Using Hormone Therapy To Reduce Recurrent UTIs in Women

April 13, 2015

Women often experience recurrent UTIs after menopause. The cause is often a result of reduced estrogen levels that is so common after menopause. This blog will discuss the use of topical estrogens to reduce the frequency to recurrent urinary tract infections.

Topical hormone replacement therapy (HRT) was associated with a lower incidence of urinary tract infections (UTIs) compared with both oral HRT or even no HRT.

UTIs are a frequent problem among postmenopausal women necessitating antimicrobial use, and resistance is increasing. Every year, 8–10% of postmenopausal women have 1 episode of a urinary tract infection; of these, 5% will have a recurrence in the next year.

Studies have demonstrated use of oral estrogens does not reduce the incidence of UTIs, but topical HRT reduced the number of UTIs in two small studies.

To determine whether a difference existed in incidence of UTIs in women 60–75 years of age, a study compared the number of UTIs per patient per year over 1 year in 3 groups of postmenopausal women: topical HRT, systemic HRT, and control (n=75 per group).
Women aged 60–75 years with a history of UTI (n=448) were identified from retrospective charts (2011–2013). Patients were excluded if they were taking antibiotics for UTI prophylaxis, treated with antibiotics for reasons other than UTI for 2 or more weeks, were on both topical and systemic HRT, or on chronic methenamine hippurate.
The number of UTIs per patient per year was significantly different among the 3 groups. There was a significant difference between topical HRT and systemic HRT, and topical HRT and control, but not systemic HRT and control. The control group had an average of 1.24 UTIs per patient per year, compared with 1.01 in the systemic group and 0.65 in the women who used topical estrogen replacement.

Bottom Line: Topical estrogens may be beneficial when other preferred agents cannot be utilized.

Fido Finds Cancer-Dogs Used To Sniff Out Prostate Cancer

April 13, 2015

We have many high tech methods to detect cancer. We have blood tests, X-rays, CT scans, MRIs just to name a few. Now there’s a low tech means to detect prostate cancer using dogs. An Italian study showed a 93% reliability rate for detecting bladder and prostate cancer.

The latest research, by the Department of Urology at the Humanitas Clinical and Research Centre in Milan, involved two German shepherds sniffing the urine of 900 men – 360 with prostate cancer and 540 without.
Scientists found that dogs were accurate in 98.7% of cases.

They said the dogs are able to detect prostate cancer specific volatile organic compounds in the urine but said an important question remains of how a dog would find it in daily practice.

Prostate cancer is the most common cancer in men in the US, with more than 250,000 new cases diagnosed every year.

Dogs can pick up a scent in a dilution of one to a thousand parts. There is no single test for prostate cancer, but the most commonly used are blood tests, a physical examination or a biopsy.

The research has been published in the Journal Of Urology, one of America’s most prestigious urologic publications.

Bottom Line: Prostate cancer is one of the most common cancers in men and there are a myriad of tests to make the diagnosis. Perhaps in the near future we will be asking fido to help us out!

News To Know About Power Napping

April 11, 2015

My mother, St. Sara (the only Jewish saint!) had a habit of taking a 15-20 minute nap every afternoon and then she had a recharged battery and was able to be exuberant and energetic for 5-6 additional hours. Naps can be quite beneficial to most people who already sleep well at night.

Americans are a sleep-deprived nation. Naps can improve our overall daily functioning. This blog will discuss the benefits of afternoon napping.

Naps can be very beneficial for workplace performance. Short naps have been routinely demonstrated to reduce accidents and mistakes while also improving attention, concentration, performance and alertness. Naps also help boost your mood and ability to manage stress. Naps can be used proactively to gain energy for a late night out. They can even be used effectively to combat drowsy driving when a short snooze is taken just before getting behind the wheel or using heavy machinery.

Routine, planned naps are necessary for some people, while others find that taking an occasional nap when sleepy might be all that is needed. For example, patients with narcolepsy find that planned short naps are crucial to managing their sleepiness every day.

Although it seems simple to take a nap, there are a few tricks to optimize the benefits of a midday snooze. Here are a few tricks from Dr. Oz to getting in a great power nap.

