Archive for November, 2013

Why Is My Drinking Water Contaminated With Lead?

November 30, 2013

Andrew Siegel, MD; Blog #130

I reside in Ridgewood, New Jersey, a lovely suburban town in Bergen County, just a short commute to New York City.   I recently received a Ridgewood Water report in the mail entitled Important Information About Lead In Your Drinking Water.

The bottom line is that elevated levels of lead were found in our drinking water during monitoring conducted in June of 2012, almost a year and a half ago. Some drinking water samples had lead levels above the EPA “action” level of 15 parts per billion, which can cause serious health problems, especially for pregnant women, infants, and young children. The report further stated that Ridgewood Water is “making every effort to remediate for this contamination and is in the process of optimizing a treatment method to control lead corrosion in the piping of its water system.”  So, a problem was detected almost 18 months ago and they are notifying me now…WTF?  Unfortunately, too, I’m fairly certain that this lead contamination is not limited to my town nor Ridgewood Water alone.

Ridgewood Water is required to have a program in place to minimize lead in our water. This includes corrosion control treatment, public education, and replacement of a portion of each lead service line owned by Ridgewood Water if testing determines that the line contributes lead concentrations of more than 15 ppb after completion of the comprehensive treatment program.  I do not know if other water companies have similar intervention programs in place.

Lead can cause serious health problems as it builds up gradually in the body over many years and is stored in our bones, potentially causing damage to the brain, kidneys, and red blood cells. While the greatest risk is to infants, young children and pregnant women, it also affects adults with kidney conditions, hypertension and other issues.

Lead a metal that is commonly found in the environment. The major sources are lead-based paint, lead-contaminated dust and soil, some plumbing materials, and drinking water. It is estimated that up to 20% of lead exposure comes from drinking water. Lead can be found in pottery, pewter, brass fixtures, food and cosmetics. Lead is not a natural water contaminant in rivers and lakes, but enters drinking water primarily on the basis of corrosion of lead-containing materials in the water distribution system and household plumbing. These materials include lead-based solder and pipes made of lead that connect homes and buildings to water mains. In 1986 Congress banned solder containing more than 0.2% lead and restricted the lead content of faucets, pipes, and other plumbing materials to 8%.

When water stagnates in lead pipes or plumbing systems, the lead may dissolve into the drinking water. The initial water drawn from the tap in the morning or anytime after the water has not been used for hours, can therefore contain fairly high levels of lead.

The following are steps that can be taken to reduce lead exposure in drinking water:

  1. Run the water to flush out the lead when the tap has not been used for more than 6 hours. This requires running the cold water for 15–30 seconds. Although it wastes water, it is typically less than a gallon, and is important to minimize lead exposure.
  2. Use cold water for cooking and preparing baby formula as hot water dissolves lead more rapidly than cold water.
  3. Don’t attempt to boil water to remove lead, as it is ineffective.
  4.  Seek alternative sources of water including bottled water or use a water filtration system.
  5.  If you are concerned about lead exposure, get your child tested by contacting your local health department or pediatrician.

BOTTOM LINE: You need to be aware of and take action against all issues that affect your health and well-being…sadly, that even includes government regulated programs.

For more information on mitigating lead exposure and the health effects of lead, visit the EPA website at www.EPA.gov/lead or call the national lead information Center at 800–424–LEAD or the safe drinking water act hotline at 1–800–426–4791.

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

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Prostate: Bigger Is Not Better

November 24, 2013

Blog #129

The following quote from Gabriel Garcia Marquez’s Love in the Time of Cholera colorfully sums up the aging prostate:

