Archive for January, 2014

Testosterone and Heart Disease – Facts & Caveats

January 30, 2014

I have received numerous calls from men who have symptoms of low testosterone, a documented decrease in their serum testosterone level, and who are receiving testosterone replacement therapy regarding a study that recently appeared in PLOS One.*

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 the norm. 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, the doctor will recommend increasing the consumption of this necessary vitamin. These actions are what we do every day; we 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. The unstudied/published issue is what is the target value? Most experts feel that there is no absolute “correct” value, but rather treatment is targeted at relief of symptoms.

There are more than 13 million men in the United States who reportedly 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.

The study recently reported a study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre).
The results of this study in all subjects revealed the rate ratio (RR) for TT prescription was 1.36. In men aged 65 years and older, the RR was 2.19 for TT prescription. The RR for TT prescription increased with age from 0.95 for men under age 55 years to 3.43 for those aged ≥75 years. In men under age 65 years, excess risk was confined to those with a prior history of heart disease.
The study summary stated that in older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.

Some comments about the study:

No follow-up or research was done on whether or not the men on testosterone therapy achieved therapeutic levels or if they stayed on treatment. It is not accurate to assume that all men treated had their testosterone levels elevated by therapy.

There is no documentation as to whether or not Endocrine Association guidelines were followed, including morning testosterone level assessments and repeating the test at least once.

In closing, a larger study in the Journal of Clinical Endocrinology and Metabolism showed that among male veterans over 40, those on testosterone had lower rates of death than those that did not. This certainly makes sense, since hypogonadism is associated with metabolic syndrome, which is associated with an increased risk of heart attack, stroke, and death.

Finally, the International Consultation in Sexual Medicine (J Sex Med 2010;7:1608) concluded that:
• Low endogenous testosterone levels correlate with an increased risk for adverse cardiovascular events
• High endogenous testosterone levels appear to be beneficially associated with decrease mortality due to all causes, including cardiovascular disease and cancer
• Testosterone supplementation in men is relatively safe in terms of cardiovascular health
• Testosterone use in men with low testosterone leads to inconsequential changes in blood pressure, glycemic control and all lipid fractions.
Bottom Line: Low testosterone levels are associated with increased atherosclerosis. Most studies confirm that administration of testosterone to men has neutral effects on cardiovascular risk factors and cardiac events. For men with a history of heart disease, a careful discussion between the doctor and patient should take place.
*http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+(PLOS+ONE+Alerts%3A+New+Articles)

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When Something Is Coming Out “Down There”-Use of A Pessary To Treat Vaginal Prolapse

January 30, 2014

As women reach menopause, many women experience changes in the vagina which include incontinence of urine and pelvic organ prolapse where organs and tissues start coming out of the vagina. For mild problems of incontinence, Kegel exercises can help control the problem. For more extensive prolapse surgery is often necessary. For women who can’t have surgery or wish not to take the surgical option, a pessary is an alternative. This blog will discuss a vaginal pessary and how it can help women with urinary incontinence and vaginal prolapse.

A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapse.

There are a variety of pessaries available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the inflatable, the doughnut, and the Gellhorn

Your physician will fit your pessary to hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully.

What To Expect After Treatment
Your pessary will be fitted in your health professional’s office. You may need to experiment with different kinds of pessaries to find one that feels right for you. Your health professional will teach you how to remove, clean, and reinsert the pessary on a regular schedule. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary. If it is hard for you to remove and replace your pessary, you can have it done regularly at your doctor’s office.

Why It Is Done
Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.

Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a “pessary test.” If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery

How Well It Works
Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.1

Risks
Possible complications from wearing a pessary include:

· Open sores in the vaginal wall.
· Bleeding.
· Wearing away of the vaginal wall. In severe cases, an opening (fistula) can form between the vagina and the rectum.
· Bulging of the rectum against the vaginal wall (rectocele formation).
Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.

In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.

Follow your health professional’s instructions for cleaning your pessary, because regular cleaning reduces the risk of complications. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.

What To Think About
Pessaries often are an effective tool for managing pelvic organ prolapse without surgery. They may be the best choice if you are a young woman who has not finished having children, if you have been told that surgery would be risky for you, or if you do not wish to have surgery for other reasons.

A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.

Many women can have sexual intercourse with their pessary in place. But you cannot insert a diaphragm (a round rubber device used as a barrier method of birth control) while wearing a pessary. If you have not reached menopause, you may want to discuss birth control with your doctor.

