Men's Health Office

Are You Ready for a Disaster?

2009-05-04T06:49:00.007-04:00

It's back again; this time because of worries over a possible flu pandemic.

In the past it was concerns over hurricanes, earthquakes, terrorist attacks, anthrax, and mass power failures. Whatever the problem, to help us survive any potential disaster, we are asked once again to prepare. Not because of fear. Instead, because you understand the consequences. You would think that sooner or later we would all get the message - the world is a great place but with the potential for something bad. How many times do we have to hear the "be prepared, just in case" to realize that maybe there is some truth to the idea?

This has always made sense to me. I have always subscribed to the idea that just because we have something does not mean it will always be here for us, under all circumstances. Whether in classes I've taken on wilderness medicine or involvement in community disaster drills, the theme is the same: if you wait until you need something, you have waited too long. I have written a checklist book for preparedness that has been popular from Manhattan skyscrapers to the Pentagon to Los Angeles apartment complexes. I have friends who are in the military, including Navy Seals and Special Forces, cops and firefighters. They all have seen and understand that being prepared does not mean you are afraid. On the contrary, preparedness means you are simply aware that you should take nothing for granted. It is about action, not reaction. People that live up North prepare for blizzards. Those on the Southeast coast prepare for hurricanes. No one would think to call them hysterical or crazy. Just prepared. One of the most wonderful aspects of life is the uncertainty of everything. And so thinking about what might happen and how it can impact on your and your family makes total sense.

Here's a few ideas to help you get started. Do something while you have the luxury of time.

Water: You won't last very long without it. Each and every person in your family will need at least one gallon each and every day. Some experts say 2 gallons per person per day. Think about this. If you are confined to your house for 1 week, how many gallons of water will you need for your family? And that really doesn't include bathing, sanitation or pets. Buy water bottles that you will use. Lots. If there is a pending disaster, there will be no water in the stores.

Food: You will be hungry and you may not be able to get to the nearby grocery store. Can you and your family eat comfortably for one to two weeks with what you have at hand? And if the electricity goes out, what you have in your refrigerator and freezer won't be any good after a day or two. When you do but food, be sure it does not require refrigeration, water or cooking. Be sure to only buy food that you will eat. Canned foods are good as they last for years. Other great emergency foods include peanut butter, jellies and preserves, honey, nuts, canned soups and beef jerky.

Health: Be sure that you always have on hand at least 2 to 4 weeks of all medications you or your loved ones take. Have a supply of ibuprofen or Tylenol, bandages, gauze, hydrogen peroxide, antibiotic ointment, a laxative (people tend to get constipated under stress), contact lens solution if needed, TUMS and cortisone cream. For flu worries, have plenty of facial tissues, hand soap and throat lozenges. Think about hygiene - toilet paper, baby wipes, skin care and feminine hygiene.

Lighting: There is nothing better when the power goes out than a reliable flashlight, and nothing worse that a reliable flashlight with dead batteries. Have plenty of batteries (make sure you get the right size for your flashlights) and several flashlights.

News: Get a hand crank or solar AM/FM radio and even better, a short wave radio to keep track of news updates and official directions.

Travel: Keep the gas tanks in your car always at least half full. For your car, have extra fuses, antifreeze, oil and a fan belt. If you have a bike, keep it in good working order with a tire pump and spare tires.

Pets: Remember they will need food and water in any emergency. They should be up-to-date on rabies and all shots.

Think about any special needs - elderly parents, infants, any disabilities or problems that should be addressed before any catastrophe occurs.

Even more important that stocking up on a few items is to get to know your neighbors. Talk to each other about preparedness, special needs, and any special skills or talents. Exchange phone numbers to keep tabs on each other in an emergency. Who is the mechanic, the dentist, the doctor or the handyman?

The key to all this - think ahead. The authorities at all levels - from local police to the federal government - have made it clear that each one of us has to take personal responsibility for our own safety. Now is the time.

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Swine Flu: Are You Prepared?

2009-04-28T10:45:00.002-04:00

Most of us know how we handle tornadoes, hurricanes, massive snow storms...but what happens when the emergency is the flu and everyone is getting it? This will help to give you some basic guidelines.

Flu comes and goes. What makes swine flu so special and worth all the hysteria? For one, this flu is a never before seen combination of viruses with proven ability to kill. The fact that it has been found so quickly in so many places suggests it is especially aggressive.

What should you do when they announce a confirmed case of swine flu in your community? What can you do to reduce your chances of becoming infected? What should you do if you start to have symptoms of the flu? What should you do to prepare even if no flu is in your state, yet?

Right now, even if your home town or city does NOT have any evidence of swine flu, there are actions you should take NOW to get ready if it arrives.

It only makes sense to be prepared and think through what you might do if your community is found to have confirmed cases. Anyone that watches TV or reads online news or newspapers is aware that the world's health officials are concerned, very worried in fact, about what could happen if this new form of flu takes off. With modern travel, the entire world could be engulfed in a new killer flu within a few days or weeks. Aspects of our lives we all take for granted could be gone. Life could be very different for some time. Though we all hope and pray this passes by without incident, it makes sense to take a few moments to think about what could happen and how you could reduce the risk to you and your family.

How should schools be handling emergency plans?
All schools should have emergency plans to close for at least 7 to 10 days if there is even a single student with suspected swine flu. Until then, all children at all ages should wash hands frequently throughout the day with soap and water as well as alcohol based gels. Students should be required to wash hands on arrival at school, when entering or leaving class, and at end of the day. Your child should stay away from any student or teacher that appears ill, coughs or sneezes. Chances are anyone even remotely sick will be sent home immediately.

What should parents look for?
Watch out for any signs of the flu in yourselves, your family and children. You might have just a few or all of these symptoms. Common signs of the flu include fever, chills, runny nose, cough, sore throat, body aches, headache, vomiting or diarrhea. If you have these symptoms, you are very infectious and can spread the infection starting one day before the symptoms start until 7 days after the symptoms start.

How does the flu spread?
The flu virus spreads in tiny microdroplets when you cough or sneeze. Breathing in or touching droplets can give you the flu.

If I get the flu should I call my doctor or go the doctor' office or to a hospital?
If you or a loved one comes down with any mild to moderate symptoms of the flu you should call your doctor for advice and direction. Do NOT go to the doctor's office or emergency room or urgent care unless you are experiencing severe signs of the flu, including shortness of breath, chest pain, shortness of breath, dehydration or difficulty breathing. Those in a high-risk category to include young children, pregnant women, the elderly, those with chronic illness such as diabetes, heart disease, lung disease, asthma, bronchitis should be in close contact with your doctor before you get sick to discuss prevention strategies. If you become ill, it is best to call your doctor immediately for instructions, which may include home isolation.

What is home isolation?
This is isolating yourself or your ill loved one for a full 7 days at home. All members of the household need to wash their hands frequently, wear masks when in the room of the sick person, wipe down all surfaces with antiseptic. The best are alcohol based gel or soap and water. It is essential to keep ill isolated even within the house, confining that person to a bedroom, keep the door closed, and don't let the sick person come out into common family areas. No one else should use the bathroom and after washing hands, each person should use paper towels or all use own towels - no one should use a shared towel.

