Archive for November, 2013

Online Purchasing of Medications-Let the Buyer Be Aware

November 27, 2013

No one knows what the Affordable Care Act will provide in the near future. One thing we know for sure is that the cost of prescription medicine will continue to rise. As a result many Americans are buying their medications online and overseas.

Though technically illegal, millions of Americans buy prescription drugs from overseas pharmacies to save money. But the practice can be a huge gamble.
The National Association of Boards of Pharmacy, a professional group, reviewed over 10,000 Internet drug outlets and found that many sold fake or unapproved drugs. Some that claimed to be Canadian pharmacies actually sold medicines from developing countries where regulations are weak and counterfeit drugs are common.

Only 2 to 3 percent of online pharmacies are legitimate. When buying Canadian look for outlets certified by the Canadian International Pharmacy Association, a trade group of Canadian pharmacies, or those certified by, a free website that verifies that the foreign sites it approves protect consumer information and meet quality standards.

A study analyzing 372 orders of five popular prescription drugs – Lipitor, Celebrex, Viagra, Nexium and Zoloft – that were purchased from 79 domestic and foreign online drug outlets. Products bought from Canadian or other foreign sites certified by C.I.P.A. or were of high quality. So were products ordered from American sites verified by either the N.A.B.P. or, a certification agency founded by a former White House aide on drug policy issues.

But that was not the case for sites that were not certified by any of these four groups. Many of the drugs they sold were fakes, including about a quarter of the Viagra samples, which largely appeared to have originated in China.

You can’t be 100% certain with any sites, frankly, but you are running a much lower risk if you buy from a credentialed site.

Bottom Line: You get what you pay for. If it’s significantly cheaper, there’s probably reason for the decreased cost. I suggest you buy drugs, like heart drugs, blood pressure medication, and medication for treating diabetes, from credible and reliable sources.

This article was excerpted from an article, Is it Safe To Buy Drugs From Online Pharmacies In Canada? by Anhad O’Connor, NYT, November 12, 2013

Tired and Fatigued? It’s Probably Not Your Adrenal Gland

November 23, 2013

Recently there has been publication about JFKs chronic medical problems which includes Addison’s disease that caused him so much discomfort including severe low back pain that required him to take powerful pain killers. In addition to the pain Addison’s disease is a source of chronic fatigue. There are multiple causes of fatigue or lack of energy. One of the rare causes is adrenal fatigue. This is a vague term that’s used by some to say that fatigue and other symptoms are caused by a poorly working adrenal gland in people who are under mental, emotional, or physical stress. But it’s not a proven medical condition.

Your adrenal glands sit atop your kidneys like caps. Certain conditions can keep your adrenal glands from working well. Your adrenal glands make hormones. One of these is cortisol, which helps your body deal with stress. If your adrenal glands stop producing cortisol, you may be suffering from Addison’s disease.
Symptoms include of real adrenal fatigue:
Trouble getting out of bed
Chronic tiredness, even after you wake up in the morning
Trouble thinking clearly or finishing your tasks
But some doctors say these symptoms can be due to other health problems. It is of interest that these are the very same symptoms which are very common in people in general.

Although adrenal exhaustion is a rare possibility of fatigue, the most common causes include poor sleep habits, poor diet, stress at work or home or depression. One of the most common causes of fatigue in men is testosterone deficiency. All of these can affect your energy level without involving your adrenal glands.

Fatigue is also a symptom of many diseases such as anemia, arthritis, diabetes, and heart failure.
Addison’s disease can cause fatigue and is associated with other symptoms, such as darkening of the skin on the palms of your hands, knees, elbows, and knuckles, general weakness, dizziness when you stand up and lack of menstrual periods in women.

If unusual fatigue is bothering you, these steps can help ensure that you get the proper treatment:
The basic elements of a healthy lifestyle will help you feel more energized.
• Eat plenty of fruits, vegetables, and lean meat. Avoid junk food.
• Get enough sleep.
• Exercise regularly.

