

LH released by the pituitary gland then travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without the continuing release of LH by the pituitary gland, the testes would shut down their production of testosterone, causing testicular atrophy and stopping natural testosterone produced by the testes.

As men age the volume of hypothalamus produced gonadotropin-releasing hormone (GnRH) declines and causes the pituitary gland to release less Luteinizing hormone (LH). The reduction if the volume of LH released by the Pituitary gland decreases the available LH in the blood stream to stimulate the testes to produce testosterone.

In males, HCG mimics LH and increases testosterone production in the testes. As such, HCG is administered to patients to increase endogenous (natural) testosterone production. The HCG medication administered combines with the patient’s own naturally available LH released into the blood stream by the Pituitary gland and thereby increases the stimulation of the testes to produce more testosterone than that produced by the Pituitary released LH alone. The additional HCG added to the blood stream combined with the Pituitary gland’s naturally produced LH triggers a greater volume of testosterone production by the testes, since HCG mimics LH and adds to the total stimulation of the testes.

HCG Clinical Pharmacology

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens.

Thus HCG sends the same message and results in increased testosterone production by the testis due to HCG’s effect on the leydig cells of the testis. HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level.

Following intramuscular injection, an increase in serum HCG concentrations may be observed within 2 hours; peak HCG concentrations occur within about 6 hours and persist for about 36 hours. Serum HCG concentrations begin to decline at 48 hours and approach baseline (undetectable) levels after about 72 hours.

HCG is not a steroid and is administered to assists the body in the continuing production of its own natural testosterone as a result of LH signals stimulating production of testosterone by the testis.

This LH stimulates the production of testosterone by the testes in males. Thus HCG sends the same message as LH to the testes and results in increased testosterone production by the testes due to HCG’s effect on the leydig cells of the testes. In males, hCG mimics LH and helps restore and maintain testosterone production in the testes. If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone

Finding a Doctor-Making the Right Choice

November 15, 2014

Probably the most important decision you will ever make is the selection of life time partner and where to live and this is followed by selecting a doctor to take care of you when you are sick. This blog will provide you with suggestions on making the right selection of a healthcare provider for you and your family.

Finding the right doctor isn’t easy—and it shouldn’t be. When you put your life in someone else’s hands, you need to feel confident that this is an individual with enough smarts, qualifications, and skills to give you the care you deserve. Don’t look for a doctor like ordering a new computer or mobile phone. It’s far more important than that. You should shop for a doctor the same way you interview a lawyer or an accountant. People know more about how to buy a car than they do about selecting a doctor. It’s not so much a matter of labeling a doctor as “good” or “bad”—you want to go beyond just weeding out physicians who have gotten themselves into professional or legal hot water.

What to Consider
I suggest starting with a primary care doctor who will be the captain of your healthcare ship and he\she can direct you to the most appropriate specialist or sub-specialist should the need arise.

Try to find a blend of the doctor’s experience and his\her personality. If it’s long-term, such as one with a primary care doctor or with a specialist who sees you for an ongoing condition, personality and demeanor will carry more weight than if it’s a one- or two-time encounter with a specialist or surgeon.

Go online and look where a doctor went to medical school and did his residency training. (Resources like U.S. News’s Top Medical Schools shed light on program quality.) But how much emphasis to place on a doctor’s schooling is often questionable. Some medical experts believe that the best medical schools produce better doctors by being more selective and training the future physicians more rigorously. Other doctors have trained outside the country and are also excellent physicians.

Go to Google. Once the candidates are narrowed down to a manageable number, Google is your friend. Most doctors have at least some degree of online presence that can give you valuable insights. What kind of communicator does he appear to be? Does it seem like he’s available via E-mail? Any research papers he’s authored and displays might give you an idea of special interests and strengths, too. But a website is just one evaluation tool, not a deal-breaker.

