Smelling Prostate Cancer

February 19, 2016

Prostate cancer is the most common cancer in older men with nearly one quarter of a million new cases discovered each year.  It is the second most cause of death in men with over 25,000 deaths each year.  Now there is a new diagnostic device that can detect prostate cancer in men’s urine.

A new device, Odoreader, was developed in the UK which can be helpful in disgnosing prostate cancer by identifying the unique odor in the urine of men with prostate cancer.

The researchers looked at a total of 155 men of which 58 had been diagnosed with prostate cancer by evaluating their urine with the Odoreader. The researchers found that Odoreader was able to successfully identify patterns of volatile compounds from urine samples, and detect those that indicate cancer.

Unfortunately at the present time there is no accurate test for prostate cancer. The standard used to day is the PSA blood test. The PSA test is not specific for prostate cancer and may also detect other prostate conditions such as benign enlargement of the prostate as well as prostate infections. The PSA test indicators can sometimes result in unnecessary biopsies, resulting in psychological toll, risk of infection from the procedure and even sometimes missing cancer cases. This new testing procedure can detect cancer in a non-invasive way by smelling the disease in men’s urine.

The Odoreader could pave the pathway for a new detection technique of prostate cancer, making invasive diagnostic procedures like a prostate biopsy less necessary and potentially saving the lives of many men who fight the disease.

Bottom Line: Prostate cancer is a prevalent medical problem affecting thousands of American men.  Now there is a new technique for the diagnosis of this disease which is non-invasive, accurate, and will help men avoid unnecessary diagnostic studies and perhaps unnecessary surgery.

Vaginal Wind Is Not Like Having Wind In Your Sails!

February 19, 2016

It is not uncommon for women to ask me about passing gas from their vaginas.  This situation goes by many names: vaginal farts, vaginal flatus, fanny farts, vaginal wind just to name a few.  The technical term is referred to as queefing.

What causes vaginal wind?

During sexual intimacy air is pushed into the vagina. Air enters the vagina not only during sex but also at the time of a speculum inserted into the vagina during a pelvic exam or with the insertion of a tampon. Air can also be pulled into the vagina during some kinds of exercise including Pilates.

If you push air in, it has to come out. And, as it escapes, it makes that characteristic sound of air coming out any small orifice such as the rectum. The difference is that vaginal wind does not have any odor like flatulence from the rectum which has an odor because of the methane gas in the colon.  Sometimes vaginal wind can happen right after the air’s been pushed in, sometimes it can be a while later when things like laughing, coughing or walking force the air out. 

Solving the problem

If you want to reduce vaginal wind during sex, avoid lots of deep and fast penetration. If you’re using sex toys with a wide girth you may want to avoid these if they’re making noise after they are inserted.

When to seek doctor’s advice

Fanny farts are very normal and not a sign there’s something wrong. However, seek medical advice if you have vaginal or abdominal pain during and after sex, notice your vagina smells bad, or there’s an unusual vaginal discharge. Particularly if you’ve recently had colorectal, bowel or gynaecological surgery, or have had a baby.

You also need a medical opinion if you’re leaking urine outside of urination, or notice fecal material inside your vagina as this might indicate a connection between the urinary tract and the gastrointestinal tract.

Bottom Line:  Vaginal wind is almost never a condition requiring treatment or therapy.  Yes, it may be a source of embarrassment but should be considered in a light hearted fashion and a source of humor not a hygienic problem.

Good News About Red Wine and Prevention of Erectile Dysfunction (ED)

February 19, 2016

 

ED affects millions of American men.  Most of the men have ED from vascular causes such as heart disease, high blood pressure, diabetes, or side effects of medications.

Men who consume red wine and blueberries and take regular exercise can cut their risk of developing erectile dysfunction by over a fifth.  My cardiologist, Dr. Frank Wilkow, informed me that two glasses of red wine a day was good for my heart and my erections.  (He also told my wife that one glass of red wine was good for her heart as well!)

Scientists have identified that foods rich in certain flavonoids cut the risk of men experiencing the sexual problem which affects up to half of all middle-aged and older men.

The foods with the greatest benefits include blueberries, cherries, blackberries, radishes and blackcurrant, which contain anthocyanins; as well as citrus fruits, which are packed with flavanones and flavones.

