Archive for January, 2016

Are You A Kidney Stoner? Update On Technological Advances

January 30, 2016

Andrew Siegel MD 1/30/16

Continuing on the theme of technological advances in medicine, today’s entry is on innovations in the diagnosis and management of kidney stones. Kidney stones cause excruciating pain, on par with the most painful human experiences– childbirth, broken bones, gout and impaired blood flow to organs.  Kidney stones are a common affliction with about 10% of Americans having experienced their misery. The good news is that most will pass spontaneously, without the necessity for surgical intervention. The other welcome news is that if surgery is required, it is minimally invasive—open surgery for kidney stones has virtually gone by the wayside.

What’s new in the world of kidney stones?

  1. Our recognition that lifestyle factors are major risks
  2. New and improved imaging techniques
  3. Technological refinements in surgical management
  4. Medical “expulsive” therapy to help stone passage

It is now well understood that although there are many causes of kidney stones, lifestyle factors are of paramount importance. This includes body weight, dietary habits and the quantity of fluids consumed. The prevalence of stone disease has DOUBLED in the last 15 years, paralleling the epidemic of obesity and type II diabetes. The more obese you are, the more likely it is that you will experience a kidney stone and the more difficult it will be to effectively treat it. Why is this so?  Obesity has metabolic consequences including increased urinary excretion of calcium, oxalate and uric acid (all common stone constituents); additionally, the obese population tends to consume excessive protein and salt, further increasing stone formation risk.  Another key risk factor is not consuming sufficient volumes of fluid to maintain a well hydrated state.

The diagnostic tools used to evaluate kidney stones have advanced considerably. Years ago, the imaging choice was intravenous urography (a series of x-rays taken after injecting contrast in a vein), which has been supplanted by unenhanced abdominal computerized tomography (CT) urography, a more sophisticated means of visualizing the anatomy of the urinary tract that does not use contrast (thus avoiding the potential risks of contrast) and has recently evolved further in terms of reduced radiation exposure. It precisely pinpoints the size and location of the stone and the extent of the obstruction. It provides insight into the mineral composition of the stone and also images the other organs in the abdomen and pelvis aside from the urinary tract.

IMG_1630

CT image of patient with stones circled in red in the lower poles of both kidneys, yellow arrow points to right kidney, blue arrow to left kidney.

In terms of stone evaluation, ultrasonography affords the advantage of less expense and no radiation, but is not on a par with CT imaging in terms of diagnostic capability.

sono kidney stone

Ultrasound image of kidney with stone circled in red; blue arrows point to border of kidney.

Minimally invasive techniques to manage kidney stones are now the norm.  Shock wave lithotripsy uses fourth generation machines that generate and focus external shockwaves at the stone.  This procedure is done under sedation, using fluoroscopy (real-time x-ray imaging) to image the stone, resulting in fragmentation of the stone into pieces that can be passed. Ureteroscopy and laser lithotripsy, done under general anesthesia, is a procedure in which a narrow lighted instrument is passed up the ureter (tube connecting the kidney to bladder) to directly visualize the stone and a laser fiber is used to pulverize the stone into pieces.  This procedure has benefited from miniaturized telescopes with increased flexibility, improved optic lens systems and fiber-optic light sources as well as advances in laser technology.

Medical expulsive therapy is now routinely used to help facilitate the passage of the stone or stone fragments. Alpha-blocker medications including Flomax, Uroxatral and Rapaflo, traditionally used to improve urinary symptoms due to prostate enlargement, are utilized “off label” to help relax the smooth muscle of the ureter and aide stone passage.

Groans, moans and other symptoms

Colicky pain results when a stone gets lodged in the ureter during the process of passage. Because of excruciating pain and the inability to find a comfortable position, stones frequently result in a visit to the emergency room. Other typical symptoms are sweating, nausea and vomiting, blood in the urine and urinary urgency and frequency. In the emergency department patients are usually hydrated intravenously, given pain medications and undergo CT imaging. Most kidney stones can be managed on outpatient basis with patients sent home on pain medication, an alpha-blocker medication and a strainer to capture the stone.

Will my stone pass?