One call that’s all. It’s smart—and completely within your rights—to set up an introductory phone call or make an appointment to interview any doctor you’re considering. Most doctors will make time to do this. A few leading questions can shed light on a doctor’s decision-making style, and whether she works with patients to design a treatment plan or whether he\she feels strongly that he’s\she’s the doctor and what he\she says goes. For example: “Can I weigh in when I have ideas about my care?” Neither approach is right or wrong.

Finding the Best Primary Care
Everyone needs a primary care doctor trained in treating and managing the usual run of medical problems, from colds to migraines, as well as chronic conditions like diabetes and high blood pressure. He will assess your symptoms and, if necessary, direct you to the right specialist. If he’s doing his job correctly, he’ll also coordinate your care, communicating with other doctors you see and making sure nothing slips through the cracks. Besides M.D.’s, nurse practitioners and physician assistants are reasonable options for healthy patients who are interested in wellness care and counseling.

Online resources claiming inside information on physicians are abundant, but most simply list easily attainable contact information and facts about the physician’s medical education, board certification, and possible disciplinary actions. U.S. News’s Top Doctors, a compendium of more than 27,000 physicians nationwide, can identify doctors recommended by their peers based on their clinical skills, including how well they relate to patients, and other qualifications such as education, training, hospital appointments, and administrative posts.
There also are websites like HealthGrades.com or RateMDs.com where patients can post reviews of their doctors.

Calling the office will also give you a chance to avoid discovering after the fact that it’s run like a credit card “customer service” call center or a fine restaurant or hotel. I don’t recommend a practice that can’t answer the phone in a few rings, forces you into a phone tree or keeps you on hold for more than 2 minutes. Spending five minutes on the phone with the receptionist will tell you how far in advance you need to make appointments, the length of a typical office visit, and whether the doctor usually sticks to the appointment schedule or is two hours behind by noon. If you hear that the doctor is very busy and doesn’t keep to his schedule well, and if you’re someone who needs to come in and be seen without a long wait, you’ll know right away that it won’t be a good fit. Some doctors understand that their patients’ time is important, and some even offer gifts or money back for enduring excessive wait time. While that’s by no means the norm, an office that doesn’t value timeliness or efficiency may be a deal breaker.
How the office is organized will affect your convenience, too. You’ll want to know whether lab work or X-rays can be done in the office, or if you’ll need to go elsewhere. If the doctor is totally booked, can you see someone else in the practice? Are Saturday morning or late afternoon hours available? What time does the practice open and close, and how will those hours work with your schedule? Is he available via E-mail, as an increasing number of physicians are?

Experts consider board certification one of the best indicators of competency and training. A study published in the Archives of Internal Medicine in 2010, for example, described a “robust relationship” between board certification and quality of care. It isn’t hard to understand why. A board-certified specialist has gone through a rigorous residency followed by more training in the specialty and finally testing and peer evaluation (plus periodic recertification). A doctor’s board status can be checked at CertificationMatters.org. The American Board of Medical Specialties recognizes more than 150 specialties and subspecialties, including family practice, internal medicine, surgery, cardiology, and orthopedics.

The more often a doctor performs a procedure, the better he gets and the lower the chance of calamity. It follows that the more cases he sees like yours, the likelier the results will be good. Finding out is surprisingly simple, and good doctors wish more patients would make the effort. You only need to ask directly how many patients like you the doctor has seen over a recent period and how they fared. If you’re discussing heart bypass surgery, for example, what you want to know is the number of these procedures the specialist has performed in the past 12 or 24 months on patients in your age group in similar physical and medical condition and the death and complication rates for those patients. To put the answers in perspective, ask if there are national benchmarks to use as comparison.

Bottom Line: Selecting a physician is one of life’s most important decisions. Your life depends on it. These are suggestions that may help make the process easier, less daunting, and likely that you will find the right match for you and your family.

Non Medical Ways to Boost Testosterone Levels

November 9, 2014

Testosterone is the male hormone produced in the testicles and it is responsible for man’s sex drive. Low testosterone levels can impact a man’s sexual performance. This blog will discuss life-style changes that men can make to improve their testosterone levels.