Bottom Line: Although adrenal insufficiency is a cause of fatigue, it is rare and there are much more common causes. Speak to your doctor and have a healthy diet, get plenty of sleep, and exercise regularly. This will not only help with fatigue but will help with many other conditions such as heart disease, diabetes, and high blood pressure

Take Two (Aspirins) “At Night” And You Won’t Need To Call Me In the Morning

November 22, 2013

Take Two “At Night” And You Won’t Need To Call Me In the Morning

For several decades doctors have been prescribing low dose aspirin as means to protect against heart disease. Most men, including myself, take the aspirin in the morning. The researchers wanted to see if taking aspirin at night could better thin a person’s blood and potentially lower their heart attack risks.
Since the 1980s, it’s been known that cardiovascular events happen more often in the morning. Morning hours are a peak period of activity for platelets, blood cells that aid in clotting, he said. Doctors suspect that might have a hand in the increased risk of heart attacks and strokes in the morning.
Aspirin reduces the activity of platelets, and thus reduces the chance that those platelets will clot in the bloodstream and cause a heart attack or stroke, according to the findings.

Until now most doctors didn’t feel that timing of the dose, morning or evening, would matter. That’s because aspirin has a long-lasting effect on platelets, helping thin the blood for days after it is taken.
That’s why, prior to surgery, patients are told to hold off on aspirin for five to seven days, and why it continues to thin your blood even when you miss a dose.

But the Dutch researchers found that taking aspirin at bedtime reduced platelet activity more than taking it in the morning, apparently because it headed off the body’s normal morning surge in platelet activity.
The team also found that people who took aspirin at bedtime did not suffer any more stomach upset or other side effects than people who took it in the morning,.

Cardiologists who have reviewed this report suggest that until larger follow-up studies take place, people prescribed aspirin for heart problems should continue to take it whenever in the day they like.

Bottom Line: Taking baby aspirin has an affect on blood clotting mechanism and prevents heart attacks and strokes. Since there is no disadvantage to taking the medicine at night, I plan to use this medication before going to bed. If you have any questions about this recommendation, ask your doctor

Diapers-Okay For a Toddler But Not For Adult Men

November 17, 2013

Loss of urine is no laughing matter.  It affects nearly 14 million American adults.  Let’s put the myth aside that incontinence only affects women.  Incontinence it’s surprisingly common in men of all age groups. In fact, it’s been reported as being only half as frequent in men as in women, which represents quite a sizeable number of sufferers. Unfortunately, men with incontinence rarely discuss it with their physician, so that the necessary attention is not paid to the problem.


Surprisingly, 25% of men aged 40 or below reported incontinence at least once during the past 12 months. All men over 40 had at least a 30% incidence of incontinence – it was 36% in the 60 to 70-year-olds – but it dropped to 20% in the over-80-year-olds.


The results were analyzed to see if there were obvious relationships between incontinence and possible causes. Men who had had prostate surgery or bladder surgery, or who were taking medications for urinary problems, had a significantly increased likelihood of being incontinent (2 to 3 times more likely). Prostate cancer, taking diuretics (water-pills) or prostate medications did not affect the likelihood of incontinence.


Not surprisingly, frequent incontinence was associated with deterioration in some aspects of the quality-of-life. For instance, emotional health, social relationships, physical activity, and travel were all less satisfactory for incontinent men.


Only a third of the men with incontinence had discussed the problem with their physicians. However, three-quarters of them expressed an interest in having a full evaluation and treatment of the problem, if it were offered.


It can be concluded that male incontinence is a real problem across all age groups, and that it affects men’s quality of life. Unfortunately, the sufferers do not often discuss it with their physicians. There is clearly much room for improvement in its diagnosis and management.


Bottom Line:  Most men with incontinence can be helped and many can even be cured with exercises, medication, and surgery.  Sufferers should not suffer in silence, but speak out to their physicians and health providers, in order that more attention is paid to their problem. 

Vasectomy and Other Medical Issues-Prostate and Testicular Cancer

November 14, 2013

There isn’t a day that goes by that men ask me about the consequences of having a vasectomy.
These reports were prompted by concerns that vasectomy, which involves surgery to cut the tubes that carry sperm, could lead to inflammation in the pelvic region. Prolonged inflammation in certain circumstances can increase cancer risk.

There has been some uncertainty surrounding this question, but recent studies have demonstrated that having a vasectomy has NO effect on the risk of prostate or testicular cancer.
Older data – from studies tracking disease rates across broad population groups – suggested a modest connection, while other studies found no such link.