“He was the first man that Fermina Daza heard urinate. She heard him on their wedding night, while she lay prostrate with seasickness
in the stateroom on the ship that was carrying them to France, and
 the sound of his stallion’s stream seemed so potent, so replete with authority, that it increased her terror of the devastation to come. That memory often returned to her as the years weakened the stream, for she never could resign herself to his wetting the rim of the toilet bowl each time he used it. Dr. Urbino tried to convince her, with arguments readily understandable to anyone who wished to understand them, that the mishap was not repeated every day through carelessness on his part, as she insisted, but because of organic reasons: as a young man his stream was so defined and so direct that when he was at school he won contests for marksmanship in filling bottles, but with the ravages of age it was not only decreasing, it was also becoming oblique and scattered, and had at last turned into a fantastic fountain, impossible to control despite his many efforts to direct it. He would say: “The toilet must have been invented by someone who knew nothing about men.” He contributed to domestic peace with a quotidian act that was more humiliating than humble: he wiped the rim of the bowl with toilet paper each time he used it. She knew, but never said anything as long as the ammoniac fumes were not too strong in the bathroom, and then she proclaimed, as if she had uncovered a crime: “This stinks like a rabbit hutch.” On the eve of old age this physical difficulty inspired Dr. Urbino with the ultimate solution: he urinated sitting down, as she did, which kept the bowl clean and him in a state of grace.”

The prostate gland is that mysterious, deep-in-the-pelvis male reproductive organ that can be the source of so much trouble.  It functions to produce prostate fluid, a milky liquid that serves as a nutrient and energy vehicle for sperm. Similar to the breast in many respects, the prostate consists of numerous glands that produce this fluid and ducts that convey the fluid into the urinary channel. At the time of sexual climax, the smooth muscle within the prostate squeezes the fluid out of the glands through the prostate ducts into the urethra (urinary channel that runs from the bladder to the tip of the penis), where it mixes with secretions from the other male reproductive organs to form semen.

The prostate gland completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many issues for the aging male. In young men the prostate gland is the size of a walnut; under the influence of three factors—aging, genetics, and adequate levels of the male hormone testosterone—the prostate enlarges, one of the few organs that actually gets bigger with time when there is so much atrophy (shrinkage) and loss of tissue mass going on elsewhere.

Who Knew?  As we age our muscles atrophy, our bones lose mass, our height shrinks and our hairlines and gums recede.  So why is it that our prostates—strategically wrapped around our urinary channels—swell up?

Prostate enlargement can be very variable; it can grow even to the size of a large Florida grapefruit!  As the prostate enlarges, it often—but not always—squeezes the sector of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and sleep disturbance.   It is similar to a hand squeezing a garden hose that affects the flow through the hose. The situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.

The condition of prostate enlargement is known as BPH—benign prostate hyperplasia—one of the most common plagues of aging men. It is important to identify other conditions that can mimic BPH, including urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction), and impaired bladder contractility (a weak bladder muscle that does not squeeze adequately to empty the bladder).

Although larger prostates tend to cause more “crimping” of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently. The factors of concern are precisely where in the prostate the enlargement is and how tight the squeeze is on the urethra. In other words, prostate enlargement in a location immediately adjacent to the urethra will cause more symptoms
 than prostate enlargement in a more peripheral location. Also, the prostate gland and the urethra contain a generous supply of muscle and, depending upon the muscle tone of the prostate, variable symptoms may result. In fact, the tone of the prostate smooth muscle can change from moment to moment depending upon one’s adrenaline (the stress hormone) level.

Typical symptoms of BPH include an urgency to urinate requiring hurrying to the bathroom that gives rise to frequent urinating day and night and sometimes even urinary leakage before arriving to the bathroom.  As a result of these “irritative” symptoms, some men have to plan their routine based upon the availability of bathrooms, sit on an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.  One symptom in particular, sleep-time urination—aka nocturia—is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.

The other symptoms that develop as a result of BPH are “obstructive” as the prostate becomes “welded shut like a lug nut.”  These symptoms include a weak stream that is slow to start, a stopping and starting quality stream, prolonged time to empty, and at times, a stream that is virtually a gravity drip with no force.  One of my patients described the urinary intermittency as “peeing in chapters.”  Many men have to urinate a second or third time to try to empty completely, a task that is often impossible. There may be a good deal of dribbling after urination is completed, known as post-void dribbling.  At times, a man cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for bleeding, infections, stone formation in the bladder, and on occasion, kidney failure.

Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are very effective medications for BPH, and surgery is used when appropriate. There are three types of medications used to manage BPH: those that relax the muscle tone of the prostate; others that actually shrink the enlarged prostate gland; and Cialis that has been FDA approved to be used on a daily basis to treat both erectile dysfunction as well as BPH.  There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.