The sex hormone testosterone is often touted as helping men maintain their vitality and virility, but levels begin to dip naturally by about 1 percent a year after age 30. Signs that your testosterone may be declining more rapidly include loss of energy, decreased sex drive, irritation or anger, and trouble sleeping.
Although testosterone supplementation is effective, there are risks and side effects that make life style changes a more attractive alternative. There are many tried and true drug-free and hormone-free ways to maintain testosterone levels.

Deep Six the Sauce (Alcohol)
A glass of wine with dinner is no problem, but overdrinking is not a good idea. Moderate alcohol consumption for men is a max of two drinks a day, with one being a 5-ounce glass of wine.

Shed Some Pounds
Being overweight or obese can increase risk for heart disease and certain cancers, but extra weight also increase the risk for low testosterone levels. Research published in Diabetes Care in June 2010 showed that 40 percent of obese men had lower-than-normal testosterone readings, and this percentage increased to 50 percent among obese men with diabetes. Weight loss can be a hormone-free way to combat low T. A benefit of weight loss for obese men is that the penis will appear to be longer because of the loss of the abdominal fat. I usually tell men that every 30 pound weight loss increases the length of the penis by 1.5 inches.

Send Out a Stress SOS
A study done at the University of Texas at Austin in 2010 suggested that the stress hormone cortisol may block the beneficial testosterone. When our stress levels are up, our testosterone can go down.

Regular exercise helps reduce stress levels as well as help you maintain a normal weight, so it packs a double whammy against low testosterone levels. Other stress reduction techniques, like deep breathing, can also serve as natural testosterone support.

Take a Big Dose of Vitamin “E”-Exercise
Exercise can help maintain your testosterone levels and avoid some of the symptoms of low T.
Research in the September 2011 issue of the Journal of Strength and Conditioning Research backs this up. The study showed that a 4-week sprint-interval training program helped boost testosterone levels in a drug-free fashion among wrestlers.

Sleep And Sex
A small study conducted at the University of Chicago School of Medicine found that men who slept less than five hours a night for one week had lower levels of testosterone than when they had a full night’s sleep.
When you are sleep deprived, it impacts levels of the stress hormone cortisol, which reduces testosterone just like stress can. A sleep-deprived state is a testosterone-deprived state. Everyone’s sleep needs are different, but it’s important that you wake up feeling refreshed.

Avoid Plastic Bottles
The controversial chemical bisphenol A (BPA) is found in many plastic water bottles as well as in the lining of food and beverage cans, and exposure to this plasticizer may result in low T. BPA can act like the female hormone estrogen in the body, which means it can lower levels of testosterone,
Don’t cook foods wrapped in plastic in the microwave, and try to drink from a glass or a steel thermos. The more flexible a plastic bottle, the more likely it is to leach BPA and affect the testosterone level

Think Zinc
If you take a multivitamin with zinc or eat oysters every day, your zinc levels are probably within the normal range. Aim for 12 to 15 milligrams a day to help stave off low T.

Some Fat Is Your Friend

Men who eat a low-fat diet have lower testosterone, because the body makes testosterone from cholesterol. But this doesn’t mean you should eat unhealthy bad fats. Instead choose healthy fats such as those found in avocado, nuts, and olive oil. These fats will boost testosterone naturally, but they won’t raise blood levels of artery-clogging cholesterol.

Skip the Sugar

Every time you eat sugar, testosterone is decreased, likely because the sugar causes a high insulin level which can decrease the testosterone level.
Bottom Line: Low testosterone levels are a treatable condition that affects millions of men. There are options that don’t require medication that also improve your overall health and wellness.

Prostate Awareness-Let Your Upper Lip Show You Care!

November 5, 2014

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ZERO – The End of Prostate Cancer has launched an exciting, new opportunity for the prostate cancer community to raise funds and awareness in November to help end prostate cancer. You can join the facial hair-growing phenomenon to end prostate cancer with ZERO’s Grow & Give campaign!