How do I prevent catching the Swine flu?
Follow some basic rules that apply to preventing any highly infectious disease.

Be smart- avoid crowds and enclosed buildings with large groups of people.
Called "social distancing," staying away from those that may be infectious will prevent most from contracting the swine flu.
Avoid close contact with anyone that may appear ill or is coughing or sneezing.
Cover your mouth and nose if you cough or sneeze.
Stay home if you feel ill.
Wash your hands.
Avoid touching your eyes, nose or mouth.
Listen to the news and follow all public health instructions.
Just in case, plan ahead- be prepared. If you have to stay home for 7 to 10 days, be sure you have all the food, water, medications and supplies you will need. Think now about buying N95 face masks at your hardware store or pharmacy, extra water, and food supplies. Keep your car's gas tank at least half full. Remember - going out into the public to buy food or water or supplies may not be an option if a true pandemic develops.

What happens when your community has a major health emergency?
Your local, regional and Federal public health officials may enact a variety of measures to minimize spread and control the disease. The goal is to prevent new people from getting infected and take care of those that are already infected. These can include mandatory school and business closures, canceling of public events, stopping public transportation, rationing and distribution of supplies and medications. In a worst case scenario, you might see full blown quarantining of homes, apartment complexes, neighborhoods, schools, hospitals or even entire communities or cities. Emergency services such as Fire Department, ambulances and emergency rooms may be overwhelmed.

What does a emergency plan look like for a big city like NYC? Or a small one like Anytown, USA?
All communities, whether a small rural town or huge metropolitan city with millions of people will have contingency emergency plans. Obviously, the larger cities and communities will probably experience more disruption from discontinued public transportation, hospitals overwhelmed, limited resources for food, water and medications. The key is to be smart minimize your risks and follow all public health instructions closely.

Survival favors the prepared.

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Vasectomies Up as the Economy Goes Down?

2009-04-01T09:09:00.007-04:00

Reevaluating family in challenging times...

Widespread concerns about the economy and job security have recently generated news stories about an increase in men requesting vasectomies. According to a recent report on CNN, there is anecdotal evidence that the number of men getting vasectomies is going up as the economy is going down. With this in mind, I looked back at my own practice and spoke to a number of urologists. For many, it does seem that more men are requesting vasectomy. This fits with what we know about past drops in childbirth rates during tough economic times. When money is tight, limiting family size is a common theme. After all, raising a child is not cheap.

There are some that actually believe just the opposite - that there has been an actual downtrend in the number of vasectomies they have performed over the past months. Patients have relayed concerns over money and the cost of the procedure and even the co-pay, forcing many to actually delay their planned vasectomy for now.

I have seen an increase in both vasectomies and vasectomy reversals in my own practice over the past 6 months. Many of my patients are worried about the economy and how this will impact on their personal finances. These concerns have made many couples rethink their own home situation. As fears increase, it appears that families are turning inwards. Some parents feel they are complete and so opt for permanent sterilization via vasectomy. For others this introspection leads to a different conclusion. Some that have had a vasectomy realize that they do want more children and so move ahead with a vasectomy reversal.

It makes sense that when money gets tight, families will move inward towards each other - either to say "our family is complete" and choose a vasectomy or if feel they want more children, then a vasectomy reversal becomes the next step. Whichever direction couples move, these challenging financial times are making everyone reevaluate their lives, their goals and what really is important - their families.

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Presidential Stress and Aging

2009-03-13T10:35:00.006-04:00

We have a new president whose image is everywhere. Over the next several years, we will all watch an amazing transformation as President Obama ages before our eyes. Based on observations of past Presidents, this change will be dramatic.

How does this happen? Does stress really cause rapid aging?

The answer is yes. Studies now confirm what we all knew to be true - prolonged stress does lead to premature and rapid aging of every cell in the body. Stress is the ultimate mind-body connection. When we perceive stress, our body responds rapidly with a multitude of changes. Changes intended to prepare us for the fight or flight response. Our heart rate goes up, our blood pressure increases, blood flow is increased to the brain, heart and muscles. Protective hormones, adrenaline and other chemicals begin surging through the bloodstream, nerves begin firing, all senses are brought to peak awareness. All this so we are in a state of extreme readiness to take on any threat. This was good hundreds and thousands years ago. What about today? Stress is inevitable. With so much stress from work and life that is not a threat to our survival, what does all this stress do to our bodies?

Long term, intense stress is not good for the body and accelerates aging. This is especially true if you don’t feel in control over the things that are causing stress. When the stresses do not resolve, your immune system is weakened. Stressed individuals become ill more frequently. Excessive stress actually shortens the life span of the cells throughout the body, so that every tissue and organ is ages rapidly. The body begins accumulating highly toxic levels of free radical particles that cause even more oxidative damage to cells and tissues. Damage that promotes aging. And because the stress response is so quick to come on and so slow to fade, it is likely that those in prolonged high stress occupations like President begin to age rapidly - an aging process we can see over time in their face, graying of hair, and behavior.

The answer? Do your best to avoid or reduce excessive and prolonged stress. If that is not possible, eat a healthy diet high in anti-oxidant rich foods, exercise regularly, sleep, and laugh. Most importantly, work to develop stress reduction behaviors and attitudes so that you can better deal with any stresses you experience.

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Health Care for Children - Who Can Argue with That?

2009-03-11T13:06:00.001-04:00

Last month President Obama signed a bill that adds nearly $33 billion to the State Children's Health Insurance Program (SCHIP). The program will insure 11 million children in lower-income families. Health care for children - who can argue with that? It makes sense, and is obviously the right thing to do. But as with so many good ideas out of Washington that turn sour, the devil will be in the details. My worry, based on past experience, is just how this may actually back-fire and end up hurting children. "But how can that happen?' you ask. Let's look at past government attempts at caring for children.

In Hawaii they came up with what sounded like a good idea - provide health care to all children in the state. Seems like a no-brainer. But it failed and failed miserably.

As happens so often with government ideas, no one bothered to think through natural and unintended consequences. What went wrong in Hawaii was simple - families who were paying for their child's insurance dropped their own health care coverage to allow their children to qualify for the free state-sponsored insurance. Why should they pay for something that the government will give them for free? Makes sense. Suddenly the number of children qualifying for the free health care skyrocketed. Within just 7 months the system went bankrupt, leaving all the kids - those in need and those whose families dropped their insurance - without any health insurance.

The idea was good - let's be sure that all children get a basic level of health care, from birth to age 18. But the fun comes in as the government decides who low income is and who is not. So who defines low income? In Hawaii, if you made less than $73,000, your children could qualify. That's more than 36 dollars an hour. That doesn't sound like low income to me.

Unintended consequence #2 - some families sign up for insurance just for their children to get health care. If our government will pay for children's care, then many parents will drop their own insurance and suddenly find themselves in the land of the uninsured.

I will be the first to admit that I do not know the details of the new plan President Obama signed. I hope and pray it works as intended. But the very fact that it comes out of Washington makes me worry. Who will qualify? What necessary treatments or medications will not be covered? What ridiculously unneeded aspects of care will be included? Were any real life "in the trenches" pediatricians included in the development of this or was this a government/big business developed program? And what incentives will be in place to encourage families who can afford it to pay for their own insurance? Seems that our government should offer an incentive for you to take responsibility for your own children's health. I am sure we will soon discover the answers to these and more questions as the plan begins.