The study from The American Journal of Clinical Nutrition showed that men who regularly consumed food high in flavonoids were 10% less likely to suffer from ED.

Bottom Line: Men who consume a diet rich in flavonoids plus participate in regular exercise and maintain their body weight are the best way to preserve sexual health as well as a reduction in cardiovascular risk factors.  And another benefit is that men who consume the healthy diet also have a reduction in risk of diabetes.

Latest News on Testosterone-NBC Nightly News on 2\17\16

February 17, 2016

Testosterone gel can help some men get back a little of their loving feelings, and helps them feel better in general, according to a new study published today by the National Institute of Health.

It’s the first study in years to show any benefit for testosterone therapy. This was the first time that a trial demonstrated that testosterone treatment of men over 65 who have low testosterone would benefit them in any way.  The trial showed that testosterone treatment of these men improved their sexual function, their mood, and reduced depressive symptoms—and perhaps also improved walking.

The FDA does not approve the use of testosterone to treat the effects of aging. But it’s already a $2 billion industry, with millions of men buying gel, pills or getting injections.

Experts stress that the results, published in the New England Journal of Medicine, only apply to men over 65 who have medically diagnosed low testosterone. The trial consisted of 800 men.

A few men had heart attacks or were diagnosed with prostate cancer during the study, but the rate were the same in men who got real hormone and in those who got placebo cream.

Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved since the beginning of the trial. Men who received testosterone reported better sexual function, including activity, desire, and erectile function, than those who received placebo. Although the effect sizes were low to moderate, men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved.

Testosterone was also associated with small but significant benefits with respect to mood and depressive symptoms. Men in the testosterone group were also more likely than those in the placebo group to report that their energy was better.

As men age, their bodies make less testosterone. It’s not as sudden as when women lose estrogen, but the effects can be similar – loss of energy, sexual desire, depression and bone loss.

Bottom Line: Testosterone is the male hormone responsible for sex drive, erections, bone strength, muscle mass, and even mood.  The hormone decreases starting in men in their 20’s and usually become symptomatic in the late 40s and 50s.  The diagnosis is easily made with a simple blood test and treatment is easily accomplished with injections, topical gels, or pellets inserted underneath the skin.  For more information speak to your doctor.

Premature Ejaculation-When Comin’ Instead Eof Goin’!

February 2, 2016

 

Nothing is more embarrassing to a man than a problem of rapid ejaculation.  Men are interested in satisfying their partners and when they ejaculate\cum too soon, it is a source of embarrassment and anxiety for every man and a source of frustration and lack of fulfillment for every partner.

Premature ejaculation (PE) is a problem that plagues 36,000,000 men and is defined as ejaculation within 5 minutes of penetration. It is important to point out that premature ejaculation depends on the satisfaction of the partners.  It is a sexual event for a male actually includes erection orgasm, and ejaculation.

The exact etiology of PE isn’t clear, but it is felt to be a lack of control of the receptors to the nerves from the spinal nerve to the prostate gland and the seminal vesicles, the two organs behind the prostate gland that store the sperm prior to ejaculation.

A list of treatments that have been shown NOT to be beneficial incldues:

1. Long-term psychoanalysis.

2. Getting drunk.

3. Use of one or more condoms.

4. Concentrating on something other than sex while having intercourse. (i.e. Baseball line-ups, or state capitals)

5. Biting one’s cheek.

6. Frequent masturbation.

7. Testosterone injections.

8. Tranquillizers.

9. PD5 inhibitors.

Current treatment options available include selective serotonin reuptake inhibitors (SSRI’s), utilizing the side effect of delayed ejaculation via their impact on the receptors in the brain. In numerous studies, these medications taken on a regular basis have been shown to prolong ejaculation. Drugs in this category include Zoloft, Anafranil and Prozac.

Topical creams have been tried in the past and recently, a company, Promescent, (for more information go to Promescent.com) has come out with a spray that is applied to the penile glans to lessen sensitivity. It is available online without a prescription and the feedback from the men who have tried it has been very positive.

My current recommendation is for men to start with Promescent if that is not successful, then consider the SSRI’s.

Bottom Line:  Premature ejaculation is a very common problem affecting millions of American men.  It certainly impacts the relationship between a man and his partner.  Help is available.  Speak to your doctor.

