Dehydration:  The primary mechanism thatwe maintain our proper hydration is through thirst.  Thirst serves two functions: 1) to regulate the volume ofwater within our bodies and 2) to control the concentration of various saltslike sodium and potassium within the body.  Fluid is lost through urination, skin loss by sweating,respiration, and a small amount in the feces, unless someone has diarrhea andthen a significant water loss may occur. If there is a loss of water by any of the above routes or if theconcentration of the salts in the blood stream increases, then the thirstmechanism kicks in, which is a strong drive to consume more fluids. 

How much water to drinkevery day?  You have heard from earlychildhood that you need to drink eight, eight ounce glasses a day.  This is probably a myth that isperpetuated many years ago from the Food and Nutrition Board, which estimatedthat the average total fluid loss each day was 64-80 ounces.  The Board did not mention that 20% ofour intake of fluid comes from food. Therefore, you don’t have to consume all of your total intake aswater. 

In addition to thirst, thecolor of your urine will serve as an indicator of your state of hydration.  If you are dehydrated, your urine willbe dark and yellow.  This is a signto increase your water consumption and the urine will turn to white or lightyellow, which is sign of adequate hydration.  If you are in a hot environment or participating in sportsand are sweating, you will want to check the color of urine when you completethe workout or sports event.  Ifthe color of your urine is dark, you know you are dehydrated and you need toconsume more fluids.  Athletes canlose up to two quarts of fluid through sweat each hour.  So whenever you are in warm or hotenvironment and you are losing lots of fluids by sweating, you must make aneffort to consume more fluids.

What about sports drinks:  A sportsdrink beverageis designed to help athletesrehydrate when fluids are depleted after training or competition. Ideally the sports drinks are intended to replacethe electrolytes that is lost in sweat during exercise and sportingevents.  Sports drinks usuallycontain a lower electrolyte concentration than found in sweat and can actuallyworsen the dilution of electrolytes. It is far easier to drink water and a salty snack.

Caffeine-Culprit or Cure ?   There is a myth that drinkswith caffeine are dehydrating.  Thetruth is that caffeine serves as a weak diuretic and promotes an increase inurine output and the fluid intake will more than compensate for the diureticeffect of the caffeine.  Like mostthings in life, anything in moderation is acceptable and this includescaffeine. 

What about bottled water?  Millions of Americans aredrinking bottled water. $22 billion is spent each year throughout the world onbottled water.  Bottledwater, although up to 1,000 times the price of tap water, may be no safer, orhealthier than tap water.  A gallonof bottled water is $3.84\gallon making it as expensive as gasoline.  In addition to the expense, 1.5 milliontons of plastic are used to bottle water and toxic chemicals can be releasedduring the manufacture and disposal of the bottles.  Studies have confirmed that microbes, pesticides, andsolvents have been detected throughout groundwater supplies, and havesubsequently found their way into bottles.

The Environmental ProtectionAgency checks the water that is consumed by the public.  In the United States the quality of thewater is very safe.  If you live inan area and drink well water, you will want to have the water checked forcontamination on a regular basis. A number of privatewater wells sampled in Louisiana showed potentially unsafe levels of arsenic,volatile organic compounds (VOCs) and pesticides, as well as secondarycontaminants in standard system tests for pH, hardness, alkalinity, dissolvedsolids and manganese. 

Bottom Line:  Water is truly the elixir of life.  Avoid dehydration by checking out thecolor of your pee.  For the most part,tap water tastes just as good as bottled water and is a whole lot cheaper.  Drink up!

Bottom Line: So, if you are trying to have a baby, use your desktop and not your laptop.

Age 20

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental exam annually

Vision examination every 2 years

Immunization (tetanus-diphtheria at age 19)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self-examination

Age 30

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental health annually

Eye examination every 2 years

Immunizations (tetanus-diphtheria every 10 years)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self examination

Age 40

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Dental health annually

Diabetes (blood sugar test at age 45, or earlier if overweight or other risk factors are present)

Heart health (EKG every 4 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years)

Prostate cancer (baseline PSA test if African American or there is a family history, age 50 otherwise)

Skin cancer (look for marks or changes on your skin)

Age 50

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Colorectal cancer or annually

Dental health annually

Eye health every 2 years if you have vision problems

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine)

Osteoporosis (if risks factors are present)

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

Age 60

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Colorectal cancer annually

Dental health annually

Diabetes (every 3 years or as doctor recommends)

Eye health every 2 years if you have vision problems

Hearing annually

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, shingles/herpes zoster vaccine once after age 60)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

Age 70+

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Cholesterol annually colorectal cancer annually dental health annually diabetes (every 3 years)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, pneumococcal vaccine after age 65)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

Although a National Institutes of Health panel decided last year that nothing conclusively prevents Alzheimer's disease, researchers continue to investigate whether a healthy diet, or specific components can have any beneficial effects.

A study of 260 people, mean age 71, were enrolled in the Cardiovascular Health Study between 1989 and 1990. At that time, they filled out questionnaires on dietary intake; 163 reported eating fish at least weekly, and some did so as often as four times a week.  All patients had an MRI 10 years later to assess brain volume, and then had follow-up cognitive testing between 2002 and 2003.

The researchers found that patients who ate fish at least once a week had greater volume in the frontal lobes and the temporal lobes, including the hippocampus and the posterior cingulate gyrus (these are the areas responsible for memory and learning, which are severely affected in Alzheimer's disease.

Five years after the MRI, they found that 30.8% of patients who had low fish intake had developed mild cognitive impairment or dementia, compared with just 3.2% of those who had the highest fish intake and the greatest preservation of brain volume.

They also saw that 47% of patients with brain atrophy who didn't eat fish had abnormal cognition five years later compared with 28% of those who ate more fish and had more gray matter volume.

In further analyses, the researchers found that mean scores for working memory -- a function severely impaired in Alzheimer's disease -- were significantly higher among those who ate fish weekly.

This simple lifestyle choice of eating more fish increases the brain's resistance to Alzheimer's disease, potentially via a few mechanisms: Fish are rich in omega-3 fatty acids, which can help increase blood flow to the brain and can also act as an antioxidant, thereby reducing inflammation, he said.

Omega-3s may also prevent the accumulation of amyloid plaques in the brain.

Fatty fish like salmon have more omega-3s, while smaller fish, such as cod, have less.

It would be safe to say that this study provides another hypothesis about the possible beneficial effect of a diet rich in fish ingredients and a delay of cognitive functioning like memory loss.

Bottom Line: In this study, eating fish at least once a week appeared to help lower older patients' risk of developing dementia.

This blog has been modified from MedPage: http://www.medpagetoday.com/MeetingCoverage/RSNA/29957

Apparently, there's another reason to quit smoking: A study published in the Journal of the American Medical Association suggests that smoking at the time of prostate cancer diagnosis is associated with an increased risk of prostate cancer recurrence as well as an increased risk of dying of prostate cancer. This is the first large-scale study to demonstrate that smoking increases the risk of dying of prostate cancer.

Researchers followed 5,366 men diagnosed with prostate cancer over two decades. Of these, 1,630 died -- 524 due to prostate cancer and 416 due to cardiovascular disease --and 878 had recurrences of their prostate cancer after treatment. When compared with men who had never smoked, those who were smoking at the time of diagnosis had an approximately 60 percent greater risk of both prostate cancer recurrence after treatment and death due to prostate cancer. Furthermore, the greater the number of years spent smoking, the greater the risk of death due to prostate cancer.

On a positive note, the study demonstrated that participants who had quit smoking for 10 or more years experienced prostate-related death and recurrence rates similar to those of nonsmokers.

African Americans have the highest incidence of prostate cancer, followed by white Americans. Although the cause of prostate cancer remains unknown, risk factors include age, family history, race and hormone levels -- with advancing age being the most notable risk factor.

The American Cancer Society recommends that men at average risk discuss prostate cancer screening with their doctor at age 50. For African Americans and men with a family history of prostate cancer, the society recommends having the discussion even earlier—starting at 40 to 45 years of age.

Bottom Line: As many of us already know, smoking is linked to a variety of deadly diseases, including cardiovascular disease and lung cancer. For multiple reasons, if you're a smoker, it's always a good idea for you to quit. This study suggests that if you have prostate cancer and you smoke, it makes sense to quit for this reason, too. And if you're at increased risk for prostate cancer, it's smart to quit now in case you’re later diagnosed with the disease

This blog was modified from the Johns Hopkins Health Alert, https://mail.google.com/mail/?shva=1#inbox/133f97bc6f953f17

Research on Smoking and Prostate Cancer

Should You Have a PSA Screening Test? Here’s what Johns Hopkins recommends for patients:

By now, you’ve probably heard that prostate-specific antigen (PSA) screening is no longer recommended for healthy men under age 75. This controversial draft recommendation was issued by the United States Preventive Services Task Force (USPSTF). Given previous recommendations from the medical community encouraging PSA screening, many men are confused. Following are answers to some questions you may have about this recommendation -- and our advice on whether you should follow it.