I only hope that there are no unintended consequences that will in the long run actually hurt our children and society.

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Why Don't Men Take Better Care of Themselves?

2008-11-13T17:45:00.003-05:00

When men are young, they think they're going to live forever - nothing's going to get in their way. That's why young guys do stupid things; they think it's not going to hurt them. Why are teenagers promiscuous in the face of HIV, hepatitis C and all those other diseases? Because they think it will happen to somebody else but it won't happen to them.

As men get older they get into this pattern of reactive care. They don't understand about proactive health care. They don't understand that that's their body for life, that they have to be in tune with their body and take care of it, and if they do, the quality of their life experience will be dramatically improved. When men do abusive things, when they drink too much, take drugs, are overweight, then that has an impact on them. They don't realize that that "never happening to me," changes to "it will happen", and then it's just around the corner. By then it's often too late.

By the time men become aware that it's too late, they've lived through years of abusive behaviors. They've eaten the wrong foods, they've had too much to drink, they smoke, have hypertension, diabetes, liver disorders, and cholesterol problems. Those are the guys, you read about: people in their 40s and 50s who suddenly get a heart attack and die or have a massive stroke. It doesn't make sense. Sometimes it's random bad luck but sometimes it's things they've been doing all these years.

Women, on the other hand, are programmed by society to be into preventative health. They go to the OB-GYN young in life. They go to the doctor for checkups. Women are the leaders in health care in this country. Almost all of the health care decisions are driven by women. On WebMD, many who post on the men's health message board are women asking the questions for their husbands or boyfriends.

You have to wonder, if it's about blood in the semen, or erection disorders, or pain or lumps or bumps, why the guy isn't there asking the question himself? It's because that's not what guys do. I don't know whether it's fear or denial, or maybe they don't value themselves enough, but the wives are the ones that will go online and ask the questions.

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6 Reasons to See Your Urologist

2008-04-15T16:31:00.002-04:00

Why this problem still exists is beyond me. So many times, whether on WebMD's Men's Health or Male Factor Infertility message boards or in my practice, I hear the same basic theme - a man has an obviously urologic problem, it is not resolving or appears to be serious, and yet his primary care doctor has not referred him to a urologist for evaluation and treatment as indicated.

Sometimes it may be for a nuisance problem - or it may be a warning sign of something potentially life threatening. So why would patients not be sent to a urologist at the first sign of something serious, potentially dangerous, and obviously urologic? Your guess is as good as mine.

I do know that many primary care doctors are under tremendous pressure by insurance companies to limit referrals to specialists. Other times it may simple ignorance by the primary doctor. Worse yet, it may be arrogance that the doctor thinks he or she knows everything urologic and so does not believe a urologist would add anything to the patient's care.

So what are a few problems that absolutely must be seen by a urologist? There are many, but here are some examples of signs or symptoms that absolutely should be seen by a urologist - nonnegotiable!

Any aspect of male infertility. A small percent of male factor infertility is because of testicular cancer. This is often missed by primary care doctors and totally missed when referred to an IVF fertility doctor.

Blood in the urine. Hematuria, whether visible (gross hematuria) or only seen under the microscope (microscopic hematuria) is not normal and can be an early warning sign of a bladder or kidney cancer. The work-up is basic, including urine tests, an x-ray such as CT scan and a look inside the bladder with a fiberoptic scope (cystoscopy). Waiting to see if the blood will go away is not smart. Blood one time is enough to see a urologist.

An elevated PSA or change in PSA. The PSA remains one of the most sensitive indicators of prostate cancer of all tests in medicine. The problem is that too many doctors don't understand what the PSA test is and probably even more and important, what the PSA test is not. Any elevation raises concerns so must be evaluated. Simply telling you to go away and let's see how high it goes or how fast it climbs is not smart. And if the PSA starts to climb, even if still within "normal "levels, the change may suggest cancer. So any change of significance should be evaluated as well.

An abnormal prostate exam. Any abnormality - firmness, small nodules, or irregularities - may be from a prostate cancer and so must be seen by a urologist. Likewise, any changed from prior exams must be seen. This is why it is so important that all men over the age of 40 to 45 get a yearly exam, ideally by the same doctor. As with all potentially serious problems, if detected early the cure rate is high.

Any abnormality of the kidney found on x-ray. It must be assumed that these are kidney cancers until proven otherwise. Do not let anyone biopsy a kidney mass unless you have seen a urologist. Biopsies of a kidney mass can actually cause more harm, and often do not provide the information desired.

A testicular mass or persistent pain. Because of the rare chances of having an underlying testicular cancer, any masses, firmness or nodules of the testicle must be seen by a urologist. This also includes men with testicular pain that does not resolve within a week or two. If caught early, testicular cancer is one of the most curable cancers in humans.

Penis Enlargement: Myths and Facts

2008-04-02T15:36:00.005-04:00

Results in seconds. Wow.

I don't know about you but I am fast growing tired of the dozens of spam e-mails I get every day about the magic new penis enlargement pill, cream or device. But it is not limited to these anonymous e-mails. Now I have to watch or listen to these same scams on major prime time TV shows and radio. What amazes me most is that these advertisements must be making money, or they wouldn't still be on the air week after week, month after month.

Here's the kicker - there is no truth or science behind any one of them. They are all pure and simple scams, designed to separate out the foolish from their money. Nothing more than snake oil salesmen, and sadly as educated as we are, we still remain gullible. Hey, if I could find a way to feel comfortable stealing money from people I might too jump in and offer "Sheldon's secret penile enlargement formula- but don't' wait, because organized medicine wants to shut me down, so order before midnight tonight and we'll throw in a free spray-on window tinter". And here is how they promote an age-old gimmick - now they call it male enhancement - kind of like a used car is now called pre-owned so they can charge more. If I sell my own secret formula, then I can lie but it is a new lie so it will take a few years for it to catch up to me and maybe by then I will have my millions hidden away in an off-shore Caribbean island. But my ethics gets in the way.

So many times people ask "why doesn't the government step in an stop these quacks from making outright lies and false claims?" The reason is simple - the supplement industry has worked very hard to keep the FDA out of the supplement market. This way, they can sell anything to anyone and they don't have to prove that it is effective, that it is even helpful or that it is even safe. So anyone with some money can create a fake treatment and sell it, making wild and extreme claims.

And what better way to trick people than playing to the secret wish of many men - to have a bigger penis? Because, after all, we know that men with bigger penises must be happier, more successful and have happier wives. And who will complain that his penis enlargement pill didn't work? I would guess very few men.

But what is a normal sized penis? This is a subject that guys never seem to understand. First of all, the size of a non-erect penis has no relevance to an erect penis. Some guys who have small penises can get quite large and other guys who are large don't change much, and everything in between. Somewhere about 4 to 6 inches erect is what a normal penis is supposed to be.

Let me explain this as simply as I can. The penis you have is the one you are genetically designed to have. It is because of the DNA you inherited from your mother and father. It is also the reason you are as tall or short as you are as well as the color of your eyes.