ZERO is committed to ending prostate cancer 365 days of the year. Everywhere you look in November, men, including me and Matt Lauer, are sporting mustaches and beards to do good. We’ve joined the fun to give patients, survivors, loved ones, and supporters an outlet to grow their fuzz and fundraise exclusively for prostate cancer, a disease that affects one in seven American men.

ZERO’s Grow & Give campaign begins November 1, but participants can start growing their facial hair any day in November and continue all month long. You can grow and give on your own or start a team with customized webpages available on ZERO’s website, zerocancer.org. The goal is to get your family, friends, and colleagues involved to raise funds and awareness. Ask people to give and sponsor whatever you have decided to grow. Staches, goatees, soul patches, beards, chops, sideburns – every whisker counts, we want you to grow it. Ladies can participate too by starting a team, fundraising, and getting the men in their life to make health a priority.

Fundraisers can share their efforts on social media using #growandgive for a chance to win prizes and have their pictures posted to ZERO’s social media pages. Stop by the office and show us your fuzzy face pictures and hear about how much fun you had in November in your effort to help save lives.

 

Bottom Line: Movember is the month to put a few whiskers on your face and show that you care about increasing awareness about prostate cancer.

Movember-A reminder To Have a Prostate Check With Your Doctor

November 4, 2014

November is a month dedicated to men’s health and male health awareness.  Thousands of men will change their appearance this month by growing a moustache for the 30 days of Movember.

Not only are the ‘Mo bros’ bring back the moustache, they are raising funds and awareness for prostate cancer, testicular cancer and mental health.

By taking a few simple steps such as maintaining a good diet and taking action early when experiencing a health issue, every man can improve their chances of living a happy and healthy life.

If prostate cancer is spotted early, prostate cancer can be very effectively treated. And many men will be able to lead a normal life for years to come. Prostate cancer has one of the best survival rates of all cancers.

The most important thing to remember about prostate cancer is that even if the doctors confirm you have it, it doesn’t mean you will die of it,

Many of the men immediately start thinking about their own mortality and worrying about their families and loved ones after they are gone.

This is why ‘Movember’ is so important – to encourage men to be more proactive about looking after their own health.”

Prostate cancer is the most common cancer in men with 250,000 new cases each year and nearly 30,000 deaths in the U.S. It is often slow-growing, but there are more aggressive forms which need active treatment.

The prostate is a walnut-sized gland located between the bladder and the penis which secretes fluid that nourishes and protects sperm.

Conditions that can affect the prostate include infections, enlarged prostate – the gland grows in nearly all men over 50, prostate infections, and prostate cancer.

The first step is to make an appointment with your primary care physician and request a PSA test. If you have an elevated PSA level, your doctor will often refer you to a urologist.  The urologist may recommend a prostate biopsy and will treat you as an individual and work out what the best treatment is depending on your age, health and other conditions you may have.

Surgery or radiotherapy is not right for everyone and sometimes a ‘watch and wait’ or surveillance plan of action is recommended if the prostate cancer is not aggressive.

A lot of men find it embarrassing to turn to a doctor about men’s issues about urinary symptoms as they fear they have prostate cancer.

A much more common condition is the enlarged prostate gland.  This is a benign condition that impacts nearly all men over the age of 60 and causes difficulty with urination such as a decrease in the force and caliber of the urinary stream, urinary frequency, urgency of urination, and getting up at night to urinate.

The condition makes life uncomfortable as it can place pressure on the bladder and urethra, the tube through which urine passes, and can make it difficult to urinate or cause a frequent need to.

Most men can be helped with oral medication such as alpha blockers and medications to actually reduce the size of the prostate gland such as Proscar or Avodart.  If medications are in effective, there are minimally invasive procedures such as microwaves, lasers and now the new Urolift procedure.  This procedure has FDA approval and consists of using an implant that pulls the prostate gland open the us making urination much easier and more comfortable.