Whether a stone will or will not pass is dependent upon factors including stone size, shape, and ureteral anatomy. 70% of stones less than 5 mm and 50% of those between 5–10 mm will pass, given sufficient time. The smoother and less irregular they are, the more easily they will pass. Passage is also influenced by the internal diameter of the ureter and the nuances of ureteral anatomy. Once a stone passes into the urinary bladder, passage out the urethra (tube from the bladder out) is usually rapid and painless.

Why do stones form?

Kidney stones form when minerals normally dissolved in the urine crystallize into solid particles. It starts out as a tiny “grain” that grows because the stone is bathed in mineral-rich urine that laminates mineral deposits around the grain. This crystal formation often occurs during periods of dehydration, typically prompted by summer heat, exercise, saunas, hot yoga, diarrhea, vomiting, being on bowel prep for colonoscopy, etc. Another big culprit is excess Vitamin C, which is converted into oxalate, one of the components of calcium oxalate stones, the most common stone variety.  Vitamin C is not stored in the body and any excess ends up in the urine in the form of oxalate. Other stone promoting factors are excessive dietary protein, fat and sodium intake. Inflammatory bowel disease and previous intestinal surgery increase the risk for stones.  Urinary infections with certain bacteria can promote stone formation. Parathyroid gland issues and high serum calcium levels increase one’s risk. Some stones have a genetic basis.

When to intervene?

If a stone does not pass in a reasonable amount of time and causes continued symptoms, it will require active intervention. Aside from unremitting pain, other reasons for intervention are unrelenting nausea and vomiting with dehydration, larger stones that are not likely to pass, significant obstruction of the kidney, a high fever from a kidney infection that does not respond to antibiotics, a solitary kidney and certain occupations that cannot risk impaired functions such as airline pilots.

What about recurrent stones?

Although the majority of people with a kidney stone will have only one isolated episode, about 35% will experience recurrent episodes. Because of the possibility of recurrence, it is important to identify the underlying metabolic causes in order to implement prevention strategies. For this reason it is important to analyze the mineral content of the stone and certainly for recurrent stones, to collect urine for 24 hours to do a metabolic evaluation.

Strategies to reduce your risk for stones

  • Healthy lifestyle (healthy diet and body weight, exercise, etc.)
  • Stay well hydrated (make sure your urine looks more clear than amber)
  • Consume citrate (high levels in citrus, particularly lemons), which is an inhibitor of stone formation
  • Avoid excess Vitamin C
  • Avoid high protein diets
  • Avoid excessive salt (kidneys tend to reabsorb sodium and compensate by excreting calcium in the urine)

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Robotics In Urology

January 23, 2016

Andrew Siegel, MD 1/23/16

The word “robot” was coined by a Czech playwright almost a century ago, derived from “robota,” meaning “forced labor.”  Now used routinely, robotics represents a significant engineering advance that has been rapidly adopted by urologists since its inception 15 years ago.  Before the availability of this technological breakthrough, major urological surgical procedures were performed through large incisions with poorer visualization, more blood loss, less precision, more pain and longer hospital stays and recovery.

With the advent of laparoscopy (“keyhole”) surgery done via small portals and thereafter the development and refinement of surgical robotics, many advantages have accrued. Major surgical procedures can be performed less invasively, with a reduction in blood loss, a brighter, sharper and magnified visual field for the surgeon, less pain and faster recovery. The robot has been put to use for prostate, bladder, kidney and adrenal surgery as well as for severe cases of female pelvic organ prolapse. Robotic technology has been beneficial in helping urologists remove diseased organs as well as in facilitating reconstructive urological procedures. Robots do not perform the surgery independent of the surgeon!  The urologist with a dedicated team of assistants harnesses the powers of the robot for the benefit of the patient, the robotic technology an extraordinary example of human-machine symbiosis.

Initially, portals are placed by small incisions that leave only small scars and cause limited pain. Through one of these portals, a camera is inserted to obtain an optically magnified, three dimensional, high definition view of the surgical field. The camera can be manipulated, zoomed, rotated, etc. Robotic instruments that are mounted on the robot’s arms are inserted through the portals. These include electric cautery used to cut and coagulate tissue, scissors, forceps, scalpels, needle holders and other surgical tools.