Testosterone and the Prostate Gland-Hormone Replacement Is Safe For Your Prostate Gland

January 28, 2016

I am also asked if using testosterone, injections, topical gels, or pellets, will worsen urinary symptoms in men suffering from testosterone deficiency.

Millions of Americans suffer from testosterone deficiency.  They have symptoms of loss of energy, erectile dysfunction, loss of libido, loss of muscle mass, and emotional mood swings.  The diagnosis is easily made with a testosterone blood test.

A recent review finds no evidence that testosterone replacement therapy causes or worsens urinary tract symptoms or increase the size of the prostate gland.

Although the Endocrine Society and other associations have suggested severe urinary symptoms as a contraindication to TRT treatment, investigators found little evidence to support it worsening urinary symptoms in men using testosterone replacement therapy.

The investigators discovered that men with mild urinary sympmtoms experienced either no change or an improvement in their symptoms following TRT.

Remarkably, the study explained that the therapy may actually improve voiding symptoms.

Bottom Line:  Testosterone replacement therapy is safe in men with urinary symptoms and will not worsen those symptoms but may actually improve their symptoms.

Source

Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, and Seftel A. The Relationship Between Testosterone Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology S0090-4295(15)01053-3. doi:10.1016/j.urology.2015.11.006.

Update on ED-When It Is Dead Down There

January 27, 2016

ED is the inability to achieve and maintain a normal erection adequate for penetration that impacts the intimate relationship between partners.  There are nearly 30 million American men suffering from ED.

ED may occur under various circumstances ranging from diabetes, hypertension, prostate gland surgery, spinal injuries, neurological and emotional problems.  There are times when there is no identifiable cause. However, it’s far more frequently seen in diabetics and to some extent in those with cardio vascular diseases, hypertension and peripheral vascular disease. The effect on the blood vessels leading to poor blood flow seems to be the primary reason.

People suffering from ED should carry out assessment of blood sugar, cardio vascular evaluation, measurement of hormones like testosterone and prolactin. A psychological evaluation will often benefit those who suffer from performance anxiety. Depression is often seen as an accompanying factor of erectile dysfunction in many people especially when there is no other identifiable cause. A detailed evaluation of a man’s medication is also important. Smoking and excessive drinking are both known to have significant adverse impact on erectile dysfunction.

Alcohol is a depressant, and using it heavily can dampen mood, decrease sexual desire, and make it difficult for a man to achieve erections or reach orgasm while under the influence.

According to the U.S. Centers for Disease Control and Prevention, CDC, moderate drinking is no more than two drinks a day for men (and one drink a day for women). The liver can only break down the amount of alcohol in about one standard-size drink an hour, so regularly drinking more than that means that toxins from alcohol can build up in your body and affect the blood vessels supplying the penis.

Heavy drinking can lead to temporary erectile dysfunction. This is because pre-sex drinking decreases blood flow to the penis, reduces the intensity of your orgasm, and can dampen your level of excitement.  Also, Long-term erectile dysfunction has been linked to chronic heavy use of alcohol. In fact, studies show that men who are dependent on alcohol have a 60 to 70 percent chance of suffering from sexual problems. The most common of these are erectile dysfunction, premature ejaculation and loss of sexual desire.

Bottom Line:  ED is a common problem affecting millions of American men.  Help is available.  If you or one you love is suffering from ED, speak to your doctor.

PSA Testing-What Every Man Needs to Know

January 18, 2016

Prostate specific antigen is a simple blood test that can be a metric for prostate health.  It is a good screening test for prostate cancer.  This blog will discuss the PSA test and what you need to know to make a decision to obtain this common test.

Let’s start by reassuring men that having an elevated PSA level does not necessarily mean you have prostate cancer.

PSA is also likely to be increased with benign enlargement of the prostate gland as well as prostate infections or prostatitis.

It is important to emphasize that the PSA test is not a specific prostate cancer test, but it is a vital first step in screening for the potential presence of cancer.

The other factors that can cause PSA levels to rise:

  • Age: PSA levels can increase gradually as you age
  • Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
  • Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
  • Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
  • Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
  • Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days. That is why I usually recommend that men refrain from sexual intimacy for 48 hours prior to PSA testing
  • Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter inserted into the blader, a prostate biopsy, or a cystoscopy which is a look using a lighted tube through the urethra (tube in the penis that transports semen and urine) can increase the PSA temporarily.