What is the USPSTF? The USPSTF is an independent group of 16 medical experts whose recommendations serve as guidelines for doctors throughout the country. In addition, the group’s recommendations ultimately impact what tests Medicare and private insurers will pay for.

Why did they make this recommendation? According to the USPSTF, the potential harms caused by prostate-specific antigen (PSA) screening of healthy men as a means of identifying prostate cancer far outweigh its potential to save lives. The group discourages the use of any screening test for which the benefits do not outweigh the harms to the target population.

What are the potential harms of PSA screening? An elevated PSA reading can lead to an unnecessary prostate biopsy. Although biopsies often reveal signs of cancer, depending on a man’s age, 30 to 50 percent will not be harmful -- even if left untreated. 

After a positive biopsy comes the decision about what to do. Most men choose radical prostatectomy, external-beam radiation therapy or brachytherapy. But each of these treatments has the potential to cause serious problems like erectile dysfunction, urinary incontinence or bowel damage. And men who choose active surveillance must live with the uncertainty of knowing that they have an untreated cancer that could start toprogress at any time.

Why does the Task Force believe PSA screening does not save lives?  The USPSTF evaluated data from five large randomized clinical trials of PSA testing, including the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Trial, which reported no mortality benefit among 77,000 men who underwent PSA testing and were followed for 10 years.

Do these recommendations apply to all men? These recommendations apply to all men regardless of age, race or family history as long as they do not have symptoms of prostate cancer.

My advice. Many leading cancer and patient groups and doctors agree that there is harm with PSA screening and the treatment that follows diagnosis. But a more targeted screening approach focusing on those at greatest risk of developing prostate cancer, and active surveillance for those who don’t need immediate treatment, could shift the balance of benefit and harm toward benefit.

PSA screening is the best test available for the detection of cancer cells in the prostate. Rather than discontinuing use of the only test available to detect the disease early and treat it successfully, efforts should focus on reducing harm.

Bottom Line:  Every man should discuss the benefits and risks of PSA screening with his physician. If you choose to be screened and the result is positive, you and your doctor should discuss whether any further intervention is appropriate or necessary. 

A study reported in the Journal of Sexual Medicine showed that 1500 mg dose of niacin in given to men with high cholesterol levels had a significant increase in their ability to engage in sexual intimacy with their partners. Even in men with severe erectile dysfunction saw even greater improvements in their sexual performance.

Since niacin has very few side effects and is relatively inexpensive, it may be a good alternative for men with erectile dysfunction with an elevated cholesterol levels.

Please don't interpret this study to suggest that treating erectile dysfunction can only be accomplished with niacin. Erectile dysfunction can be a precursor of heart disease and should be treated under a doctor's supervision.

Bottom line: Erectile dysfunction is a common condition affecting millions of American men. One cause of erectile dysfunction is high cholesterol levels which be impaired the blood supply to the penis. In some men this condition can be improved with oral niacin.

What Women Want to Know About Vasectomies

Answers to your most intimate questions.

The vasectomy procedure should be considered carefully by each man and every couple, as vasectomies should be considered permanent. As a woman, you may have special concerns that need to be addressed. Don’t hesitate to ask your physician for more information.

Vasectomy sterilization raises questions for every couple, both men and women, such as "do vasectomies affect male sexual performance?" or "how does the Essure® procedure compare to vasectomy?". Although men can be forthcoming about the questions, concerns and fears they share with their physician, it's just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about vasectomies that men have.

Candid questions, correct information, and the assurance of an experienced physician are the keys to feeling more comfortable and sure about the decision you and your spouse to limit the size of your family. Make a list of the questions that concern you most about vasectomies before meeting with your doctor.

Here are some, but not all, of the questions commonly asked by women:

Will a vasectomy affect a man's sexual performance or ejaculation?
How long will it be until my spouse and I can resume sex?
Does the vasectomy procedure leave scars?
After the vasectomy, how soon will it be until my husband is no longer producing sperm?
How long will my husband be in pain after surgery, and how can I help?
Does a vasectomy make you more, or less, susceptible to sexually transmitted diseases?
How young is "too young" for a couple considering vasectomy surgery?
My husband doesn't want surgery-he says that a tubal ligation is just as safe, easy and effective. Is it?
What is the Essure® procedure and how does it compare to vasectomy?

Men with vasectomies typically feel no vasectomy related side effects or change in sexual drive after the vasectomy recovery. Sperm is only a tiny portion of the seminal fluid that is released at ejaculation. A vasectomy does not change the volume, color, or consistency of the ejaculate. Sperm are impossible to detect without the use of a microscope. The quality, intensity and duration of a man's orgasm and ejaculate should not change after a vasectomy.

Physicians usually advise that it's best to wait a week or two following the procedure before returning to sexual activity. It will take additional time before sperm is no longer ejaculated, so an alternate form of birth control will need to be used initially.

Vasectomies leave virtually no scar or noticeable difference to the feel or appearance of the scrotum. Vasectomy is a safe, simple procedure.

the vasectomy procedure, men continue to produce sperm, which are absorbed by the body. Your husband will have one or more sperm tests following surgery, and it will take 6 weeks or longer before he no longer ejaculates sperm and the vasectomy is considered successful.

You can expect your husband to experience some degree of discomfort and swelling on the day of, and after, surgery. A gradually decreasing ache in the scrotal region may follow and last for a week or so. The best medicine for him during his vasectomy recovery time is to follow doctors' orders, lots of ice and rest, and your tender loving care.

Vasectomy surgery does not protect couples from the risk of transmitting or contracting a sexually transmitted disease. These diseases are transferred in body fluids, such as saliva or semen. Both men and women should use condoms if any potential risk of sexually transmitted disease exists.

An individual may choose not to ever father a child at any stage of life, and age is a subjective consideration. However, a good rule of thumb is that couples over the age of 25, who have all the children they desire, are old enough to make this personal, permanent decision.

Vasectomies are performed in just a few minutes with a local anesthetic. The procedure is faster, easier, less expensive and poses much less risk of complications to men than does a tubal ligation for women, which must be performed under general anesthesia, and requires a longer recovery period and is more expensive.

The Essure® procedure involves placing metal coils into the fallopian tubes with a scope through the uterus. Occlusion of the fallopian tubes then usually occurs through scarring over the ensuing months. It is complicated (requiring special expertise with internal instruments) and much more expensive than the simple 15 minute vasectomy. While vasectomies are virtually painless, the Essure procedure is done frequently with anesthesia, or at least with intravenous sedation. While confirmation of sterilization with vasectomy involves only a semen sample, that confirmation after an Essure procedure requires at least one uterine dye x-ray procedure. The Essure procedure offers no better sterilization and its long term data is much more limited than with vasectomy. A vasectomy would be much easier to reverse than the Essure procedure.

In Summary:

• Vasectomies should be considered permanent birth control, so consider carefully your decision in light of your age financial and marital situation.
• Be informed and discuss all your options with your spouse and your physician.
• There is virtually no vasectomy scar post the procedure and sexual performance is not affected.
• Tubal ligation is a more complicated sterilization procedure compared to vasectomy, which is safer, easier and just as effective.
• Vasectomy is generally not recommended for couples under the age of 25.

It's a natural concern, for both husband and wife. Couples often want to know, but sometimes don't know how to ask the question. Will things be the same - especially for the man - following a vasectomy?

Does a vasectomy effect a male sex life? The straightforward answer to this question is a "No." A vasectomy does not reduce a man's sexual drive or his ability to have or enjoy sex. The procedure eliminates only the man's ability to father a child...   he can still experience an erection and ejaculation as before.

This is an excellent topic for a candid discussion between husband and wife, and perhaps with the doctor of their choice. Some couples are concerned about a reduced libido or sex drive, but they may be shy about asking the question.

What they may come to discover is, once sterility is complete, they no longer need to worry about accidental pregnancy - and that lovemaking can be more spontaneous, more sensuous and more enjoyable than before.

A vasectomy does not effect the blood vessels or nerves that are part of having an erection or ejaculation. Nothing physiologically changes in that respect.

Two important cautions!

It's important to note that a man will not be sterile immediately following a vasectomy. Talk to your doctor, who will test your semen for sperm before you can have unprotected sex. It may take up to 20 ejaculations or more and several weeks before your reproductive system is free of active sperm.

Another caution is that a vasectomy is not a protection against sexually transmitted disease (STD). If you are at risk of transmitting or acquiring an STD, you and your partner will still need the protection of a condom or other means of protection.

So what’s the difference?

