Posts Tagged ‘healthy lifestyle’

Sleep: The (Undeserved) Least Respected Piece of a Healthy Lifestyle

October 13, 2018

Andrew Siegel MD  10/13/2018

DSC00702

Photo above: my two daughters in peaceful repose (quite a few years ago!)

 

Exercise is king. Nutrition is queen. Put them together and you’ve got a kingdom.
Jack Lalanne

In addition to Lalanne’s emphasis on exercise and healthy eating as the key pieces to a healthy lifestyle, modern science supports adequate quality and quantity of sleep as a third component of equal importance.  More than one- third of Americans suffer with chronic sleep deprivation and today’s entry explores the consequences and solutions to  this.

Nature has not intended mankind to work from 8 in the morning to midnight without the refreshment of blessed oblivion which, even if it only lasts 20 minutes, is sufficient to renew all the vital forces.

Winston Churchill

What’s Obvious

That adequate quantity and quality of sleep is vital to our well-being and optimal functioning is readily apparent. We have all enjoyed the blissful experience of a great night’s sleep, awakening well-rested, energetic, optimistic and ready to approach the new day with vigor. Conversely, we have all experienced a poor night’s sleep, awakening feeling physically exhausted, mentally spent, lids heavy, dark circles under our eyes, and often in a disassociated “zombie” state, totally unmotivated and unenthusiastic about facing the new day (a situation not unlike jet lag).

The amount of sleep one needs is biologically determined and different for each person. Some can make do with five hours of sleep while others require ten hours, but as a general rule, seven to eight hours is recommended.  Regardless, sleeping has an essential restorative function as our brains and bodies require this important down time for optimal functioning.

What’s not so obvious

Good quality sleep is an important component of overall health, wellness, and fitness with potential dire consequences to the chronically deprived. Sleep disruption or deprivation has numerous negative mental and physical effects including disturbed cognitive, endocrine, metabolic, cardiovascular, gastrointestinal and immune function. While sleeping, there is an increased rate of anabolism (cellular growth and synthesis) and a decreased rate of catabolism (cellular breakdown), processes that are disrupted by sleep deprivation. Chronic sleep issues can result in making one feel ill and appearing much older than they are chronologically.

Sleep disruption results in decreased levels of leptin (a chemical appetite suppressant), increased ghrelin levels (a chemical appetite stimulant), increased corticosteroids (stress hormones) and increased glucose levels (higher amounts of sugar in the bloodstream). As a result, chronic sleep deprivation commonly gives rise to increased appetite, increased caloric intake and the disassociated “zombie” state lends itself to dysfunctional eating patterns and consumption of unhealthy foods, and as such, weight gain is a predictable consequence.  Compounding the issue, a chronically-fatigued state impairs one’s ability to exercise properly, if at all.

Chronic sleep deficits results in irritability, impaired cognitive function and poor judgment.  The inability to be attentive and focused interferes with work and school performance and causes increased injuries (such as falls) and motor vehicle accidents.

Fact: Shift work sleep disorder.   Non-standard shift workers (health professionals, emergency workers, airline pilots, plant and manufacturing operators, etc.) make up nearly 20% of the U.S. work force. Their irregular working hours are often associated with disturbance of circadian rhythms and resultant insomnia and poor quality and quantity of sleep.  Scientific evidence shows an increased risk of developing diabetes, high blood pressure, high cholesterol, cardiovascular disease, peptic ulcer disease and depression.

What to do

The good news is that sleep deprivation is a modifiable risk factor, with a variety of ways to facilitate a good night’s sleep.

Sensible measures to help ensure a good night’s sleep:

  • Lead an active lifestyle with abundant exercise and stimulation.
  • Whether you are an early riser or a night owl, try to be consistent with respect to wake-up and bedtimes on both weekdays and weekends; if these times vary greatly it is a setup for sleep problems by disturbing your internal body clock.
  • Maintain a comfortable sleeping environment—a good quality supportive bed, comfortable pillows, a dark room, cool temperature and, if you like, “white noise” (I find that the monotonous sound of the sea produced by a sound machine, coupled with the gentle whirring of an overhead fan, is an instant relaxer).
  • Avoid caffeinated beverages—coffee, tea, cola, etc.—particularly after 6:00 p.m.  On the other hand, herbal teas, e.g., chamomile, can be soothing and relaxing.
  • Avoid consuming a large meal at dinner or eating very late at night.
  • Avoid imbibing too much alcohol.
  • Avoid exercising late in the evening.
  • Minimize the stress in your life, as much as is conceivable. Engage in a de-stressing activity immediately before sleep—reading, watching a movie or television show, crossword puzzle, sudoku, sex—whatever helps relax you and bring upon sleepiness.
  • Try to minimize evening exposure to the bright light (“blue light”) of cell phones, tablets and computers that inhibits production of the sleep-promoting hormone melatonin, levels of which under normal circumstances rise coincident with darkness. If possible, dim the light settings on electronic devices that are used at night.
  • Supplemental melatonin seems to help some people, but is ineffective for many others (including myself), but may be worth a try 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Cover

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

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Sculpt Your Bod

September 22, 2018

Andrew Siegel MD  9/22/2018

David by Michelangelo Florence Galleria dell'Accademia

David by Michelangelo Florence Galleria dell’Accademia

Image above by Jörg Bittner Unna [CC BY 3.0  (https://creativecommons.org/licenses/by/3.0)%5D, from Wikimedia Commons”

Dad bod is a slang term in popular culture referring to a body shape particular to middle-aged men. The phrase has been adopted in U.S. culture as a celebration of this particular type of physique, with references generally skewing toward a positive and light-hearted tone. This masculine body type is a unique cross between muscular and overweight physiques.” ….Wikipedia

You can think of your body as a dynamic piece of sculpture, capable of being modified at will by you—the artist—who has some definite say regarding its appearance.  This human sculpture is not static and fixed in composition, but forever evolving, continually being remodeled, restructured and refashioned in accordance with the availability of building materials, how they are used, and in response to the cut of the chisel or lack thereof.