Prostate cancer – what you need to know if you are a man:

  • Ask your primary care Dr. for a special test (called PSA) – spotting prostate cancer early is really important , this is especially important if you are in your 50s or have any risk factors
  • Many diagnoses of prostate cancer will not cause problems and can be effectively treated and cured
  • There are no symptoms of prostate cancer unless it is very advanced
  • Contrary to popular belief difficulty in passing water is not a necessarily a sign of prostate cancer
  • You are three or four times more likely to develop the disease if your brother, father or close male relative has been diagnosed with it
  • If you are African American, then there is an increased risk you will develop prostate cancer.
  • It is a known fact that all men will develop prostate cancer if they live long enough.

Prostate and prostate cancer facts:

  • The prostate is a walnut-sized gland located between the bladder and the penis. It secretes fluid that nourishes and protects sperm
  • Conditions that can affect the prostate include infections, enlarged prostate (the gland grows in nearly all men over 50) and prostate cancer.
  • Prostate cancer is the most common cancer in men with 250,000 new cases each year and 30,000 deaths in the U.S.
  • Prostate cancer is often slow-growing, but there are more aggressive forms need active treatment
  • Most men who are diagnosed with prostate cancer survive 10 years or more
  • Familial inheritance represents 1-5% of all prostate cancers diagnosed
  • It is predicted that there will be 60% more diagnoses over the next 20 years
  • The number of advanced cancers is falling as awareness spreads

Prostate cancer – what happens:

The doctor will take some blood and test it to measure the amount of protein called prostate specific antigen – PSA.

It is normal to have a small amount of PSA in your blood. An elevated PSA level may be a sign of prostate cancer but equally the elevated PSA could be something like a urine\prostate infection or an enlarged prostate which is a benign condition.

An elevated PSA level may require an ultrasound prostate biopsy, which is where a small part of the prostate removed for further testing, or recommend an MRI scan, or both

If the scans and the biopsy confirm prostate cancer, your urologist will examine the information to determine exactly what risk type of cancer it is

You may need to have further scans such as bone scan or a CT scan

Types of treatment include active surveillance, radiotherapy or surgery depending on the type and severity of the cancer.

The important thing to remember is that prostate cancer can be effectively treated and you can live a perfectly normal life

More information on treatment options are available on my website: http://neilbaum.com/services/prostate-cancer

Bottom Line: Prostate cancer is the most common cancer in men and the second most common cause of death in American men. Most men with prostate cancer can be successfully treated. It starts with a digital rectal exam and a blood test, PSA.

Testosterone and the Prostate Gland-It’s Not Gasoline On a Fire

November 3, 2014

For the past two years I have made the decision of treating prostate cancer patients who are documented to be hypogonadal with testosterone replacement therapy. Many of my colleagues have asked me about this decision and I would like to provide you with the evidence that this treatment of hypogonadal men who have been treated for localized prostate cancer with either radical prostatectomy or radiation therapy is safe.

In the late 1980s Dr. Abraham Morgentaler, a urologist in Boston, Massachusetts, began researching the relationship between testosterone and prostate cancer.  Since the early 1940s testosterone had been believed to be a key contributor to the development of prostate cancer, and once cancer was established, testosterone was believed to be its fuel.  As a result, generations of medical students around the world were taught that providing additional testosterone to a man with prostate cancer was “like pouring gasoline on a fire.” On the flip side, it was similarly believed that low levels of testosterone protected a man from ever having prostate cancer.

As one of the first physicians in the modern era to offer testosterone therapy to otherwise healthy men with sexual problems, Dr. Morgentaler was concerned that this treatment, while effective, might precipitate rapid growth of undetected, “occult” prostate cancers in his patients.  In order to avoid causing more harm than good, Dr. Morgentaler took the bold step of performing prostate biopsies in these men to exclude the possibility that these men harbored an undetected prostate cancer, even though they had none of the standard indications for a biopsy, such as elevated PSA or a nodule.  Although it had been assumed these men were at extremely low risk for prostate cancer because of their low testosterone levels, Dr. Morgentaler and his colleagues found exactly the opposite. One in seven of these “normal” men that underwent biopsy was found to have cancer, a rate similar to that seen in men known to be at increased risk.