Typically, the only significant difference after a vasectomy is that the sperm normally produced is missing from the semen. The glands that produce semen are not changed by a vasectomy. Sperm is such a tiny portion of the total ejaculation fluid (about 2 percent) that the change can't be noticed. Even the color and consistency of the ejaculate are not changed.

There's no effect on "masculinity," either. The man's body continues to produce hormones as before, and there is no change in any of the male characteristics such as beard or voice. Testosterone continues to be produced and released into the bloodstream. Testicles continue to manufacture sperm, but they don't leave the body. Unused sperm are simply absorbed by the body as normally occurs with or without a vasectomy.

In Summary:

• Talk candidly with your spouse and your doctor.
• A vasectomy will not decrease your sex drive.
• The procedure only eliminates your ability to father a child.
• Sterility is not immediate; your doctor will need to test you and advise.
• Vasectomy is no protection against sexually transmitted disease (STD).
• You can still have an erection and ejaculate.
• The body continues to produce hormones.
• Male characteristics (voice, beard) are not affected.

For years we have told our patients that large daily doses of vitamin E, long touted as a virtual wonder drug containing cancer-fighting anti-oxidants could protect against cancer, heart disease, dementia and other ailments, increase the risk for prostate cancer among middle-aged men.
In 2001 he National Institutes of Health launched a $119 million project to study prostate cancer after laboratory studies and some clinical data indicated that the anti-oxidant vitamin E and selenium might protect against prostate cancer, the second most common cancer and cancer killer in men.
The study followed more than 35,533 men age 50 or older at 427 sites in the United States, Canada and Puerto Rico. The men were divided into four groups who took daily doses of 400 international units of vitamin E and 200 micrograms of selenium; vitamin E and a placebo that looked like selenium; selenium and a placebo that looked like vitamin E; or two placebos.
An independent panel monitoring the experiment halted the study in 2008 when it became clear there was no benefit and indications emerged the supplements might be increasing the risk for prostate cancer and diabetes.

The analysis of data from more than 35,000 healthy men concluded that those who took vitamin E every day at the relatively large dose levels were 17 percent more likely to develop prostate cancer.
The study concluded that vitamin E is unlikely to help prevent prostate cancer but it apparently could harm the very men who were taking the vitamin for its beneficial effect.

The findings were recently published in the Journal of the American Medical Association and are the latest in a series of carefully designed experiments that have found that vitamins and other dietary supplements are useless or possibly dangerous.
Bottom Line: If you are taking vitamin E, I suggest you discuss this with your physician and be certain that the beneficial effects are worth the increased risk of taking vitamin E.
Neil Baum is a urologist and a clinical faculty member at Tulane and LSU medical schools in New Orleans. He blogs at Blog: Dr. Neil Baum’s Urology Blog

Aim for a healthy eating pattern

Instead of focusing on specific foods, dietitians, physicians, and researchers tout an overall pattern of healthy eating — and healthy eating is easier than you might think. In a nutshell, here’s what experts recommend:

Eat at least five servings of fruits and vegetables every day. Go for those with deep, bright color.

Choose whole-grain bread instead of white bread, and choose whole-grain pasta and cereals.

Limit your consumption of red meat, including beef, pork, lamb, and goat, and processed meats, such as bologna and hot dogs. Fish, skinless poultry, beans, and eggs are healthier sources of protein.

Choose healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Avoid partially hydrogenated fats (trans fats), which are in many fast foods and packaged foods.

Avoid sugar-sweetened drinks, such as sodas and many fruit juices. Eat sweets as an occasional treat.

Cut down on salt. Choose foods low in sodium by reading and comparing food labels. Limit the use of canned, processed, and frozen foods.

Watch portion sizes. Eat slowly, and stop eating when you are full.

Stay active

In addition to eating a healthy diet, you should stay active. Regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer. And although relatively few studies have directly assessed the impact of exercise on prostate health, those that have been done have concluded, for the most part, that exercise is beneficial. For example:

Based on questionnaires completed by more than 30,000 men in the Health Professionals Follow-up Study, researchers found an inverse relationship between physical activity and BPH symptoms. Simply put, men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits.

Using data from the Health Professionals Follow-up Study, researchers also examined the relationship between erectile dysfunction (ED) and exercise. They found that men who ran for an hour and a half or did three hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise at all. More physical activity conferred a greater benefit. Interestingly, regardless of the level of exercise, men who were overweight or obese had a greater risk of ED than men with an ideal body mass index, or BMI.

Italian researchers randomly assigned 231 sedentary men with chronic prostatitis to one of two exercise programs for 18 weeks: aerobic exercise, which included brisk walking, or nonaerobic exercise, which included leg lifts, sit-ups, and stretching. Each group exercised three times a week. At the end of the trial, men in both groups felt better, but those in the aerobic exercise group experienced significantly greater improvements in prostatitis pain, anxiety and depression, and quality of life.

This article was excerpted from https://mail.google.com/mail/?shva=1#inbox/132cfb68cd03a854

What do most of us do when that situation occurs? We put our tail between our legs, crawl away and think of excuses why they didn't follow our directions, heed our advice or buy our products. That's the natural response, and it probably won't make us feel better and it certainly won't help us promote and sell our products.

Let me begin this article with a story involving my 10-year-old son, Craig, when he was cut from a "major" baseball team that he wanted to join. Upon hearing the devastating news, he came home and shed a few tears and thought about how miserable the summer would be playing in a "minor" league.

I suggested that he write the coach a letter to thank him for giving him an opportunity to try out and for all the instruction he received during the month of try-outs. My son just sniffled and told me that he was only ten, and he couldn't do that. That evening I came home and found a letter that he wrote to the coach. He expressed his appreciation for giving him a chance to make the team, and that he felt his baseball skills had improved as a result of working with the good players and the coach. He also wished the coach and the team good luck, and that he would come around to cheer and root for them. Upon reading that letter, I awakened my son and congratulated him on hitting a home run.

The coach wrote to my son and told him that in 15 years of coaching he had never received a letter like that from a player who made the team, let alone from a player who was cut. He also mentioned that Craig had class and character and that he would be a success both on and off the field and that he was looking forward to his trying out next year.

My message is that if a ten-year-old boy can say "thanks" when the coach says "no" then all of us can say "thanks for giving me a chance to show you my products or my services" when the customer says "no". I can assure you, that just like Craig's coach, it will be the only thank you that they will receive from a doctor or a sales person when they don't use your products or services.

Does this work? Yes, but not always. I recall a sales representative that called on me for several months and encouraged me to switch to her product, which was very similar to one that I had been using for nearly 15 years. She wrote me several notes and each time said, "thank you for seeing me and learning about my product." Nearly 6 months later she came in for a visit and gave me a laminated copy of an article that appeared in Pharmaceutical Representative. That day she received my undivided attention, and her kindness and persistence resulted in changing a 15-year prescribing habit. All this for a few letters and a few dollars to have the article laminated.

Another time a medical manufacturing representative came for a visit and I told him that I used his competitor's product and was satisfied with the product and the service. He said that he would be by on a regular basis and would be available if the situation ever changed with the competitor's product or service. After every visit he sent a note of thanks and promised to come back in a month. After nearly 15 visits, he came when a window of opportunity occurred and he was there to fill a void that occurred that was not being met by the competitor.

I recall having seen a patient that came to discuss surgery, and who had visited with several other doctors in the community and decided to have his surgery elsewhere. When I heard he was in the hospital, I went by to visit him after surgery and wished him a speedy recovery. He called me several months later and thanked me for the visit and requested an appointment to see me concerning another health matter.

Would he have called if I didn't stop by to visit? I don't know. But as my wise Jewish mother would say the visit didn't "hoit."

Bottom Line: Let's take a lesson from Craig and those sales representatives who said, "Thanks for saying no". If everyone said 'yes' to all of our sales presentations, we wouldn't need representatives at all. We would be out of a job. One way to hopefully insure a sale is to thank those customers, clients and patients that say 'no". I can assure you that eventually this kind of response on your part will change 'no's' to "go's"

P.S. Craig did well in the minors and worked hard all winter and tried out and made the "majors" the very next summer!

Side effects can produce symptoms ranging from lethargy, insomnia, muscle aches, depression, dizziness, diarrhea, constipation, and even chest paid. 

So what can you do to avoid side effects of medications?  First be sure your doctor knows what medications you are currently taking.  Ask if the drug he is prescribing has any interactions with the drugs you are currently taking.  There are computer programs that are available that will alert the doctor of any possible drug interactions.  One of the most popular programs is e-Pocrates where the doctor or nurse can write in the drug being prescribed and the drug(s) the patient is currently taking and will list any potential drug interactions.  Most electronic medical record programs that are becoming so prevalent among physicians’ practices will notify the doctor of any potential drug interactions.