  1. Short, 20-minute power naps are generally much better than longer ones since longer naps cause you to get into deeper stages of sleep, leading to an increased feeling of grogginess upon awakening. Longer naps can also interfere with nighttime sleep. Shorter naps are typically refreshing and can help increase alertness for a few hours.
  1. Make sure that your sleep environment is comfortable, quiet, dark and cool. If you are at home, try to nap only in your bed. If you aren’t at home, find a place where you can either lie down or recline. Block as much light as possible coming into the room (or get a light-blocking eye mask), and consider using a white noise machine, fan or silicone earplugs to block the noise around you.
  2. Power naps taken before 2 p.m. tend not to interfere as much with nighttime sleep, so earlier naps are better. If you find that you have trouble sleeping at night, avoid napping during the day.

Bottom Line: Getting enough sleep is important to our health and well being. Taking a short afternoon nap is an excellent to recharge our batteries just like my mother, St. Sara, was able to do for her whole life.

Bladder Symptoms-Stop Depending On Depends!

April 1, 2015

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.

Clinical Management of Urinary Incontinence in Women

March 30, 2015

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the treatment options for urinary incontinence.
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. I believe in going from tshe least invasive (behavioral modification) to more invasive (surgery) interventions is the best approach. Bladder retraining and pelvic floor muscle exercises are first-line treatments who present with urge incontinence or “I gotta go right now”! Medication with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects such as constipation and blurred vision and confusion, these agents are not recommended in older adults.

Pelvic floor muscle exercises or Kegel exercises are considered first-line treatment for stress incontinence or loss of urine with coughing, laughing or sneezing. Alternatives for treating stress incontinence include vaginal pessaries. At this time no medications are approved by the U.S. Food and Drug Administration for treating stress incontinence. Minimally invasive procedures injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments.

Third line treatment consists of surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.

Bottom Line: Women suffering from urinary incontinence do not have to suffer and should speak to their doctor about treatment options. Usually some of the options are helpful and can make women comfortable and able to engage in most activities without the embarrassment of the loss of urine.

Non-Medical Treatments of Urinary Incontinence

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the non-medical treatment options for urinary incontinence.

WEIGHT LOSS
Women who are overweight or obese and who experience stress incontinence should be encouraged to lose weight, which has been shown to reduce the frequency of incontinence symptoms.32

BEHAVIORAL TREATMENTS
Pelvic floor muscle exercises are the mainstay of behavioral therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure. Increased effectiveness is demonstrated in women undergoing longer training and in those following comprehensive clinic-based training rather than self-help booklets.
Manual feedback (palpating the pelvic muscles during the exercises) and biofeedback (using a vaginal or anal device that provides visual or audio feedback about pelvic muscle contraction) have been used to teach patients the correct technique. Weighted intravaginal cones have also been used for improving technique when women have difficulty identifying their pelvic floor muscles. Although these strategies may improve technique and, consequently, symptoms in the short term, there is no evidence that they result in higher rates of long-term improvement or cure than the exercises alone.

ELECTRICAL AND MAGNETIC STIMULATION
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.

Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence (i.e., using three sanitary pads per day or fewer). A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.

DEVICES
Vaginal inserts, including incontinence pessaries and incontinence tampons, can be used for treating stress incontinence in pregnant women, in those who are not surgical candidates, and in those whose symptoms have not responded to previous surgeries. Vaginal inserts compress the bladder neck and urethra, thus decreasing urine loss caused by stress incontinence. Although pessaries are not widely used, their associated risks and costs are low, and they achieve results quickly. There are few contraindications to pessary use (e.g., active pelvic infection, severe ulceration, allergy to product materials, noncompliance). Incontinence tampons, which also place pressure on the bladder neck, are available in Europe.
[corrected] Urethral plugs are devices that are inserted into the urethra to prevent urine loss during activities that cause stress incontinence (e.g., running). They are available in two lengths: 3.5 cm and 4.5 cm. There is limited evidence promoting or discouraging their use, and they are associated with a number of adverse effects, including urinary tract infection (occurring in up to 31 percent of women over a two-year period), hematuria or blood in the urine (3 percent), and migration into the bladder (1 percent). Despite this, multi-year studies indicate a high degree of patient satisfaction, and the likelihood of significant adverse effects diminishes with continued use.