In terms of the three factors that drive prostate growth: aging, genetics and testosterone: There is nothing much we can do about aging; in fact, it is quite desirable to live a long and healthy life!  We cannot do a thing about our inherited genes.  Having adequate levels of testosterone is actually quite desirable in terms of our general health.

So what can we do to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH.  Regular exercising and maintaining a physically active existence results in increased blood flow to the pelvis, which is prostate-healthy as it reduces inflammation. Sympathetic nervous system tone tends to increase prostate smooth muscle tone, worsening the symptoms of BPH; exercise mitigates sympathetic tone.  Maintaining a healthy weight and avoiding abdominal obesity, will minimize inflammatory chemicals that can worsen BPH.   Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli, and peas as well as those that are high in beta-carotene including carrots, sweet potatoes, and spinach can lower the risk of BPH.  

Bottom Line: BPH is a common problem as one ages, oftentimes negatively impacting quality of life.  There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.

Ten Steps To A Healthy Prostate 1. Decrease the amount of animal fat in your diet 2. Eat less meat and dairy 3. Eat more fish 4. Eat more tomatoes 5. Increase the amount of soy in your diet 6. Eat more fruits, veggies, beans, cereals and whole grains 7. Drink a cup of green tea daily 8. Maintain a healthy weight 9. Exercise regularly 10. Manage stress

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

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Shingles—Dreadful and Avoidable—A Physician’s Personal Experience

November 16, 2013

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(Photos above are images of my sorry back taken by my partner on November 6, 2013 with his iPhone 5…who needs a real camera anymore?  Top is closeup–note blisters known as vesicles; bottom is from a distance)

Andrew Siegel, MD   Blog #128

My internist had suggested that at some point I should get the shingles vaccination and it truly was on my list of things to do—eventually do—you know that list that we all have.  Also on that list of mine is to get my bicycle serviced, to get my tennis racquet restrung, and to read The Rise and Fall of the Third Reich.

Well, I finally did get vaccinated, but it was the hard way, by way of an outbreak of shingles!  People, this is NOT the smart way to get inoculated…this is yet another example of me foolishly not listening to my own advice (Blog #94—Vaccinations Are Not Just For Kids).

Shingles—aka herpes zoster—results from the very same virus that causes chickenpox. After exposure to chickenpox, the virus never quite completely leaves one’s system, living dormant in nerve cell bodies.  For most people, the antibodies manufactured by the body keep the virus in check for many, many years. However, when one’s immunity becomes compromised by age or other factors, the virus can be re-activated and break out of its home within nerve cell bodies and travel down a nerve to cause a viral infection of the skin in the region of the nerve known as a dermatome, causing a painful (often agonizingly so) skin rash known as shingles. A one-time vaccination for shingles can prevent the occurrence of this painful condition.  The FDA has approved the vaccine for adults 50 or older, although some insurance companies will not cover it until age 60.

As a physician, I have insight into many disease processes, both through academic knowledge acquired in medical school and clinical knowledge acquired through years of experience in taking care of patients.  However, there is no better teacher than the school of “hard knocks,” when one personally suffers with the disease process!  In this narrative, I wish to share that experience with you.

My story: In retrospect it all started with vague symptoms of a head cold a bout of insomnia.  Upon arising one morning, my upper back muscles on my left side hurt in a strange way when I stood erect.  I then developed a strange sensation—it felt raw and irritated, somewhere between what a rug burn and what getting struck with a bullwhip would feel like.  The symptoms temporally followed getting a massage, so my immediate thought was that I was having a reaction to the massage oil or to the vigorous sports massage I had had with the massage therapist digging her elbows deep into my knotty back muscles.  I had my wife check my back out, but she saw nothing.  The following day I experienced tingling, pain and burning that rapidly increased in intensity and when I gazed in the mirror, I witnessed the ugliest looking bright red rash with blisters, completely confined to my left side, starting near the midline of the upper back and extending towards my underarm.  It looked like shingles to me, but I had my doubts because it didn’t hurt excessively, and most of my patients whom I observed with shingles had severe and disabling pain.  I thought it might even be poison ivy.  I smeared some hydrocortisone ointment on and tried to forget about it.  The next day at work, I peeled off my OR scrubs and showed my progressive rash to my partner who took the two photos that are attached.  The unequivocal diagnosis was shingles.  He prescribed Valtrex for one week, which I started immediately and I took Ibuprofen before sleeping to help the discomfort.  The shingles continued to progress with the burning feeling extending down my left arm towards my fingers, although there was no rash in this area.  Within a few days the rash improved dramatically and the blisters ruptured, crusted and started healing. Ten days later, the rashes are scabbed and continue to heal and the burning has improved significantly, but is still present. 