Also, you can go to the Internet and use one of the search engines such as Google and type in the name of the medication and the phrase “drug interactions” and you will learn what drugs should not be taken together. There are drug interaction checkers available online.  One of the best is aarp.org/healthtools.

Next, ask the doctor what are the most common side effects and what is the likelihood of having any of the side effects.  If the medical problem is not serious and not incapacitating, you may decide to forgo any new medications. 

Also, ask your doctor if there are any lifestyle changes you can make as an alternative to taking medications.  For example, if you have newly diagnosed high blood pressure, you can undergo a weight loss program and significantly reduce the salt in your diet, and you may avoid taking blood pressure lowering medications, which have side effects.

If you are taking multiple medications, you can ask your pharmacist to review all of your medications and the pharmacist will let you know which drugs are incompatible.  Some pharmacists will charge you a few for this review but it is certainly worth it especially if you are older and if you take multiple medications.  Also, if you are in a Medicare Advantage program, you may qualify for its medications therapy management services.

If you begin to experience a change or symptoms shortly after starting a new medication, you should contact the doctor’s office and speak to the doctor or nurse to find out if this is an expected side effect, how long it might last, or if the side effect is more serious and the drug should be discontinued. 

It is also important to mention to your doctor any supplements, herbal medications, or vitamins that you routinely take as these may interact with your prescribed medications.  

Final advice: Even if you are experiencing side effects due to medications, don’t stop taking the medication without calling your doctor first.

Bottom Line: For the most part drugs properly prescribed can be very helpful and will alleviate symptoms and treat your medical condition.  However, all medications have side effects and you can minimize these side effects by being knowledgeable and informed about drugs and drug side effects.

Staxyn helps increase blood flow to the penis, so it may help men with ED get and keep an erection that lasts long enough for sexual activity. Once a man has stopped sexual activity, blood flow to his penis decreases, and his erection goes away.
It is suggested that you take Staxyn about an hour before sexual activity.  The tablet is place on the tongue where it will dissolve rapidly. The tablet should be taken whole and not crushed or split.  The tablet should not be taken with liquid.  The tablet may be taken with or without food.  It is not recommend to take more than one Staxyn a day.
Forget the Rumors
Staxyn will not give you an instant erection; you'll need to be sexually stimulated for it to work.
The medication not leave you erect for hours. If an erection lasts more than 4 hours, get medical help right away to prevent lasting damage that may make future erections difficult or impossible.
No the drug will not make you have a stiff tongue.  It’s mechanism of action is on the blood supply to the penis and not the tongue!
No, no, with nitrates
Do not take Staxyn if you take any medications called ”nitrates” (often used to control chest pain, also known as angina).  Nitrates may cause abnormally low blood pressure and Staxyn may increase that risk.

Bottom Line:  Erectile dysfunction is a common problem affecting millions of American men.  Help is available.  You don’t have to suffer the “tragedy of the bedroom”. 

For a patient who failed on PDE5 inhibitors and cannot use a needle to self inject his penis, TriMix-gel® has been used as an alternative.

Many ED sufferers cannot take PDE5 inhibitors for a variety of reasons.  Contraindications include patients on nitrates, certain beta blockers or patients with nonarteritic anterior ischemic optic neuropthy (NAION).  Still other patients cannot tolerate the side effects, which increase when dosage is increased.  At the point PDE5 inhibitors are eliminated as a viable option, of the remaining options, penile injections with vasodilators prevail as the most effective non surgical alternative.  There are some patients who are not receptive to this alternative because they cannot self inject the penis.

TriMix-gel® is an easy to apply gel used before sexual intercourse. Each dose contains trimix in powder form which is energized into a gel at time of use. Trimix ingredients (alprostadil, phentolamine, and papaverine) have been tested and widely prescribed for many years for improvement of sexual health.

• There are no needles, pellets, or pills
• Can be carried by the patient at room temperature
• ED-gel® Easy Applicator (pat. pending)

Typically, the trimix for injection version of the compound would have to be refrigerated and then self injected with a needle at time of use. But the compound in gel form, called TriMix-gel®, allows the patient to carry the medicine at room temperature. More importantly, an erectile dysfunction patient wil not have to use a needle to self inject his penis before sexual intercourse.

Precautions

• Tell your doctor and pharmacist if you are allergic to alprostadil/prostaglandin or any other drugs.
• Tell your doctor and pharmacist what prescription and nonprescription medications you are taking.
• Tell your doctor if you have or have ever had anemia, bleeding disorders, sickle cell disease, leukemia, cancer, kidney or liver disease.

The effects of TriMix-gel® should last no longer than one hour. We have found that this is satisfactory for most men who live in the Gulf Coast area!

Bottom Line:  If you suffer from ED and the oral medications are not working, there are still options that help nearly every man so they don’t have to suffer the "tragedy of the bedroom".

For the approximately 16% of people over the age of 18 who have an overactive bladder (OAB), getting up two or more times a night can become a regular occurrence. Even if they make it to the bathroom in time, they wake up so often to urinate that they aren’t getting a good night’s sleep.

Generally, the amount of urine in our bodies decreases and becomes more concentrated at night, so we can sleep six or eight hours without having to get up to use the bathroom more than once. But many people with OAB have nocturia, the need to urinate several times a night, which interrupts their sleep cycles.

Even worse, there are some men and women who are particularly sound sleepers or can’t get out of bed fast enough can wind up with wet sheets.

Take these steps to prevent accidents from happening:

            Limit your fluid intake before bedtime. Try not to drink any liquids after 5 p.m. or 6 p.m.

            Avoid foods and beverages that can irritate your bladder. If you can’t cut them out entirely, skip them in the hours before bedtime to help prevent nocturia. That includes:

                             Caffeine, which is a diuretic, which increases urine output

                             Alcohol

     Citrus juices

     Cranberry juice -- though it is touted as great for bladder health, it is actually an irritant if you have OAB

     Spicy foods, like curries

      Acidic foods, such as tomatoes and tomato sauces

Chocolate

Artificial sweeteners

Double-void before bed or urinate twice, right before bed. For example, you can go to the bathroom, then brush your teeth and go through the rest of your bedtime routine. Then, just before you’re about to lie down -- even if you don’t feel like you have to go -- try to urinate and see if you can squeeze out another tablespoon or so.

Do Kegel exercises. Done regularly, they help control an overactive bladder. They will trigger a reflex mechanism to relax the bladder. If you feel a tremendous urge to urinate, doing a Kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.  Kegels simply involve contracting and releasing the muscles around the opening of your urethra, just as you do when going to the bathroom. You can learn what a Kegel exercise feels like by starting, then stopping, your urine stream. Start with three sets of 8-12 contractions. Hold them for six to 10 seconds each and perform these three to four times per week.

OAB and Your Sex Life

OAB can interfere with sexual intimacy another important activity that takes place in the bed. There’s nothing that can shut down an intimate moment faster than realizing you’ve lost control of your bladder during sexual intimacy -- something that happens for many people with OAB. About 15% of my patients report having incontinence during sex.

When you’re being intimate, you’re used to secretions and moistness, but the thought that it’s actually urine leakage is really upsetting and uncomfortable.  Usually it’s the female patient who has the leakage, and it’s actually more bothersome for her than for her partner.

Tips for Getting Your Groove Back

There are some things you can do to ward off discomfort or embarrassment during sex.

Talk about it. First, know that your partner will probably be a lot more understanding than you expect. Then bring it up before you have intercourse. Plan and prepare for sex, just as you do for bedtime. Double-void, cut back on fluids, and avoid foods and beverages that are likely to irritate your bladder. This means passing up that romantic glass of wine to get you in the mood.

Keep up the Kegels. Doing these several times a day -- and even during intercourse -- will help prevent urine leakage during sex.

All of these approaches can help you manage your overactive bladder at night, letting you get a better night’s sleep and have a more active and satisfying sex life.

Bottom Line:  An overactive bladder can wreck havoc with sleep, your sex life, and your entire life.  I suggest you try these few self-help ideas.  If they do not resolve the problem, then contact your doctor, urologist or gynecologist.  Help is available.   You don’t have to be embarrassed and tired because your overactive bladder is controlling your life.

This article has been modified from “Putting an Overactive Bladder to Bed-Insights for Good Sleep and Good Sex”

By Gina Shaw

http://www.webmd.com/urinary-incontinence-oab/oab-11/sex-and-sleep

The new test is the "AccuPSA, which is a simple blood test that can tell your doctor important information about prostate specific antigen levels after radical prostatectomy or removal of the entire prostate gland.  AccuPSA has the potential to eliminate unnecessary treatments and enable earlier detection of recurrence, which may lead to earlier treatment, better outcomes.