After spending more than 20 plus years in urology, it is clear that no pill or cream or vacuum contraption will change your penis size. It is not like the penis is elastic and can be enlarged. It is what it is. If you have extra weight, then you can lose a few pounds and your penis will seem bigger. You could opt for disfiguring surgery to cut the ligament that will let your penis fall down, and give you the appearance of maybe 1/2 inch more for a lucky few, but that is about it. And so you know, most men who have penile enlargement surgery regret doing so. It must be something about all the scarring and pain.

So here is what it comes down to. You can spend lots of money trying to change something that can't be changed, or you can learn what is really important, be satisfied and save a few bucks.

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Technorati Tags: mens health, urology, snake oil, advertising, scams

Foreskin Facts: Turtleneck or No, It All Feels the Same

2007-07-26T16:07:00.000-04:00

Okay. It's official now. A study in the Journal of Sexual Medicine¹ looked at a question that has been plaguing men for thousands of years. I know I stay up many nights tossing and turning, wondering the answer to this question. As a urologist, I know in my heart that millions of other men also spend hours each day thinking about this timeless problem. But now we finally have an answer. We can all put this behind us and get on with our lives.

The study looked at the age old question, do circumcised men have less penile sensation than uncircumcised men? The answer, no. It appears that whether or not a man is circumcised, whether aroused or not, his penile sensation is the same. Thank God. I was so worried that because I was circumcised at birth, I have been missing out on lots of fun. And wouldn't you know. it's the Canadians that figured this one out. Another advantage to those long dark winters.
But wait, there was another interesting fact that Dr. Payne and others discovered. They found that the penile sensitivity of men, whether circumcised or not, is actually less than they had anticipated. I'm not sure how much sensitivity these researchers expected.

So now that we are all the same, will all those men who have wanted a foreskin rebuilt change their minds? What about all those that travel the world warning us about the horrible catastrophic hazards of circumcision? I have read accounts of men who just knew that they had dramatically reduced penile sensation since their newborn circumcision. Now they too can rest assured that they are fine...at least physically.

Thank you Dr. Payne. Thank you Canada. I am finally complete and ready to move on, circumcised on not.

¹Kimberley Payne PhD, Lea Thaler BA, Tuuli Kukkonen BA, Serge Carrier MD, Yitzchak Binik PhD (2007) Sensation and Sexual Arousal in Circumcised and Uncircumcised Men The Journal of Sexual Medicine 4 (3), 667-674. doi:10.1111/j.1743-6109.2007.00471.x

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Technorati Tags: foreskin, circumcision, sexual health

Testosterone, Tragedy and Responsibility

2007-07-19T20:23:00.000-04:00

Well, they are at it again. Chris Benoit and his family are dead, and now it is time for the media to find someone or something to blame. After all, this is America and blame is what we are all about. No one ever needs to take responsibility for their own actions. It is always someone else's fault. A criminal can always blame his aloof stepfather. A drunk slams into a car, killing the occupants, and it is time to sue the car manufacturer. A criminal shoots someone during a robbery, and the gun manufacturer is guilty.

Now an entire family is dead and night after night, all we hear is how the doctor and the steroids are to blame. "Did the steroids kill his family?" we hear the experts debate. Sure, the doctor may have over-prescribed medications and steroids. Sure the steroids in excess could have played a role. Let's remember that doctors have no control of how their patients take their medications or even if the patients follow the instructions. Once again, responsibility for one's own health rests with the individual. Realistically the patient is only one that decides what to take and how often.

It seems to me that we should focus on making Mr. Benoit responsible for his actions. Was there some underlying mental health illness? Most certainly. Sane people don't kill their wife and child over 48 hours, then hang themselves. Normal people who take testosterone don't kill.

We know that men with low testosterone do indeed have a higher incidence of depression, which usually improves with correct testosterone replacement. Appropriate testosterone replacement doses bring the hormone levels back to normal. Yes, anyone started on testosterone replacement should have regular monitoring of testosterone levels. This testosterone replacement therapy is not associated with changes in behavior.

We also know that doses far above normal (supra-physiologic) can have an impact on behavior. Extremely high doses of testosterone in the body, much higher than the normal range, can lead to depression, suicidal tendencies and impulse control. Maybe the testosterone levels exacerbated an underlying mental illness. So perhaps the doctor contributed to what happened. Maybe he didn't monitor the testosterone levels enough. Then again, maybe he asked the patient to do so and Benoit never followed up. When it all comes down to it, the responsibility for this horrible tragedy still rests entirely with Chris Benoit- whether or not he was taking testosterone.

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Home Sperm Analysis: Beware the Pitfalls

2007-06-04T15:45:00.000-04:00

"A little information can be a dangerous thing."

Once again, there is something new hitting the stores - a new test that measures sperm motility so couples at home can check their fertility status. Wow. At first this seems like a great idea. So easy, so comfortable, so inexpensive.

But there is a problem. In fact, a lot of problems. First, as a male fertility specialist that works with semen analysis daily as part of my vasectomy reversal program, motility alone is almost meaningless. What about the sperm count? What about semen volume? These numbers individually mean almost nothing. But when you look at the total count of motile sperm, which require all these numbers to be multiplied, then you have a number to start with. Then, anyone with any knowledge will tell you that you need two or three counts, each one after 3 days of sexual abstinence, each 8 weeks apart.

So how does this home quickie home test fit in? Especially since there are so many other important aspects of a semen analysis that are not addressed? My fear is that for most couples, they will assume that if their numbers come back "ok" then they will use that information to justify not seeing a male fertility specialist. Simply bad medicine.

But it gets worse. Many times men will have what looks like adequate numbers but could still have serious problems. Testicular cancer is found in one out of every 100 men that is evaluated at a specialty male fertility clinic - something that could not be detected on a home semen analysis kit. So what happens to those guys? Do they not know until the tumor has grown? Will men still go see a male fertility specialist for an exam? I doubt it.

Lastly, all the advances in human fertility and all the amazing miracles are a direct result and spin-off of animal/livestock fertility research. Yet something strange has happened over the past decade. Somehow, the human fertility specialists have lost touch with the animal researchers that are years ahead. Human fertility specialists still use sperm motility as a major marker for fertility. This has been shown to be of minimal importance in the animal world, which has now identified markers for fertility. Then why are we still looking at motility? That's a good question.

I am sure the kit will be a good tool to use in conjunction with a formal fertility evaluation. My experience suggests that most will not do this, and use the information from this home test to replace a doctor's exam and formal fertility testing. I hope I am wrong. A little information can be a dangerous thing.

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Technorati Tags: male fetility, semen analysis, motility, testicular cancer, men's health, health and wellness

Dannielynn: Who's Your Daddy?

2007-04-10T15:31:00.000-04:00

DNA - It's all in the genes... and I don't mean your denim pants.

DNA remains in the news. Years ago we learned that OJ's DNA was found at a crime scene. Today the news media is waiting to hear the results of the DNA tests on Anna Nicole Smith's daughter, Dannielynn. Last week Spice Girl Melanie Brown had a baby girl which she says is Eddie Murphy's. He's not sure, but DNA tests can tell the tale. DNA has been used to identify victims of the 9/11 terrorist attacks. DNA is used to release prisoners when found to be innocent because DNA did not match that of the criminal. DNA used to solve crimes by identifying the bad guy. You can pay to track your ancestry by analyzing your DNA.