Half of Americans will develop shingles, aka varicella-zoster, by age 80, and although most cases develop in people over 60, it can occur at any age. Essentially it is a painful, blistering skin rash and debilitating disease caused by reactivation of the chickenpox virus (herpes) that lies dormant for years in nerves and becomes activated at times of stress, decline in immunity, or other unknown reasons.  It is a unique disease as it develops only on one side of the body.  It characteristically causes waves of burning pain, insomnia, and a significant interference with one’s ability to pursue activities of daily living.

The term shingles is derived from the Latin cingulum, meaning belt, because of the girdle-like pattern  of distribution of the rash along the line of a nerve fiber’s course, usually a narrow band from the spine extending around the abdomen or chest.  Similarly, the word zoster is derived from the Greek zoster, meaning belt. The word herpes is derived from the Greek herpein, meaning to creep, because of the recurrent and latent infections of this viral group.

My shingles involved my upper back and extended to my underarm and down my arm. There are much worse locales for shingles to occur, particularly the face, eyes, mouth and ears, where it can cause visual and hearing deficits.  When shingles involves the lumbar area, it can affect urinary and bowel function.  I had a recent patient with lumbar shingles causing an inability to urinate, requiring the temporary placement of a bladder catheter. In addition to the painful skin rash, shingles can often cause systemic symptoms including malaise, fevers and chills, headache, joint pain and specific symptoms depending on the nerves involved.

Shingles is not contagious to those who have had chickenpox. However, if one has not had chickenpox, exposure to anyone with shingles at the stage at they have open blisters may be infectious, potentially causing chickenpox and not shingles.  It is for pregnant women to avoid exposure to those infected with shingles because of the potential for transmitting the virus to the fetus.

Shingles is treated with an anti-viral medicine that combats the virus, reduces the pain, shortens the course of the outbreak and helps prevents complications.  For really bad outbreaks, steroids and narcotics may be necessary. I was able to suffice with Ibuprofen because I’m tough as nails (absolutely not the truth!).  Topical lotions containing calamine may be soothing.  After the resolution of shingles, which typically occurs within 2-3 weeks, there is the possibility of permanent pain known as post-herpetic neuralgia.  The good news is that for most people, after shingles resolves, it will never resurface.

Bottom Line: Shingles is now a largely avoidable infection so getting the vaccine deserves to be put on your active to-do list!  I seriously regret not regarding my internist’s advice, because the long and the short of it is that shingles is not fun at all and can potentially have devastating long-term consequences. The shingles vaccine—Zostavax—is the most effective means of reducing the incidence of herpes zoster and post-herpetic neuralgia, as well as reducing the severity of an outbreak if it occurs.  

 

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

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Men’s Health: Lab Tests You Should Be Getting

November 9, 2013

Blog #127

Despite the nihilistic attitude of the United States Preventive Services Task Force—an agency that condemns all kinds of testing and even annual physical exams—it is my fundamental belief that preemptive testing and periodic doctor visits play a significant role in maintaining one’s health.

Clearly, genetics loads the gun and lifestyle pulls the trigger; however, physicians can help your cause and should be considered part of your advocacy team with the goal of maintaining health and quality and quantity of life and lending service when disease rears its head.

There are several lab tests that can lend insight into one’s health or lack thereof, and there are a number of findings on physical examination that must be actively sought after because they cause no symptoms whatsoever.  For example, high blood pressure, glaucoma (high eye pressure), and prostate nodules and lumps all generally are asymptomatic, and if unrecognized and untreated can lead to heart attacks and strokes, blindness, and metastatic prostate cancer, respectively.   Simple examinations can readily detect all of the three aforementioned problems.  Lab tests that are helpful include the following: glucose; hemoglobin A1c; lipid profile; PSA; uric acid; C-reactive protein; testosterone; and thyroid profile.