After undergoing radical prostatectomy, many men remain at a significant risk for cancer recurrence. Because of this, patients are monitored very closely for rapid increases in PSA, which may signal cancer recurrence.  Once the prostate is surgically removed, PSA levels are usually undetectable using standard tests.  This new test is able to detect PSA with unprecedented sensitivity, and at much lower levels than standard PSA tests because it can selectively capture and measure individual PSA molecules.

What this new test  might mean for a post-radical prostatectomy patient is that a low level of PSA could indicate if the patient is effectively considered cured.

Excerpted from: http://www.sciencedaily.com/releases/2011/08/110808104618.htm

Men who smoke at the time they’re diagnosed with prostate cancer have an increased risk of recurrence and death compared with those who have never smoked cigarettes. Odds for men who quit smoking at least 10 years previously, on the other hand, are similar to those of never smokers.

Evidence continues to mount of an association between lifestyle factors and health. Smoking is a commonly investigated behavior for its association with several forms of cancer as well as other disease and illnesses.

To better investigate whether smoking affects outcomes for patients with prostate cancer, researchers with Harvard School of Public Health and University of California, San Francisco, evaluated 5,366 men diagnosed with prostate cancer between 1986 and 2006. The outcomes they measured included overall mortality, prostate cancer-specific mortality, death from cardiovascular disease, and a rise in PSA level).

• Men who currently smoked had an increased risk for all-cause mortality, prostate cancer mortality, death from cardiovascular disease, and biochemical recurrence compared with never smokers.
• Smokers who had quit for 10 years or more had a similar risk of prostate cancer death as never smokers.

Bottom Line: This is one more reason to stop smoking cigarettes especially if you are at risk for prostate cancer, i.e., have a close relative with prostate cancer or are African-American as the incidence of prostate cancer is greater in both groups of men.   

Reference: Kenfield SA, Stampfer MJ, Chan JM, et al. Smoking and prostate cancer survival and recurrence. JAMA.2011;305(24):2548-2555. doi: 10.1001/jama.2011.879.

June 20, 2011 by neilbaum

I was seeing another patient who was having difficulty with urination associated with chronic low back pain. I asked if his urinary problem was improving and inquired about his back pain.

"Dr. Baum," he said, "I have had a terrible 3 days, with such severe pain and discomfort that I almost took out my pistol and ended it all."

I completed my exam and stepped out of the room to alert the patient's primary care physician to my findings. I was told that my patient was seen and psychiatrist and that his primary care physician would make sure that the psychiatrist was aware of the patient's depression and suicidal comments. Then I asked the patient to accompany me to the reception area where I gathered my staff and the patient next to a prominently posted sign that says, "if you are feeling less than a B+, please let us know and we will give you a hug." I whispered to my staff members that the patient needed a hug. When we hugged him, the patient's head tears in his eyes because I believe we showed real concern for him and his well-being, which included his mental health as well as his urinary stream.

Later, my staff members wrote to the patient and expressing their concerns and saying that they look forward to seeing him at his next appointment. When the patient returned to my office several weeks later, he said that he had found my staff's hugs were far more effective and  far more encouraging than his psychotherapy sessions and the three  antidepressant medications.

This patient encounter remains one of the highlights of my medical career. The patient clearly demonstrates the power of high touch and that as long as physicians are willing to use high touch, they will never be replaced by high tech.

By Neil Baum

I was in practice about five years and was about to do a radical nephrectomy on a patient. I met with the patient and his son in my office and the son informed me that he and his father were Jehovah's Witnesses and that he didn't want his father to receive any blood or blood products before, during, or after surgery. I asked the father if that was his wish and he sheepishly agreed that it was his decision as well. I had him sign a consent form, with the appropriate documentation, that would absolve me of any negligence if he should require a blood transfusion and didn't receive it.

The night before surgery, I met with the patient alone in his room. He confided in me that he was not as "religious" as his son —if he needed blood, he wanted to receive it. However, he requested that I shouldn't tell him or his son if he received a transfusion.

I thought that was a prudent plan of action, and I documented our discussion in the patient's chart. I then made calls to the laboratory and the blood bank, to type and hold several units of packed cells.

The surgery was a little more difficult than I anticipated and the patient lost several units of blood —he had signs of hypovolemia in the immediate post-operative period. At the end of the procedure I ordered that the blood be given to the patient in the recovery room. I told the nurses not to allow any family members into the recovery room while the transfusions were being given. I also had the nurses change the IV tubing after the transfusions were given so that there would be no tell-tale signs of blood in the IV tubing that could be seen by the family. I thought I had covered all of my bases.

I then walked out to meet with the family in the family lounge. The son asked me about the surgery and I told him about the difficulty of the operation but that his father was stable and doing well in the recovery room. The son then asked me, "Did my father receive any transfusions or any blood products?" Pow! I know I had the look of a deer stunned by the headlights. There were so many thoughts that raced through my mind in the interval between his questions and my response.

I responded, "Why do you ask?" as I was hoping to have just a few more seconds to gather my thoughts. The son said that someone from the blood bank had come into the family lounge during the surgery and asked if anyone in the family would consider donating blood, as their father was going to receive blood. I thought I had taken care of everything but I didn't give the blood bank a heads up on  my agreement with the patient. I thought, do I tell the truth and risk rupturing rapport between the father and the son and/or between the patient and myself? To give an adult patient blood against their will or wishes could be considered an assault with battery. I was truly scared about the legal ramifications the truth would subject me to. Or do I lie and protect the patient? I decided that my responsibility was to the patient and that the patient deserved that I protect his wishes and preserve his relationship with his son.

I said, "There must have been a mistake as your father did not receive any blood." The son gave a sigh of relief and I know that inside I, too, was also relieved that the rapport was not blown between the patient and me, or between the patient and his son.

I ask, if you were the doctor in this situation, what would you have done? Would you be perfectly honest and tell the son about your discussion with the father the night before? Or would you do as I did, and lie to the son in order to protect your patient, his father?

We have all taken the Hippocratic Oath, which admonishes us "To do no harm." I believe this dictum refers to more than just clinical harm to the patient, but also to psychological harm. I believe that had I been forthright about the transfusions, I would have harmed the patient — the lie protected the patient.

A certain moral goodness is expected in physicians, and if goodness is not present, education probably will not create it. Superior moral reasoning can enhance moral behavior, and we only have to look at the lessons of the great physicians who preceded us for the answers and the advice that can guide us in the practice of our profession.

This was one of the scariest days in my professional life and I believe, to this day, that I behaved in the best interest of my patient.

Addendum: I have researched this issue and the legal implications associated with blood transfusions in Jehovah's Witness patients. The advice is that "medical providers should take care that each patient presenting as one of Jehovah's Witnesses has ample opportunity to express their personal preferences of treatment outside the presence of any other member of the faith, including close family members." And that is exactly what I did.

Dr. Neil Baumis a practicing urologist in New Orleans, Louisiana and the author of "Marketing Your Clinical Practice: Ethically, Effectively, and Economically," (4^thedition)Jones and Bartlett, 2009. 

http://bit.ly/f2wYjR

Everyone with prostate cancer who goes on the Internet receives information about green tea preventing prostate cancer, that pomegranate juice can be consumed to lower the prostate-specific antigen (PSA) and advice on consuming broccoli and cauliflower.  So what is a man to do?

Numerous studies have been conducted that have looked at vitamin E, selenium, vitamin C and combinations of these 3 supplements. There has been no conclusive study that any of these supplements or vitamins reduce the risk of prostate cancer or prevented the recurrence of prostate cancer.

However there are compelling data supporting the therapeutic potential of a high vegetable diet for prostate cancer. Red meat and fat tend to be associated with increased risk of prostate cancer while broccoli, cauliflower and radishes and tomato products tend to be associated with decreasing the risk of prostate cancer.

So here are my recommendations: 1) avoid supplements for cancer prevention, 2) maintain a diet rich in vegetables and whole grains, 3) limit red meat and refined or processed carbohydrates, and 4) be physically active at least 30 minutes a day.  So go to your grocery store and visit the vegetable counter and pass up the bakery area!  Your prostate gland will thank you!

Zhen-Yu Chen and colleagues note that damaging substances generated in the body, termed free radicals, cause undesirable changes believed to be involved in the aging process and some diseases. Substances known as antioxidants can combat this damage. Fruits and vegetables in the diet, especially brightly colored foods like tomatoes, broccoli, blueberries, and apples are excellent sources of antioxidants. A previous study with other test animals hinted that an apple antioxidant could extend average lifespan. In the current report, the researchers studied whether different apple antioxidants, known as polyphenols, could do the same thing in fruit flies.  (This is particularly good news for fruit flies. If I were a fruit fly I would want to live longer too.)