Bottom Line: Incontinence and prolapse are common concerns of many middle age, post-menopausal women. Certainly medications are a first line of treatment. For women who do not respond to medication and do not want to have surgery, a pessary is treatment option.

Restoring The Fountain of Youth-DHEA Just May Be The Youth Hormone For Women

January 28, 2014

American women (men too) are always looking to find a way to turn back the biologic clock. We all would like to look like the women in Cosmopolitan and Vogue Magazines. If your goal is to look younger, feel better, and improve energy level, then you might consider the benefits of DHEA.

DHEA, dehydroepiandrosterone, is a hormone produced in the adrenal gland, the small triangular structure that sits on top of the kidneys. DHEA is made by the adrenal glands and is then converted to androgens, estrogens and other hormones. These are the hormones that regulate fat and mineral metabolism, sexual and reproductive function, and energy levels. DHEA levels increase until our mid to late 20′s then gradually decline. DHEA is a very powerful precursor to all of your major sex hormones: estrogen, progesterone, and testosterone. (Its molecular structure is closely related to testosterone). DHEA is called the “mother hormone” — the source that fuels the body’s metabolic pathway.

When DHEA levels are low, your body does not have enough working material for proper endocrine function. This throws off your hormone production and you feel a general sense of malaise, along with other symptoms of hormonal imbalance — how severe depends on how many other demands are being made on your body at the same time.
There is a growing body of evidence that healthy levels of DHEA may help stave off Alzheimer’s disease, cancer, osteoporosis, depression, heart disease and obesity, but there is still no clear-cut consensus. There may be some increased risks associated with DHEA for women with a history of breast cancer — all the more reason to take DHEA under medical supervision.

Symptoms of low DHEA include extreme fatigue, decrease in muscle mass, decrease in bone density, depression, aching joints, loss of libido, and lowered immunity.
DHEA is stated to be possibly effective for these conditions:
1. Aging Skin – Taking DHEA orally seems to increase epidermal thickness, sebum production, skin hydration, and decrease facial skin pigmentation in elderly men and women
2. Osteoporosis – Taking DHEA orally 50-100 mg per day seems to improve bone mineral density (BMD) in older women and men with osteoporosis or osteopenia.
3. DHEA is also thought to contribute to a sense of well-being when used by those with adrenal and/or androgen insufficiency.
4. It may also support lean body mass in postmenopausal women.

DHEA has many potential benefits but does also have some side effects, which include hair loss, hair growth on the face (in women), aggressiveness, irritability and increased levels of estrogen. Calcium channel blockers may increase DHEA levels and those using calcium channel blockers should avoid supplementation. Anyone with a history of hormone-related cancer such as estrogen sensitive breast cancer should definitely avoid DHEA due to the probability of increased estrogen levels.

If you don’t feel DHEA is appropriate for you, it may be possible to increase the body’s natural production of DHEA with regular exercise and restricting the number of calories you consume. Calorie restriction is associated with a longer life span and the increase in DHEA production may be partially responsible. In fact, there are many studies that show you can improve your DHEA levels naturally by maintaining a body mass index of 19-25, getting adequate rest and exposure to sunlight, exercising regularly (including sexual activity), and fostering more “downtime” in your life — but more on that in a moment.

Without a medical test it’s impossible to know what your DHEA levels are. Using blood tests, your doctor can check for estradiol in the follicular phase (usually days 3–9 of a menstrual cycle); progesterone in the luteal phase (days 14–28); DHEA-S; and both free and total testosterone levels.
Treatment With DHEA Supplements

If tests indicate the need for DHEA supplementation, you may start off with as little as 1-5 mg, twice a day. The dosage can be slowly increased to 10–12 mg per day. Most doctors do not suggest any woman exceed 25 mg per day if capsule forms are used. Once balance has been restored and symptoms even out, most women produce enough DHEA on their own.

Bottom Line: Many women are suffering from hormone imbalance. Decreased DHEA can be a cause of many problems affecting middle age women and can even impact her libido and her energy levels. DHEA should never be taken casually or unsupervised, but its benefits are real for the women who need it.