In my medical practice as a vasectomy reversal specialist we use DNA frequently, but not to establish who is the father. Instead, when a man is found to have zero sperm counts and there are reasons to suspect that he is a carrier of cystic fibrosis, we check his DNA to see if he carries the cystic fibrosis gene. Bladder cancer and prostate cancer tests are now available to analyze the DNA from cells in the urine to check for cancer.

So what is exactly DNA and why has this become such a regular news topic?

DNA stands for Deoxyribonucleic acid. A persons' DNA is his or her own unique genetic fingerprint. No one else in the world has or will ever have your exact DNA match. Every person, animal and plant has a DNA blueprint that directs the action of every single cell. Your DNA dictates when and where each cell grows, what it does (muscle, blood cell, brain cell, etc) and when it dies.

With this knowledge and current technology that allows us to actually measure and document a person's DNA, scientists can confirm that you were indeed at a certain location, have a particular disease or fathered a specific child. With continued advancements in science and with computer technology there is a very good chance that early in a person's life, we will be able to perform a simple blood test and identify which diseases and health problems the person may be at risk of developing in his lifetime. This will allow for specific genetic modification, social or dietary intervention to block the development of the disease or illness.

While you're most likely to hear about DNA on Entertainment Tonight, Court TV or the evening news, there are much more interesting and far-reaching implications for this young technology.

Will Howard K. Stern be Dannielynn's father? Or Larry Birkhead? Or will the real value of the DNA tests performed on this child be the uncovering of potential health problems she may encounter as an adult?

Stay tuned.

Update: Shortly after I wrote this, the DNA test results were reported: Larry Birkhead is Dannielynn's daddy.

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Technorati Tags: anna-nicole-smith, dna, eddie murphy, daniellynn, genetics, technology

Comb Your Baldness Away?

2007-02-16T15:28:00.001-05:00

Great. As if I don't get enough spam each day for treatments for baldness, a small penis, notification that my loan had been approved or an urgent request to help out a Nigerian doctor to bring 20 million dollars to the US, now there is a treatment for male pattern baldness that actually seems to work. Using a low level "cold" laser, the new FDA-approved hair brush will, if their claims and studies are true, actually result in increased hair growth.

How can this be? Don't lasers actually destroy tissue? Well, I called an old friend who has been using low level laser for years to treat chronic pain and inflammation and asked him: Can this really work and if so, how the heck does this work?

Here is how Dr. Leonard Rudnick of Tucson explained this to me. Low level laser accelerates healing and inflammation, restoring tissues and cells to their normal healthy function. When applied to hair follicles, this return to normal cellular function and stabilization of the membranes results in a return of hair growth. Think about it -- years of damage from sun, poor diet, tobacco, excess hormones and bad genetics can be overcome by a laser hair brush.

But as with all new and magical solutions to age-old problems, let's let time decide whether or not this will really work. Is it really worth $500? How quickly will hair regrow and if so, will the hair remain or will it fall out again? Will the hair look the same or will it be different? What about any side effects? Could these treatments do any damage, after all, we are aiming these lasers into our brains? My guess is that like most press release "breakthroughs," this will be of some benefit but not the cure-all we all would hope.

Rest assured that if it helps in any way, then these laser hair brushes will be a hotter topic than the next presidential election. Just be careful where you aim them.

I can hear the spammers at their computers now.

Related Topics:

Technorati Tags: hairmax, male pattern baldness, hair loss

Routine Plans Can Turn into Disaster: Be Prepared

2006-12-06T15:41:00.000-05:00

Once again, an ongoing story in the news about the Kim family reminds us how the most routine plans can turn into disaster for the unprepared. The good news is that the family survived nine days in an isolated and remote area in Oregon, though the father remains missing.

Stuck in the snow with "minor provisions," the mother and two daughters are doing well. How did they survive without any contact in the harsh climate hidden away in the rugged mountains? Because of ingenuity and some basic preparation, they will be alive to share their story with others.

This is a lesson for us all. Whatever we are doing -- whether at home, visiting friends, at work, driving around town or on a vacation -- the possibility always exists for the unexpected. Maybe you will encounter a sudden storm, earthquake, power outage, or terrorist attack, so it makes sense to be prepared. Yet most of us, aware of the potential for disaster, do nothing. We sit back and feel safe that somehow other people or the government will be there to take care of us.

Just look at the aftermath of Hurricane Katrina, and how everyone was left to fend for themselves. That is the nature of a sudden crisis. Even the government and the local police tell us they will not and cannot be there in the immediate hours to days after any disaster to protect us. Accept that many of the services you take for granted may be nonexistent for days or weeks.

So what can we do? Simple. Just take a few moments and think about what items you may need to keep yourself and your family safe if the unexpected should occur. In your car, keep a small duffle bag of critical supplies, especially if you live or travel in areas of bad or sudden weather. Here's a great place to start:

Dried food

Bottled water

Matches

Flashlights and batteries

A radio

Blankets

Work gloves

A small first aid kit, including any medications taken by family members

Whistles

Hygiene products

Toilet paper

Garbage bags

Jumper cables

Some quarters

Playing cards

Take a few moments and stop and think. What will you need to stay safe through any possible emergency? If you do, then you dramatically improve your chances of surviving the unexpected.

Editor's Note and Update: CBS News is reporting that James Kim's body has been found by search parties. All of us at WebMD extend our condolences and prayers to the Kim family for their tragic loss.

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Technorati Tags: James Kim, first aid, emergencies

My Top 10 Reasons Why Men Don't Want Sex

2006-09-21T13:51:00.000-04:00

A recent blog by Dr. Louanne Cole Weston on why women don't want sex had me thinking. What about the guys? Don't our feelings count? Isn't it important what the men want and feel? Why is all the attention about when women want or don't want sex? What about our needs? Isn't the man supposed to be half the relationship?

I have had a busy practice for almost 20 years, with extensive traveling and speaking and answering questions on WebMD's Men's Health and Male Fertility Message boards. It has become clear to me over these decades in this field that it is about time that woman acknowledge that compromise doesn't mean getting what they want or don't want. It means giving in and sharing in their resolution. How about meeting somewhere in the middle. So...

Here, for the first time ever, the top 10 reasons Men Don't Want Sex:

.... okay, so there aren't any reasons that men would not want sex.

But doesn't that say a lot? Actually for men it is something different...apparently significantly different from how women feel about sex. And that will be discussed in the next blog.

Related Topics: Sexual Fitness for Men: The Hardness Factor, 10 Secrets to a Better Love Life

Technorati Tags: men's health, sexuality, top 10

A Penis Bank? Just who is going to make the deposit?

2006-09-20T17:18:00.000-04:00

I just read that the Chinese performed a breakthrough penile transplant. Though unsuccessful, this raises many questions that remain unanswered.

First of all, who said "Hey, sure I'd love to donate my penis to a total stranger!"

Or what about being an organ donor? We all think of giving up our heart or kidneys or even pancreas. Sure that is fine. I don't need those things where I am going. But wait, do I really want my penis to live on for years after I am gone?

What if there is an afterlife and you need your member? When you sign the organ donor card, I don't think anyone really meant "that organ." Clearly this is an issue that needs to be resolved before penis banks take off here in the States.