Bottom Line: Urinary incontinence is a devastating problem affecting millions of American women. You don’t have to suffer in silence. Help is available; speak to your physician

Take Care of Yourself-How To Age Gracefully and Healthfully

March 24, 2015

We are living at a time of longevity. We can live longer and live better today than at any time in recorded history. It is possible with good health to live to 80,90, or even 100 years of age.

Start with setting a goal to live as long as you would like. Ask yourself, are you practicing habits today that will get you to that goal of your desired age.

The three areas that you need to keep in mind to achieve your goal.

1. Achieve an ideal weight. You need to get your weight under control. When you reach your ideal weight, make a commitment to remain at that level for the rest of your life. There should be no yo-yo of your weight but you must remain at the ideal weight for the rest of your life.

The best advice I have is to eat less and exercise more. The law of thermodynamics applies to weight loss. The law simply states the net heat supplied to the system equals the net work done by the system. Therefore, you need to consume fewer calories than you burn from exercise or you need to exercise harder and longer in order to burn more calories than you consume. There is no short cut. There are numerous websites that can help you with your diet and give you a ballpark on the caloric burning that takes place with every day exercises. (http://www.freedieting.com/tools/calorie_calculator.htm, http://calorielab.com/burned/, and http://www.myfitnesspal.com/exercise/lookup

2. Proper diet
Eat better quality foods and fewer of them. Eat more fruits, vegetables and good proteins such as lean meat, chicken, and fish. Eliminate soft drinks, deserts, candies and any other foods containing mostly sugar. Stop consuming extra salt. Eliminate any white flower products. Eat smaller portions and eat 4-6 times a day rather than 3 large meals. By taking control of your eating habits, you can take control of other areas of your life.

3. Exercise
A suggested exercise regimen is 200 minutes\week or 30 minutes a day. You can get all the exercise you need by going for a vigorous walk for 30-60 minutes 3 times a week.

You can even get exercise if you declare that you won’t take the elevator up the stairs or you can park your car 3-5 blocks further than your normal parking spot every day.

Bottom Line: set goals for your life regarding health and fitness and be disciplined to stick to those goals for the rest of your life. You need to make a daily plan and work your plan every day. This requires self-discipline but this self-discipline will help with the discipline you will need in other areas of your life.

Leaking Urine? You Don’t Have To Depend on Depends!

March 24, 2015

Urinary incontinence is one of the most discouraging and depression conditions that affects both men and women. Incontinence can lead to a reclusive life style because of embarrassment and even be a cause of nursing home admission.

Urinary incontinence affects millions of men and women. There are numerous medical treatment options and perhaps one of the easiest solutions is dietary modification. This blog will discuss some of the dietary changes that you can implement to help control your urinary incontinence.

The solution isn’t always to limit your water intake
Remember that if you don’t drink enough water, you might get dehydrated. The problem is, when you have incontinence, drinking a lot of water could also give you problems. Even, the recommended six to eight glasses of water a day can give you problem since you have incontinence. Now, if you don’t drink as much and you will only have little water in your body, this can irritate your bladder and this could make you go often. So, the best way is to ask your doctor what would work best for you.

Cut down on alcohol
Alcohol directly affects your bladder. This is diuretic – so, that makes you go more often to the comfort room. The problem with alcohol is that, this interferes with the signaling mechanism of the brain down to your bladder. So, if you have alcohol with you, you will not be able to control your bladder fully.
However, there are some people who can still control their bladder even if they are drinking alcohol. So, if you don’t want to stop alcohol, the best bet here is to stop it first – and then, add back little by little, so you will know how much of alcohol your body can tolerate.

Go low on the “joe” (caffeine)

You can find caffeine in your soft drinks, teas, chocolate and even in decaffeinated coffees – though in small quantity. The problem with caffeine is since it tells your body to get rid of liquid; you’ll keep on coming back to the comfort room. So, avoid them if you can.

However, if you really love that coffee zest, be sure to do it in the morning. Avoid it at night, though – especially after past 7 p.m. – if you don’t want that sleep disturbed. Be sure also to limit yourself to one or two caffeinated drinks a day.

Avoid Spicy Foods
Avoid eating spicy foods like Mexican, Chinese, chili peppers, chili, and horseradish. Remember that spicy foods can irritate the lining of your bladder -just like caffeine does.