A PSA level of less than 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of prostate cancer.

I point out that there is a familial or inherited basis of prostate cancer and also an increased risk of prostate cancer in African-American men.  In these men who are are at a greater risk of prostate cancer, I suggest annual testing with a digital rectal examination and a PSA test after age 40.  For all others, I suggest testing begin at age 50.

For men who have an elevated PSA test, then a discussion with the doctor about repeating the test in a few weeks or proceeding to an ultrasound examination and a prostate biopsy is in order.

Bottom Line: PSA testing is a non-specific test used to screen for prostate cancer.  Not all elevations of the PSA test indicate cancer.  Further testing and close monitoring as well as a prostate biopsy is in order.  For more information, speak to your doctor.

Preventive Health For All Men

January 18, 2016

Do you know that most men spend more time taking care of their cars or planning a vacation than they do taking care of their health?  In the U.S., women live 5-7 years longer than men.  I believe one of the reasons is that women seek out regular medical care throughout their entire lives.  They see a obstetrician during child bearing years; they get regular mammograms; they obtain routine PAP smears and other preventive health measures for their entire lives.  Men, on the other hand, stop seeing a doctor around age 18 and never see the inside of a medical office until middle age.  During that time they can have high blood pressure, elevated cholesterol levels, diabetes, and prostate diseases.

But there are some things men, in particular, should keep in mind when it comes to maintaining their health:

Heart disease and cholesterol

According to the Centers for Disease Control and Prevention, about 200,000 people die each year from preventable heart disease and strokes, with men being significantly more at risk than women.

Men should begin screenings for these issues in their mid-30s.

Annual health examinations should begin at around age 50.  This should include a test for anemia, a cholesterol level, a chest x-ray if the man is a smoker, a PSA test for prostate cancer, and a blood pressure determination.

For those men with an elevated cholesterol level, they can lower the level by adhereing to  a healthy diet consisting less heavy in red meats and carbohydrates, and limiting alcohol consumption, i.e., 2 drinks\day. Men of all ages should also continue to stay physically active by incorporating aerobic activities, i.e., any activity that increases the heart rate for 20 minutes 3-4 times a week, into their lifestyle, as well as strength training.

Prostate health

There is some debate among health care professionals about when men should begin screening for prostate cancer. The U.S. Preventive Services Task Force and the CDC recommend against screening unless men begin experiencing the symptoms associated with prostate cancer. These include frequent urination, especially at night, pain during urination and difficulty fully emptying the bladder.

Prostate screening can begin earlier in life, around age 40, if there is a high risk for prostate cancer, such as family history, or bothersome lower urinary tract symptoms.

Testosterone

As men age, lowering testosterone levels can become another area men should monitor.  Significantly low testosterone levels can predispose a man to low bone mineral density with subsequent bone fractures, erectile dysfunction (impotence) and low energy levels.

Testing for testosterone levels is done through a blood test.

Bottom Line: these are the minimal preventive care that all men should consider around age 30-40.  Remember if it ain’t broke don’t fix it, may apply to your car, but not to your body.  You need to take preventive measures with your body just as you do with your automobile.

Pelvic floor exercises for men

January 15, 2016

Historically, pelvic floor exercises, have been recommended for women with urinary incontinence.  However, doctors have discovered that these same exercises are useful for men as well.  This blog will discuss the use of pelvic floor exercise for men.

The muscles of the pelvic floor not only hold organs in place, but they are also important for bladder control. Because these muscles often weaken with age, men are advised to exercise them regularly by doing pelvic floor exercises in order to maintain their continence of urine as well as having improvement in their sexual functioning.

What are the pelvic floor muscles?

The muscles that support the organs in the pelvic area are known as pubococcygeus or pelvic floor muscles. These muscles are like a trampoline or sling that stretches along the bottom of the pelvic area from the pubic bone in the front to the tail bone (or coccyx) at the back, as well as from side to side between the sitting bones. In men, they support both the bladder and the bowel, with the urethra (the tube carrying urine from the bladder) and the rectum (back passage) passing through the muscles. Pelvic floor muscles are also important for erectile function, and they work with other muscles to help stabilise the back. 