Every human being starts with a unique block of matter that has certain fixed structural features—based upon what was inherited from one’s parents—but other aspects that are capable of being modified, for better or worse. Since the sculpture is dynamic and constantly being restructured, one can think of the “sculpting materials” as one’s diet and energy intake and of the “actions of the chisel” as exercise and physical activity.

For the optimally-shaped sculpture, it is vital to use the finest sculpting materials in the proper quantities, i.e., a diet that is both wholesome and nutritious—”real” food that is not over-refined, over-processed, and nutritionally-empty—and provides the right balance of calories to satisfy metabolic demands, but not so much that the excess energy is stored as fat.  A calorie-rich, nutrient-poor, typical Western diet overloaded with processed foods will result in a bloated sculpture with over-ample proportions.

The actions of the chisel are equally—if not more—important to the sculpted product as are the proper quality and quantity of sculpting materials.  The chisel—when properly and deftly applied—will remove extraneous materials in a proportionate manner and nicely shape and fashion the sculpture. The chisel represents the cumulative total of exercise, physical activities and bio-mechanical forces, resistances, and stresses applied to the sculpture.

At any given moment in time the sculpture’s appearance is the living record of the lifetime integrated sum total of nutritional input, energy expenditure, exercise and physical activity. Obviously, this is a gross simplification; this entire schema ignores the other internal and external elements that contribute to our physique, including a lifetime of metabolic and hormonal factors, trauma, injury, disease, aging, environmental factors, etc.  Nonetheless, the artist has some genuine say in the shape of the sculpture and it is a matter of what and how much we eat or don’t and what kind of and how much we exercise and stay physically active or don’t that figures prominently in the ultimate form of the sculpture.

With some applied discipline, the artist is capable of changing the appearance of the sculpture for the better, or without discipline the artist is capable of changing the appearance of the sculpture for the worse. The proper quality and quantity of sculpting materials will give rise to a pleasing appearance of the sculpture when veiled with clothing, but it is the actions of the chisel that provide the attractive sculpted and chiseled appearance when the sculpture is unveiled.

Losing weight makes you look good in clothes,

Exercise makes you look good naked.

As I am giving thought to the human-as-sculpture metaphor, I am at the Jersey shore relaxing in a beach chair under an umbrella, gazing into the surf and observing a myriad of different bodies—of varying sizes, shapes and forms—walking by.  Some are rail thin, some sinewy and muscular, many overweight and far too many are obese.  I can’t help but think that each and every one of us has the power to sculpt their bodies—certainly to some extent—and that prior to making the decision to put a food item in our mouth– or not– or engage in physical activity– or not–a tiny bit of thought about what effect that may or may not have on our body as sculpture might be in order.

 

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fat david

Image above attribution: Stupid.photos: https://www.flickr.com/photos/27248028@N02/2627052650; no changes made to image

With the creative touch of the chisel and other sculpting tools, Michelangelo transformed a solid block of marble into the magnificently sculpted David. You, too, can wield the power of the artist and optimize your body’s form (and function for that matter), understanding that the process will be a slow, steady and gradual evolution.  While the initial motivation may be vanity, the deeper reward will be improved health and fitness.

Upon returning from an awesome vacation in Iceland where I had certainly enjoyed the gorgeous terrain as well as the lamb, arctic char and beer, I felt an uncomfortable (and unattractive) roll in my mid-section.  I could certainly “pinch more than an inch”—more like 4 inches—and this, in combination with my tightening pants, both repulsed and motivated me.  Starting in June, I made a concerted effort with both “sculpture materials” and the “actions of the chisel” to modify the “dad bod” and whittle myself back into optimal shape. Clearly, this kind of effort that becomes more challenging as we get older. I tried to maintain the healthy diet that I genuinely enjoy— Mediterranean-style—and ate clean, lean and mostly green, actively avoiding (as much as feasible) cheese and other animal fats (replacing them with fats from seafood, olives/olive oil, avocado, nuts, seeds, etc.).  On the avoid list were cookies, cake, candy and other sweets. I never drink carbs (sodas, juices, sports drinks, sweetened tea, lemonade, etc.) with the exception of alcohol (in moderation). I stepped up the exercise, doing a balance of cardio, core and strength training. Without a great deal of difficulty, I managed to drop the pounds and carve the body for the better and my daughters now describe my physique as “partial dad bod,” which might be the best I will ever be able to do, although I will continue to challenge that in the future.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

 

 

 

 

 

6 Ways To Reduce Risk for Pelvic Problems: Urinary Leakage, Dropped Bladder & Sexual Issues

November 4, 2017

Andrew Siegel MD  11/4/17

shutterstock_femalebluepelvic

Ease into this topic with a write-up by Melanie Hearse about altered vaginal anatomy after childbirth and what to do and not to do about it, from BodyandSoul.com Australia: This woman has a warning about ‘fixing’ your downstairs after birth.