The researchers found that apple polyphenols not only prolonged the average lifespan of fruit flies but helped preserve their ability to walk, climb and move about. In addition, apple polyphenols reversed the levels of various biochemical substances found in older fruit flies and used as markers for age-related deterioration and approaching death. Chen and colleagues note that the results support those from other studies, including one in which women who often ate apples had a 13-22 percent decrease in the risk of heart disease, and polish the apple’s popular culture image as a healthy food.

J Agric Food Chem. 2011 Mar 9;59(5):2097-106. Epub 2011 Feb 14.
Apple Polyphenols Extend the Mean Lifespan of Drosophila melanogaster.

.

Previous recommendations said parents could switch babies to forward-facing seats at 12 months old or 20 pounds. Switching to a forward-facing seat on a child's first birthday was a common rite of passage.

But new recommendations from the American Academy of Pediatrics say babies and toddlers should ride in rear-facing car seats until at least age 2 — even longer if the child is small enough.

The pediatrics group is changing its recommendation because research shows children under 2 are 75% less likely to die or be severely injured in a crash if they're in rear-facing car seats, according to the policy statement, published today in the journal Pediatrics.

Car accidents are the leading cause of death in children over age 4; about 1,500 kids under 16 die in car crashes each year, the statement says. In Sweden, many children ride in rear-facing car seats until age 4.

Rear-facing seats do a better job of supporting the head, neck and spine in an accident, because they distribute the force of the collision over the entire body, says study author Dennis Durbin, a pediatrician at Children's Hospital of Philadelphia Center for Injury Research and Prevention.

The new guidelines are "a fantastic step," says Jennifer Hoekstra, who coordinates a child safety program at Helen DeVos Children's Hospital in Grand Rapids, Mich.

Hoekstra says parents of toddlers under age 2 who already are using forward-facing seats shouldn't panic, because forward-facing seats still provide good protection.

"If you are using your forward-facing car seat correctly, your child is safe," Hoekstra says. But 73% of car seats are installed incorrectly, according to a 2005 study in the journal Accident Analysis and Prevention.

Parents won't necessarily have to buy new car seats, which range in price from about $40 to more than $300,

Thirty of the 35 convertible car seats now on the market can accommodate a 2-year-old, even up to 35 pounds, which is at the top of the weight range for that age.

Owners of convertible car seats may be able to follow the new advice simply by turning the seats around, so that kids face the back.

Yet some of the greatest objections may come from toddlers themselves.

An 18-month-old, newly allowed to face front, may not agree to turn back around — at least without a lot of crying — especially if the child has an older sibling who is allowed to face front.

Bottom Line: For the safety of your child, have them face back until age 2.

While aging and menopause may contribute to stress incontinence, overactive bladder, or general bladder weakness, loss of bladder control is very common, treatable, and sometimes even curable. You can also help ward off complications of urinary incontinence -- like the development of bladder and kidney infections -- by seeking help from your doctor.

Now there is a free and reliable source of information about overactive bladder, stress incontinence, and bladder weakness. 5 keys to manage a leaking bladder or overactive bladder for women over 50 is a free publication from the editors of VibrantNation.com that provides the accurate and trustworthy information for proven relief from bladder control issues.

Many women experience overactive bladder, stress incontinence, or bladder weakness issues during menopause. Some experts theorize that estrogen plumps the lining of the bladder and urethra, and that lack of estrogen could contribute to bladder weakness. Pressure from coughing, sneezing, or lifting can push urine through the weakened muscle. This kind of leakage, called stress incontinence, is one of the most common kinds of bladder control problems in older women.

According to the National Association for Continence, one in five adults over 40 are affected by overactive bladder and women wait an average of 6.5 years to see a doctor for their overactive bladder, stress incontinence, or bladder weakness issues. While there are several medical solutions to consider, this report from Vibrant Nation addresses the most common fixes and ways to cope with a leaking bladder or overactive bladder, including surprising facts about foods and drinks that irritate your bladder, how to ensure you do Kegel exercises correctly, and how to train your bladder.

Vibrant Nation is dedicated to helping women over 50 connect with like-minded and similar lifestage women. In addition to eBooks, Vibrant Nation publishes conversations and weblogs about a variety of topics, from work & money, to fashion & beauty, from love & sex, to family & relationships. VibrantNation.com is the reliable online source for information, inspiration and peer support for 50 million women over 50.

According to Susan Lee Ward, Vibrant Nation Editorial Director, "Every day, more members and contributors discuss bladder control as an issue that is important to them and look to their peers for inspiration and support, so we produced this free report addressing proven relief from bladder weakness and stress incontinence."

Download your complimentary copy of Vibrant Nation's 5 keys to manage a leaking bladder or overactive bladder for women over 50 at http://www.vibrantnation.com/freemiums/5-keys-to-manage-a-leaking-bladder-or-overactive-bladder-for-women-over-50/. Get the facts about overactive bladder, stress incontinence, or bladder weakness from a source you can trust. Discover why thousands of women have become enthusiastic online visitors to VibrantNation.com.

About VibrantNation.com

VibrantNation.com is the leading online community devoted exclusively to the influential and fast-growing demographic of smart, successful women over 50. VibrantNation.com is the place where they can connect with other women at their life stage and discuss the issues they are passionate about. http://www.vibrantnation.com/.

Bottom Line: If you answered yest to any of these quesitons, you should check with with your doctor. Help is available. You don't need to be a prisioner held hostage in the restroom.

From John Hopkins Health Newsletter, 2-22-11

Once again I love it when a mystery is revealed, or at least partially explained.
A case study in the Journal of Clinical Sleep Medicine helped confirm the importance of vitamins to your sleep.
But a recent case study has shown that a patient with severe sleepiness and a vitamin D deficiency, vitamin D supplementation improved daytime sleepiness dramatically. The patient was a 28 year old female. She was suffering for about four months with excessive sleepiness. Her symptoms started slowly and continued to progress. She kept a standard bedtime between 10 and 11 pm, and she reported falling asleep within minutes. She would wake at 7:30 am and reported that she did not think that she was sleeping poorly. She would get her kids ready for school and then be back in bed by 8am until noon. She would then nap from 4 pm to 7 pm. She reported about 14 hours of sleep per day.
Her sleep study showed no signs of sleep apnea or other sleep disorder. During her clinic visit she showed no signs of narcolepsy, depression or anxiety. Her next day nap study was unremarkable. She reported muscle fatigue and pain, as well as headaches. Her lab work showed a thyroid in the low but normal range and she had low levels of vitamin D.
She was started on a vitamin D supplementation at 50,000 units once per week (IV) and within 2 weeks she started to see a decrease in her sleepiness and fatigue.
Vitamin D is actually considered a fat soluble hormone that can be received in foods (dietary sources and fish) or is self-manufactured by the skin after exposure to UVB light. A vitamin D deficiency has been noticed as a global issue and recently found in underserved populations, patients in northern latitudes, people with darker skin tones, the elderly, obese and pregnant or lactating women. Also very common in areas with a high degree of sunshine (this seems counter-intuitive, but think about all that sunblock!). Recent studies have linked vitamin D deficiency to metabolic syndrome, muscle pain, and even type 2 diabetes.
So why do we think it helped her sleepiness? It is really hard to say, but I have seen this in some of my patients. It could be linked to a decrease in sleep disturbing pain. Or vitamin D may be something that will help decrease a person's drive for sleep. Only more research in this exciting new area can tell us.
Check with your doctor about vitamin supplementation. We all work hard, and eating right isn't always easy - and even when we do, we may not get what we need from the food we eat. Our bodies actually make vitamin D, but we have to get enough sunlight to make that happen effectively.
Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™

http://bit.ly/g006uz

(Reuters Health) - A new study finds that one in five U.S. men have to get up at least twice a night to empty their bladders -- which for some could signal an underlying medical problem or even contribute to poorer health.
Known as nocturia, those frequent overnight trips to the bathroom can be a sign of a health condition, ranging from a urinary tract infection to diabetes to chronic heart failure. In men, a benign enlargement of the prostate can also be a cause.
For some people, the constant sleep disruptions can themselves cause problems -- contributing to depression symptoms or, particularly in older adults, falls.
On the other hand, getting up during the night to urinate can also be normal. If you drink a lot of fluids close to bedtime, for example, don't be surprised if your bladder wakes you up at night.
Nocturia also becomes more common with age. Part of that is related to older adults' higher rate of medical conditions. But it could also result from a decrease in bladder capacity that comes with age.
The researchers found that men age 20 and up, 21 percent said they had gotten up at least twice per night to urinate.
Nocturia was more common among African-American men (30 percent) than those of other races and ethnicities (20 percent). Not surprisingly, it also increased with age: Just 8 percent of men ages 20 to 34 reported it, compared with 56 percent of men age 75 or older.
Other factors linked to an increased risk of nocturia included prostate enlargement, a history of prostate cancer, high blood pressure and depression.
Nocturia can also be a side effect of some medications, such as diuretics used to treat high blood pressure. This study did not have information on men's medication use.
Avoiding caffeine and a large fluid intake at night may help as may other lifestyle tactics, like adjusting your sleep habits.
One recent study of 56 older adults with nocturia found that lifestyle changes -- including fluid restriction, limiting any excess hours in bed, moderate daily exercise, and keeping warm while sleeping -- helped more than half of the patients significantly cut down their overnight trips to the bathroom.
There are also medications available specifically for overactive bladder and nocturia. Those include a synthetic version of a hormone, anti-diuretic hormone, that keeps the body from making urine at night, a drug that blocks the ability of the bladder muscles to contract, and antidepressants that make it harder to urinate by increasing tension at the bladder neck.
The bottom line for men is that bothersome nocturia is something they should bring up to their doctor.
SOURCE: bit.ly/fGZKNN Journal of Urology, online January 19, 2011

THE CLAIM Keeping a wallet in your back pocket can cause sciatica. 