IMG_1614

(The operative field with robotic instruments mounted on robotic arms)

The surgeon sits at a console remote from the patient and controls and maneuvers the miniaturized robotic instruments while viewing the operation in real time. An advantage of sitting at the console is that it is a very comfortable, ergonomically favorable position that minimizes the postural fatigue that often accompanies standing up for traditional open surgery. The surgeon’s fingers are inserted into surgical joysticks that provide control of the instruments by using natural hand and wrist movements, with the system capable of “motion scaling,”  converting the surgeon’s movements to precise, tremor-free robotic micro-movements.  In addition to hand controls the surgeon uses foot pedals to control the camera, focus, electro-cautery and coagulation.  Seven degrees of freedom (each direction a joint can move is a degree of freedom) are provided at the instrument tips. 540 degrees of pivoting provide greater maneuverability than is possible with the human hands or laparoscopic instruments.

IMG_1613

(Dr. Mutahar Ahmed seated at the console performing a robotic prostatectomy)

Robot-assisted laparoscopic prostatectomy is the surgical approach of choice for removing a cancerous prostate gland, allowing the surgeon the benefits of markedly better vision and maneuverability, very refined precision in the dissection of delicate tissue and facilitation of suturing. Because of these advantages, in addition to less bleeding, less post-operative pain and shorter hospital stays, there are improved outcomes in terms of urinary incontinence and erectile dysfunction as compared with the open approach.

Bottom Line: Surgical robotics is a revolutionary technological advance that has been rapidly adopted by urology, general surgery, gynecology, cardio-thoracic, pediatric and ear-nose-throat surgeons. It affords numerous advantages including surgeon comfort and ergonomics, high quality 3D vision, motion scaling, enhancement of surgeon dexterity and elimination of tremors, which translates to numerous benefits and advantages to the patient.

Exactly one year ago,  New Jersey Center for Prostate Cancer & Urology (NJCPCU) and Bergen Urological Associates (BUA) merged practices.  The main office is located at 255 W. Spring Valley Avenue in Maywood, New Jersey. The combined group consists of  8 urologists, a physician’s assistant and nurse practitioner. The merger brings together the exceptional robotic skills of the NJCPCU urologists (having pioneered robotic prostatectomy in New Jersey and having performed more than 7000 such procedures) with the urological expertise and experience of the BUA urologists.

RoboticUrology.com                                                                                                BergenUrological.com

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Shy Bladder Syndrome

January 16, 2016

Andrew Siegel MD   1/16/16

charlie pink leaves

The image above is of Charley Morgan, my Springer spaniel, who is standing in a bed of cherry blossoms.  She has the very opposite of shy bladder syndrome, urinating involuntarily whenever people visit!

 

The following are quotes from patients of mine who suffer with shy bladder syndrome, the difficulty or inability to urinate in a public venue or in the presence of others:

“ I can’t urinate in front of other people.”

 “No way could I ever use a urinal.”

 “No beer for me at the sports arena.”

 “I would die before I ever attempted to urinate into one of those trough urinals they have at some stadiums and gyms.”

 “I need a private stall when in a public restroom.”

In medical speak, the condition “shy bladder syndrome” is known as “paruresis,” although I prefer the term “bashful bladder.” There are an estimated 20 million or so Americans suffering with this social phobia in which even the thought of having to urinate in public causes great distress, making the physical act of urinating impossible. However, those with bashful bladder have no such issues when in a private venue. In its most extreme form, a person with this phobia can only urinate at home when no other family members are present.

This problem occurs in both women and men and often manifests itself in adolescent years. It is a classic example of the mind-body connection in action. Anxiety brought on by the thought of having to pee in public causes the release of adrenaline and other stress chemicals, which cause a host of general effects such as  rapid pulse, shallow breathing, but also specific effects including the clenching of the muscles in the urethra (and male prostate gland). The inability to relax these sphincter muscles make the act of urinating difficult, if not impossible. It is little different than stage fright or the inability to speak in a public setting.

There are a variety of coping measures that people with shy bladder syndrome use, including restricting fluid and caffeine intake, deliberately holding in their urine and avoiding travel and other circumstances that would require the use of public restrooms.

Solutions to Bashful Bladder

The seemingly simple act of urination is actually a very complex event. Effective urination requires a contraction of the bladder muscle with coordinated relaxation of the sphincter muscles that pinch the urethra closed.  In order to improve bashful bladder, efforts need to be directed at general relaxation/anxiety management as well as at relaxing the urethra and sphincter muscles.