Our health culture in the USA is largely reactive as opposed to proactive.  Undoubtedly, a better model is prevention as opposed to intervention.  Attention to a few basic measures can make all the  difference in your pelvic health “destiny”:

  • Maintain a healthy lifestyle. Weight gain and obesity increase the occurrence of urinary control problems, dropped bladder, sexual, and other pelvic issues. Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”  Consume a nutritionally-rich diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, versus processed and refined food products.  A healthy diet (quality fuel) is essential for ongoing tissue repair, reconstruction and regeneration. Stay physically active, obtain sufficient sleep, manage stress as best as possible, avoid tobacco (an awful habit, with chronic cough contributing to pelvic floor issues) and consume alcohol moderately.  Physical activity should include aerobic (cardio), strength, flexibility and core training (yoga, Pilates, etc.), the latter of which is especially helpful in preventing pelvic issues since the pelvic floor muscles form the floor of the core. A recent Harvard Medical School health report entitled “Best exercises for your body” recommended swimming, Tai chi, strength training, walking and Kegel exercises.
  • Prepare before pregnancy. Pregnancy, labor and vaginal delivery are the most compelling risk factors for pelvic floor issues. Commit to healthy lifestyle measures and pelvic floor muscle training as detailed above even before considering pregnancy in order to prevent/minimize the onset of pelvic issues that commonly follow pregnancy and childbirth.  The following article, written by Corynne Cirilli for Refinery 29 on October 6, addresses this issue in detail and is well worth reading: Why Aren’t We Talking About Pre-Baby Bodies?
  • Pelvic floor muscle training. Kegel exercises to increase pelvic muscle strength and endurance are vital to prevent pelvic floor issues. The Kegel Fix is a paperback book that guides you how to do Kegel contractions properly, provides specific training programs for each pelvic issue and teaches you how to put this skill set into practical use—Kegels “on demand.”
  • Avoid constipation and other forms of chronic increased abdominal pressure. Chronic constipation (bowel “labor”) can be as damaging to the pelvic floor as vaginal deliveries. Coughing, sneezing, heavy lifting (particularly weight training) and high impact sports all increase abdominal pressures, so take measures to suppress coughing, treat allergies to minimize sneezing and not overdo weight training and high-impact sports.
  • Consider vaginal estrogen therapy. After menopause, topical estrogen can nourish and nurture the vaginal and pelvic tissues that are adversely affected by the cessation of estrogen production. Low dose topical therapy can be effective with minimal systemic absorption, providing benefits while avoiding systemic side effects.
  • Get checked! Be proactive by periodically seeing your physician for a pelvic exam. It is best to diagnose a problem in its earliest presentation and manage it before it becomes a greater issue.

Bottom Line: Prepare and prevent rather than repair and prevent!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning individuals who care about health, well-being, fitness and nutrition and enjoy feeling strong and confident.

 

 

Practical Approach To Erectile Dysfunction

September 16, 2017

Andrew Siegel MD  9/16/17

shutterstock_side view manjpeg

ED is a highly prevalent condition and a common reason for a urology consultation.  A pragmatic approach to its diagnosis and treatment–the topic of today’s entry–has always worked well for my patients.  A practical approach starts with simple and sensible measures, and only in the event that these are not successful, proceeding with more complex and involved strategies, dividing management options into four tiers of complexity. 

 Principles to managing male sexual issues are the following:

  • If it ‘ain’t broke,’ don’t fix it: “First do no harm.”
  • Educate to enable informed decisions: “The best prescription is knowledge.”
  • Try simple, conservative options before complex and aggressive ones: “Simple is good.”
  • Healthy lifestyle is vital: “Genes load the gun, but lifestyle pulls the trigger.”

Questions that need to be asked in order to evaluate ED include the following:

AS and DM

  • How long has your problem been present?
  • Was the onset sudden or gradual?
  • How is your sexual desire?
  • How is your erection quality on a scale of 0-5 (0 = flaccid; 5 = rigid)?
  • Can you achieve an erection capable of penetration?
  • Is your problem obtaining an erection, maintaining an erection, or both?
  • Is your problem situational? Consistent? Variable?
  • Are nocturnal, early morning and spontaneous erections present?
  • Do you have a bend or deformity to the erect penis?
  • How confident are you about your ability to complete the sexual act?
  • Are there ejaculation issues (rapid, delayed, painful, inability)?
  • Do you have symptoms of low testosterone?
  • What treatments have been tried?

Of equal relevance are medical, nutritional, exercise and surgical history, medications, and use of tobacco, alcohol and recreational drugs.  A tailored physical includes blood pressure, pulses and an exam of the penis, testes and prostate.  Basic lab tests including urinalysis, serum glucose, HbA1c, lipid profile and testosterone.

Information derived from the evaluation as described above will provide a working diagnosis and the ability to formulate a treatment approach.  Although a nuanced and individualized approach is always best, four lines of treatment for ED are defined—from simple to complex—in a similar way that four lines of treatment can be considered for arthritis.  For arthritis of the knee, for example, first-line therapy is weight loss to lessen the mechanical stress on the joint, in conjunction with physical therapy and muscle strengthening exercises. Second-line therapy is anti-inflammatory and other oral medications that can help alleviate the pain and inflammation. Third-line therapy is injections of steroids and other formulations.  Fourth-line therapy is surgery.