Ms. O'Conner said that a wallet stuffed with business cards or scraps of paper might seem like more of an eyesore than a health hazard.

But one old bromide holds that a thick wallet -- or even one that's not so thick -- can harm the lower back for those sit on it for too long. And while experts says the fears are probably exaggerated, the wallet can definitely carry some hazards.

Although it was popularized by an episode of the "Seinfeld" series in the 1990's, the phenomenon was first described in a brief article in The New England Journal of Medicine in 1966, when credit cards were beginning to proliferate.

The report, about a lawyer who suffered aches and pains in the left leg, not far from a wallet growing thick with charge cards, referred to the condition as "credit-carditis."

Although that term never quite caught on, doctors say the condition has become increasingly common. Its onset is gradual, caused by an object that presses on the piriformis muscle in the buttocks, which is connected to the sciatic nerve, which runs down the leg.

Over time, a person can develop radiating pain in the back and hip area.

"Just the other day, I had to tell one patient with back pain to remove at least 20 years of stored data from his wallet," said Dr. Gerard P. Varlotta of the New York University School of Medicine.

Wallets are not the only culprits. Numerous case reports have linked the condition to various back-pocket objects like large handkerchiefs and golf balls.

THE BOTTOM LINE -- Keeping a thick wallet or object in the back pocket can gradually cause sciatica.

Urine is an important part of the body's regulation process. Its job is to remove the extra water and wastes that the kidneys filter out of the blood. The urine is there primarily to get rid of toxins or things that would otherwise build up in the body that would be bad for the body.
When you notice that your urine has changed color, or there's a strange odor emanating from the toilet, the cause might be something as harmless as what you had for dinner such as asparagus. It also might be a sign of a more serious condition, such as an infection or cancer.
Color Changes
Urine normally varies from pale yellow to deep amber, depending on the concentration of the urine, which is determined by the amount of fluid you consume. Darker urine is usually a sign that you're not drinking enough water. Correction is as simple as consuming more liquids, especially water.
The opposite is also true. If your urine is very pale, it means that you're either drinking a lot of fluid, or you're taking a diuretic or water pill which is a drug that forces the body to eliminate excess water.
Urine can turn a rainbow of colors, and an unusual hue isn't necessarily cause for alarm. Certain medications can turn the urine fluorescent green or blue, the carotene in carrots can tint it orange, and vitamins can give it a yellow hue. Pyridium, a medication, which is used to treat burning on urination, will turn the urine orange-red.
Seeing red is typically a sign that there is blood in the urine, but before you panic, know that a little blood can produce a dramatic color change. Just like a drop of food coloring will add color to a large volume of food or fluids, it only takes one drop of blood to turn an entire toilet bowl red.
Red urine is usually an ominous sign and can indicate an infection or maybe even cancer. Red blood is a real warning sign and should prompt you to see your doctor or urologist, a doctor who specializes in disease of the kidneys and bladder.

Odor Changes
Urine normally doesn't have a very strong smell. If your urine has a foul odor, you could have an infection or urinary stones, which can create an ammonia-like odor. Diabetics might notice that their urine smells sweet, because of excess sugar.
Some foods can also change urine odor. Asparagus is among the most notorious. What people are smelling when they eat asparagus is the breakdown of a sulfur compound called methyl mercaptan (the same compound found in garlic).
How Often Do You Need to Go?
How often you need to go can be as important an indicator of your health as the color or smell of your urine. Most people take bathroom breaks about six to eight times a day, but you might go more or less depending on how much fluid you drink. If you're constantly feeling the urge to go and it's not because you're not drinking extra fluid, causes can include:
Overactive bladder (when you gotta go, you gotta go!), urinary tract infection, Interstitial cystitis (painful urination without an infection), prostate gland enlargement, and diabetes.

The opposite problem, not going to the bathroom enough, can occur when there is a blockage or infection. Or, it can be the result of bad bathroom habits. Some people -- especially teachers, surgeons, and anyone else who doesn't have time for regular bathroom breaks throughout the day -- tend to hold it in.
Delaying urination can also cause problems. The bladder can develop a chronic over-distension and will not empty completely. As a result urine is left in the bladder and can be a source for developing a urinary tract infection.
Develop good bathroom habits.
Drink whenever you're thirsty, but certainly increase your fluids before going outside in the hot summer sun or before exercising.
If you're getting up during the night to use the bathroom, stop drinking three to four hours before bedtime. Limit caffeine, which can irritate the lining of the bladder. Also watch your intake of alcohol, which can have an effect similar to a diuretic.
Finally, don't hold it in. Don't delay answering the call of the rest room. Your bladder will thank you.
Bottom Line: Pay attention to the color and odor of your urine. If there is a change, contact your physician.

Bottom Line: Constipation is a common problem. Most people can prevent constipation with diet and moderate exercise.

There are many women who will develop urinary incontinence after vaginal surgery. For example if a woman has a protrusion of her bladder, uterus, or rectum into the vagina and needs a surgical correction, the surgery may result in the involuntary loss of urine with coughing and sneezing after the surgery. The reason is that the protrusion or prolapse kinks or bends the urethra or the tube from the bladder that transports urine to the outside of the body before the surgical correction thus preventing incontinence. Once the normal anatomy has been restored and the urethra is no longer kinked, urinary incontinence may occur. It is estimated that more than 30% of women who are continent before surgery will develop incontinence or loss of urine after the procedure.

What to do? Be sure that your doctor checks for incontinence in the office BEFORE you have the surgery. This may require some testing or maneuvers in the office to reduce the prolapse or protrusion and check for incontinence. If incontinence is unmasked, then the doctor can perform a small procedure during the surgery to repair the prolapse that will prevent incontinence afterwards.

Bottom Line: Urinary incontinence is a significant problem that results in loss of self-esteem, confidence, and may lead to a reclusive life-style. In most instances this can be cured and prevented in women who are undergoing vaginal surgery if the doctor is aware of this possibility before the surgery takes place.

It is estimated that one in ten men over the age of 35 has bought prescription medicines online. This certainly has an appeal to many men. It allows them to make the purchase cheaply sometimes at 1\3 of the cost of the drug from a pharmacy. The man can obtain the medication discreetly and with only the most rudimentary of health checks. But purchasing Viagra over the Internet doesn't come without risks. A recent report by Pfizer suggested 90 per cent of the drug bought this way is fake and may contain toxic ingredients such as rat poison and paint and paracetamol - which if unwittingly combined with paracetamol-based cold or headache remedies could cause liver failure. Also, drugs like Viagra are contraindicated with certain medications like nitroglycerin and can result in a fatal heart attack if a man takes Viagra, develops chest pain and then takes a nitroglycerin tablet. Remember the movie, "XXXX", when Jack Nicholson took both medications and ended up in the emergency room?

Bottom Line: You get what you pay for. Better and safer to get your medications from a reputable source and at the advice from your physician. There's no erection worth a heart attack!

Nationally recognized urologist, Dr. Neil Baum, is now offering same and next-day appointments to accommodate the needs and schedules of his patients.
NEW ORLEANS, LA -- Dr. Neil Baum, a well-known urologist in New Orleans, is pleased to announce that his practice is now offering same and next-day appointments. Whether patients are coming in for a routine visit or have health concerns that require immediate attention, Dr. Baum is providing same and next-day attention that is convenient for his patients' schedules.
"A patient's care should never be put on hold because they can't get in to see the doctor. Our practice makes it as easy as possible to get the care you need, when you need it. Simply call or email requesting a same-day or next-day appointment, and we'll work around your schedule to bring you urological care at your convenience, "said Dr. Neil Baum, New Orleans urologist.