Stay away from acidic foods
Acidic foods like citrus foods and juices – as, oranges and pineapple have acids that can irritate your bladder – just like what spicy foods and caffeine can do – which can make you feel on the go – always!
Tomatoes and cranberry juice are also acidic. Yes, cranberry juice may help bladder infections – but, this doesn’t help if your bladder is overactive. So, please stay away from them if you can.

The Whiz says go easy on the fizz
The carbonated drinks may not have caffeine, but they can irritate a sensitive bladder – and when your bladders are irritated, then you have that urge to go to the rest room as always.
You have to remember that diet is not the only way to go to control your urinary incontinence. You also have to check on your weight gain, diabetes, constipation, aging – and certain cancers (well, I hope this is not the case) since these conditions may cause you your problem.

Bottom Line: Now, if even after following those diet regimen and your condition is still not improving, it is time that you should check with your doctor.

Sperm Counts Really Do Count-Improving Sperm Quality

March 24, 2015

Infertility affects 24% of couples wishing to have a baby. Nearly 1\3 are due to female causes, 1\3 to male causes, and 1\3 are due to both the man and the female partner. Therefore, men are involved in 2\3 of the problems that are responsible for failure to achieve a pregnancy. The first test for any man is the semen analysis. This test is obtained after two days of abstinence or no ejaculation and submitted for a sperm count, sperm movement or motility, and the shape of the sperm.

The world’s largest study on the effects of lifestyle on the quality of sperm has been published this week, with some surprising findings.
Researchers at the universities of Manchester and Sheffield found that smoking cannabis can have a severe effect on male fertility, yet other lifestyle choices such as drinking alcohol and wearing tight briefs were not considered to cause problems, despite earlier reports suggesting otherwise.

Sperm quality has been in decline for decades, and scientists seem unable to make up their minds as to the exact causes, citing everything from smoking to an increased exposure to estrogen.
The latest evidence is good news for jockstrap-wearers and bad news for dope smokers, but how else can you improve your sperm count? Here are five recommendations from leading experts:

1. Eat red food
Last month a report published by Ohio’s Cleveland Clinic, following analysis of 12 studies conducted by different groups around the world, found that consumption of lycopene improved the quality, mobility and volume of sperm dramatically, increasing sperm count by up to 70 per cent. Lycopene is an essential nutrient found commonly in red fruit and vegetables such as tomatoes, strawberries, cherries and peppers.

2. Lay off the laptop
A 2011 study published in the journal Fertility and Sterility suggested there could be a link between using a laptop with a Wi-Fi connection and a reduction in sperm quality. Sperm samples from 29 men were stored normally and under a laptop connected to WiFi. The sperm stored under the laptop became more sluggish and showed signs of DNA damage.

3. Get off your bike
Cycling has myriad health benefits, but not when it comes to your sperm. A 2009 Spanish study found that a prolonged spell on your bike can severely affect the shape and quality of your sperm. After monitoring 15 Spanish triathletes with an average age of 33 the study found that those men that cycled 300 kilometers a week (about 160 miles) – had dered a fertility problem.

4. Keep your cool
The optimum temperature for sperm production is 34.5 degrees celsius, which is slightly below body temperature. A three-year University of California study in 2007 found that five out of 11 men who stopped taking hot baths (including saunas) experienced a sperm count rise of almost 500 per cent.

5. Drink coffee – Go For Joe-but not too much
In 2003, researchers from Sao Paolo University in Brazil studied 750 men and concluded that drinking coffee can improve the swimming speed, or motility, of human sperm, although whether this means pregnancy rates are higher among coffee drinkers is unclear.

Bottom Line: Men are part and parcel of the baby making equation. If you have any questions, see your urologist and start with a sperm count.

Meet the New Orleans magician / urologist who offers a March Madness vasectomy special

March 19, 2015

This article appeared in USA Today Sports
By: NATE SCOTT March 18, 2015 2:19 pm ET

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Dr. Neil “The Whiz” Baum is a New Orleans urologist and part-time magician who, every year at the start of March Madness, offers a vasectomy special to local men. The deal is patients get a scalpel-free vasectomy, a pizza, a Sports Illustrated swimsuit issue, a frozen gel pack, and a bell, so that patients can sit on the couch and ring for someone to “bring them a fresh beer or whatever they need.”