Then as things progress to the absurd, as they often do, are we going to see "designer penis banks" popping up? (no pun intended) Will you be able to go online and peruse a catalogue of premium penises to choose from or walk down Rodeo Drive in Beverly Hills and see the newest high fashion Armani or Versace penis?

Will we get to the point where men get to change or improve their "parts" as women do so many body parts throughout their lives? I can see it now: Get your midlife crisis Corvette model penis, new and improved over last year's model!

And then who decides what is best? Is it the man looking for increased respect and admiration from his other male friends? "Hey, Jim did you get a look at Tom's new companion? Pretty impressive!" will be heard from the men's locker room.

Or does he go for impressing his wife? "Why thank you, honey, you remembered it's my birthday!"

I think before we all jump on the "I want a new penis" bandwagon we need to step back and take a good look at ourselves. Is this really how we want to think of ourselves, with a sort of penis du jour attitude? I think not.

Related Topics: Should Donors Be Able to Sell Organs?, WebMD Video: The Importance of Organ Donation

Technorati Tags: penile transplant, organ transplant, penis bank

Lessons from 9/11: 5 Bullets to Kill Terror

2006-09-12T16:16:00.000-04:00

It all starts with understanding the goal of the terrorists - to cripple us with fear. Terrorists aren't celebrating the destruction of a building or the death of a few innocent souls. What they thrive on, what drives them to spend years planning an attack, is the desire for sheer and total panic and fear that grips everyone that learns of their actions.

Terrorists today depend more on the magic of real-time 24/7 in-your-face news coverage, an unwitting accomplice, to play the most important hand in their attack. What would happen if they blew up a bridge and no one knew or cared? They need to show the world what they have done. To kill and maim innocent people. Without warning, to destroy lives through random barbaric acts. Their ultimate goal - intimidation and blackmail through fear.

So what can we as individuals do to stop this fear, to restore control and maintain internal peace? The answer is simple. All we have to do is be prepared. The real damage that comes out of any terrorist act is the deep-seated emotional loss of control. No electricity, no water, no food, no access to paramedics, fire or police. In fact, nothing but a sudden and dramatic loss of everything we take for granted.

But we can do something. Through simple planning, we can take steps to prepare and anticipate. We can build up our own personal arsenal of knowledge and preparedness, to restore, maintain and control our lives even in times of uncertainty.

Preparedness is the ultimate anti-terrorism tool. If they can only hurt us briefly, and we can continue on with our lives without fear and panic, then the impact of their attack is dramatically reduced. We can guarantee that we can provide for our own needs.

And isn't this what we teach our children? Isn't this what our country was founded on so long ago? Self-sufficiency! "Grow up and take responsibility for yourself," we tell our children. "Don't sit there and wait for someone to come along and solve your problems."

After any terrorist attack (or even natural disaster) do you really think you can just wait and Big Brother will rush in to save you? No one in police or fire or the government will tell you that they are there for you immediately after any attack. It is unrealistic to count on someone else to be there for you. They will be there to pick up the pieces days or even weeks later.

It is you and you alone that is responsible for caring for yourself in the immediate aftermath of any disaster, natural or man-made. The government has even come out and told us to have an emergency survival kit.

So use this time to act.

Talk to your family, friends and neighbors.
Discuss what you will do and where you will meet.
Buy extra batteries and cans of food.
Keep your gas tank at least half full.
Read up on preparedness.

Then, next time you hear of a terrorist threat, you can rest comfortably knowing that you are prepared. No matter what they do, you are ready. And if we all can do this, the terrorists are a lot weaker than they think.

Related Topics: Antidote to Terrorism: Preparedness, Crisis! How Will You Respond?

Technorati Tags: 9/11, terrorism, fear, disaster preparedness

Lessons from 9/11: Prepare for Disaster Today

2006-09-11T01:31:00.000-04:00

This is a special week--we are remembering the panic and fear that hit us so suddenly 5 years ago. "How could they do this?" "What was next?" "Could as many as 50,000 people be in the Towers?" "Was this the beginning of an all-out assault?" "Will they strike in our hometown next?"

These questions ran through everyone's minds. How quickly we forget. For many of us, it has become business as usual.

A common thought today is that terrorism is something that affects other people, not us. Even Hurricane Katrina was something that happened to "those people." I would think that every American with any compassion or concern for their loved ones would stop and think about the horrors our fellow citizens have suffered in the recent past, both natural and man-made. Many thousands still feel the pain every day for their losses. And yet we do nothing.

Is it a normal human response to avoid the painful thoughts and feelings that could move us to action? Is it normal to ignore this fear and, in so doing, to risk the our lives of ourselves and those of loved ones? Could this explain why so many people living in disaster-prone areas seem surprised when a catastrophe hits?

I know of many who live in Los Angeles or San Francisco who are almost proud of the fact that the only preparedness supplies they have in case of a big earthquake are an extra package of toilet paper and a 6-pack of Diet Coke. If you live in an area that is threatened by hurricanes yearly, how hard is it to keep extra food and water and gas in the tank? We hear from experts "in the know" that it is not IF the terrorists hit us again but WHEN and WHERE.

To its credit, our government keeps trying to remind us to be prepared. I often hear radio messages and read billboards, all calling us to action. The news media really tries to keep the threat at the forefront of our attention. And yet, most of us seem to have this instinctive need to believe it will never happen to us.

What will it take to stir us to action? How many times do we need to see and experience the devastating loss of others before we are compelled to prepare ourselves for a potential disaster-- whether it is a natural disaster or an act of terror?

Here is a challenge for you -- take a few moments and think about what you have done to protect yourself and your loved ones. How have you prepared for the loss of electricity? No police or fire protection? No heat for your homes or gas for your car? No food at the stores or water in the pipes? Then if you realize that you are not prepared, do something about it. Buy some water and flashlight batteries. Always keep your car's gas tank half full. Talk to your neighbors. Then you have taken the first steps to being ready, just in case. Not because of fear, but because it is the right thing to do.

Consider this ancient Chinese saying: "Is it not already too late if one waits until one is thirsty to begin digging a well?" *

*"When Technology Fails", Matthew Stein, Clear Light Publishers, 2000

Related Topics: Docs at Front Line of Terror War, WebMD University: Planning Ahead: Preparing for Disaster

Technorati Tags: 911, disaster preparedness

iJournals

2006-08-29T13:04:00.000-04:00

or...Britney Spears sings the classic: "Degradation of Sperm Mitochondria"

As the world has changed so dramatically with the internet, I find it unfortunate that modern scientific journals have lagged behind. Still, in this day of instant real-time blogs and transoceanic e-conferences, why do journals still insist on publishing articles 6 to 12 months after submission, using the old journal format with limited academic access?

In my experience researching subjects for WebMD's Men's Health and Male Fertility message boards, I often find an article that I would like to read. Time and again, when I click on the journal, I find that to read this one article for educational purposes, I must pay 10 to 12 dollars or more.

And this for a journal that only costs $100 for an entire year of monthly publications! I can understand paying for the cost of printing and distribution of entire journals, but to buy a single article? It's not that online instant access academic journals don’t exist. They do, with a rapid peer review and publication. But they are few and far between.