Glucose:  Glucose (blood sugar) is a major source of energy for our cells.  The level of fasting glucose should range between 60–100 mg/deciliter. Anything over 100 is considered abnormal and could indicate the possibility of a pre-diabetic state.  If substantially elevated, diabetes mellitus is likely present.  This is important to recognize because of the cardiovascular and health ramifications if unmanaged.

The pancreatic hormones insulin and glucagon regulate blood glucose by decreasing and increasing glucose levels, respectively.  Diabetes is a condition in which either there is insufficient insulin present or resistance to the effects of insulin.

Hemoglobin A1c:  This is a measurement of how sugarcoated your red blood cells are.  Anything above 5.7% is considered abnormal and the higher the level, the greater the risk for poorly controlled diabetes.

Lipid Profile:  Total cholesterol and its components consisting of HDL, LDL and VLDL as well as triglycerides are important tests in terms of predicting cardiovascular disease, which remains the leading cause of death in Americans.

PSA:  Prostate Specific Antigen is a blood test for a protein that is produced by the prostate and, if elevated, may indicate an underlying process including prostate cancer, prostatitis, or benign prostate enlargement.   It is most useful after a baseline has been established and year-to-year comparisons are made; when there is a rapid acceleration over a one-year time interval, it demands evaluation to seek out the source.  Absolute elevations in PSA and rapid accelerations in PSA over time are the most common reasons that prostate biopsies are performed and are the underlying basis upon which most diagnoses of prostate cancer are made.  This test allows recognition of prostate cancer years before it may present as a nodule or lump of the prostate gland.  Don’t let anyone tell you otherwise…early diagnosis and treatment saves lives.

Uric Acid:  This chemical is a byproduct of metabolism of purines that are found in rich protein sources including shellfish, red meat, and other foods.   If elevated, it can cause gout and/or kidney stones.  High levels of uric acid are correlated with cardiovascular and kidney disease.

C-Reactive Protein:  This is a protein that is manufactured by the liver, frequently in response to inflammation; when elevated, it is often a signal to check the arteries for blockages.

Testosterone:  This is the all-important male sex hormone that is responsible for much more than male sexuality.   Many experts view the level of testosterone as a general marker of overall men’s health.  Testosterone has a critical role in the masculinizing process at the time of puberty and has a major role in male physical development, promoting tissue growth responsible for the building of muscle mass, bone mass and strength.   Testosterone greatly impacts physical development, sexuality, mood, energy levels, etc., so it is wise to know what your testosterone level is, particularly if you are experiencing any of the symptoms associated with low testosterone.

Thyroid Profile:  This includes thyroid stimulating hormone (TSH) as well as T3 and T4.   The thyroid is our gland that regulates our metabolism and is therefore very important in terms of our weight.

Bottom Line:  Don’t take better care of your car than yourself!  Avail yourself of the diagnostic and preemptive tests that modern medicine has to offer. An annual visit after age 40 to an internist is a prudent move.

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

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Key to a Healthy Life

November 2, 2013

Andrew Siegel MD  Blog #126

My oldest cousin, who is in his late 60’s and resides in London, recently had a total knee replacement for disabling arthritis that interfered with his quality of life.  Even though this is a very tough operation in terms of recovery and rehabilitation, he did remarkably well.  He sent me an email about his situation and I would like to share his sage words as they provide meaningful advice regarding the key to a healthy life.

“Three months ago I had a total knee replacement surgery on my left knee.  The operation was a success, and with lots of hard work, rehab, improved diet and a positive attitude, I have made a remarkable recovery.  Last weekend I took a 3-mile walk with Monika, and didn’t suffer any knee pain or even tightness.  In fact, my operated knee appears to be stronger than my other knee.

From my own life experience, I have understood that the key to a healthy life involves the following

1- Eating a healthy diet

2- Regular exercising

3- A positive attitude, including coping with stress

4- Educating yourself regarding your health problems, being an advocate and involving yourself with your medical treatment and actively participating in the healing process 

I incorporated all these principles concerning my knee surgery, and credit these efforts with aiding my remarkable recovery.”

Facebook Page: Our Greatest Wealth Is Health

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe and receive notifications of new posts in your inbox.  Please feel free to avail yourself of these educational materials and share them with your friends and family.