Dr. Morgentaler presented his findings at the annual meeting of the American Urological Association in 1995.  At the end of the presentation an influential chairman of a major urology department came to the microphone and loudly described this work as “garbage.” “Everyone knows high testosterone causes prostate cancer and low testosterone is protective,” he proclaimed in a booming voice.  The research was published the following year in the prestigious Journal of the American Medical Association.

As the testosterone and prostate cancer link became less persuasive, Dr. Morgentaler began to offer testosterone to men with pre-cancerous abnormalities on prostate biopsy, and reported no increased rate of subsequent cancer. Yet at his own hospital, the Beth Israel Deaconess Medical Center, a senior endocrinologist complained to the administration that this research was “dangerous”.

However, Dr. Morgentaler prevailed and went on to publish clinical research on the safety of testosterone in men with actual prostate cancer, some treated with radiation or surgery, and even in selected men with untreated prostate cancer.

Dr. Morgentaler’s results were difficult to accept initially because a longstanding treatment for advanced prostate cancer has been androgen deprivation, a surgical or medical treatment designed to permanently reduce testosterone levels as much as possible. Numerous studies in these men had shown improvement in prostate cancer with this treatment, so it seemed logical that raising testosterone would cause prostate cancer progression.

Dr. Morgentaler’s elegant solution to this apparent paradox was the saturation model, based on studies in humans, animals, and in prostate cancer cell lines in the laboratory. It turned out that prostate tissue does indeed require testosterone for optimal growth, but that it can only use a limited amount of testosterone (or its metabolite, dihydrotestosterone) before it reaches a maximum. In biological terms, this is called saturation.  Once saturation is achieved, additional testosterone has little or no capability to stimulate further growth. And saturation occurs at very low levels of testosterone, approximately 20ng\dl. This explained why testosterone treatments did not appear to harm men with existing or treated prostate cancer, namely because the cancers already had seen all the testosterone they could use.

The Evidence

A number of physicians have treated patients with testosterone despite the fact that they’d been treated for prostate cancer in the past. The first to publish their experience with doing this were Drs. Joel Kaufman and James Graydon, whose article appeared in the Journal of Urology in 2004.

In this article, Drs. Kaufman and Graydon described their experience in treating seven men with T therapy some time after these men had undergone radical prostatectomy as treatment for prostate cancer, with the longest follow-up being 12 years. None of the men had developed a recurrence of his cancer. Soon afterward, there was another paper by a group from Case Western Reserve University School of Medicine describing a similar experience in 10 men with an average follow-up of approximately 19 months. Then another group from Baylor College of Medicine reported the same results in 21 men.

In all these reports, not a single man out of the 38 treated with testosterone developed a cancer recurrence. It is important to emphasize that all these reports included only men who were considered good candidates because they were at low risk of recurrence anyway. And in some cases, the duration of time the men received T therapy was relatively short. But it was reassuring that none of the 38 men who had suffered from prostate cancer in the past and who were treated for years with testosterone had developed a recurrence of prostate cancer.

This reassuring experience was bolstered by the published experience of Dr. Michael Sarosdy, who reported the results of T therapy in a group of 31 men who had received prostate cancer treatment in the form of radioactive seeds, called brachytherapy. This less-invasive form of treatment does not remove the prostate, so theoretically there is the possibility that a spot of residual cancer might still be present. With an average of five years of follow-up in these men, none of the 31 men had evidence of cancer recurrence.

My Approach

Men who have low-grade prostate cancer, i.e., Gleason score of <6, and low stage disease, T1 or T2, and have a nadir of their PSA following curative treatment with either surgery or radiation for 9-12 months, and have symptoms of hypogonadism and documented low testosterone levels, are candidates for hormone replacement therapy. I provide them with educational materials similar to what is in this newsletter and request that they return every month to monitor their PSA levels. Any increase in PSA levels for two successive months results in cessation of their hormone replacement therapy. Of the several dozen patients that meet this criteria and have received testosterone replacement therapy, none have had a rise in their PSA or evidence of recurrence of their prostate cancer.

