Posts Tagged ‘genetics’

It’s Not Just What’s In Your Genes That Counts: 10 Interesting Genetic Facts

October 1, 2016

Andrew Siegel MD 10/1/2016

This entry is a little diversion from my usual pelvic health blogs, but covers a fascinating topic that is at the forefront of medical research.


(Thank you, Pixabay, for image above of DNA)

  1. Humans have 23 pairs of chromosomes, but apes have 24 pairs. We lost a chromosome during evolution, but gained a thumb…less is more! Noteworthy is that the genetic material of apes is 96% identical to that of humans.
  2. Our chromosomes contain 20,000 or so genes—only 2000 fewer than worms and less than corn, rice or wheat…in this instance, size doesn’t matter!
  3. Every cell in our body has identical chromosomes and genes, yet the expression of the genes varies greatly from cell to cell—skin cells are clearly very different than kidney cells, yet share the same genetic blueprint. The nuance, complexity and real mystery of our chromosomes is the orchestration of turning on and turning off certain genes in certain cells at certain times at certain places.
  4. Our genes can magically shuffle their sequence to make genetic variants to enable fighting off invading pathogens. This dynamic ability allows us to ward off pathogens that are constantly evolving.
  5. The basic function of genes is to encode for proteins. However, only 2% of the chromosome contains genes that do so. 98% of the genetic material of the chromosome does not encode for proteins and is either located between or within protein-encoding genes and is responsible either for regulating genes or has mysterious functions that are not understood.
  6. Many of our human genes are actually not human.  Embedded within our chromosomes are inactive portions derived from ancient viruses and other non-human sources.
  7. The ends of chromosomes have “telomeres” that protects the chromosomes from fraying, acting like the plastic pieces at the end of shoelaces.
  8. The simplicity of the genetic code is well understood: DNA builds RNA, RNA builds proteins, and a triplet of bases of DNA specifies one amino acid of the protein. However, we are clueless about the complexity of the genomic code, with no clear understanding of the coordination of gene expression to build, maintain and repair a human being.
  9. The Y chromosome determines maleness. It is the only unpaired chromosome, meaning no mate chromosome or duplicate copy, leaving each gene on the chromosome to fend for itself. If a mutation occurs, there is no repairing it by copying it from the intact gene on the sister chromosome. In other words, the Y chromosome has no backup (spare tire) and when a mutation occurs, it spells trouble, being the most vulnerable spot in the human genome. As a consequence, evolutionary forces have transferred important genetic material to less vulnerable chromosomes, whittling the Y chromosome down to being the smallest of all chromosomes. Like risk-taking men, the male chromosome lives dangerously!
  10. Mitochondria are the “powerhouses” of our cells, responsible for energy and metabolism. All human embryos inherit their mitochondria exclusively from their mothers, as sperm do not contribute mitochondria. If you feel depleted of energy, blame it on your mother!

 Much of the information for this entry was derived from an awesome book: The Gene: An Intimate History by Siddhartha Mukherjee, MD, one that I highly suggest that you put on your reading list.

Wishing you the best of health,

2014-04-23 20:16:29

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Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at

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Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 


Manhood: You Can’t Make it Bigger, but You Can Make it Stronger with Man Kegels

August 27, 2014

The following is a guest blog written by David Mandell, entrepreneur and cofounder of The Private Gym, a company whose mission is to provide men with the means of learning Kegel exercises in order to become masters of their pelvic floor and improve their pelvic health.


Let’s face the facts. Life isn’t fair. The sooner we realize this as human beings, the better – – since it enables us to begin to prepare for what’s to come.

Everything starts and ends with genetics. How do we know this? Well, here’s the scientific analysis: How often have you been told, “You’re acting just like your father?” I hear this at least once a week from my wife, mother, and even my mother-in-law. As you can imagine, it isn’t always a compliment. What is my father’s typical response? “It’s cultural, get used to it.” There’s also a genetic component to that, but that’s another discussion.

Will your child excel at the violin? Well, is there anyone with any musical talent in the family? Want to know what the woman you’re dating will look like in 30 years? Check out her mother. It’s about as close to a crystal ball as you can get. Body shape, facial structure, intelligence, talents, abilities, it almost all relates back to your genetic makeup. And, yes . . . the size of a man’s penis is also dictated by genetics

There is no single aspect of the human body that plays such a critical role in defining a man’s identity as his penis. How do we know this? Take me, for example. If I had a very large penis, during my dating years, I would have worn clear pants with an internal glowing chamber that highlighted my manhood. It’s even possible I would still wear them today on special occasions and national holidays.

So how do you combat genetics? It isn’t easy with the basic scientific remedies available to most of us. You can study hard in school, outwork your competition in your professional career, and eat right and exercise to transform your body.

I’m not going to debate whether it is possible to enlarge your penis. There are all sorts of medieval-looking torture devices that will stretch out your manhood. However, these products are not mainstream and never will be—and in fact, many really don’t work. Just ask the Mayo Clinic:

And the herbal supplements that claim to make your penis bigger? Just think for a minute about how absurd this is. If there was a pill – – any pill – – that actually made your penis bigger, it would be given to men at birth. The father would insist upon it – – no matter what the cost. “Forget about the Gerber Life College Fund, he needs that penis growing pill now.”