More recent studies from researchers at institutions such as Boston University and the University of Washington showed no convincing association between vasectomy and prostate cancer. The Boston University group and researchers in Denmark found no link between vasectomy and testicular cancer.

Bottom Line: Today, we can say with confidence that vasectomy does not increase or decrease the likelihood of developing prostate or testicular cancer.

Testosterone And Heart Disease – Facts and Caveats

November 6, 2013

Like most urologists, endocrinologists, and cardiologists, I have received numerous calls from men who have symptoms of low testosterone, documented decrease in their blood testosterone level, and who are receiving testosterone replacement therapy about a study that appeared in a reputable medical journal that treatment with testosterone increases the risk of heart disease. (JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386).

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from normal. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, then the doctor will recommend increase the consumption of this necessary vitamin. These actions are what doctors do every day; they attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal.

There are more than 13 million men in the United States who suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

I would like to list several comments about the study that was reported in the recent Journal of the American Medical Association (JAMA).

Of nearly 7,500 guys who did not get extra T, about 1 in 5 had bad cardiovascular outcomes, including stroke, heart attack or death. In the more than 1,200 men who got testosterone, nearly 1 in 4 had those terrible problems, an increased risk of nearly 30 percent. A truly scientific study has similar number of study patients in each group, not 7500 in the control group and 1200 in the experimental group.
The researchers concluded that taking testosterone came with an increased risk of an adverse outcome. If a statistician would add up the actual reported events in the paper for each group and divide by the numbers of men in each group. What you will find is that the absolute risk of events (death, heart attack, or a stroke) was 10% in men treated with T and 21% in men not treated. That’s right- the risk was REDUCED BY HALF in men treated with T. So a closer scrutiny needs to be done before conclusions can be made and distributed to the media.
This is obviously the opposite of what the authors reported. They come up with absolute risk rates that are not explained by any numbers in their paper. They used a complex statistical analysis to get to their conclusions without showing the numbers it was based on.

That’s not the whole story, though. Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania wrote in an accompanying editorial: “The most important question is the generalizing the results of this study to the broader population of men taking testosterone ….” The take home message is not possible to generalize from this study to the entire population of men some of whom may have a low testosterone level.
That’s a very big caveat: By definition, all the men in the study were older than 60 and all had heart problems. It’s still not clear whether those same risks apply to younger, healthier guys.
“These were sick, older veterans,” Dr. Michael Ho, a cardiologist with the VA Eastern Colorado Health Care System who helped direct the study, said in an interview. Many were obese, had diabetes, and other ailments, he said. Obese men with diabetes and other co-morbid conditions are certainly at risk for heart disease, stroke, and even death.

Bottom Line: So what is a man who has low testosterone to do? I would suggest that they have a discussion with their doctor. If they have symptoms of low testosterone, and a documented level of low testosterone blood test, then the doctor and the patient have to weight the risks of testosterone replacement therapy versus the benefits. Certainly if the benefits outweigh the risks and the risks are composed of an older man with heart disease, diabetes, and other illnesses, then raising the testosterone level may not be in his best interest.

Penis Size-Facts, Fiction, and What You Can Do To Get a Bigger Penis

November 5, 2013

“It’s not the size that counts, it’s how you use it.”
– Anonymous

As a urologist I am asked every day “Is my penis normal? What can I do to make it larger?” One of the most widely searched topics on, penis size has remained an enduring interest to men for decades and is understandably a source of much anxiety. However, while size does matter, it really does not matter as much as most men think. The issue here is one of perception: Men perceive it as the defining element of their masculinity, while women often evaluate the whole package: looks, style, intelligence, personality, behavior, and even a man’s sense of humor.

Regardless of whose perceptions are misplaced, penis size will forever persist as a primary concern for men worldwide, which is why AM has explored the topic so deeply. Look no further, as all you need to know is here, standing at the ready.

Penis Size Fact
When surveyed, women consistently claimed that girth was more important than length. This surprising response is seemingly odd as there appears to be no physiological basis for such claims, although more girth may provide more clitoral stimulation.

