Urinary Incontinence is No Joking Matter

April 16, 2014

Have you ever heard someone say after telling a joke, “I laughed so hard, I peed my pants”? If it is indeed true, then it is no laughing matter. Incontinence affects millions of American men and women. It is more common as men and women age but can occur at any time and may impact a man or woman’s quality of life because of embarrassing leakage. It can affect a man or woman’s self-image and confidence.

There are two categories of urinary incontinence: stress incontinence and urge incontinence. Stress incontinence is due to laughing or sneezing. Basically, small amount of leakage occurs when the pressure in the belly is more than what the urethra – the urine tube leading out of the bladder – can stand. This is what happens when you laugh or sneeze and leak.

Urge incontinence occurs when the bladder contracts and forces usually large volume of urine out. People may describe a sudden urge to urinate, and they simply cannot make it in time to the bathroom. Sometimes both types of incontinence may be present and is referred to mixed incontinence.

Women are more likely to experience urinary incontinence because their anatomy predisposes them to leakage of urine. Also, hormonal changes occurring at the time of menopause with a decrease in estrogen levels, childbirth and aging make leakage more common for women. If the incontinence affects a woman’s day-to-day life and it keeps them from taking part in their daily activities, then they should take the initiative and obtain the assistance of the physicians.
Men with incontinence, on the other hand, should see their doctor as it may represent a more serious problem with their prostate gland.
The good news is that urinary incontinence can be treated. It may be as simple as behavioral changes quit, special exercises and medicines. In some cases it may involve surgery.

Bottom Line: Urinary incontinence affects millions of American men and women. It is not a condition that kills those who suffer but it does affect their quality of life. Help is available and most men and women who suffer from urinary incontinence can be helped. Remember you don’t have to depend on Depends!

FAQ From My Patients

April 12, 2014

I am frequently asked questions by my patients and the answers may be of interest to you. If you have any questions that you would like me to answer, please write me at nbaum@neilbaum.com. to your good health.

I am a 60 yr. woman with recurrent urinary tract infections. I was told to drink cranberry juice. Is that effective?
Studies have documented that within eight hours of drinking cranberry juice, the juice could help prevent bacteria from developing into an infection in the urinary tract. Previous studies have suggested that the active compounds in cranberry juice work to fight against bacteria, including E. coli. Naturopaths believe in the medicinal value of cranberries. My own experience with hundreds of patients is that cranberry juice helps but you must drink 4-6 glasses a day, which is also a lot of sugar. So I suggest the cranberry juice pills. Anyone who suspects they have an infection should see a doctor, but drinking cranberry juice may be an easy, inexpensive way to help keep E. coli at bay.
I have chronic prostatitis. Is zinc helpful for this condition?
Zinc plays an important role in maintaining and improving prostate health. While zinc is found in every organ, tissue and cell in the human body, in males, the prostate has more zinc than any other tissue except bone.
As men get older, they tend to exercise less and their diets change as well, often causing them to fall short of the recommended daily allowance of zinc. Men who don’t have significant levels of zinc in their diets tend to have higher instances prostatitis. They also have higher prostate cancer rates.
The recommended daily allowance for men is 11 milligrams. Zinc is found in many popular foods, including meat and poultry, as well as oysters, beans, nuts, crab, lobster, whole grains, fortified breakfast cereals and dairy products.

My urologist told me that I have a varicocele. Will this cause me to have a problem with infertility?

Yes it may. Varicoceles are enlarged varicose veins that occur in the scrotum. They are fairly common, affecting 15 out of 100 men overall and one of the most common causes of male infertility because the heat from the dilated veins affect sperm production. Varicoceles occur most often in the left testicle. A varicocele repair is done to improve male fertility and is accomplished on an outpatient basis with improvement in the sperm producing in 3-4 months after the procedure.

I had radiation therapy for prostate cancer and now have a loss of my sex drive. What is the cause?
Men who receive radiation therapy for prostate cancer often receive injections to lower the testosterone level to decrease the growth of the cancer. Testosterone is responsible for the sex drive or libido. Often the testosterone level will return to normal after the medication is discontinued after the radiation therapy. In some instances men can receive testosterone one year after radiation if the PSA level stays at a low level. I suggest you have a discussion with your urologist about the use of testosterone in men with prostate cancer.

Caution On Use of Testosterone-Don’t Let Partner and Children Touch The Application Site

April 11, 2014

Testosterone is recommended for millions of American men with low T. These men report significant improvement in their symptoms of low T such as improved energy level, improvement in libido and erections, improved bone mineral density thus preventing osteoporosis in men. However, there are some precautions regarding the use of testosterone topical gels, which is the most used method of testosterone replacement. Testosterone left on the skin that is not absorbed can be transferred to your partner or your children if they come in contact with the application site.