If the initial evaluation indicates a high likelihood that the ED is largely psychological/emotional in origin, referral to a qualified psychologist/counselor is often in order.  If the lab evaluation is indicative of low testosterone, additional hormone blood tests to determine the precise cause of the low testosterone are done prior to consideration for treatment aimed at getting the testosterone in normal range.  If the lab evaluation demonstrates unrecognized or poorly controlled diabetes or a risky lipid and cholesterol profile, appropriate medical referral is important.

Practical treatment of ED


elephant penis
 Credit for photo above goes to one of my patients; note the 7 prodigious appendages!

First-line: Lifestyle makeover

 A healthy lifestyle can “reverse” ED naturally, as opposed to “managing” it. ED can be considered a “chronic disease,” and as such, changes in diet and lifestyle can reverse it, prevent its progression and even prevent its onset.

My initial approach is to think “big picture” (and not just one particular aspect of the body working poorly).  Since sexual functioning is based upon many body components working harmoniously (central and peripheral nerve system, hormone system, blood vessel system, smooth and skeletal muscles), the first-line approach is to do what nurtures every cell, tissue and organ in the body. This translates to getting down to “fighting” weight, adopting a heart-healthy and penis-healthy diet (whole foods, nutrient-dense, calorie-light, avoiding processed and refined junk foods), exercising moderately, losing the tobacco habit, consuming alcohol in moderation, managing stress (yoga, meditation, massage, hot baths, whatever it takes, etc.), and getting adequate quantity and quality of sleep. Aside from general exercises (cardio, core, strength and flexibility training), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

If a healthy lifestyle can be adopted, sexual function will often improve dramatically, in parallel to overall health improvements. Many medications have side effects that negatively impact sexual function. A bonus of improved lifestyle is potentially allowing lower dosages or elimination of medications (blood pressure, cholesterol, diabetic meds, etc.), which can further improve sexual function.

“The food you eat is so profoundly instrumental to your health that breakfast, lunch and dinner are in fact exercises in medical decision making.”  Thomas Campbell MD

 

healthy meal

Above: A nice, healthy meal consisting of salmon, salad, veggies and quinoa

 

fat belly

Above: Not the kind of belly you want–visceral obesity is a virtual guarantee of pre-diabetes–if not diabetes–and greatly increases one’s risk of cardiovascular disease, including ED

Bottom line: Drop pounds, eat better, move more, stress less, sleep soundly = love better!

Second-line: ED pills and mechanical devices

In my opinion, the oral ED medications should be reserved for when lifestyle optimization fails to improve the sexual issues. This may be at odds with other physicians who find it convenient to simply prescribe meds, and with patients who want the quick and easy fix.  However, as good as Viagra, Levitra, Cialis and Stendra may be, they are expensive, have side effects, are not effective for every patient and cannot be used in everyone, as there are medical situations and medications that you might be on that preclude their use. In the second-line category, I also include the mechanical, non-pharmacological, non-surgical devices, including the Viberect and the vacuum suction devices.

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and once swallowed, it will increase penile blood flow and produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

 Levitra (Vardenefil). Similar to Viagra, it is available in 5, 10, and 20 mg doses. Its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil).  Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. Its duration of action is approximately 36 hours, which has earned it the nickname of “the weekender.” Daily lower doses of Cialis are also FDA-approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. Its advantage is rapid onset.

Vacuum suction device                                                                                                                          This is a mechanical means of producing an erection in which the penis is placed within a plastic cylinder connected to a manual or battery-powered vacuum. The negative pressure engorges the penis with blood and a constriction band is temporarily placed around the base of the penis to maintain the erection.

Viberect device                                                                                                                               Initially employed as a means of triggering ejaculation in men with spinal cord injuries using vibrational energy, it has achieved wider use in provoking erections in men with ED. The device has dual arms that are placed in direct contact with the penile shaft. The vibratory stimulation will cause an erection and ultimately induce ejaculation.

Third-line: Vasodilating (increase blood flow) urethral suppositories and penile injections

These drugs are not pills, but other formulations (suppositories and injections) that increase penile blood flow and induce an erection.

M.U.S.E. (Medical urethral system for erection).  This is a vasodilator pellet—available in 125, 250, 500, and 1000 microgram dosages—that is placed into the urinary channel after urinating.  Absorption occurs through the urethra into the adjacent erectile chambers, inducing increased penile blood flow and potentially an erection.

Caverject and Edex (Prostaglandin E1) are vasodilators that when injected directly into the erectile chambers result in increased blood flow and erectile rigidity. After one is taught the technique of self-injection, the medication can be used on demand, resulting in rigid and durable erections.  A combination of medications can be used for optimal results– this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Fourth-line: Penile implants

There are two types of these devices that are surgically implanted into the erectile chambers under anesthesia, most often on an outpatient basis. Penile implants are totally internal, with no visible external parts, and aim to provide sufficient penile rigidity to permit vaginal penetration.

The semi-rigid device is a simple one-piece flexible unit consisting of paired rods that are implanted into the erectile chambers. The penis with implanted flexible rods is bent up for sexual intercourse and bent down for concealment. The inflatable device is a three-piece unit that is capable of inflation and deflation. Inflatable inner tubes are implanted within the erectile chambers, a fluid reservoir is implanted behind the pubic bone and a control pump in the scrotum, adjacent to the testes. When the patient desires an erection, he pumps the control pump several times, which transfers fluid from the reservoir to the inflatable inner tubes, creating a hydraulic erection which can be used for as long as desired. When the sexual act is completed, he deflates the mechanism via the control pump, transferring fluid back to the reservoir.