Just like a pill won’t make you taller, it also won’t increase the size of your penis. So, save your money.

I’m not here to argue that size doesn’t matter – – it does, given our whole discussion to this point. However, the strength of your penis matters just as much – – if not more.

How hard your erection is and how long you are able to perform impacts your partner’s sexual experience more than the size of your penis alone. This is a fact.

Unlike genetics, the strength of your penis – – and the pelvic muscles that support the penis – – is something you can control. You can workout your penis with Kegel exercises for men. Regardless of your age or condition, strengthening your pelvic muscles will have a direct impact in improving your sexual performance and reproductive health.

However, if you won the genetic lottery and are blessed with a large penis, you are not immune to potential problems lurking just below the surface. In fact, you may be even more at risk as you age. One of the only downsides of a large penis – – I’ve been told – – is that it is hard to keep it really hard. In fact, it takes more pelvic muscle strength to hold blood in the penis and ensure rigidity. As the pelvic muscles weaken over time, loss of rigidity may become even more of an issue for the well-endowed male.

So what can you do? Start now, and begin working out one of your most important muscle systems. Men of all ages – – whether completely healthy or experiencing sexual, urinary or bladder conditions – – can learn all about the importance of your pelvic muscles and how to exercise them at Also, Dr. Andrew Siegel, one of the nation’s leading urologists and co-founder of Private Gym, teaches you about these muscles in his new book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.


David Mandell

President and CEO of the Private Gym


Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

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Penis Size: Does It Matter?

May 17, 2014

Blog #154

As I was walking through the gateway on my way to board an airplane, I saw a poster advertisement stating the following: Size should never outrank service, referring to the smaller size regional jets that now offer first-class, wi-fi and more. I recently saw another poster ad for the same airline stating: How fast the flight goes isn’t always up to pilot. I find these double entendres quite amusing and entertaining.

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Penis size is no exception, with some of us phallically endowed, some phallically challenged, but most of us somewhere towards the center. In a study of 3500 penises published by Alfred Kinsey, the average flaccid length was 8.8 centimeters (3.5 inches). The average erect length ranged between 12.9 -15 centimeters (5-6 inches). The average circumference of the erect penis was 12.3 centimeters (4.75 inches).

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that there is no clear cut correlation between ethnicity and penis size. Flaccid length does not necessarily predict erect length and can vary depending upon emotional state and ambient temperature. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

Some women prefer men who are formidably hung, just like some men prefer women with large breasts. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort, particularly if cervical contact occurs. The long and the short of it are summarized in the adage, “It’s not the size of the ship, but the motion of the ocean.

Who Knew? “Genital Genetics.” As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (or mother). In actuality, it is the roll of the genetic dice and how the inherited blueprint that determines physical traits interacts with the local hormonal environment.

Who Knew? Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Who Knew? On the subject of penis size, one of my favorite things to do when driving on the highway and seeing some idiot in a Lamborghini driving hazardously from lane to lane at about 95 miles an hour is not to flash him my middle finger, but to show him my hand with my thumb and index finger separated about 1 inch apart to indicate to him what I think is the likely size of his penis.

Who Knew? “Men are from Mars, Women from Venus.” Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Who Knew? There are a bunch of “amenities” that accompany the aging process, one of which is “presbyopia” or farsightedness, which demands reading glasses. They are a real nuisance, never around when you need them and always getting lost. But one thing I have observed is that if you forget to take them off when you get up to relieve your full bladder, when you glance down, you see a rather large “member,” thanks to the magic of magnification. I am currently wearing 1.5 power; perhaps it’s time for 2.0!

Who Knew? There is no correlation between penis size and shoe size, hand size or nose size.

Who Knew? “Where’s Woody?” Three of the most common words I hear in my urology practice are the following: “Doc, I’m shrinking.”

Who Knew? Part of the problem is the pervasive pornography industry, where many male stars are endowed like the centaur, the mythological creature with the head and torso of man and the lower body of a horse. This has given the average guy a bit of an inferiority complex.

Many men complain of “shrinkage,” which is a very real phenomenon on the basis of blood flow. The typical circumstances evoking this are exposure to cold weather or cold water, the state of being nervous, and athletic pursuits. The mechanism in all cases involves blood circulation. Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s periphery to help maintain core temperature. This is the very reason one places ice on an injury as the vasoconstriction will reduce swelling and inflammation.

It stands to reason that exposure to heat will cause vasodilation (expansion of arterial flow) and this is the very reason that some penile tumescence (state of fullness without rigidity) can occur in a warm shower. Nervous states or anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in a flaccid penis. Participation in vigorous athletic activity “steals” blood flow to the organs that need the oxygen and nutrients the most, namely the muscles, at the expense of organs like the penis.

Who Knew? Do you remember the Seinfeld episode in which Jerry’s girlfriend Rachel sees George naked after George steps out of a swimming pool?

 Rachel: “Oh my God, I’m really sorry.”

George: “I was in the pool; I was in the pool.”