In fact, plenty of well-endowed men are ashamed of their penises, while lots of men with smaller penises strut their stuff with confidence, according to a study published online Sept. 30 in the Journal of Sexual Medicine.

Men worry far more than women about penis size, according to Veale and his colleagues. One study, published in April in the journal Proceedings of the National Academy of Sciences, found that women preferred larger penises only up to a point anything bigger than a flaccid length of 2.99 inches did not additionally impress women.

So what is average? A recent Journal of Sexual Medicine study found that the average American man’s penis measures 5.6 inches long when erect.

Now let me leave you with a guaranteed method to make your penis 1-1.5 inches longer. Let me ask you if I could offer you a pill that would lower your blood pressure, decrease your risk of diabetes, lower your cholesterol level, decrease your risk of prostate cancer and colon cancer, improve your mood and libido or sex drive, help you lose weight, it’s very inexpensive and, yes, it will make your penis longer, would you take the pill? Every man answers, “Yes, of course. Where do I get those pills? I then smile at the man and say, “I’m sorry, it’s not a pill, it’s exercise!” Why is this the case? When you exercise, lose weight and lose the girth of your abdomen, your penis will appear longer. If you don’t believe me, try it. Lose 25 pounds and see for yourself. You’ll also be able to see your toes or shoes, too!

Bottom Line: It’s true, use it or lose it. It’s a good idea to have regular sex and to not be preoccupied with the length of your Johnson!

Urinating at Night? Don’t Suffer Incontinence In Silence

November 3, 2013

Getting up at night to urinate, i.e., nocturia, more than you would like? If so, this article will help you control that problem and provide you with a good nights sleep. Nocturnal polyuria (NP) has a high prevalence among older adults and is commonly encountered in nursing homes. The condition can cause nocturia or nocturnal incontinence (ie, involuntary discharge of urine at night), both of which are highly bothersome problems. Although these conditions are prevalent in nursing homes, little research has focused on how they may impact quality of life among nursing home residents.
The prevalence of NP within the study population of nursing home patients was 84%. Of the individuals with NP, 17 (37%) reported nocturnal incontinence.
Based on these findings, the investigators surmised that nocturnal hormonal imbalances might contribute to the increased urine volume in these residents.

Bottom Line: Nursing hone patients have an increased incidence of incontinence and can significantly increase the residents of the nursing home quality of life. Many of these patients can be helped with medication or with behavior therapy

Bladder Cancer-It Now Has To Pass the Smell Test

November 3, 2013

Researchers from the University of Liverpool and University of the West of England, have built a device that can read odors in urine to help diagnose patients with early signs of bladder cancer.

There are currently no reliable biomarkers to screen patients for bladder cancer in the same way that there are for breast and prostate cancers. Previous research has suggested that a particular odor in the urine could be detected by dogs trained to recognize the scent, indicating that methods of diagnoses could be based on the smell of certain gases.
The ODOREADER ® contains a sensor which responds to chemicals in gases emitted from urine.
The device works by inserting a urine sample into the device. The ODOREADER® is capable of showing the diagnosis on the computer screen if the sample comes from a patient with bladder cancer.

It is thought that dogs can smell cancer, but this is obviously not a practical way for hospitals to diagnose the disease. This new device can give doctors a profile of the odor in urine. The device correctly diagnosed bladder cancer 100% of cancer patients who are known to have bladder cancer. The ODOREADER ® has the potential to dramatically cut costs of diagnosing balder cancer by avoiding repeat cystoscopies and bladder biopsies.

Bottom Line: New technologies are on the horizon for detecting bladder cancer. This is the first time that a device used to detect the odor coming from the urine may uncover bladder cancer.

What Did You Say? Impotence Linked to Hearing Loss

November 3, 2013

A recent study demonstrated that men with sudden hearing loss may be at risk for impotence or erectile dysfunction.  The risk of the possibility of erectile dysfunction in patients with sudden sensorineural hearing loss was nearly twofold greater compared to men without any hearing loss. This risk remained increased for up to 4 years. Among 23,212 men who had a first episode of SSHL, the rate of ED was 95% greater than in 46,424 age-matched controls over a minimum follow-up of 4 years. The study was published in Otology & Neurotology.  So if you have sudden hearing loss you need to know that you may be at increased risk of erectile dysfunction.