Why exercise the pelvic floor muscles?

The pelvic floor muscles naturally stretch and weaken with age, which can gradually make them less efficient. The muscles can also be weakened in men who often strain to empty their bowels – such as having constipation on a regular basis – who have a chronic cough, bronchitis or asthma, who perform tasks that involve repeated heavy lifting, and who are overweight or generally unfit. Having surgery for an enlarged prostate gland can cause the pelvic floor muscles to weaken, as can neurological damage such as from a stroke, diabetes, multiple sclerosis or a spinal injury.

Weak pelvic floor muscles in men can lead to stress urinary incontinence, in which small amounts of urine leak when pressure is placed on the bladder – for example, when bending forward, sitting, coughing or laughing – or urge incontinence, when there is an urgent need to urinate more often. You may leak just a few drops of urine, have a dribble after you finish urinating or leak a steady stream of urine. Weak pelvic floor muscles can affect erectile function too.

However, in a similar way that you can strengthen the muscles of your arms or legs through exercise, you can also strengthen your pelvic floor muscles.

These exercises are also recommended for men prior to having surgery for an enlarged prostate or prostate cancer to help improve their bladder control. They are also recommended for men who experience chronic pelvic pain syndrome – performing the exercises when pain starts can help to interrupt a cycle of pain-spasm-pain.

How can you find your pelvic floor muscles?

Before you start doing pelvic floor muscle exercises, it’s important to find the correct muscles to ensure you are exercising them. The next time you urinate, stop urinating mid-stream and concentrate on the muscles that allowed you to do this – these are also the same ones you use to prevent passing wind. Once you have emptied your bladder (don’t stop the flow mid-stream more than once), try contracting the same muscles – you should notice the base of your penis rising towards your tummy and see your testicles move up as you contract the muscles.

Another way to find your pelvic floor muscles is to sit comfortably or lie down, ensuring the muscles of your abdomen, thighs and buttocks are relaxed. Now, tighten only the muscles that control your back passage as if you are trying to avoid passing wind for a few seconds, then relax.

To ensure you aren’t squeezing other muscles, try squeezing your pelvic floor muscles again and:

  • Rest your hand on your tummy – you should not feel your abdominal muscles tighten
  • Pay attention to your breath – if you are holding your breath, you are using your chest muscles; try to breathe normally while squeezing your pelvic floor muscles
  • Sit in front of a mirror – if you notice your body moving up and down, even slightly, you are squeezing your buttocks
  • Watch your thighs – their muscles should be relaxed without noticeable movement in the upper legs. 

How should men do pelvic floor exercises?

Now that you’ve identified your pelvic floor muscles, simply contract them, squeezing and drawing up the muscles around your urethra and back passage at the same time, and holding them for a count of 5, then release the muscles slowly. By doing this simple technique, you have just flexed your pelvic floor muscles. Don’t hold your breath, and make sure you are not working other muscles such as those in the buttocks, thighs or abdominal area.

Wait a few seconds before repeating the technique, doing a set of 8-10 squeezes using strong slow contractions, then follow with one set of 8-10 quick rapid contractions. Repeat this sequence 4-5 times a day. Once you find it easy, you can increase the count for longer, up to 10 seconds. However, take care you don’t over-exercise the muscles and cause muscle fatigue towards the end of the day, thereby increasing urine leakage.

It will take 4-6 weeks before you notice any improvement, but after about 3 months you should experience the full benefit of doing pelvic floor exercises. At this point, you can change your routine to doing pelvic floor exercises twice a day.

If you have problems with incontinence or have recently had prostate surgery, you may be referred to a specialist who will help train you in how to do the exercise correctly and establish a program based on the strength of your muscles.

Pelvic floor exercises take very little time and can be done while sitting, standing, lying down or walking. Because others will not notice the muscles moving, you can do them discreetly during your everyday activities, such as while on a bus or train, sitting in a car, even standing in a queue – the main thing is to get into a routine of doing them every day. Try getting into the practice of doing them at the same time, such as when brushing your, after urinating, when commuting home from work or during advert breaks while watching the TV in the evening.

Bottom Line:  Pelvic floor exercises aren’t just for women but men can also benefit from these exercises.  Men should consider doing these exercises that don’t require any equipment, very little time, and have very effective results.


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