Prostate Cancer-Watch, Wait, and Not Whither

January 28, 2014

Prostate cancer is the most common cancer in men and the second most common cause of death in men after lung cancer. The diagnosis is made with a PSA blood test and a digital rectal exam and if either of these are abnormal, the man is subjected to a prostate biopsy. Then comes the big decision: does the man proceed to treatment and face the risk of urinary incontinence and\or erectile dysfunction\impotence?

In the past few years there has been a trend towards active surveillance or after receiving the diagnosis of prostate cancer, the man accepts close monitoring with repeated blood tests and possibly repeat prostate biopsies to make certain that the cancer is not progressing or escaping from the prostate and spreading to other organs or structures.

First a comment on screening. Men between the ages of 55 and 69 are those most likely to benefit from screening with a PSA blood test and a digital rectal examination. A man should only be screened after a discussion with his\her physician about the benefits and harms of screening. A new trend is not to treat every man diagnosed with prostate cancer or active surveillance. Not every man qualifies for active surveillance.

Men with a very low risk of cancer progression have a low-grade cancer of the prostate. Prostate cancers are graded from 1-10 and those with a score of 6 or less may be candidates for active surveillance. Men are in the very low risk group if only a few of the biopsies are positive for cancer and that the cancer is not felt on the digital rectal exam.

Men who were on the active surveillance program at John Hopkins School of Medicine had a 2.8% would die of their prostate cancer compared to 1.6% of men who had a very low risk of cancer progression who had surgical removal of their prostate glands. The researches at John Hopkins found that the average increase in life expectancy after surgical removal of the prostate gland was only 1.8 months and that the men on active surveillance would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment with surgery on their prostate glands.

Bottom Line: Men need to have a discussion with their physicians about the benefits and risks of prostate cancer screening. Men with a life expectancy in excess of 20 years or younger men who have low risk disease may accept the risks of treatment rather than take the chance their cancer will cause harm later. Men with very low risk disease can take comfort that their disease can safely be managed by active surveillance.

Obesity and Sedentary Life Style Can Affect Your Prostate and Your Outcomes of Treatment

January 24, 2014

Obese men are more likely to develop aggressive prostate cancer and are more likely to die of their disease. Researchers at Johns Hopkins may have uncovered the explanation. Obese men have shorter telomeres. Telomeres are like aglets on shoelaces or the little tips that protect the ends of their chromosomes. Short telomeres can cause the chromosomes to become unstable and this abnormality is strongly associated with cancer. Their research in collaboration with doctors at Harvard Medical School found that men with shorter telomeres had a much higher risk of dying from prostate cancer.

Not only did obesity demonstrate shorter telomeres and who were physically inactive had even shorter telomeres compared to men of normal weight and who were the most physically active.

Bottom Line: Telomere shortening in prostate cells is associated with obesity and decreased physical activity. Therefore, this is one more reason for men to adopt a healthy lifestyle and develop good nutritional habits and get moving!

Prostate Cancer-Watch, Wait, and Not Whither

January 24, 2014

Prostate cancer is the most common cancer in men and the second most common cause of death in men after lung cancer.  The diagnosis is made with a PSA blood test and a digital rectal exam and if either of these are abnormal, the man is subjected to a prostate biopsy.  Then comes the big decision: does the man proceed to treatment and face the risk of urinary incontinence and\or erectile dysfunction\impotence?

In the past few years there has been a trend towards active surveillance or after receiving the diagnosis of prostate cancer, the man accepts close monitoring with repeated blood tests and possibly repeat prostate biopsies to make certain that the cancer is not progressing or escaping from the prostate and spreading to other organs or structures. 

First a comment on screening.  Men between the ages of 55 and 69 are those most likely to benefit from screening with a PSA blood test and a digital rectal examination.  A man should only be screened after a discussion with his\her physician about the benefits and harms of screening.  A new trend is not to treat every man diagnosed with prostate cancer or active surveillance.   Not every man qualifies for active surveillance. 

Men with a very low risk of cancer progression have a low-grade cancer of the prostate.  Prostate cancers are graded from 1-10 and those with a score of 6 or less may be candidates for active surveillance.  Men are in the very low risk group if only a few of the biopsies are positive for cancer and that the cancer is not felt on the digital rectal exam. 

Men who were on the active surveillance program at John Hopkins School of Medicine had a 2.8% would die of their prostate cancer compared to 1.6% of men who had a very low risk of cancer progression who had surgical removal of their prostate glands.  The researches at John Hopkins found that the average increase in life expectancy after surgical removal of the prostate gland was only 1.8 months and that the men on active surveillance would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment with surgery on their prostate glands. 

