Archive for May, 2014

Underactive Bladder-Also a Quality of Life Condition

May 26, 2014

No one can listen to T.V. or watch their Internet screen without hearing about overactive bladder or OAB. However, and equally serious and common bladder condition is underactive bladder or lazy bladder. This condition is characterized by urinary symptoms such as hesitancy of urination, straining to urinate, and incomplete bladder emptying.

An underactive bladder is a chronic disease where the bladder holds large amounts of urine, yet the individual cannot feel when the bladder is full, nor does the bladder muscle contrct sufficiently for the bladder to empty completely.

Risk factors for under active bladder are damage to the nerves that go from the back to the bladder, diabetes, pelvic surgery which may cause injury to the bladder nerves, changes caused by aging, diabetes, urinary tract infections, medications that cause the bladder muscle to relax. Examples of these medications include anti-depressants, antihistamines, and bladder muscle relaxants, and spinal cord injuries.

Underactive bladder has no known cure. The management focuses on reduction of the residual urine or the amount of of urine left in the bladder after voiding, avoidance of over distention of the bladder, and protecting the kidneys from damage.

At the present time the treatments for underactive bladder include medications, scheduled voiding by the clock, i.e., going to the restroom every 2-3 hours whether you feel that you have to empty the bladder or not, double voiding, and intermittent catherization where a small tube is inserted through the urethra into the bladder and drain the bladder and the tube is removed and discarded. This is usually done 3-4 times a day depending upon the amount of fluids consumed.

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Becoming a Better Patient-Making Your Doctor Love You

May 26, 2014

The healthcare system is going to have a huge hiccough up in the next few years. The Affordable Care Act or Obamacare is going to pump 20-40 million new patients into the healthcare system. Many of these new patients are going to need more medical services as they have gone for so many years without insurance and without medical care. As a result your doctor is going to have less time to spend with each of his\her patients. In addition to the new patients in the healthcare system, the aging of the population and the millions baby boomers who are reaching 65 will be requiring more medical care. This is compounded by the fact that there is not going to be a proportionate increase in new physicians produced in the medical schools to care for the increase in the number of patients requiring care.

Look around you when you go to the doctor’s office. Do you notice that the older doctors are retiring early? Other physicians re looking for new ways to make adjustments to increase efficiency including: conducting shared medical appointments and seeing large numbers of patients with the same medical condition or considering a similar treatment, doctors establishing concierge practices in order to spend more time with fewer patients, or delegating responsibilities to physician assistants and\or nurse practioners.

So what can you do to become a better patient and help the doctor with efficiency?
Here are a few ideas to make you a darling of your physician.
1) Write out a list of questions that you would like answered on your encounter with your doctor. You can ask your doctor if he\she would like this E mailed, FAXed, or handed to the doctor at the time of your visit

2) Show up on time. Don’t be delayed for your visit and disrupt the doctor’s schedule. If you cancel your appointment or going to be delayed, contact the office so they can adjust the schedule or contact another patient to take your time slot

3) If you are a new patient to the practice, arrive early and complete your patient information and your health questionnaire so you are ready for the appointment at the designated time. This can also be done online and assists in making your visit more efficient.

4) Ask at the beginning of your appointment how much time will be allotted to your visit. If you have more issues and questions, offer to schedule a second appointment as this allows the doctor to remain on time for his other patients.

5. If the doctor makes recommendations or prescribes medication that has side effects that you would consider intolerable, tell the doctor so an alternate plan of action can be created.

6. Check your list of questions and see if other healthcare professionals such as the pharmacist or the nurse practioner can answer some of them.

7. Ask your doctor for educational material so you might become more knowledgeable about your condition. This will impress the doctor that you are interested in becoming a partner in your care. Also ask the doctor for any credible Internet sites that you might visit to learn more about your condition. Going to the Internet and doing your own surfing might lead you to information that is not accurate or misleading. The doctor should be able to provide you with education and Internet sites that will be helpful.

7. Finally, end every appointment with a question such as, “Is there anything else I should have asked that would help with my treatment or my health?” This clearly lets the doctor know that you are engaged and interested in your health and well-being. Also, ask the doctor if there is anything you can do to improve the efficiency of your visit. I can assure you that few other patients are this considerate of the doctor’s time and you will, indeed, by a darling and special patient of the practice.