If you are using topical testosterone gels, you should avoid contact between the applications sites and the skin of your partner and children.

To minimize the risk of testosterone gel transfer, men should wash the exposed area thoroughly before allowing direct, skin-to-skin contact. I also suggest than men wash their hands with soap and water immediately AFTER application of the gel. However, subsequent skin-to-skin exposure to the application site can still lead to transfer of testosterone from the man using the topical gel to others.

I also suggest that men be instructed to wear a T-shirt over the application site if the gel is applied to the abdomen and\or upper shoulders to prevent inadvertent testosterone transfer.

Men using topical gels should watch carefully for signs of testosterone transfer to partners and children.

Signs of testosterone in little boys include increased public hair, penile enlargement and accelerated bone growth. Other symptoms in both boys and girls include deepening of the voice, overactive oil gland in the skin leading to acne, increased body odor, increased muscle mass, frequent erections and masturbation, as well as behavioral changes.

In women the signs of testosterone transfer toxicity may include growth of hair on the face, male pattern baldness, irregular menses, enlargement of the clitoris, and deepening of the voice.

Bottom Line: Testosterone from accidental exposure from the topical gel from the man to his partner or children places the women or children to the deleterious effects of testosterone in women and\or children. The best advice for protection of partners and children is for the man to wash his hands after applying the gel and covering the application sites with a T-shirt or underclothing.

Sexual Wellness Program on Angela WWL, April 9, 2014

April 11, 2014

Angela Hill

Email: angela@wwl.com
Twitter: @AHillWWL

Angela: Help with sexual wellness is available, you just have to speak up!

by Angela Hill posted Apr 9 2014 4:22PM
Dr. Neil Baum has been a friend of “An Open Mind” ever since we started last fall, helping us understand medical issues that can affect our sex lives.

He spent a whole hour talking to WWL listeners today and pointed out that oftentimes, when it comes to sexual problems, women are suffering in silence, even though sexual dysfunction is more common in women than it is in men.

So what are the problems women are facing, and why can’t we speak out about it? It seems like every time you turn on the television or radio you hear an ad for a product that helps men with erectile dysfunction. Where is the help for women? Products to help women are just now starting to crack through, but haven’t gone mainstream yet.

So many men are having an open and honest dialogue with each other and their doctors, it is easy for them to speak out on these topics, but the lack of dialogue concercing female sexual dysfunction is holding women back. But it doesn’t have to be that way!

“Women who have problems with enjoyment, who have problems with dryness, who have problems with decreased libido are afraid to bring it up with their physicians. There are things that can be done for these women, and they should be encouraged to talk to their doctors,” Dr. Baum said. “Women have to understand that help is available for them, and they don’t have to suffer in silence.”

Is there Viagra for women?

“Right now, there is not. But there are things that can be done for decrease in drive for women, those whose interest is waning. It is primarily hormone-driven.”

Could hormone replacement therapy help your sex life? It’s not for everyone, but no matter what stage of life you are in, it’s imperative that you talk to your doctor, because there are options that can help you restore your love life.

One woman calls in to talk about her experience at “The Vagina Clinic,” where she found good medical advice from professionals tailored to her needs. Another man calls in with a question about testicular pain, and another with a question about fertility treatments

Everyone should take a moment to listen to the full interview – hear from men and women who have problems that may mirror those in your own life, or in the lives of your loved ones.

Bottom line? Talk to your Doctor!

FULL AUDIO: Angela talks to Dr. Neil Baum about sexual dysfunction and wellness

Low T, To Treat Or Not To Treat?

April 11, 2014

There’s controversy on the use of testosterone in men who suffer from low T. In this blog I would like to share the benefits of treating low T
from several thousand men who had symptoms of decreased testosterone.

About 40% of men older than 40 have low T. If you have low T, with symptoms that are decreasing your enjoyment of life, you need to weigh the risks and benefits of treatment. There could be a big upside to treatment.

Once you start low T treatment, you need to continue it or your testosterone level will drop back down.

The U.S. Food and Drug Administration has approved testosterone treatment for men with low testosterone and symptoms of low T, such as:
• Lack of sex drive
• Fatigue
• Weak bones
• Depressed mood
• Loss of muscle
• Erectile dysfunction (ED)

The Benefits of Treating Low T
If you meet the guidelines for treatment and you and your health care provider decide the benefits outweigh the risks for you, there are good reasons to treat low T.
Possible benefits you may experience include:
• Reduced weakness
• Less chance of falls and fractures
• Improved mental ability
• Improved sexual desire
• More energy
• Better quality of life
According to the American Urological Association, you may also experience:
• Better sleep
• Better erections
• Decreased body fat
• Increased muscle mass
• Stronger bones

Current Guidelines
The most up-to-date guidelines for when to treat low T are from the Endocrine Society. The guidelines say that low T should be treated if you have an early morning blood test that shows low testosterone and you have symptoms of low T.
The guidelines also list other medical conditions where the risks of low T therapy outweigh the benefits. The conditions include prostate cancer, sleep apnea, and heart disease.