Dr. Neil Baum is a nationally recognized author, speaker and urologist in New Orleans and has been in private practice in New Orleans for over 30 years. He offers care for a full array of urologic conditions including minimally invasive-in office procedures and treatment for urinary incontinence, erectile dysfunction, kidney stones, male infertility, prostate inflammation and male sterilization in New Orleans. His research interests focus on treatments for benign prostatic hyperplasia (BPH), overactive bladder (OAB) and lower urinary tract infections.

As patients navigate through the website for this New Orleans urologist, they will find a wealth of information about urological symptoms, treatments and technology. Additionally, patients have easy access to valuable practice information, including new patient forms, online appointment requesting, service descriptions, doctor bios and directions to the office. Whether a patient needs directions to the office or information about a treatment, such as a vasectomy in New Orleans, all of these resources are conveniently available with the click of a mouse.

Patients searching for an experienced urologist in New Orleans and the same-day convenience when scheduling appointments turn to Dr. Baum and his professional, caring staff for all of their urology needs.

To make an appointment today, call 504-891-8454 or visit www.neilbaum.com.

About Neil Baum M.D.: Dr. Neil Baum is a nationally recognized urologist in New Orleans and has been in the private practice of urology in New Orleans, LA, since 1978. He offers state-of-the-art evaluation and treatment of many urologic conditions including male sterilization, BPH treatment, male infertility and benign prostate enlargement in New Orleans. Dr. Baum frequently shares his extensive experience in urology by contributing regularly to the medical press and speaking at numerous medical meetings, practices and hospitals. Dr. Baum is also a member of numerous associations such as the American Urological Association, the American Fertility Society and the Louisiana State Medical Society.

The UK's Telegraph (7/21, Jamieson) reports that "hospital patients...whose ring finger on the right hand was significantly longer than the index finger were more likely to" develop prostate cancer "than those fingers were roughly same length," South Korean researchers found after looking at 366 men. "Blood tests showed that men whose ring fingers were much longer than their index finger, next to the thumb, had almost double the normal levels of prostate specific antigen." And, "three times as many of these men went on to be diagnosed with prostate cancer."

I recently attended the American Urologic Society meeting in San Francisco, May 31-June 3, and I attended a program about male sexual dysfunction. I was pleasantly surprised to hear of a study that reported that men who exercised on a regular basis were better performers in the bedroom. Those men who exercised regularly had better erections and had sexual intimacy more frequently those men who led sedentary life styles. Even men who had moderate exercise, like take a brisk walk for 30 minutes four times a week were much less likely to have sexual dysfunction than those who were walkers. It was noteworthy that even moderate exercise such as yoga and walking were just as beneficial as strenuous exercise such as jogging and swimming.

The researches from Duke University suggested that exercise may increase blood flow through the penis, making it easier to get an erection. Also, working out may make men feel better about themselves and that in turn may improve sexual prowess.

Bottom Line: Men, you may just be able to keep that Viagra, Levitra, or Cialis tablet in the medicine cabinet if you started a regular exercise program. The best would be to take that walk with your partner as your relationship will also improve if you take time to be with each other on a regular basis.

SOURCES: 105th annual meeting of the American Urological Association, San Francisco, May 29-June 3, 2010. 

Erin R. McNamara, MD, Duke University Medical Center and June 4, 2010 issue of WebMD article by Charlene Laino

Prostate cancer is the most common cancer in American men causing nearly 250,000 new cases each year. It is the second most common cause of death in American men, killing nearly 40,000 men annually. However, with regular examination consisting of a digital rectal exam and a PSA blood test, prostate cancer can be detected early and treated.

There are other healthy life-style changes that can be easily done that may even help prevent prostate cancer.


1. Start taking vitamin D, E and selenium supplements. Although further research is needed to confirm their effectiveness, studies have demonstrated that all three, vitamin D, E and selenium, show promise with regard to prostate cancer prevention when taken regularly.

2. Eat more soybeans (or soybean products) and other legumes. Elevated levels of testosterone may increase your risk for developing prostate cancer. The phytoestrogens-nonsteroidal plant compounds that act like estrogen in the body and thus can help to regulate imbalanced hormone levels-contained in these foods may help to prevent prostate cancer; genistein, an isoflavone also found in soy foods, helps to normalize hormone levels and thus may reduce prostate cancer.

3. Drink green tea. Antioxidant compounds in green tea may help prevent prostate cancer; some have even been found to kill prostate cancer cells in test tubes, while others have blocked enzymes that promote prostate cancer.

4. Get plenty of fiber. Fiber can eliminate excess testosterone in the body; thus, a high-fiber diet can aid in the regulation of your body's hormone levels and may help reduce the risk for prostate cancer.

5. Reduce your intake of meat and saturated fats. Follow a low-fat diet: diets high in saturated fat animal fat in particular-and red met have been found to increase the risk for prostate cancer. Eating a low-tat diet also helps to prevent obesity, a condition that may also increase prostate cancer risk.

6. Eat more broccoli, cauliflower, cabbage, brussel sprouts and greens. A recent study found that men who ate cruciferous vegetables more than once a week were 40% less likely to be diagnosed with prostate cancer than men who rarely ate them.

7. Eat cooked tomatoes. Lycopene, the carotenoid pigment that makes tomatoes bright red, possesses powerful antioxidant properties and has been linked in some studies to a decreased risk for prostate cancer.

8. Limit your dairy consumption. Diets high in dairy products and calcium may be associated with small increases in prostate cancer risk. Moderate your dairy consumption, and don't overdo calcium¬ supplements or foods fortified with extra calcium.

9. Get regular aerobic exercise. Regular aerobic exercise has been associated with reduced risk levels for prostate cancer: exercise also helps prevent obesity and other health-related complications that obesity causes.

10. See your physician for prostate cancer screenings regularly. While regular screenings can't reduce your risk for prostate cancer, changes in diet and exercise can. They help ensure early diagnosis so that prostate cancer can be treated as effectively as possible. My best advice is to get screened annually if you are over the age of 50, if you have a family member who has prostate cancer, or if you are an African-American man.

Bottom Line: Prostate cancer may have a relationship with diet. I cannot tell you for certain if you follow these instructions you will not develop prostate cancer. But as my wonderful Jewish mother would say, "It may not help, but it voidn't hoit!"

The dogs used in the study were trained in three phases. In the first phase, which lasted five months, dogs were trained to recognize cancer urine. In the second phase, which lasted 11 months, dogs were trained to discriminate cancer urine from control urine. In the final phase, dogs were presented with five urine samples and prompted to select the one sample that was cancer urine.

Dogs correctly classified 63 of 66 samples. These results suggest that volitle organic compounds produced by cancer cells can be detected in urine samples.

So if you come to a French doctor's office and you find a dog in the exam room, don't be alarmed. The dog may just be one of the doctor's helpers used to diagnose your illness! For my office, I'm going to "go standard" and suggest for all men over the age of 50 that they have an annual PSA blood test and a digital rectal exam. It's the American way!

To your good health.

Dr. Baum

Try these measures:

Remember what goes in must come out. Therefore, don't drink anything several hours before you go to sleep. Especially avoid caffeinated beverages such as coffee (which also causes insomnia) and tea,as the caffeine acts as a diuretic and causes increased urine output that may result in getting up at night to empty your bladder.

Limit your alcohol consumption, especially at the dinner meal. Again, alcohol acts as a diuretic, causing increased production of urine and causing your bladder to fill up sooner than you would like.Avoid spicy foods. These appear to irritate the bladder and can result in urinary frequency and nighttime voiding.

Check your medications. Some medications like lasix and hydrochlorothiazide are diuretics and increase urine production. It's best to take those medications early in the day when going to the bathroom to urinate is not such an inconvenience. You may also speak with your doctor about lowering the dosage of the diuretic, especially the evening dose if you are bothered by nighttime urination.

Avoid antihistamines and decongestants, as these cause the bladder to decrease the force of contraction and result in the bladder not emptying as well. If you have to take antihistamines, use them earlier in the day.

Don't hold off going to the restroom. This habit distends the bladder and can result in a weaker muscle to expel the urine from the bladder.

Use the clock to help with urination. If you find that you are going to the bathroom infrequently and then more at night, make an effort to urinate every 3-4 hours. Putting your bladder on a schedule is very helpful and a good habit to have.

Go and then go again. Double voiding is a technique to ensure adequate emptying of the bladder. If you stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again. This helps to expel more urine from your bladder than just standing there one time and voiding.

Avoid cold seats, such as those at football games in the winter. The cold temperature seems to cause the muscles around the prostate gland to contract and makes urination difficult. Instead, take a blanket or a cushion. Your prostate gland will be glad that you did.

If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland. Also consider using a seat that has a groove down the middle which alleviates the pressure on your prostate gland.

Bottom Line: These steps won't cure the enlarged prostate but they will lessen the symptoms. If they don't help, see your doctor for medication or one of the treatments that reduces the obstruction of your prostate gland.