Penile implants can be a life changer for a man who cannot achieve a sustainable erection. They provide the necessary penile rigidity to have intercourse whenever and for however long that is desirable.

 

Wishing you the best of health,

2014-04-23 20:16:29

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Maintaining Masculinity With Aging

July 21, 2017

Andrew Siegel MD  7/21/17

“Time has a nasty way with human materials.”…Zadie Smith

“The reality of our bodies is that they are born and grow and in time suffer and decline.”  …Senator Ben Sasse

Bona Lane

No matter how old, most men wish to be able to travel down this road until their final breath.

Although the term masculinity may be better understood conceptually than described in words, it can be defined as possessing positive qualities traditionally associated with men: virility, drive, strength, vigor, resiliency, confidence, self-sufficiency, etc. Carried to an extreme, it can sometimes be associated with alpha behaviors including aggression, hyper-sexuality and supreme authority. Certainly, masculinity implies a certain “swagger” that clearly is unique from femininity. Sadly, aging and natural deterioration gradually rob men of many masculine attributes with the ultimate result–at some point in time–infirmity and frailty.

The Inevitable Loss of Horsepower

Our bodies-as-machines slowly lose their maximal horsepower and morph into less performative and functional machines.  The realities and challenges that accompany reaching senior years–the anatomical and functional deterioration that affect every organ system–are a direct blow to masculinity. A central premise of masculinity is having a strong and fit body; however, aging is at direct odds with masculinity because of the loss of bone and muscle mass, slower healing, accumulation of injuries and the occurrence of disease processes, resulting in declining strength and fitness.

All systems go to ground, as eventually we do. The senses–vision, hearing, taste, smell, touch–slowly rust away. Locomotion, nervous system, urinary system, bowel system, cognition and memory deteriorate. There is a good reason that athletes are considered “old” in their thirties. Rigidity of erections, the literal totem of masculinity, declines in proportion to age in years.

The silver lining is that although the degenerative process is inevitable and there will come a time when frailty will ensue, with the combination of strength training, cardiovascular conditioning, core and balance work, this process can be deferred substantially. Thinned bones, wasted muscles and hunched posture can be largely prevented by proactive and preemptive strikes against their onset.

I have an amazingly fit and cognitively intact 95-year-old patient who goes to the gym three times a week.  He lamented to me that because of an injury he was unable to work out for a few weeks and as a result he felt flabby and listless.

Retirement: Death with Benefits

At some point in the aging process, retirement from work becomes a reality for the vast majority of men.  Leaving work is one of the more challenging aspects of aging as our careers can often be considered “masculine” experiences from a primal perspective, since our roles as “hunter”—“warrior”—“gatherer” provide for our families.  Aside from financial resources, works provides benefits on so many levels—engendering a sense of usefulness and purpose, identity, dignity, self-worth, achievement, recognition, respect, (particularly self-respect), status and influence.  Furthermore, work also provides connection, collaboration and networking that are central to the human experience.  There is something special about having purpose and being productive, both of which give real meaning to one’s existence and help maintain vitality. This does not necessarily involve continuing to work full-time and compromising our fun and leisure activities, but rather achieving a healthy balance between work and play with part-time work, an encore career, volunteering, etc.

As a urologist with many years of clinical experience, I can attest to the fact that one of the shared attributes of my older patients who have aged well (Youthful Elderly Persons, a.k.a. Yeppies) is that they have NOT retired, often working well into their eighties and beyond.

Mitigate Risks

Typically associated with “masculinity” is risk-taking behavior.  Men are more likely than women to engage in activities such as smoking, heavy drinking, fast driving without seat belts, participating in sports with high injury rates, etc.  However, as we age, continued participation in such activities will not help the masculine cause, so at some point those who wish to maintain their masculinity will need to curtail unhealthy lifestyle activities and tailor sport participation in such a way as to maximize benefits, but minimize risks, for example, playing doubles tennis instead of singles.

Masculine to be Feminine

Masculinity often entails “alpha” behavior, which typically implies stoicism and self-reliance, in contrast to the female gender that is generally more emotive, communicative and willing to seek help from others. This translates to less preventive health care as men tend to be more reactive than proactive.  Furthermore, it generally leads to men having less meaningful and more superficial relationships than our female counterparts. This cool and independent alpha manner does not foster the skillset necessary to deal with many of the unpleasant circumstances that often accompany aging. It behooves men to seek preventive health care as well as nourish internal health by developing deeper and more meaningful relationships with our significant other, children, family and friends. We are a species who exists to coexist and connect and it is this social web that provides a safety net for us, valuable always, but particularly so when isolation, depression, fear, anxiety, etc., strike.

Bottom LineThe aging process gradually and insidiously erodes “masculinity.” Continuing to work in some capacity, working out regularity, working towards minimizing high-risk activities and maintaining a healthy lifestyle, and working “inwards”—fighting the culturally-based stoicism and self-reliance that runs counter to humans as highly social creatures–in concert can preserve “masculine capital” to an advanced age.  Although aging can be considered the “enemy” and will ultimately prevail, it is all about the possibilities as opposed to the limitations of the process.