George to Jerry: “Well I just got back from swimming in the pool and the water was cold.”

Jerry: “Oh, you mean shrinkage.”

George: “Yes, significant shrinkage.”

As mentioned, truly not a day goes by in my practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity will cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to man-o-metrics.

Who Knew? “Fatal Retraction.” It is estimated that for every 35 lbs. of weight gain, there will be a one-inch loss in apparent penile length.

Who Knew? “Penile Dysmorphic Disorder,” very much paralleling “Body Dysmorphic Disorder,” is a condition in which one’s image of their penis is at odds with reality. Typically, one envisions himself as small when in fact he is quite within the normal range and an obsessive focus on this issue creates a great deal of psychological stress.

Who Knew? “Koro” (“head of the turtle” in Malay) is a cultural form of psychological panic that occurs predominantly in East Asian men. Those who suffer from this delusional disorder are terrified that their genitals will retract into their bodies and take extreme measures to prevent this from occurring.

The erectile cylinders of the penis are essentially our “erector sets,” consisting of three inner tubes within the penis that are composed of vascular (consisting of blood vessels) smooth muscle and sinuses that fill with blood upon sexual stimulation. An erection is on the basis of blood expanding these cylinders to the point of penile rigidity. Like any other muscle, the muscle of the penis needs to be used on a regular basis, the way nature intended for it to be used. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile smooth muscle can occur. In a vicious cycle, any loss of sexual function can lead to further progression of the problem. Poor genital blood flow produces a state of poor oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the sexual dysfunction.

Radical prostatectomy, the surgical removal of the entire prostate gland as a treatment for prostate cancer, can cause penile shortening by virtue of the removal of the prostate gland. The resultant gap in the urethra because of the removed prostate is repaired by sewing the bladder to the urethra with a consequent loss of urethral length. Penile shortening can be compounded by the disuse atrophy and scarring that can occur as a result of the erectile dysfunction associated with the surgical procedure, which sometimes can damage the nerves that are responsible for erections. Getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shortening because of scarring of the erectile cylinders that prevents them from expanding properly.

Androgen deprivation therapy is a means of suppressing the male hormone testosterone, typically used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage.

Who Knew? Penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky, ineffective and not ready for prime time. Certain procedures are what I call “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone and other tissue grafts. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis—certainly a far cry from a “proud soldier” and more like a “wounded warrior.” Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

Who Knew? The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident. Hmmm, now there is a concept for penile enlargement.

Andrew Siegel, MD

The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

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”:



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.

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Pancreatic Cancer

October 19, 2013

 Pancreatic Cancer 

Andrew Siegel, M.D.  Blog #124

The pancreas is a vitally important organ that serves dual roles: as an endocrine organ that produces hormones including insulin and glucagon and as an exocrine organ that secretes digestive enzymes that help the process of fat, protein and carbohydrate breakdown and digestion.  It is located deep within the upper abdomen and is divided into a head, body and tail.  The head lies within the concavity of the duodenum (the first part of the intestine).  The body runs behind the stomach and the tail touches the spleen.  The fact that it is such a deep-seated organ makes it virtually impossible to examine on a physical exam (unlike superficial organs such as the breasts or testicles) and pathological problems of the pancreas are identifiable only on sophisticated imaging studies of the abdomen.

Cancer of the pancreas is an incredibly lethal malignant tumor.  Approximately 45,000 Americans will be diagnosed with pancreatic cancer in 2013 and more than 38,000 will die from the disease, with a five-year survival rate of only about 5%.   The greatest challenge is that there are no early detection tests and, unfortunately, most patients who have early and localized disease have no recognizable symptoms such that most are not diagnosed until late in the disease—after the cancer has spread (metastasized).

In spite of the dismal prognosis, there has been recent progress in pancreatic cancer with surgery becoming safer and less invasive, the availability of new drug combinations that have been shown to improve survival, and advances in radiation that have resulted in less side effects. Significant strides forward have been made in the understanding of the genetics of pancreatic cancer, and unlocking the molecular basis of this horrific disease hopefully will translate into better treatment options.

The most common form of pancreatic cancer is invasive ductal adenocarcinoma.  The second most common type is a pancreatic neuroendocrine tumor; this is less aggressive than the ductal carcinomas, but still has a 10-year survival rate of only 45%. Some of the neuroendocrine tumors manufacture hormones such as insulin that produce clinical syndromes.

A combination of inherited and environmental factors contributes to the development of pancreatic cancer. The most common environmental risk factor is tobacco; smokers having a more than double the risk of pancreatic cancer as compared to non-smokers.  The good news is that smoking cessation will substantially reduce the risk.  Other risk factors are long-standing type II diabetes, increased body mass index, heavy alcohol consumption, and chronic pancreatitis.   A strong family history of pancreatic cancer puts an individual at significant risk.  BRCA2 gene mutations also increase the risk. Additionally, patients who have hereditary pancreatitis have a 60-fold increased risk; this is so substantial that some patients with this disease opt for a prophylactic removal of the pancreas.