  • Relaxation techniques include deep breathing with exhalation to maximally relax the voluntary sphincter when in a public restroom; other methods include meditation and any of the many means of achieving a relaxed state including yoga, massage, tai chi, aromatherapy, hypnosis, etc.
  • Pelvic floor physical therapy to help relax tense pelvic muscles that can contribute to the problem, since they contribute in a major way to the voluntary sphincter muscle.
  • Cognitive behavioral therapy, which aims to retrain the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of emptying one’s bladder in public.
  • Medications: Alpha blockers, “anti-adrenaline” agents used to relax the muscles of the urethra and prostate (Flomax, Rapaflo, Uroxatral, etc.);  Anti-anxiety medications can be helpful as well at times.

Bottom Line: Bashful bladder is a not uncommon social phobia that can severely impact one’s quality of life.  The good news is that this is a manageable problem.  For more information visit paruresis.org.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Uterine Fibroids And The Bladder

January 9, 2016

Andrew Siegel MD   1/9/16

shutterstock_femalebluepelvic

 

Fibroids are muscular growths that develop within the womb that can put direct pressure on the next door neighbor of the uterus–the urinary bladder.  This compression can give rise to a host of annoying urinary symptoms including urinary urgency, frequency, urinary leakage and difficulty urinating.  

Although fibroids usually grow within the uterine wall, at times they do so internally into the uterine cavity or, alternatively, externally on the outside of the uterus. They are virtually always benign and much of the time they do not cause symptoms. When symptomatic they may cause the following: heavy uterine bleeding; pelvic pressure; a swollen and distended lower abdomen; urinary and bowel issues; pelvic and lower back pain; pain with sexual intercourse; as well as fertility problems, reproductive issues and complications of pregnancy (breech births, failure of labor to progress, the need for C-section, preterm delivery, and bleeding following delivery).

The most common presenting symptom of uterine fibroids is uterine bleeding, which often begins as prolonged menstruation and can be severe enough to cause a low blood count.  Fibroids are problems of the reproductive years, prevalent in women in their 30s, 40s and 50s. They can be solitary or multiple, range in size from tiny to huge and vary in location within the uterus. The largest fibroids can outgrow their blood supply and undergo degenerative changes. When extremely large, they can distort the lower abdomen, simulating pregnancy. Fibroids are “tumors”–-although benign–- that microscopically consist of interlacing bundles of smooth muscle surrounded by condensed uterine tissue. There is a genetic basis for fibroids with an increased prevalence in women with a family history. Obesity increases one’s risk for fibroids.

The growth of uterine fibroids is largely controlled by estrogen, the key female sex hormone. Fibroids tend to grow rapidly during pregnancy and regress after menopause when estrogen production ceases.

The presence of fibroids may significantly impair one’s quality of life. Because of the pressure they apply against the typically balloon-thin female urinary bladder, they often cause urinary symptoms, much as in pregnancy when an enlarged uterus compresses the bladder. Urinary symptoms most often occur when the fibroids are located closest to the bladder and/or urethra. Typical symptoms include urinary urgency, frequency and stress urinary incontinence (leakage of urine with sneezing, coughing, and exertion). Symptoms are proportionate to the size of the fibroid, with larger fibroids causing more significant symptoms. On occasion, a fibroid can cause an obstruction of the urinary tract, impairing one’s ability to empty their bladder, sometimes requiring the placement of a urinary catheter to alleviate the obstruction.

On pelvic examination, fibroids can often be recognized as pelvic masses. Thye can be further evaluated with imaging studies, including ultrasound, computerized tomography and magnetic resonance imaging. They characteristically cause a “popcorn” appearing calcification on abdominal radiographs.

Those fibroids that do not cause symptoms or bleeding do not require treatment. There are numerous pharmacological options for symptomatic fibroids including medications that lower estrogen levels that cause suppression and shrinkage of the fibroids. Surgery may be required when there is an inadequate response to conservative measures. Surgical options include removing or destroying the uterine lining to control heavy bleeding, deliberately blocking the blood supply to the fibroid, surgical removal of one or more of the fibroids and, at times, removing the entire uterus (hysterectomy).