Thank you to Rick Siegel–my brother–for suggesting an entry on this topic, based upon reading a Wall Street Journal article from 2/27/17: “Need To Redefine Masculinity As We Get Older” by Dana Wechsler Linden.

Wishing you the best of health,

2014-04-23 20:16:29

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Co-creator of the PelvicRx male pelvic floor muscle training DVD.

 

 

 

6 Ways To Reduce Your Risk Of Prostate Cancer

May 13, 2017

Andrew Siegel MD  5/13/17

Prostate cancer is incredibly common– one man in seven will be diagnosed with it in his lifetime–with average age at diagnosis mid 60s. In 2015, an estimated 221,000 American men were diagnosed and 28,000 men died of the disease.  Although many with low-risk prostate cancer can be managed with careful observation and monitoring, those with moderate-risk and high-risk disease need to be managed more aggressively. With proper evaluation and treatment, only 3% of men will die of the disease. There are over 2.5 million prostate cancer survivors who are alive today.

Factoid: The #1 cause of death in men with prostate cancer is heart disease, as it is in the rest of the population. 

finger 2

This is the index finger of yours truly; observe the narrow digit, a most desirable feature for a urologist who examines many prostates in any given day.  The digital rectal exam of the prostate is a 15-second exam that is at most a bit uncomfortable, but vital in the screening process and certainly nothing to fear.

Wouldn’t it be wonderful if prostate cancer could be prevented? Unfortunately, we are not there yet—but we do have an understanding of measures that can be pursued to help minimize your chances of developing prostate cancer.

Factoid: When Asian men–who have one of the lowest rates of prostate cancer– migrate to western countries, their risk of prostate cancer increases over time. Clearly, a coronary-clogging western diet high in animal fat and highly processed foods and low in fruits and vegetables is associated with a higher incidence of many preventable problems, including prostate cancer.

The presence of prostate cancer pre-cancerous lesions commonly seen on prostate biopsy—including high-grade prostate intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP)—many years before the onset of prostate cancer, coupled with the fact the prostate cancer increases in prevalence with aging, suggest that the process of developing prostate cancer takes place over a protracted period of time. It is estimated that it takes many years—often more than a decade—from the initial prostate cell mutation to the time when prostate cancer manifests with either a PSA elevation, an acceleration in PSA, or an abnormal digital rectal examination. In theory, this provides the opportunity for intervention before the establishment of a cancer.

Measures to Reduce Your Risk of Prostate Cancer

  1. Maintain a healthy weight since obesity has been correlated with an increased prostate cancer incidence.
  2. Consume a healthy diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, as opposed to processed and refined foods. Eat plenty of red vegetables and fruits including tomato products (rich in lycopene). Consume isoflavones (chickpeas, tofu, lentils, alfalfa sprouts, peanuts). Eat animal fats and dairy in moderation. Consume fatty fish containing omega-3 fatty acids such as salmon, tuna, sardines, trout and mackerel.  Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”
  3. Avoid tobacco and excessive alcohol intake.
  4. Stay active and exercise on a regular basis. If you do develop prostate cancer, you will be in tip-top physical shape and will heal that much better from any intervention necessary to treat the prostate cancer.
  5. Get checked out! Be proactive by seeing your doctor annually for a digital rectal exam of the prostate and a PSA blood test. Abnormal findings on these screening tests are what prompt prostate biopsies, the definitive means of diagnosing prostate cancer. The most common scenario that ultimately leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.

Important Factoid: An isolated PSA (out of context) is not particularly helpful. What is meaningful is comparing PSA on a year-to-year basis and observing for any acceleration above and beyond the expected annual incremental change associated with aging and benign prostate growth. Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that you can be falsely lulled into the impression that your PSA is normal.  For example, if your PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA even though it has tripled (highly suspicious for a problem) and mandates further investigation. 

  1. Certain medications reduce the risk of prostate cancer by 25% or so and may be used for those at high risk, including men with a strong family history of prostate cancer or those with pre-cancerous biopsies. These medications include Finasteride and Dutasteride, which are commonly used to treat benign prostate enlargement as well as male pattern hair loss. These medications lower the PSA by 50%, so any man taking this class of medication will need to double their PSA in order to approximate the actual PSA. If the PSA does not drop, or if it goes up while on this class of medication, it is suspicious for undiagnosed prostate cancer. By shrinking benign prostate growth, these medications also increase the ability of the digital rectal exam to detect an abnormality.

Bottom Line: A healthy lifestyle, including a wholesome and nutritious diet, maintaining proper weight, participating in an exercise program and avoiding tobacco and excessive alcohol can lessen one’s risk of all chronic diseases, including prostate cancer.  Be proactive by getting a 15-second digital exam of the prostate and PSA blood test annually.  Prevention and early detection are the key elements to maintaining both quantity and quality of life. 

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

Is There A Better Way To Manage Erectile Dysfunction Than “Doping”?

October 3, 2015

Andrew Siegel, MD    10/3/15

IMG_1457(1)

(My patient Ben Blank, a talented artist and cartoonist, gave me the cartoon shown above in 1998 when Viagra first became available.  It is hanging in one of my exam rooms)

Erectile dysfunction is usually caused by a combination of many factors, including lifestyle, medical issues, medications, impaired blood flow, nerve damage, pelvic muscle weakness, stress and psychological conditions.