Now for Molecular Biology 101:  Genes are inherited bits of information that code for proteins.  When genes become mutated, the proteins that the genes code for become dysfunctional.  One can think of genes as the written recipe for a particular meal and their product as the meal itself—when the recipe is changed (mutated) the resultant meal is defective.  In the case of the human body, the altered genes code for altered proteins that damage cellular function and replication in such a way as to alter the normal orderly process of cellular reproduction, resulting in unrestrained, disorderly cell replication, aka cancer.  Scientists have identified numerous genetic mutations responsible for cancers and they are named with bizarre combinations of letters and numbers—do not be daunted by their names as follow.

So, on a molecular level, cancer is caused by inherited and acquired mutations in genes. The sequencing of the genetic material of the pancreatic ductal adenocarcinomas has demonstrated that four specific genes are each altered in more than 50% of these cancers.  KRAS, an oncogene (a gene with the potential to cause cancer), becomes activated in 95% of pancreatic cancers—the protein coded for by this gene plays an important role in cell signaling, a complex system of communication that governs basic cellular activities and coordinates cell actions. The p16/CDKN2A gene, a tumor suppressor gene (a gene that protects a cell from cancer that, when mutated, would allow the cell to progress to cancer), becomes inactivated in 95% of pancreatic cancers.  The protein product of this gene plays an important role in the regulation of the cell cycle and its loss promotes unrestricted cell growth. The TP53 tumor suppressor gene is inactivated in 75% of pancreatic cancers. Loss of its function through mutation promotes pancreatic cancer through the loss of a number of critical cell functions.  The SMAD4 tumor suppressor gene has a protein product in the cell signaling pathway that when interfered with is associated with a very poor prognosis and widely metastatic disease. In addition to these 4 major genes, there are numerous other genes that are mutated in pancreatic cancer at lower frequencies.

Unfortunately, most pancreatic cancers do not cause specific symptoms and are not diagnosed in a timely manner. Typical non-specific symptoms include upper abdominal pain radiating to the back; unexplained weight loss; nausea; jaundice; clay colored stools; and in a small percentage of people, migratory thrombophlebitis (multiple blood clots appearing in a variety of veins). At times, it can present with diabetes, symptoms of pancreatitis, or depression. Diagnosis is predicated upon imaging tests including CT, MRI, and endoscopic ultrasound.  Standard cancer staging is stage I through stage IV, with stages I an II being localized, III being locally advanced, and IV being metastatic. In the absence of metastatic disease, the ability to surgically remove the cancer is predicated on the relationship of the tumor to the adjacent major blood vessels.

Pancreatic cancer is a complex disease and is best treated by a multidisciplinary team including a surgeon, medical oncologist, and radiation oncologist. In general, patients with stage I/II disease should undergo surgery followed by adjuvant therapy (chemotherapy and/or radiation).  Patients with stage III locally advanced disease should be treated with chemotherapy and/or chemo-radiation.  Patients with stage IV and good performance status may receive systemic therapy and those with poor health should be given supportive therapy.

The best chance of long-term survival of a patient with localized pancreatic cancer is surgical removal. However, because pancreatic cancer is often beyond the confines of the pancreas at presentation and due to the potentially negative impact of surgery on quality of life as well as the low chance of long-term survival, surgery is often non-curative. Certainly, the risk of local and systemic recurrence after surgery is very high.

Bottom Line: Pancreatic cancer is a wickedly lethal cancer.  In terms of minimizing one’s risk, avoid tobacco, obesity and heavy alcohol consumption. So, don’t smoke, eat a healthy diet, maintain a good weight, and be moderate with alcohol.  Despite the dismal prognosis, there have been recent advances on many fronts, particularly in terms of the genetics of the cancer, wherein the key to treating this miserable cancer most likely lies.

“Sometimes life hits you in the head with a brick. Don’t lose faith. I’m convinced that the only thing that kept me going was that I loved what I did. You’ve got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.” 

Steve Jobs, who died of neuroendocrine cancer of the pancreas

Reference: Recent Progress in Pancreatic Cancer, Wolfgang, Herman, Laheru, Klein, Erdek, Fishman and Hruban

CA CANCER J CLIN 2013;63:318-348 September/October 2013

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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.

Bone Health

September 7, 2013

Bone Health

Andrew Siegel, MD   Blog #118

Our bones are our foundation, the framework that supports the rest of our body.  If our infrastructure is “crumbling,” other organs and tissues that depend on intact structural support can be profoundly affected.  In other words, if our foundation and framework are shoddily constructed, the rest of our structures and functions are likely to be adversely impacted.

“Rickety” is a descriptive adjective meaning shaky, run down, and dilapidated.  It is derived from the disease rickets, a “softening” of the bones due to Vitamin D issues that can lead to fractures and deformities, typically seen in children suffering from malnutrition.  It is important to avoid the development of rickety bones—we do not want to be built of a “house of cards,” as we function best if our bones are “steely.”

A fundamental problem in terms of bone health and vigor is that most people do not consider their bone health early in life.  Unfortunately, it only becomes a matter of concern at a time in which it is getting late in the game to protect against loss of bone strength and fractures. The time to focus on bone health is during childhood when the achievement of bone integrity and strength begins.  This bone formative process continues through adolescence, when the body builds the lion’s share of bone mass, and peaks in our early 20’s. One-quarter of bone mass is obtained within the two-year window of time around puberty; as much bone is gained in this two-year period as is typically lost in the 30-year interval between ages 50-80.