Bottom Line: Men need to have a discussion with their physicians about the benefits and risks of prostate cancer screening.  Men with a life expectancy in excess of 20 years or younger men who have low risk disease may accept the risks of treatment rather than take the chance their cancer will cause harm later.  Men with very low risk disease can take comfort that their disease can safely be managed by active surveillance. 

 

Sex Drive In the Tank? Then Filler Up With DHEA

January 22, 2014

Nearly every doctor and every patient believes that their sex drive or libido comes from their testosterone level and that restoring testosterone with injections, gels, or pellets will restore a man’s virility. The answer is yes and no. Yes, testosterone is responsible for a man’s sex drive but so is the ratio of testosterone to estrogen. A testosterone/estrogen imbalance can severely inhibit sexual desire and sexual performance.

In a man’s youth, low amounts of estrogen are used to shut down the powerful cell stimulating effects of testosterone. As estrogen levels increase with age, testosterone cell stimulation may be locked in the “off” position, thus turning off sexual arousal and sensation and resulting in a loss of libido in aging men.

Another concern is that aging men sometimes convert testosterone to estrogen. The increase in estrogen is taken up by testosterone receptor sites in the cells and prevents circulating testosterone from gaining access to the cells where it can do its greatest function.

Testosterone is responsible for the sex drive in both men and women. In order for testosterone to do its job, it must be in the free form and not bound to other circulating proteins like sex hormone binding globulin (SHBG). SHBG increases with age and grabs the free testosterone making it unavailable to the cells where it is needed to initiate sex-stimulating centers in the brain. Also excess estrogen increases the production of SHBG and blocks the testosterone-receptor sites. These are the two mechanisms that impact a man’s libido associated with aging.
Therefore, it is necessary to suppress excess levels of SHBG and estrogen while increasing free testosterone to the level of a younger more youthful man. By restoring the normal ratio of testosterone to estrogen ratio a man’s libido and sexual performance often improves.

One of the easiest ways to accomplish this restoration of the normal T\E ratio is to prevent testosterone from being converted into excess estrogen. Too much estrogen plays havoc with a man’s sex life by binding to testosterone receptor sites and also the associated increase in SHBG, which decreases the freely available testosterone.
Certainly estrogen is a necessary hormone for men just as testosterone is necessary hormone for women.

The problem of an abnormal ratio of T\E can easily be diagnosed with a simple blood test for estradiol. Levels that are greater than 30pg/ml are abnormal and would benefit from treatment that lowers the estrogen level and the SHBG levels.

Treatment of elevated estradiol in men can be accomplished with a prescription medication, Armidex, which is aromatase inhibitor and blocks the conversion of testosterone to estrogen. The dosage is 50mg\day. Studies have demonstrated that this dosage decreases the estrogen level in approximately one month.

Bottom Line: Testosterone deficiency is a common problem affecting many middle age and older men. Often this is due to an imbalance of testosterone\estrogen ratio. This can be easily treated with oral aromatase inhibitors. So if you are middle age and your doctor prescribed testosterone and it isn’t working, I suggest you speak to him or her about getting an estradiol level and if it is elevated, then treatment with an aromatase inhibitor.

Dr. Neil Baum is a physician practicing at Touro Infirmary and can be reached at his office, 504 891-8454, or via his website, http://www.neilbaum.com

More zzzzzz’s May Protect Against the Big C-The Relationship Of Sleep and Prostate Cancer

January 22, 2014

You have all heard that it’s healthy to get 8 hours of sleep a day. Now you have another reason to make sure that you don’t cheat the sleep fairy. A good nights sleep well may help to protect men from deadly prostate cancer.
Scientists linked higher levels of the night-time hormone melatonin with a 75 per cent reduced risk of advanced disease.
Melatonin is produced in the dark at night. It plays a key role in regulating the body’s sleep-wake cycle and influences many other functions associated with the body’s 24-hour clock, or circadian rhythm.
Low levels of the hormone are typically associated with disrupted sleep. Men who reported taking medication for sleep problems, and difficulty falling and staying asleep, had significantly lower amounts of the melatonin marker.
Men whose melatonin marker levels were higher than the middle of the range were 75 per cent less likely to develop advanced prostate cancer than those with lower values.
Here are some suggestions for good sleep hygiene and getting a good nights sleep without resorting to medication:
Avoid napping during the day; it can disturb the normal pattern of sleep and wakefulness.
Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night’s sleep.
Food can be disruptive right before sleep; stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don’t dwell on, or bring your problems to bed.
Associate your bed with sleep. It’s not a good idea to use your bed to watch TV, listen to the radio, or read.
Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