Managing any medical problem should employ a sensible strategy trying the simplest, safest, and least expensive alternatives first. If unsuccessful, more aggressive, complicated and invasive options can be entertained.

For example, when a patient presents with arthritis, he or she is not offered a total knee replacement from the get-go (at least I hope not!). In accordance with the aforementioned strategy, managing knee arthritis should start with rest and anti-inflammatory medications and proceed, if necessary, down the pathway of exercise/physical therapy, arthroscopy, endoscopic knee surgery, and ultimately if all else fails, under the proper circumstances, to prosthetic joint replacement.

A Sensible and Practical Approach To Erectile Dysfunction

A similar approach should be applied to managing erectile dysfunction. Unfortunately, however, many patients and physicians alike seek the “quick fix” and ignore many treatments that can help prevent or reverse the condition.

I like to adhere to the following principles to manage sexual dysfunction:

  1. Provide education (verbal and in writing) so informed decisions can be made.
  2. Try simple and conservative solutions before complex and aggressive ones.
  3. If it isn’t broken, don’t fix it: “First do no harm.”
  4. Healthy lifestyle is crucial: “Genes load the gun, but lifestyle pulls the trigger.” Lifestyle improvement measures are of paramount importance.

“Doping” is common among athletes, who use illicit drugs to enhance their athletic performance. In my urology practice, many of my patients “dope”—with legal drugs—in an effort to improve their sexual performance. Is there not a better and more natural way than starting with performance-enhancing drugs from the get-go?

Don’t get me wrong, the oral meds for ED (Viagra, Levitra, Cialis and Stendra) are “revolutionary” additions to the limited resources we once had to treat ED. Although far from perfect—expensive, contraindicated with certain cardiac conditions and for those on nitrate medications, associated with some annoying side effects, and not effective in everyone—nonetheless, for many men they are highly effective in creating a “penetrable” erection.

These drugs are commonly used as the first-line approach to ED. As useful as they are, I contend that “doping” should not be first-line treatment, but should be reserved for situations in which the simple and natural first-line interventions fail to work.

Since erections are nerve/blood vessel/erectile smooth muscle/pelvic skeletal muscle events, optimizing erection capability involves doing what you can to have healthy nerves, blood vessels and muscles. How does one keep their tissues and organs healthy? The first-line approach is commonsense—getting in the best physical (and emotional) shape possible. This might mean a lifestyle makeover to get down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—measures that will improve all aspects of health in general and blood vessel health in particular.

Focused pelvic floor muscle exercises improve the strength and endurance of the male “rigidity” muscles that surround the deep roots of the penis.

Since intact and functioning nerves are fundamental to the erectile process, activation of the nerves via penile vibratory stimulation can be an effective means of resurrecting erectile function.

The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable penetration.

Second-line treatments are the well-established oral medications for ED. Although Viagra, Levitra, Cialis and Stendra all have the same mechanism of action, there are nuanced differences in potency, time to onset, duration of action, side effects, etc., so it may take some trial and error to find out which works best for you. Cialis uniquely is approved for both ED and prostate issues, so can be an excellent choice if you have both sexual and urinary issues.

Third-line alternatives include urethral suppositories and penile injection therapy. Suppositories are absorbable pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, but are injected directly into the penile erectile chambers.

Fourth-line treatment is the prosthetic penile implant. One variety is a semi-rigid non-inflatable device and another is a hydraulic inflatable device. They are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse. For the right man, under the right circumstances, the penile implant is a life changer—as magical as a total knee replacement can be—converting a penile “cripple” into a functional male. However, it is vital to understand that the implant is a fourth-line approach, and less invasive options should be exhausted before its consideration.

Bottom Line: Sadly, our medical culture and patient population often prefer the quick fix of medications or surgery rather than the slow fix of lifestyle measures. A sensible approach to most medical issues—including ED—should be the following:

  • Get educated about all treatment options.
  • Explore the simplest, safest, and least expensive alternatives first.
  • Before considering medications to improve performance, think about committing to a healthy lifestyle and getting into optimal physical shape, including exercising the rigidity muscles of the penis and using vibratory nerve stimulation.

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.

Sex and the Mediterranean Diet

February 1, 2014

Blog # 139

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure.  Although not a necessity for a healthy life, the loss or diminution of sexual function may result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us it is vital that we maintain our sexual health. Loss of sexual function further exacerbates progression of sexual dysfunction—the deficiency of genital blood flow that often causes sexual dysfunction produces a state of poor oxygen levels (hypoxia) in the genital tissues, which induces scarring (fibrosis) that further compounds the problem.  So “use it or lose it” is a very relevant statement when it comes to sexual function, as much as it relates to muscle function.

Healthy sexual function for a man involves a satisfactory libido (sex drive), the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. For a woman, sexual function involves a healthy libido and the ability to become aroused, lubricate adequately, to have sexual intercourse without pain or discomfort, and the ability to achieve an orgasm.   Sexual function is a very complex event contingent upon the intact functioning of a number of systems including the endocrine system (produces sex hormones), the central and peripheral nervous systems (provides the nerve control) and the vascular system (conducts the blood flow).