Since children, understandably so, are not likely to consider their bone health, as responsible parents we must educate our kids and be the overseers of their diets, physical activities and sun exposure—all of which can positively contribute to healthy bone development—as well as lead by example. Helping them achieve the goal of bone health during adolescence is an investment in personal health that will pay dividends later in life, helping to prevent bone thinning and the potential for fractures.   It is important to direct our children away from computer games, television and other sedentary activities and motivate them towards the outdoors to participate in a variety of physical activities. It is equally important to encourage them to have a nutritionally sound diet rich in calcium-containing foods including dairy sources such as milk, yogurt and cheese; non-dairy sources including vegetables such as Chinese cabbage, kale, broccoli and spinach; seafood sources such as salmon and sardines; and calcium-fortified sources such as cereals, tofu and fruit juices.  It is equally as important to ensure sufficient vitamin intake.  Vitamin D is necessary in order to absorb and utilize dietary calcium; a brief amount of sunlight exposure on a daily basis is generally sufficient to ensure adequate levels of vitamin D. Children can kill two birds with one stone by participating in athletic activities outside in the sunlight.

In terms of key factors determining bone health, genetics looms large.  In other words, if bone thinning tends to run in your family, you will have a greater likelihood of suffering the same fate.  Like so many of our physical attributes, bone strength and integrity have a strong hereditary basis and there is not a thing that we can do about the genes that we inherit. Additionally, age and gender are important elements.  There is a gradual but insidious loss of bone mass that correlates with the aging process, and the older we are, the greater the likelihood for osteopenia, the medical term for bone loss. Osteoporosis is the medical term applied to severe bone loss with great risk for fractures.  Women are at much higher risk for such bone thinning and wasting processes than men.

Although genetics, age, and gender are factors beyond our control, exercise and intake of bone-building nutrients including calcium and vitamin D are modifiable factors that we have some real influence over. Thin people tend to have greater issues with osteopenia than heavy people.  One of the few advantages of being overweight is that it requires extra anti-gravitational weight-bearing effort to carry around that excess poundage; this exertion against the force of gravity helps to mineralize and fortify bones.

The male and female sex hormones, testosterone and estrogen respectively, play a health role that goes way beyond sexuality.  Both of these hormones promote bone health and mineralization. After menopause, with the precipitous drop in estrogen, there is often an acceleration of bone loss. Men often experience a gradual drop in testosterone levels correlating with the aging process.  A healthy testosterone level is correlated with bone health and low levels of testosterone are linked with osteopenia.   Men who are on medication to purposefully lower testosterone—most typically used for the management of prostate cancer—experience an accelerated loss of bone mass, akin to women at the time of menopause.  Reasons that males experience bone loss at a less accelerated rate than females include the fact that men in general weigh more than women, and thus by virtue of the fact that they have to carry around extra weight, they keep their bones mineralized; additionally, the variable changes in testosterone with aging that men experience are much more minor as opposed to the major precipitous decline in estrogen at menopause in women.

Our bones demand physical activity in order to stay well mineralized.   When our bodies are kept in a sedentary state—for example when one’s arm is in a cast because of a fracture, or when one is immobilized by a severe injury and is at bed rest—there is a rapid demineralization and thinning of our bones.  Spinal cord injured patients who are paralyzed undergo a very rapid demineralization. Astronauts who spend time in zero gravity experience a remarkably fast demineralization and run the risk not only of thinning bones—as does anybody with rapid demineralization— but also of developing kidney stones that result from the calcium mobilized from the bones.

In general, the more active the individual, the greater the bone mineral density (BMD) and the less risk for fracture.  Most any physical exercise is healthy for our bones, but there are certain exercises that are better to achieve the endpoint of achieving bone mineralization and vigor. BMD is greater in sprinters, ball sport athletes and gymnasts than in endurance sports athletes including walkers, runners, swimmers and cyclists.  Bone mineralization is promoted by stresses placed upon the bones, rest periods, and variety, as opposed to repetitive, monotonous movements.  Aerobic ball sports activities provide highly effective variable stresses on our bones that work against gravity and provide periods of rest; these include tennis, squash, football, soccer, basketball, hockey, field hockey, lacrosse, dancing, and gymnastics.   Additionally, weight training and any activity that uses resistance equipment can be a highly effective means of promoting bone mineralization.  Training that necessitates straining, versatile movements, and a high peak force is more effective in terms of bone mineralization than training with a large number of low-force repetitions. It seems that just as ones body requires a variety of different and variable nutrients to maintain its health, so ones bones require a variety of different exercises, movements, and stresses to maintain their health

Runners and swimmers have the lowest bone densities among athletes. Some studies have even shown that participants in endurance and non-weight-bearing sports have bones that are less robust and at a greater risk of fracture than the population of sedentary and inactive people.  In terms of increasing bone mineral density, when running, swimming, and cycling, it is best to shake it up and do interval training at variable speeds, intensities, and durations and not maintain a monotonous motion, since repetitive unvarying stress can actually demineralize bone and is thus not a productive means of increasing bone fortitude.