Bottom Line: As a urologist, I not uncommonly see women with urinary urgency, frequency, incontinence or urinary obstruction caused by one or more uterine fibroids pushing and compressing the bladder or urethra. It is usually very obvious on pelvic ultrasound or cystoscopy (visual inspection of the bladder), where the fibroid can be seen to cause extrinsic compression. The good news is that such fibroids are eminently manageable, which most often resolves the urinary issues.    

Wishing you the best of health and a very happy New Year,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Eating Yourself Limp

January 2, 2016

Andrew Siegel MD   1/2/16

Central_Obesity_008.jpg

Today’s entry is on the topic of how overeating and obesity affect one’s manhood and vitality (this holds true for female sexual function as well).  While optimal sexual function is based on many factors, it is important to recognize that our food choices play a definite role. What we eat—or don’t eat—impacts our sex lives.  It’s a new  year– a fresh start–and time for many resolutions, which often involve weight loss and a healthier lifestyle.  Yet another benefit of becoming leaner and fitter is improved sexual function. 

Sexuality is an important part of our human existence. Healthy sexual function involves a good libido, the ability to obtain and maintain a rigid erection and the ability to ejaculate and experience a climax. Although not a necessity for a healthy life, diminished sexual function can result in loss of self-esteem, embarrassment, a sense of isolation and frustration and even depression.

Sexual functioning is complicated and dependent upon a number of systems working in tandem– the endocrine system (which produces hormones); the central and peripheral nervous systems (which provide nerve control); the vascular system (which conducts blood flow); and the musculo-skeletal system (specifically the pelvic floor muscles that help maintain the high blood pressures in the penis necessary for erectile rigidity).

Sexual function is a good indicator of underlying cardiovascular health. A healthy sexual response is largely about blood flow to the genital and pelvic area. The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge happening within seconds and responsible for the remarkable physical transition from flaccid to erect. This is accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. Pelvic muscle engagement and contraction help prevent the exit of blood from the penis, enhancing penile rigidity and creating penile blood pressures that far exceed normal blood pressure in arteries. For good reason, Gray’s Anatomy textbook over 100 years ago referred to one of the key pelvic floor muscle as the “erector penis.”

Blood flow to the penis is analogous to air pressure within a tire: if there is insufficient pressure, the tire will not properly inflate and will function sub-optimally; at the extreme the tire may be completely flat. Furthermore, slow leaks (that often occur with aging and failure of the smooth muscle within the penile arteries and erectile tissues to relax) promote poor function.

Just as your car suffers a decline in performance if it is dragging around too much of a load, so you penis will function sub-optimally if you are carrying excessive weight. Obesity steals your manhood and reduces male hormone levels. Abdominal fat converts the male hormone testosterone to the female hormone estrogen. Obese men are more likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it more difficult to obtain and maintain good-quality erections. Additionally, as your belly gets bigger, your penis appears smaller, lost in the protuberant roundness of your large midriff and the abundant pubic fat pad.

Remember the days when you could achieve a rock-hard erection—majestically pointing upwards—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and had an abdomen that somewhat resembled a six-pack. Perhaps now it takes a great deal of physical stimulation to achieve an erection that is barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need pharmacological assistance to make it possible.

If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft where it counts.  A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body. If your is penis difficult to find, if you have noticed man-boob development, and your libido and erections are not up to par, it may be time to rethink your lifestyle habits.

Healthy lifestyle choices are of paramount importance towards achieving an optimal quality and quantity of life. It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices. These include proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and minimizing stress.

Eating properly is incredibly important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome and natural and real foods will help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products—including lean meats and dairy—should be eaten in moderation. The Mediterranean-style diet is an excellent one for minimizing both sexual dysfunction and heart disease. Poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast tract to obesity and clogged arteries that can make your sexual function as small as your belly is big.

Bottom Line: If you want a “sexier” lifestyle, start with a “sexier” style of eating that will improve your overall health and make you feel better, look better and enhance your sexual function.  Smart nutritional choices are a key component of sexual fitness. If you are carrying the burden of too many pounds, now is the perfect time to start on the pathway towards better health and reversing the sexual dysfunction that has been brought on by poor lifestyle choices. 

Wishing you a healthy, peaceful, happy (and sexy) 2016,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. Coming soon is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Author of Promiscuous Eating: Ending Our Self-Destructive Relationship With Food: http://www.PromiscuousEating.com

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.