Dr. Baum hopped on the phone with For The Win to discuss his special, its popularity, and his friendship with Chicago Bears running back Matt Forte.

FTW: So I remember when I lived down in New Orleans, I used to hear about your special on the radio, and my friends and I thought it was the funniest thing in the world. Is it still happening?

NB: Oh yes. I have to limit it to about ten a weekend. I could probably do more. I want to make sure I’m not exhausted so I can enjoy the games myself. I limit it to ten each weekend.

FTW: When did this start?

NB: This started about 3 or 4 years ago. [It actually began back in 2009.] I’ve tried to do it for Super Bowl weekend and I’ve tried to do NBA playoffs, but neither worked, and I can’t figure out why.

But Super Bowl weekend, there are too many parties. No one wants to be by themselves. And NBA, I just don’t think it’s as big.

FTW: It’s also a lot more spread out, the NBA playoffs. Where March Madness all happens right in a row, so it’s OK to sit on the couch for a day.

NB: Yep. March Madness. It works every year. The patients love it.

FTW: Am I remembering wrong? Didn’t you at one point give out a bag of frozen peas with this special?

NB: We give out a gel pack now. And it has my name on it. It lasts longer than the frozen peas.

FTW: Are you still doing magic shows as “The Whiz”?

NB: Oh yeah. Absolutely. It’s so cool that I can call up people and say “Oh hi, it’s the Whiz,” and everyone who knows me and has interacted with my magic knows it’s me, and gets the double entendre with my name. Urologist and a magician. And my license plate is “THE WHIZ.”

FTW: I remember seeing it around New Orleans.

NB: Oh yeah. I gave my daughter Lauren my car once, she was in high school, and she didn’t quite have the confidence she has today. And she would scream: “I don’t want a car that has THE WHIZ on the back!”

FTW: So, to change topics a bit, Matt Forte used to live in your house when he was finishing up his degree at Tulane, right?

NB: Yes, Matt. He lived here for four months after his rookie year. We used to play ping pong. If I lost, I had to do 25 push-ups, and if he lost, he had to do 50 push-ups. And I used to beat him badly, for so many months, his big arms are due to me. [Laughs] No, no. He used to beat me. And the thing with Matt is, you can’t trash talk him. He’s been around all that. You can’t get under his skin, ever.

New Treatment For The Enlarged Prostate Gland-The UroLift

March 13, 2015

NEW ORLEANS – It’s a condition that men may not want to talk about, but it affects their sleep, their intimate relationships, and work.

But now there’s a new, simple fix for a common prostate condition.

Doug Depp is one of the millions of baby boomer men with a common health problem, Benign Prostatic Hyperplasia, called BPH.
“I was getting up 4, 5 times a night easy and feeling the discomforts of it. I couldn’t empty my bladder. I lost a lot of confidence in being able to go places, be comfortable,” said Depp, 68.

After the age of 50, the prostate gland, for some reason, grows. When it does, it squeezes down the size of the tube that urine flows through. It affects a man’s quality of life. But now there is a new procedure called UroLift System. It involves no cutting or heating away tissue in an O.R.

“I think this is a game changer, and the reason being is that often times men who have an enlarged prostate, are treated with medications. These medications affect their sex life,” explained Dr. Neil Baum, a urologist at Touro.

The UroLift has a pin on one side and a clip on the other. In less than an hour in the office or outpatient surgery, Dr. Baum inserts a few of the devices through the urethra. They permanently hold both sides of the enlarged prostate away from putting pressure on the urethra. Men can either be under mild IV sedation or a local anesthesia.

“This procedure, the UroLift, preserves sexual performance. The men have no problem with ejaculation. It doesn’t affect their erections and the beauty is when they have the procedure, they go out without a catheter most of the time, and they are able to urinate with improved stream immediately,” Dr. Baum explained.

Depp says there was not a lot of discomfort and a few days later he was 100 percent normal again.

“I used to always think of a place to go, you know, McDonald’s or some place you know, on the way, and you have to pick and choose but now it’s a lot more freedom not to worry about it,” laughs Depp.

The UroLift is FDA approved and most insurance companies pay for the procedure.


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