Bone mineralization is a dynamic process as opposed to a static process.  In other words, our bones are not fixed in composition like the framing and foundation of our homes.  Our bones are constantly being remodeled, restructured and refashioned in accordance with the building blocks available and in an adaptive response to biomechanical forces including gravity and musculo-skeletal stresses.

The concept of  “energy availability” is important in terms of understanding bone building versus bone destruction.  Energy availability is defined as the amount of energy taken in while exercising minus the amount expended, divided by lean body mass (consisting of bone and muscle).  Energy availability is the net amount of energy available to support all the body’s functions including new bone formation, a process that requires energy.  Low energy availability will occur if there is insufficient intake of calories, excessive burning of calories, or a combination of both.  Endurance athletes—including long-distance runners and cyclists—can burn so many calories that there is not sufficient energy remaining to fuel the dynamic process of maintaining bone health.  When there is low energy availability, the consequence can be stress fractures, fractures due to repeated stresses on a weight-bearing bone.

Bottom Line: Bone health has its critical beginnings in childhood, then continues (at a slower pace) into adulthood.  Key factors contributing to maximal bone health are proper nutrition, varied and continued physical activity, vitamin intake, and exposure to sunlight.  It is never too early to address—and take the necessary measures—to ensure the life-long health of the body’s vital skeletal framework

Reference:  “To Ensure Bone Health, Start Early,” article in New York Times by Jane E Brody, August 5, 2013

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, in press and will be available in e-book and paperback formats in the Autumn 2013.

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

My Blood Pressure Ordeal

July 6, 2013

Andrew Siegel, MD  Blog #111

I consider myself to be a very fit person—for the most part, I eat a very healthy diet with abundant fruits and vegetable and avoid processed, fast and junk foods, don’t smoke, drink alcohol very moderately, and exercise religiously and aggressively.  I’m 5’9” tall and weigh 155 lbs., so I’m not carrying around much body fat.  Nonetheless, in spite of my healthy lifestyle, I was diagnosed with hypertension this year.  I am a strong believer in the mind-body connection and initially attributed my blood pressure issue to the incorporation of electronic medical records into my urology practice, a frustrating and tedious experience that has added hours of time to my workday and much grief and hassle to my life.  That stated, it is difficult to hide from one’s genetics—I have a bunch of family members with high blood pressure, including my younger sister who is a vegetarian and avid cyclist and runner who truly could not be any leaner or in any better physical shape.  But it really irks me that I know many obese and sedentary individuals who do not have blood pressure iss

Earlier this year, I was in Florida with my brother, cousin, and brother’s friend for an extended weekend golf and tennis excursion. We went to the Publix supermarket where we chanced upon one of those free blood pressure machines that you stick your arm in and presto, in a few moments you have a blood pressure reading.   Suffice it to say that among the four of us, I lost the blood pressure contest!   I wrote it off to the stressful week that I had had, but at a visit to my dentist several weeks later, the elevated blood pressure was confirmed.  Suffice it to say that I was not pleased with this news.

You are probably aware that high pressure within the arterial walls (hypertension) contributes to many serious ailments including the following: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA. So it behooves anyone with high blood pressure to get it treated, pronto.

I saw my internist and was prescribed medication called Diovan, which I started immediately.  It controlled my blood pressure nicely, but I experienced some side effects, so I returned to my doctor and I recommended to him a trial of a different class of medication called a beta-blocker.   This is typically not a first-line drug for hypertension and is often used for people with cardiac problems.   It works by decreasing the heart rate and contractility (the ability of the heart muscle to squeeze out blood).   This class of medication generally has a calming effect and I thought that because of my rather “energetic” style and persona, it might have a beneficial effect beyond managing the high blood pressure. Beta-blockers are sometimes used by people before public speaking, work on tremors of the hand, and have a general blunting/“take off the edge” effect.  I have some early morning insomnia and thought that this might help with that as well.

The medication was effective in normalizing my blood pressure.   However, it did “knock” me down a few notches.  I experienced fatigue in the late afternoon that was new to me.  More disturbing was that it was more difficult for me to exercise when it required major exertion.   When working out, I became short of breath and tired much more readily than previously. I’m a recreational cyclist and have always enjoyed bike riding since my earliest days of childhood.  I observed that I was having trouble keeping up with my cycling buddies and that hills—previously one of my strengths—were suddenly particularly difficult.  Understand that I’m going to be 58 years old on my next birthday, so I thought that my age might have finally caught up with me a bit, but I also questioned what role the beta blocker was playing.

My old heart rate monitor that I typically use when I cycle was not working properly so I headed out to Campmor and picked up a new one.  It is basically a chest strap that detects one’s heart rate that is displayed on a wristwatch. It is a very helpful device when cycling that helps one stay in the proper zone of heart rates to assure the appropriate level of exertion.   For example, I know that my maximum heart rate is 160 and a level of 125–140 is a comfortable heart rate for an endurance ride. When I start heading above 145, I begin experiencing shortness of breath and need to tamp down the exertion if I want to maintain the endurance.  I learned all of this when I attended Chris Carmichael hill cycling camp, located in Asheville North Carolina where I went a number of years ago with my cycling buddies to learn the proper techniques of attacking hills.