I was very moved as a young boy when John F. Kennedy ended his inaugural speech by saying, “Ask not what your country can do for you, but what can you do for your country.” Perhaps this could be modified for patients in 2014 and beyond by thinking, “Ask not what your doctor can do for you, but what can you do for your doctor!”

10 Medical Tests You MAY Be Able To Do Without

May 15, 2014

For years I have been writing and speaking on wellness and taking good care of yourself using preventive healthcare measures. Now with greater understanding of risks and benefits of tests, I am informing you of some tests that you may want to reconsider.

1. Nuclear stress tests, and other imaging tests, after heart procedures
Many people who have had a hear bypass, stent or other heart procedure feel they’ve had a brush with death. So patients — and doctors — understandably want to be reassured through a nuclear stress test or other tests that their hearts are beating strong. But performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment. In fact, post bypass or stent nuclear stress tests, can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve. Instead, patients and doctors should focus on what does make a difference in keeping the heart healty: managing weight, quitting smoking, controlling blood pressure and increasing exercise.
2. Yearly electrocardiogram or exercise stress test
A survey of nearly 1,200 people ages 40 to 60 without any symptoms had an EKG over the previous five years. The problem: Someone at low risk for heart disease is more likely to get a false-positive result than to find a true problem. This could lead to unnecessary heart catheterization and stents. Instead, have your blood pressure and cholesterol checked. And if you’re at risk for diabetes, have your blood glucose level checked as well.
3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. As a result of the test, he says, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there — an estimated 75 percent of tests that show high PSA levels turn out to have negative prostate biopsies. When men do have treatments such as surgery or radiation, 20 to 40 percent end up with impotence, incontinence or both.
The American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men ages 55 to 69. After age 70, men without any urinary symptoms probably do not need further PSA testing.

4. PET scan to diagnose Alzheimer’s disease
Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy. In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the disease. Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of a fuzzy memory. PET scans in older people consistently find the protein in 30 to 40 percent of people whose memories are just fine.

5. X-ray, CT scan or MRI for lower back pain
Unfortunately, back pain is incredibly common — 80 percent of people, myself included, will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery. However, if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor as soon as possible.
6. Yearly Pap tests
The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.
7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.
To help keep your bones strong, try walking and weight-bearing exercises. Get enough calcium and vitamin D in your diet. If you smoke, quit.
8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
The likelihood of these small simple cysts ever becoming cancer is exceedingly low.
In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound. For premenopausal women, who typically have benign cysts every month when they ovulate, cysts smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s report, says Levine.

9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
Just the preparation for colonoscopy can be exceptionally harsh. Some patients become incontinent or experience weeks of pain, diarrhea and constipation. In worst cases, the procedure can perforate the colon. Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.
To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you’re overweight and exercise. Sound familiar? It should, because that’s the best advice for protecting the rest of your body — and mind — as well.
10. Yearly physical
There’s little evidence that having an annual checkup can keep you healthy. Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem. A healthy 52-year-old does not need to see the doctor once a year.
Certainly, if you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested. For these other tests, ask your doctor if they really are necessary and is the screening worth the risk of the procedure and are the benefits greater than the risks.

Questions I Am Frequently “Axed”

May 12, 2014

I often discuss common medical conditions with patients and questions come up on multiple occasions. I have recorded these questions and will answer them periodically on this blog site. If you have any questions you like me to answer, please let me hear from you,

I am 31 years old and have just had a baby. When can I resume sexual intimacy with my husband?
Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.
The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, stress and fear of pain all can take a toll on your sex drive. If you have any questions contact your obstetrician.

I have loss of urine when I cough or sneeze or do any kind of exercise. My doctor said I have stress incontinence and he recommended a vaginal sling using mesh material. Is this safe?

Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling).

Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”

The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator. There is also a “mini-sling” procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

Complications of this type of procedure are rare but may occur. The most common complications include bleeding and infection, erosion or infection of the graft material (possibly requiring further surgery), injury to nearby structures, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge type-incontinence.

I am 65 years old man and had my prostate gland removed for prostate cancer three years ago. My PSA test is rising after several years being at an undetectable level. Is there anything else I can do?

First, I would get the test repeated. Although mistakes are rare, you need to confirm the results with a second test. Next a test has to be done to see if there has been any spread or recurrence of the cancer at the location of the surgical removal of the prostate gland. There are several tests that can be useful for this purpose including a bone scan to see if there has been any spread to the bones.

For men with less than five years life expectancy or with other medical conditions that may affect their longevity, then no treatment is needed and watchful waiting is an option.