Isn't it time that the leading academic and scientific societies insist that their journals be made available online to all that seek the knowledge? Or do the journals exist primarily to generate a profit for publishing houses, with the spread of scientific knowledge a secondary purpose?

If the goal truly is timely and accurate dissemination of cutting-edge academic knowledge, then the ancient concept of a written published journal should be phased out as soon as possible.

Let me see if I understand this. I can pay 99 cents to download a song, yet it costs about $12 for an article. Perhaps the answer is to arrange for someone to sing each journal article. Then I can save $11, paying only the 99 cents for the article with, I hope, a catchy tune.

Related Topics: Medscape: Journals & Reference, Health Week in Review

Technorati Tags: medical journals, e-medicine

Floyd Landis: By Intention or Accident?

2006-08-09T19:04:00.000-04:00

Testosterone seems to be the hot topic today, with all the excitement in the Tour de France and Floyd Landis -- he was found to have abnormally elevated levels of a synthetic testosterone AND his normal pituitary hormone levels were abnormally suppressed.

This does not look good for Floyd.

Okay, a quick endocrinology lesson. The pituitary gland in the brain constantly monitors testosterone levels in the body. When the levels are too low, then the pituitary secretes hormones to raise testosterone levels. When the levels are too high, then the pituitary drops these stimulating hormones to reduce testosterone levels.

If a person takes testosterone therapy, then the body detects too much testosterone and so drops the levels of these pituitary hormones. So Floyd having low pituitary levels suggests a more long term, deliberate problem.

Moving back to the controversy at hand: Could it be that somehow testosterone worked its way from Floyd's masseuse's massage cream or that mysteriously he absorbed testosterone from his bicycle seat? Could someone have unscrupulously snuck a testosterone lozenge, if one existed, into his sport drink while he was signing autographs? Maybe he was framed, though I think I will never be one of those chosen few who really gets the true facts.

Since you did so well with the endocrinology class, it is now time to move into advanced endocrinology for men.

There are two types of testosterone treatments. One is to restore a man's testosterone levels back to normal when they are abnormally low. This is called testosterone replacement. This is used when a man has seriously low energy, excess fatigue, weak bones from osteoporosis, and low testosterone caused depression to name a few. The goal of replacement therapy is to bring back the man's testosterone levels to normal "physiologic" levels.

This is not what we are talking about when we are discussing Mr. Landis. When an athlete needs an extra burst of energy or endurance beyond what humans are normally capable of, then some choose to unethically use performance enhancing testosterone therapy, both illegal and easily available. The goal is to get the already normal levels of testosterone to abnormally high "supraphysiologic" levels. With Floyd's situation, this is where all the excitement has been, as well as in most modern sports.

Believe it or not, there are labs that can tell an athlete how long it takes for the illegal testosterone to clear from his or her system, so he or she can gauge when they can use it and when they have to stop it prior to an event.

Could this be a single dose somehow snuck into his system or without his knowledge? Very unlikely. I am told that to get such high levels of testosterone AND to have measured byproducts of synthetic testosterone in his system AND to have suppression of his normal pituitary hormones requires intentional, repeated injections of testosterone or a testosterone-like substance over time.

Can we check and see if he is telling the truth? Easy enough. Just continue, over the next several months, to monitor his blood to measure his normal testosterone levels, levels of synthetic testosterone and the byproducts as well as his pituitary hormones. If they return to normal levels, then he did indeed somehow end up with performance enhancing testosterone in his system.

No way to explain away these results. Not a good thing for Mr. Landis. If they stay at his current levels, then really smart endocrinologists will have to get involved to explain what is happening with the hormones in his body and he may get to keep the yellow jersey.

Related Topics: Innocent Reasons for Landis Dope Test?, High-Tech Cheating: Gene Therapy to Boost Athletic Performance

Technorati Tags: Floyd Landis, Tour de France, doping, testosterone

Welcome back, Bill

2006-08-02T15:16:00.000-04:00

"Dr. Marks," my assistant started. "I have some bad news. One of your long-time favorite patients, Bill, just passed away. Here is his chart." Wow, I thought. I have known Bill for so long.

After I removed his prostate 15 years ago, we became friends. We even played golf together (though it was at that point that I think I decided that golf didn't like me as much as I liked it.). So Bill was dead. So sad. And so bad for his wife, Martha. What a nice lady. It must be tough for her right now. Okay, time to make one of those dreaded calls.

Ringing, ringing, ringing then a familiar male voice. "Bill?" I asked. "Yes, this is Bill," he responded. "This is Sheldon. I thought you were dead."

"Hmmm, I don't think so. Let me check. Martha, it's Sheldon on the phone. Am I dead?" "No, I don't think so. Yet." she called from far away. "No, Sheldon, I guess I am not dead. How are you?" "Well pretty good, now." So went my first conversation with the dead-but-not-yet.

Perhaps this is what it is like for psychics and mediums who routinely talk to people on the other side. But for Bill and I, it was just the other side of town. I guess a sort of trial run.

Today Bill came in for his annual check-up, and I must say, he looks pretty darn good for a guy who came back from the dead, even if only for a few moments in my office records. Once again, just another reason to enjoy every day as if it may be your last. Especially if you are one of my favorite patients.

Related Topics: 8 Summer Steps for Healthy Living, WebMD Video: Why Men Don't Go to the Doctor

Technorati Tags: men's health, prostate

Blood in the semen

2006-07-17T13:50:00.000-04:00

So scary, but usually so meaningless...

Blood in the semen, or hematospermia, is a fairly common event that can occur at any point in a man's life. Men are not accustomed to seeing bleeding from any body part or in any secretion. So when blood is present, most men panic.

"Could it be cancer? Infection? Injury? Will my genitals shrivel up and fall off?" are questions that race through men's minds when they see blood in a place that is not expected.

It can be bright red, clots, speckles, or just brown tinged. The good news is that hematospermia is not rare and is almost always a meaningless finding of no concern.

Usually not associated with any pain or discomfort, blood probably enters the semen from a small blood vessel that tears during ejaculation or even straining with constipation. Sometimes it just happens.

And as fast as it comes on, it can disappear. Other times, blood may linger for days, weeks or even months. If the bleeding is heavy or prolonged, then further evaluation by a urologist is in order. If there is pain or burning, then it is time to see your urologist.

For older men over 45, it is probably a good idea to get a prostate exam and PSA blood test, just to rule out any prostate cancer concerns. The good news is that if and when it occurs, it is not an omen of pending death or spontaneous combustion of your genitals.

Related Topics:

Technorati Tags: hematospermia, blood in semen, mens health

Insurance: Deciding who benefits

2006-07-05T13:53:00.000-04:00

Part II- Deciding who gets what, or "I've always wanted to be a psychiatrist"

Several years ago I accepted the position on an HMO's medical review committee. Wow, the power. Getting to decide who gets what. This was apparently an important committee for those who were looking to move up the ladder. I was very excited.

At my first session, I was handed requests for care from a number of surgeons. As a urologist with several years of intense general surgery while a resident at the Mayo Clinic, I felt comfortable making decisions about surgical patients. Hmmm. An elderly lady needs a hip replacement. Yes, of course. A new knee after an injury. Absolutely yes. Reconstructive arm surgery with skin grafting after a severe burn in a 6 year old girl. Sure, who could think otherwise?