Bottom Line: We do know that advanced age, family history of prostate cancer, and African American men have a greater risk of prostate cancer. Add to this list, disrupted sleep, lack of sleep, or sleep deficit can also be added to risk factors associated with prostate cancer. Make sure you get a good nights sleep and you may reduce your risk of prostate cancer. As my wonderful Jewish mother might say, “It may not help, but it voidn’t hoit!”

Urine Incontinence — It’s Nothing to Sneeze At

January 17, 2014

One of life’s most embarrassing experiences is not being able to control your urination and soiling your clothes forcing you to leave any situation where you are engaged with others. It is one of the last medical conditions to remain in the closet as many men and women fail to seek medical attention for this common problem.
This blog will discuss the 4 types of urinary incontinence and what treatment options are available for this common problem.

Urge Incontinence occurs in women with an overactive bladder who may not be able to get to the toilet in time to prevent leakage, even though they tighten up all of their pelvic muscles, because they can’t control the bladder and keep urine in. Overactive bladder that leads to urge incontinence affects about 17 percent of women, but it increases to over 50 percent after menopause. Overactive bladder isn’t a normal part of aging.

Stress incontinence is a much more common type of incontinence. Menopause contributes to this problem, but stretching and tearing of the pelvic muscles during childbirth definitely sets the stage. The reduced muscle tone causes the urethra to sag. When pressure builds up in the abdomen from a cough, sneeze, laugh, jump or lift, internal organs put pressure on the bladder and a small amount of urine may escape.

Overflow incontinence occurs when more urine collects in the bladder than the bladder can hold and the excess urine leaks out. It can be caused by blockage of the urinary tract or nerve damage caused by conditions such as diabetes, stroke, or injury.

Functional incontinence is not really a problem with the urinary tract. It happens to people who can’t move quickly, who have eye problems or who suffer from confusion or memory loss. They simply can’t get to the bathroom in time.

Certain prescription drugs such as diuretics and some tranquilizers, and smoking and eating spicy foods or artificial sweeteners, or drinking alcohol and caffeine can irritate the bladder and worsen incontinence.

Mixed incontinence is a combination of both stress and urge incontinence.

Today, there are many more options to consider, from medications, pelvic floor physical therapy, and surgery. The first step is to have a work up to diagnose the underlying problem so that an appropriate treatment plan can be put into place. Sometimes more than one treatment is needed.
Treatment options include:
1. Bladder training — This approach teaches you to urinate only at scheduled times and waiting longer between trips to the bathroom. Start by going to the bathroom every 30 to 60 minutes while you are awake, even if you don’t have to go. After about one week, slowly increase the time interval by 30 minutes every week.

2. Kegel exercises — Dr. Arnold Kegel, a gynecologist at the University of Southern California, developed the exercises to strengthen pelvic floor muscles in 1948. Kegel exercises are often the first line of treatment for the millions of women in the U.S. suffering from unexpected bladder leakage due to coughing, sneezing, laughing or exercise. This if defined as stress incontinence but many women experience frustration because they unknowingly don’t perform the Kegels effectively, which leads to no improvement in symptoms. Most men or women need to do the exercises for 3-6 months before any changes will occur.

3. Pelvic Floor Electrical Stimulation with Biofeedback Therapy — This treatment uses computer graphs and sounds you can hear to show you which muscles you are exercising so you can perfect the exercises. Physical therapists and other professionals specially trained in problems related to women’s health teach exercises for the pelvic floor, trunk, back and extremities that can help strengthen the pelvic muscles and improve bladder control. The physical therapist may use devices that use mild, comfortable, electrical stimulation to train the bladder muscles when and how to squeeze.

4. InTone is a new FDA listed Class II Medical Device for home use that has been shown to effectively strengthen the pelvic floormuscles and helps to prevent embarrassing leakage without surgery or medication and can be done in the privacy of home. InTone is like a personal trainer for Kegel exercises.