So I put on my new heart monitor and went out on a hilly ride.  Much to my surprise, my maximum heart rate was now 125, being 160 under normal circumstances.   At 115, I started experiencing shortness of breath; 110 was a comfortable rate.  I was astonished by the profound effect the beta-blocker had my heart rate.

Understand that beta-blockers do not just work on heart rate but also on contractility.  The term “stroke volume” refers to the amount of blood that the heart pumps out with one beat. Beta-blockers reduce both heart rate and stroke volume.   The ability to succeed in aerobic sports such as cycling and running is contingent upon satisfactory cardiac output to provide oxygen and nutrients to our cells. Cardiac output is the product of heart rate and stroke volume. So, cardiac output goes way down on a beta-blocker and clearly explains my sub-normal performance with highly exertion physical sports.

I saw my internist yet again, stopped the beta-blocker, and started an alternative medication—the same one that my sister is on—that has no cardiac effects. I went on a bike ride in Fort Lee Park and Route 9W with my sister and friends and noticed a dramatic subjective improvement in my cycling performance, more in line with my typical cycling functioning of previous years.  This was just one day after getting the beta-blocker out of my system. Objectively, my maximum heart rate was 140, much improved over the 125 on the beta-blocker, but still not up to the 160 that was typical for me.  On my next ride, my maximum heart rate was back to normal and my cycling performance was fully back to days of old.  I was back!  I’m very happy to say that age is not catching up with me—yet.

Bottom Line: The morals of the story are several: 

1.    High blood pressure usually causes no symptoms whatsoever and must be sought after, so get your blood pressure checked periodically even if you’re feeling great

2.    Do not assume that because you are in great physical shape, exercise regularly, are not overweight, are a non-smoker and have a healthy diet, that you are immune from high blood pressure, which is often genetic despite a very healthy lifestyle

3.    Be wary of beta-blockers if you are an endurance exercise enthusiast.   Apparently what I experienced does not happen to everybody, but it was quite profound with me.  

4.    Don’t tell your doctor what to prescribe you even if you are a doctor!  Physician—do not treat thyself; let your internist provide their sage input regarding management of medical problems.



Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

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

Happiness Deconstructed

April 27, 2013


Andrew Siegel, MD   Blog #104


What causes us to experience the emotion of happiness? Certainly, under the right set of circumstances, our bodies release a “cocktail” of “happy” chemicals including serotonin, dopamine, endorphins and numerous other elusive mediators of the mysterious mind-body connection.  But what is the root source of this reaction—what sets this biochemical cascade of happiness into motion? 

There have been several recent articles on the subject of happiness in the New York Times—Gary Gutting and Elizabeth Weil have both opined on the determinants of happiness.  Reading them has provoked me to wax philosophical on the topic

I begin with a quote from Martha Washington that I believe to be factual: “The greater part of our happiness or misery depends upon our dispositions and not our circumstances.” Every human has a happiness set point that is probably largely genetic in basis.  When “favorable” events occur and the “threshold” is surpassed, our happiness sense is triggered; with “unfavorable” occurrences, the threshold is not achieved and not only is happiness not triggered, but unhappiness may be prompted.

We bring that set point (disposition) into any and every situation that we face.  For example, when I recently found out that my daughter (who is completing her junior year in college) was accepted into a paid summer internship program in the field in which she desires to work (marketing/fashion), I was elated, both from the practical standpoint of her obtaining a solid position aligned with her career desires, but also from the vantage point of my being happy for no other reason than because of her being happy.  The Yiddish term “naches”—meaning happiness at another’s success—was brought into play here. On the other hand, when earlier this week I received a letter from a lawyer about a copyright infringement based upon two Google images that I used for my educational videos and blogs, I became quite distraught and unhappy, and felt a sullen heaviness of my jaw line, blunting any possibility of a smile.

As Gary Gutting articulated in his New York Times article, there are a number of factors that determine our happiness or lack thereof, and I will highlight them in boldface.  Happiness typically demands that we are sufficiently free of physical and emotional suffering.  I deem this to be largely true, with rare exceptions, as some remarkable people even in the most dire of circumstances—such as being confined to a concentration camp or being severely physically compromised—are able to maintain happiness and meaning in their lives. There is much wisdom in the words of Nietzsche: He who has a ‘why’ to live for can bear almost any ‘how.’

Luck certainly plays a prominent role in determining our happiness—the good fortune to be healthy and to be born into a family of reasonable means that can provide basic necessities. Although money cannot buy happiness, it can buy food, shelter, medications and security, all of which can help us to be rendered free of suffering. As my father’s friend Stuart Goldsmith stated so succinctly with regard to money: “It’s not so good with as it’s bad without.”  In other words, as desirable as it is to have means, it is even more desirable to avoid not having means.