Bottom Line: Millions of American men suffer from low T. Low testosterone on a blood test is not enough reason to treat low T. If you meet have symptoms of low T and have a blood test that confirms low T, the benefits can make treatment worthwhile.
If you have any questions about the management of low T, speak to your doctor.

A Hop, Skip and a Jump May Just Help Women With Urinary Incontinence

April 9, 2014

Urinary incontinence affects millions of American women. It is a quality of life condition that can lead to embarrassment, anxiety, and even depression. Conventional treatment is medication, exercises, and surgery. Now a new study from Canada has shown that dancing may strengthen the muscles in the pelvis and help control urinary incontinence.

Women were provided a series of dance exercises via a video game console in addition to a program for pelvic floor muscles exercises. The results revealed a greater decrease in daily urine leakage than for the usual program (improvement in effectiveness) as well as no dropouts from the program and a higher weekly participation rate (increase in compliance).

According to the researchers, fun is a recipe for success. The researches suggested that the more you practice, the more you strengthen the pelvic floor muscles. The investigators quickly learned that the dance component was the part that the women found most fun and didn’t want to miss.

The dance period also served as a concrete way for women to apply pelvic floor muscle exercises that are traditionally weak an ineffective to help hold the urine in the bladder until it is convenient to empty the bladder in a toilet. Dancing gives women confidence, as they have to move their legs quickly to keep up with the choreography in the video game while controlling their urine. They now know they can contract their pelvic floor muscles when they perform any daily activity to prevent urine leakage. These exercises are therefore more functional.

This is the first time that it has been used to treat urinary incontinence.

Bottom Line: Dancing may be effective in helping women with a problem of urinary incontinence. If this is a problem that is affecting your life style, contact your physician. Help is available. You don’t have to depend on Depends!

What You Need To Know About Low T (Testosterone) and Heart Disease

March 27, 2014

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.

Really Saving Souls

March 21, 2014

My medical soul was lifted after reading an editorial, A Wedding In Intensive Care, in the Thursday, March 20 2014 New York Times by Dr. Haider Javid Warraich. The story describes a terminally ill lady in the ICU whose daughter’s wedding was to take place in a few months. The doctor informed the daughter that her mother, who was on IV opiates, would certainly not be able to attend her wedding. The crying daughter called her fiancé and told him that her mother would was very sick and would not be there for her wedding. The fiancé stepped up to the plate and suggested that they immediately arrange the wedding and to hold the ceremony in the ICU. The entire ICU staff, doctors, nurses, and administration, went into “let’s make it happen” mode and organized a beautiful wedding in the ICU.

The patient stopped her pain medication for a few hours to be able to be “in the moment”. The wedding was beautiful and one that will be remembered for a lifetime by the family, the doctors, the nurses, and the entire ICU staff. The next day the patient was transferred to hospice and all the tubes and IVs were discontinued in order to “make her comfortable.”

Dr. Warraich concluded, “Doctors often share their patients’ sorrow, but rarely their joys.” This lovely story should help all doctors focus on the wonder that we can bring to our patients and their families. We are part of an amazing profession that affords us the opportunity to not only diagnose and treat diseases, but also to make magic happen for so much of the world. Perhaps we can collect such stories and write our own “Chicken Soup For The Doctors’ Souls.”

P.S. Four months later the patient was still alive and doing well in the hospice environment.

Dr. Neil Baum is a physician in New Orleans

ED Prevention-It May Take More Than Take Two Aspirin In the Morning

March 19, 2014

Erectile dysfunction (ED) affects millions of American men. Most of the causes are do to physical reasons and many can be reversed. This article will discuss action steps every man can take prevent and perhaps reverse ED.

Most men will experience an occasional erection problem. However when ED occurs most of the time, it is an indication that action steps need to be taken and an evaluation of a doctor is in order.

Here are some steps to consider to prevent ED from rearing its ugly head.

Kick the butts in the butt. Numero uno on your ED prevention list is to stop smoking. For men under the age of 40, smoking is the biggest cause of erectile dysfunction.

That’s because maintaining an erection requires a healthy blood supply, and nicotine causes your blood vessels to constrict, and can even result in your penis shrinking in size. The longer you’re a smoker, the more difficult it is to treat or reverse erectile dysfunction.

Get off your butt and get moving. Regular exercise is a must for both your heart and circulation — and because of that, it’s also an important way to prevent ED.