Bottom Line: Today, most urologists throughout the world, myself included, are comfortable using testosterone in men without the fear of causing prostate cancer, and in the US a majority will now offer testosterone treatment to some men previously treated for prostate cancer.  This revolutionary change in medical beliefs and practice resulted directly from the work of Dr. Morgentaler, who became a David against Goliath and was relentless in his pursuit of scientific truth and making it possible for some men who have prostate cancer with documented hypogoandism to receive hormone replacement therapy.

Treatment of Incontinence With Confidence

November 3, 2014

Incontinence is devastating problem that impacts millions of American men and women. Although diapers are acceptable in toddlers, it is not very acceptable in middle aged and older men and women. This blog will discuss the common problem of urinary incontinence and what are some of the solutions for this common urologic problem.

Do you visit the bathroom more than usual? Or worse, do you not make it on time to the bathroom because your bladder is out of control? This is nothing to be ashamed of, and can be solved if addressed properly.

Urinary incontinence is a common problem resulting in the loss of bladder control. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that is so sudden and strong you do not get to a toilet in time.

If urinary incontinence affects your daily activities, then the person must visit the doctor. The earlier rehabilitation techniques are started, the lesser the complications and the better the results.

There are different reasons for urinary incontinence but the main reason for women is pregnancy and child birth.

Pregnancy puts pressure on the bladder and the urethra and normal delivery further weakens the muscles needed for bladder control. Women who have had a C-section are less prone to face this problem but in many cases pregnancy itself can affect the muscles which causes urinary incontinence after delivering the baby.

Worldwide 25 per cent of women above 40 years and 40 per cent of women above 65 years have urinary incontinence.

A high percentage of these women are prone to urinary incontinence due to multiple pregnancies and childbirth. However, despite providing women with educational leaflets during their pregnancy and carrying other awareness activities, not everyone with the problem seeks medical assistance.

The problem is more common in women that give birth to babies that weigh 8 pounds or more and in patients that have a complicated or prolonged labor.

I recommend that all women practice pelvic exercises, which are important to tighten these muscles. Exercises such as Kegels are now getting popular and more women are aware of it.

Other reasons for incontinence include ageing and menopause, obesity, neurological causes, and diabetes. After menopause women are more prone to incontinence as there is loss of estrogen hormone which has a direct effect on the bladder and the muscles supporting it.

Treatment

One form of treatment is lifestyle modification. Certain drinks and foods act as diuretics, these include alcohol, coffee, decaffeinated tea and coffee, carbonated drinks, artificial sweeteners, foods high in spice or sugar. We ask women to reduce the intake of these foods and drinks.

Another option is to reduce the bladder irritants. These foods and fluids cause urinary frequency, urgency, and urinary incontinence. A complete list of bladder irritants is shown at the end of this blog.

Diabetic patients are asked to keep their sugar in control, and obese patients are put on a diet. Physiotherapy is another method to manage the disease. Bladder training and pelvic floor exercises such as Kegels are taught to patients to be performed at home on a daily basis.

In some causes electrical stimulation is performed, said the doctor. Gentle electrical stimulation can be effective in some types of incontinence and one may need multiple sessions over a period of few months, in addition to exercises.

Bottom Line: You don’t have to suffer incontinence in silence. Help is available. See your doctor.

List of Common Bladder Irritants*

Citrus fruit
Coffee (including decaffeinated)
Cranberries and cranberry juice
Grapes
Guava
Milk Products: milk, cheese, cottage cheese, yogurt, ice cream
Peaches
Pineapple
Plums
Strawberries
Sugar especially artificial sweeteners, saccharin, aspartame, corn sweeteners, honey, fructose, sucrose, lactose Tea
Tomatoes and tomato juice
Vitamin B complex
Vinegar
*Most people are not sensitive to ALL of these products; your goal is to find the foods that make YOUR symptoms worse


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