5. Medications — Estrogen can be very helpful in improving the symptoms of some cases of incontinence. Studies have demonstrated improvement in 40- 70 percent of women. I have found that estrogen cream (one fourth to half an applicator) works better than either tablets or patches for this particular problem. Medications called smooth muscle relaxants (examples are oxybutynin and tolterodine) can also help if the problem is caused by abnormal bladder contractions.

6. Pessaries — These donut-like plastic or rubber rings are similar to a diaphragm used for birth control. They are fit into the vagina to lift and offer added support for the bladder when the pelvic muscles are weak.

7. Surgery — There are many operations that have been developed to support the bladder and improve or correct incontinence. Women don’t need to have a hysterectomy in order to control urinary incontinence. Most of these operations for incontinence can be performed as one-day surgeries.

8. Botox– If you don’t respond to oral medications, you may be a candidate for Botox injections directly into the bladder muscle. This, too, can be done as a one-day stay procedure and usually produces relief of symptoms of frequency of urination and urgency of urination with urge incontinence

Bottom Line: Women don’t have to suffer in silence. Successful treatment options are available and most women can be helped and made more comfortable and reduce their embarrassment.

A Pill Or Pounding the Pavement To Produce Good Health And Lower Healthcare Costs

January 5, 2014

Many times I am consulted by patients for a solution for their medical problem. Most often it comes with a pill, an injection, or a surgical treatment. But I enjoy having conversations with middle-age men who visit my office to find a solution to their problem with erectile dysfunction (ED) or impotence. Many of these men are 50-70 years of age and are over-weight; take multiple medications for arthritis, diabetes, high blood pressure, and heart disease. I then have the following conversation with them:

Mr. Smith if I could offer you a pill that would lower your blood pressure, lower your cholesterol, decrease your pain in your back, knees and hips, decrease your obesity, decrease your glucose level and improve your diabetes, improve your mood, decreases your risk of prostate and colon cancer, has absolutely no side effects and is very affordable and would be covered by your insurance company, and best of all it will make your penis appear 1-2 inches longer, would you take the pill?

One hundred percent of the men say, “Why yes. Will you write me a prescription?”

I respond by gently tapping the man on his shoulder and say, “Mr. Smith, I’m so very sorry, it’s not a pill; it’s exercise!”

That’s exactly what exercise will do for you. It will improve your overall health and will make it possible to throw away so many of the multiple medications that middle age men AND women take. We are a polymedicated society and look for a pill to solve our healthcare needs. Except for genetics, which we can’t change, there are lifestyle changes that ALL of us can make that will improve our health and allow us to live longer and healthy lives.

Let’s look at the facts about obesity in America.
Obesity rates are soaring in the U.S.
Between 1980 and 2000, obesity rates doubled among adults. About 60 million adults, or 30% of the adult population, are now obese.

Similarly since 1980, overweight rates have doubled among children and tripled among adolescents – increasing the number of years they are exposed to the health risks of obesity.

Fact: Most people still do not practice healthy behaviors that can prevent obesity
The primary behaviors causing the obesity epidemic are well known and preventable: physical inactivity and unhealthy diet.

Despite this knowledge: Only about 25% of U.S. adults eat the recommended five or more servings of fruits and vegetables each day.

More than 50% of American adults do not get the recommended amount of physical activity to provide health benefits.

No one knows with any degree of certainty what the Affordable Healthcare Act (ObamaCare) will bring to modern medicine. One thing we do know for sure that one of the best ways to control healthcare costs is to control obesity. Obesity-related costs place a huge burden on the U.S. economy Direct health costs attributable to obesity have been estimated at $52 billion in 1995 and $75 billion in 2003 and by now is over $100 billion of the more than a trillion dollar healthcare budget.

Bottom Line: As Everett Dirkson, the late Senator from Illinois, once said, “A billion here, a billion there, pretty soon, you’re talking real money.” This holds true today as it was uttered by the senator nearly 50 years ago. Americans must take responsibility for their health. We need to quit looking for the quick fix or a pill to solve our healthcare problems. We need to start exercising. You will be happier, your doctor will be pleased with your weight reduction, and the percent that Americans spend on healthcare related to obesity will come down. Advice from Doctor Baum…..get moving!

P.S. How does the penis get longer from weight loss? When you lose that belly fat and reduce your abdominal girth, you will see your toes and the end of your penis for the first time in many years!

Dr. Neil Baum is a physician at Touro Infirmary and can be reached at 504 891-8454 or through his website, http://www.neilbaum.com