Regular exercise can improve blood flow to the penis, as well as to the rest of your body. Not to mention, working out increases your energy, lowers blood pressure, reduces stress, helps you sleep better, and makes you feel (and look!) more attractive — which are all helpers in avoiding erection problems.

Deep six the alcohol bottle. Sure, kicking back with a little booze is a great way to de-stress — but in large amounts, alcohol is a depressant. That means the more you drink, the more likely the alcohol will lead to erectile dysfunction (depression is one of the biggest causes of ED). This effect increases as you get older, so older men who are at greater risk for erection problems should take steps to limit the number of alcoholic beverages they consume. Talk to your doctor to find out if you should aim for less than the two-drinks-per-day maximum that’s often advised for men.

Fruits and veggies are an ED buster. A number of studies show that obesity, high cholesterol, diabetes, heart disease, and high blood pressure are linked to erectile dysfunction. Since a healthy diet is one of the best ways to protect against these diseases, it makes sense for your sexual health to eat healthily. What foods should be a part of your ED-prevention diet? Lots of fruits and vegetables, plenty of fiber, and very little saturated fat. If you’re struggling with your weight or cholesterol, ask your doctor for help.

Floss and brush your teeth. 
Turns out, erectile dysfunction and chronic gum disease share many of the same risk factors. In one recent study, 80 percent of men who had severe erectile dysfunction (caused by poor penile blood supply) also had chronic gum disease. Keeping your mouth healthy with flossing, brushing, and regular dental visits is one more way to keep your sex life in tip-top shape.

Relax. 
Stress and anxiety are frequent contributors to erection problems. That’s because stress causes your body to release stress hormones that are good for your “fight or flight” response, but bad for your blood flow because it causes blood vessels to contract. To prevent ED, find ways to reduce stress (without resorting to drugs, cigarettes, or alcohol, of course).

Good Zzzzzzzs can be a game changer. 
Fatigue can be a detriment to your sex life — so getting plenty of rest before a romp in the hay is always a good idea. But if you’re struggling to get a good night’s sleep and feeling drained throughout the day, you could have a condition called sleep apnea (which is signaled by very noisy snoring and periods of interrupted breathing). Studies show that men with erectile dysfunction are more than twice as likely to have sleep apnea, so if your partner is sleeping in the other room because of your snoring, talk to your doctor.

Bottom Line: ED is a devastating condition that can be a harbinger of other conditions such as high blood pressure, high cholesterol, heart disease, diabetes, depression, kidney disease and stroke. Take the steps provided in this article and you will have better erections and a much healthier life.

Dr. Neil Baum is a urologist in New Orleans and can be reached at (504) 891-8454 or through his website: http://www.neilbaum.com

Overactieve Bladder-Botox May Be a Solution

March 16, 2014

Overactive bladder or urinary frequency, urgency and urge incontinence affects millions of American men and women. Most men and women can be helped with medication. However, some suffers are unable to achieve any relief with medication or suffer from the side effects so that taking the medication is not possible. Now a new FDA treatment using Botox has been tested for those patients, mostly women, who have difficult to treat overactive bladder.

Botulinum toxin, otherwise known as Botox, has been historically used by the plastic surgery community to help alleviate wrinkles on the face. Botox relaxes muscular tissue. When used in the bladder, it can relax the bladder muscle resulting in fewer visits to the bathroom. Women who use the bathroom more than 8 times during the day and may be experiencing frequent bathroom trips at night may benefit from Botox treatment. Botox has been determined to be a safe and effective treatment for overactive bladder and urinary incontinence.

The procedure of Botox injections is simple, quick, and can easily be done in the office setting. It is typically done with the help of a cystoscope under local anesthesia but can also be done in the same day surgery setting under monitored anesthesia depending on patient preference. There are no incisions. The bladder is examined carefully with the cystoscope and Botox is injected into the bladder wall through a special needle passed through the cystoscope directly into the bladder muscle. Most patients tolerate the procedure very well, maximum benefit is obtained in about 2 weeks, and the treatment lasts 4 to 9 months and then can be repeated again.

Patients usually notice a reduction in their urinary frequency and urgency about 5 days after the procedure. If leakage occurred before Botox, there should be no leakage afterwards. There are a few reported side effects such as blood in the urine after the procedure but then clearing within a few days. Bladder infection may occur as a result of the minimally invasive procedure, so antibiotics are typically given as a precaution after the procedure. About 1 in 10 to 1 in 20 patients describe difficulty emptying the bladder after the procedure and may need to pass a urinary catheter intermittently to achieve complete emptying of the bladder for a few weeks post op.

Bottom Line: Overactive bladder is a common problem that affects the quality of lives of millions of American men and women. Most of patients can be helped with medication. Now Botox is available for those who find the medication ineffective or suffer from intolerable side effects.


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