Pursuing meaningful and fulfilling work that is satisfying to both the individual and society at large is an important determinant of happiness.  Unfortunately, there are many meaningful and fulfilling sources of work that do not provide a sufficient means of earning an adequate living, many of these occupations being in the creative arts. On the other hand, there are many sources of work that provide sufficient means to earn an adequate living, but are unfulfilling—what comes to mind are the many unhappy lawyers I know of who have left the profession for more satisfying work. The challenge is to find work that provides both meaning and sufficient means.  Although much of my work can be routine, repetitive and even monotonous at times, my profession certainly brings me moments of great human connection where I have been able to truly help someone in terms of his or her quality and quantity of life, and making such a difference brings with it a heady sense of happiness and satisfaction.

I’m not sure of the source from which I co-opted the following lines, but I appreciated it enough to have it framed and displayed in my office.   It is a parable about one’s personal sense of the meaning of their work experience.   Three stonecutters building a cathedral in the 14th century were interviewed regarding their work.  The first stonecutter replied with bitterness that he is cutting stones into blocks, a foot by foot by three quarters of a foot. With frustration, he describes a life in which this is done over and over, and will continue to do it until he dies. The second stonecutter is also cutting stones into blocks, a foot by foot by three quarters of a foot, but he replies in a somewhat different way. With warmth, he tells the interviewer that he is earning a living for his beloved family; through this work his children have clothes and food to grow strong, and he and his family have a home, which they have filled with love.  But it is the third man whose response gives us pause. In a joyous voice, he tells us of the privilege of participating in the building of this great cathedral, so strong that it will stand as a holy lighthouse for a thousand years.  Clearly, one’s perspective and disposition can affect one’s sense of happiness.

Human connection and love is a sine qua none for happiness: our spouse, our children, other family members, and friends.  It is in the company of others that we are often most happy, although we need to be reasonably intrinsically happy in order to be happy in others’ presence.

Pleasure—defined as immediate gratification of one or more of the five physical senses (but also aesthetic feelings directed towards art, beauty and nature)—is an obvious determinant of happiness.  In my opinion, pleasure is not so much derived from things and possessions as it is from activities and experiences. In the words of Graham Hill: “Intuitively, we know the best stuff in life is not stuff at all, and that relationships, experiences and meaningful work are staples of a happy life.”   

The “little things” that pique my senses (sensual happiness) provide more “happiness fuel” than possessions such as a fancy car or jewelry including, for example, the following: a bike ride on a beautiful and sunny afternoon with birds chirping and the fragrance of honeysuckle; walking on the beach seeing and hearing the waves crash at your feet while inhaling the scent of the sea and hearing the gulls; rolling on the carpet frolicking with my English Springer Spaniel; a great massage; reading an engaging book; laughing; watching a movie lying on the couch in comfortable well-broken in jeans and a cozy old sweatshirt with my leg intertwined with my wife’s; a very early weekend morning on a gray and sullen, Seattle kind of winter day, clacking away on my computer keyboard, articulating my thoughts into the written word while my family sleeps safely and peacefully upstairs; drinking a St. Pauli Girl beer from a frosty mug when I’m so thirsty that my mouth is parched; listening to beautiful music; watching my youngest daughter sing and perform; hitting a perfect, soft approach shot on the green; crafting a delicate drop shot on the tennis court; etc.

What can make many of us happiest is when we can overcome an issue or circumstance that previously made us very unhappy. I digress with a short anecdote to illustrate this point.  I am a recreational doubles tennis player who participates in a U.S.T.A. league.  Several years ago, my team won first place in the men’s 4.0 league in Bergen County and had to compete against the first place team in Essex County in order to determine who would go to the regional play-offs in Syracuse.  When I arrived at the outdoor courts in Essex County, I was introduced to our two opponents.  One player had been on the doubles team that had beaten my doubles team 6-0, 6-0 the previous year.  The other opponent was an aggressive, incredibly unpleasant plaintiff’s attorney who had represented a party that had sued me in a medical malpractice case that went to trial on two occasions; I had prevailed in both of them but, nonetheless, they had proven a source of great frustration, anger and annoyance for me. I didn’t recognize him at first, but it soon became readily apparent who he was.  So, my opponents were a player who embarrassingly “double-bageled” us on a previous occasion and a vicious, relentless plaintiff’s attorney who had caused me indescribable angst.  The match became much more than a match, and in a grueling victory of 6-4, 6-4, our win became the deciding match in propelling our team to the regional matches.  I was hyper-focused and single-minded, as the need for that win became of exaggerated, all-consuming importance and the victory never tasted sweeter or brought me a greater sense of happiness and justified retribution and redemption for all that had gone before.  It was with the greatest of delight that evening when I sent off an email to the attorney, informing him that it was an absolute pleasure having prevailed in both the court of law as well as the tennis court…yes, I am perhaps guilty of a little schadenfreude.

I end this composition with a quote from Viktor Frankl that nicely sums up some of the salient features of happiness: “Happiness cannot be pursued; it must ensue, and it only does so as the unintended side effect of one’s personal dedication to a cause greater than oneself or as the by-product of one’s surrender to a person other than oneself.  Happiness must happen: you have to let it happen by not caring about it.”

And yes, you may have gleaned something about my general feelings about lawyers!

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

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