"Excuse me, Dr. Marks. Apparently you have not read the indications approval guidelines. I, as the committee chairman will have to override the approval for the girls arm surgery. You see, she does not qualify."

"What do you mean she doesn't qualify? Her family pays a lot of money each month for this comprehensive insurance. She had a bad burn, and now she is seriously scarred and disfigured. Aren't we as her doctors supposed to care for her?" I asked.

I had no idea how he was going to get out of this. And this was going to be one of those moments where you start to wonder about some doctors, and who they are working for.

His answer: "You see, Sheldon, page 176, paragraph 4 clearly says that she still has a majority of arm movement so even though this is an emotionally crippling injury, and though she does have a serious impairment of the use of her arm, we are not required to pay for any additional reconstructive surgery."

Despite several minutes of heated arguing, it was clear I could not win this battle. I was after all just a lowly urologist and he was a senior internist who had apparently gone over to the dark side.

In punishment for my obviously non-team behavior, I was moved over to review psychiatric requests for office visits.

"Harmless," they must have thought. "He can't cost us much over there." So request after request, Board Certified, licensed, practicing psychiatrists were requesting anywhere from 2 to 6 additional visits to handle a multitude of patients with serious psychiatric problems.

Heck, I had done a rotation in psychiatry. I knew that these problems did not go away overnight after one visit. Who was I, a urologist, to tell a psychiatrist what number of visits were appropriate to care for his patients? Here, again I was apparently wrong.

"Dr. Marks," he started out again. "What could I have done wrong this time?" I thought. He went on, "Just because they tell us they need 6 visits does not mean we need to approve 6 visits. Here, give this request 2 visits. If it is that important, he can request more in a few weeks."

I responded, "But he's a psychiatrist that our clinic hired to care for patients. If we don't trust him to do his job, shouldn't we fire and replace him? ...and by the way, are you having a bad day?"

Apparently the wrong thing to say on both points. As I packed up my stuff and departed from my short-lived committee experience, I realized that simply going to medical school doesn't make everyone a caring doctor. So sad.

Related Topics: Learning about Outpatient Services, Mental Health Insurance Pays

Technorati Tags: HMO, managed care

When it rains, it pours

2006-07-04T13:15:00.000-04:00

When it rains it pours.

As we continue to manage one family member's 8-1/2 year battle with ovarian cancer, another family member was just diagnosed with a fairly aggressive and somewhat advanced melanoma. After extensive research and discussions with a number of experts, we arranged for him to enroll in a promising vaccine protocol. It is overwhelming to simply be diagnosed with an advanced version of a bad cancer. Then, to top it off, to be told that most of the standard therapies have not been shown to prolong life span. Tough news to absorb when you are feeling great. So he has opted for a combination of a new chemotherapy agent, Abraxane, with a protocol using his own melanoma cells to create a vaccine.

After many visits and quite a few blood tests and x-rays, the moment has finally come to get his first dose of chemotherapy. As he sits, waiting for an unknown but potentially unpleasant experience, the nurse comes out and announces, "everything looks good but there is a slight glitch" that must be taken care of. Even though the world's experts in melanoma have recommended this new and exciting chemotherapy agent, apparently Medicare and the FDA have not approved this drug specifically for melanoma. This means he is now responsible for almost $5,000 dose of medication, or he can come back in a few weeks for another treatment to be decided at a later time.

What a decision to have to make under such pressure! How do most people deal with this unexpected problem? What if there are no other options and you cannot afford the high price of a new chemotherapy agent? But how can you not proceed, knowing that all the other treatments are relatively ineffective? And why, if the world's specialists in melanoma feel that this drug is the best thing to do to save his life, do the bureaucrats and pencil pushers at Medicare and the FDA have the power to override these doctors' recommendations? At what point is this interfering with the doctor-patient relationship?

This is not the first time we have encountered stupid, blanket decisions from non-medical decision-makers that can and do hurt patients. Going back to my other family member with ovarian cancer, year after year we have found that having a PET scan has been the most reliable way to diagnose her recurrent cancers. Even though the medical literature is filled with dozens of articles supporting the use of the PET scan for a evaluating recurrent ovarian cancer, our federal government is still many years behind the experts so each $1200 scan is still not covered by Medicare. "But what about private insurance companies," you ask? I'm sure you won't be surprised to learn that they, for the most part, follow the Medicare guidelines. These companies that claim to care about you have chosen not to follow the recommendations of the very experts and specialists that they employ. Sadly, I think it is not about doing what is best for the individual. It seems to be about the money.

What is the solution? It is relatively simple. Allow the doctors to be doctors. It is quite clear that the CEOs and accountants at the helm of our medical insurance companies (including Medicare) feel that cost control and bureaucracy are more important than caring for patients and saving lives. Why do non-medical business people feel qualified to interfere with and override your doctor-patient relationship? If you find yourself in one of these situations, become vocal. Call and write to the medical directors of your health plan. Call and write to your congressmen and senators. Tell them that unless they have gone through decades of training and practice, to get out of your doctor-patient relationship. It's just not right. Ask them if they are willing to assume personal liability for a negative medical outcome as a result of their decisions. It's about time we all say enough is enough.

Related Topics: Is Workplace Health Coverage Dying?, Milestone Medical Tests

Technorati Tags: ovarian cancer, melanoma, Medicare, cost of healthcare

Sperm: It's Quantity, Not Quality

2006-06-21T13:51:00.000-04:00

Every day when I talk to my vasectomy reversal patients the subject of quality of sperm comes up. "But doctor, my sperm are not all healthy and normal. Does that mean I have a higher risk for birth defects? I am worried about the quality of the sperm. Is this a problem?"

No, no and no. It is very simple - guys work in numbers. Quality is not what we are about. We are driven by quantity not quality. Women on the other hand are all about quality. It's not just with eggs and sperm.

We know that women put out one egg each month. Not a gazillion, just one perfect, happy little egg. A guy's purpose is different - distribution of hundreds of millions of sperm. And with that, the quality is not what it is all about. It is numbers. Sheer numbers.

If we provide 100 million motile kicking sperm with each ejaculation, if timed correctly, then maybe a few hundred are likely to get through all the natural barriers and hurdles that exist in the female reproductive tract. It would be reasonable to say that the female tract is designed to kill sperm. So the fact that any get through and end up making a baby still amazes me.

But this is deeper that just sperm and egg talk. Consider all aspects of life. Men are like mosquitoes. Put millions of sperm out there and a few will survive. That is how men look at fertility, and probably sex, too. Lots of sex. Quality is not an issue. Lots of food. More burgers are better than one great sandwich. Not just one good tennis match - give men an entire weekend of football reruns.

Women want things to be just perfect. A single happy moment they can enjoy and relish. A romantic moment rather than a weekend of sex. For them, it's quality ... that is, unless we are talking about shoes. That is the only aspect of quantity/quality with men and women that consistently breaks the rules (probably a sex-linked shoe collecting gene).

So when you are looking at semen analysis results, you can relax as long as you've got the numbers. Leave the quality for the women.

Related Topics: Abstinence Makes the Sperm Grow Stronger, Diabetes and Your Sex Life

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