For men with spread to other organs or to lymph nodes, hormone therapy is a consideration. This usually consists of medication to decrease the testosterone level which almost always results in loss of libido and erectile dysfunction.

Finally, if there is localized disease in the pelvis, radiation therapy is an option after surgery has failed to cure the disease.

The bottom line is that a rising PSA after surgery is usually treatable.

To Your Good Health,
Dr. Neil Baum

Saving Lives With One Squeeze At A Time-Using the Heimlich Maneuver

May 12, 2014

You are at the mall or in the park and you see someone choking. What you do can mean the difference between life and death. On two occasions I have had the opportunity to use the Heimlich maneuver. I once saw someone choking at a picnic in the park and on another occasion I used the maneuver on a friend at a restaurant who was short of breadth after eating a piece of steak and was able to save both of their lives. In this article I will discuss how to do the Heimlich maneuver and perhaps one day you find it necessary to use and it just may save a life.

The Heimlich maneuver is an emergency procedure that is used to dislodge foreign bodies from the throats of choking victims. In the early 1970s, the American surgeon Henry J. Heimlich observed that food and other objects causing choking were not freed by the recommended technique of delivering sharp blows to the back. As an alternative, he devised a method of using air expelled from the victim’s lungs to propel the object up and out of the throat. The Heimlich maneuver is used only when the victim’s airway is totally obstructed and he is rendered unable to speak, breathe, or to cough the object out; with only partial blockage of the throat, the victim can generally work the object free by his own efforts.

Three thousand people a year died from choking in this country alone. What was most striking was how choking usually occurred in the most ordinary circumstances. The object on which most people choked was usually on a piece of food or, with children, a toy, a coin, or any small object that they happened to put in their mouths. It is of interest that you will rarely hear of these deaths by choking. Only when a prominent person died – such as Ethel Kennedy’s sister-in-law, Joan Skakel, who choked to death on a chunk of meat, did you read about it in the newspaper. Two music stars, bandleader Tommy Dorsey and pop singer Mama Cass Elliot, lost their lives to choking. Even Claudius I, Emperor of Rome, had also choked to death accidentally – not strangled by a rival, as is commonly believed. One of my urologic colleagues, Dr. Mims Ochsner, was at a restaurant in Atlanta and was coughing and excused himself to go to the restroom and died in the restroom with at least ten doctors within twenty feet of the toilet. His death didn’t have to happen.
Who may need the Heimlich maneuver?

The universal sign for choking is hands clutched to the throat. If the person doesn’t give the signal, look for these indications:
Inability to talk
Difficulty breathing or noisy breathing
Inability to cough forcefully
Skin, lips and nails turning blue or dusky
Loss of consciousness

The Heimlich maneuver is not designed as a procedure performed by a doctor a healthcare professional. The procedure can be performed by anyone.
How is it done?

For a conscious person who is sitting or standing, position yourself behind the person and reach your arms around the person’s waist.

Place your fist, thumb side in, just above the person’s navel and grab the fist tightly with your other hand.
Pull your fist abruptly upward and inward to increase airway pressure behind the obstructing object and force it from the windpipe.

If the person is conscious and lying on his or her back, straddle the person facing the head. Push your grasped fist upward and inward in a maneuver similar to the one above.

You may need to repeat the procedure several times before the object is dislodged. If repeated attempts do not free the airway, an emergency cut in the windpipe may be necessary.

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.

New Agent for Female Sexual Dysfunction Has Promise

May 2, 2014

Female sexual dysfunction, decreased sex drive, decreased vaginal lubrication, and lack of orgasm, is more common than male sexual dysfunction or erectile dysfunction. Unfortunately, until recently no treatment has been found to be effective for female sexual dysfunction.

A new drug, bremelanotide, appeared to reduce distress and increase satisfaction among premenopausal women with female sexual dysfunction, researchers reported here.

In a study that specifically looked at decreased sexual desire reported that treatment with bremelanotide resulted in women boosting the number of satisfactory sexual events in a month.

Patients taking bremelanotide reported more nausea, flushing, and headaches than those on placebo. About 10% of the woman using bremelanotide withdrew from the study because of adverse events, but the drug was generally well tolerated.

Bremelanotide is now awaiting approval from the FDA.

Bottom Line: Female sexual dysfunction affects millions of women. Until now little could be done to help women regain their desire for intimacy. The FDA is now looking into the use of bremelanotide as a solution for this common problem.