A healthy sexual response is largely about adequate blood flow to the genital and pelvic area, although hormonal, neurological, and psychological factors are also important.  The increase in the blood flow to the genitals from sexual stimulation is what is responsible for the erect penis in the male and the well-lubricated vagina and engorged clitoris in the female. Diminished blood flow—often on the basis of an accumulation of fatty deposits creating narrowing within the walls of blood vessels—is a finding associated with the aging. This diminution in blood flow to our organs will negatively affect the function of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of oxygen and nutrients and removal of metabolic waste products.  Sexual dysfunction is often on the basis of decreased blood flow to the genitals from pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the blood vessels that bring blood to the penis and vagina.

Sexual dysfunction may be a sign of cardiovascular disease. In other words, the quality of erections in a man and the quality of sexual response in a female can serve as a barometer of cardiovascular health. The presence of sexual dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels).  The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our sedentary lifestyle and poor dietary choices.  Civilization Syndrome can lead to obesity, high blood pressure, and elevated cholesterol and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death.  The diabetic situation in our nation has become outrageous—20 million people have diabetes and more than 50 million are pre-diabetic, many of whom are unaware of their pre-diabetic state! It probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.

Civilization Syndrome can cause a variety of health issues that result in sexual dysfunction.  Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the arteries which function to bring blood to the genitalia.  Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less forceful blood flow through the arteries.  Thus, blood pressure medications, although very helpful to prevent the negative effects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction.  High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction.  Tobacco constricts blood vessels and impairs blood flow through our arteries, including those to our genitals. Smoking is really not very sexy at all!  Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function.  In fact, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical.

A healthy lifestyle is of paramount importance towards the endpoint of achieving a health quality and quantity of life.  Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases that are brought on by poor lifestyle choices.  Sexual dysfunction is often in the category of a medical problem that is engendered by imprudent lifestyle choices.  It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices.  Simply by pursuing a healthy lifestyle, Civilization Syndrome can be prevented or ameliorated, and the myriad of medical problems that can ensue from Civilization Syndrome, including sexual dysfunction, can be mitigated.

In terms of maintaining good cardiovascular health (of which healthy sexual function can serve as a proxy), eating properly is incredibly important—obviously in conjunction with other smart lifestyle choices. Fueling up with the best and most wholesome choices available will help prevent the build up of fatty plaques within blood vessels that can lead to compromised blood flow. Poor nutritional decisions with a diet replete with fatty, nutritionally-empty choices such as fast food, puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!.

A classic healthy food lifestyle choice is the increasingly popular Mediterranean diet.  This diet, the traditional cooking style of the countries bordering the Mediterranean Sea including Spain, France, Greece, Cyprus, Turkey, Southern Italy, and nearby regions, has been popular for hundreds of years. The Mediterranean cuisine is very appealing to the senses and includes products that are largely plant-based, such as anti-oxidant rich fruits and vegetables, whole grains, nuts, seeds and legumes.  Legumes—including peas, beans, and lentils—are a wonderful source of non-animal protein.  Soybeans are high in protein, and contain a healthy type of fat.  Soy is available in many forms— edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), and soymilk. Fish and poultry are also mainstays of the Mediterranean diet, with limited use of red meats and dairy products.  The benefits of fish in the diet can be fully exploited by eating a good variety of fish.  Olive oil is by far the principal fat in this diet, replacing butter and margarine. The Mediterranean diet avoids processed foods, instead focuses on wholesome products, often produced locally, that are low in saturated fats and high in healthy unsaturated fats. The Mediterranean diet is high in the good fats (monounsaturated and polyunsaturated) which are present in such foods as olive, canola and safflower oils, avocados, nuts, fish, and legumes, and low in the bad fats (saturated fats and trans fats).  The Mediterranean style of eating provides an excellent source of fiber and anti-oxidants.  A moderate consumption of wine is permitted with meals.

Clearly, a healthy diet is an important component of a healthy lifestyle, the maintenance of which can help prevent the onset of many disease processes.  There are many healthy dietary choices, of which the Mediterranean diet is one.  A recent study reported in the International Journal of Impotence Research (Esposito, Ciobola, Giugliano et al) concluded that the Mediterranean diet improved sexual function in those with the Metabolic Syndrome, a cluster of findings including high blood pressure, elevated insulin levels, excessive body fat around the waist and abnormal cholesterol and triglyceride levels.  35 patients with sexual dysfunction were put on a Mediterranean diet and after two years blood test markers of endothelial function and inflammation significantly improved in the intervention group versus the control group. The intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol (LDL—the “bad” cholesterol), triglycerides, and blood pressure, with a significant increase in high-density lipoprotein cholesterol (HDL—the “good” cholesterol).  14 men in the intervention group had glucose intolerance and 6 had diabetes at baseline, but by two years, the numbers were reduced to 8 and 3, respectively.

Why is the Mediterranean diet so good for our hearts and sexual health?  The Mediterranean diet is high in anti-oxidants—vitamins, minerals and enzymes that act as “scavengers” that can mitigate damage caused by reactive oxygen species.  Reactive oxygen species (also known as free radicals) are the by-products of our metabolism and also occur from oxidative damage from environmental toxins to which we are all exposed.  The oxidative stress theory hypothesizes that, over the course of many years, progressive oxidative damage occurs by the accumulation of the chemicals the accumulation of reactive oxygen species engender diseases, aging and, ultimately, death.  The most common anti-oxidants are Vitamins A, B-6, B-12, C, E, folic acid, lycopene and selenium.  Many plants contain anti-oxidants—they are concentrated in beans, fruits, vegetables, grain products and green tea.  Brightly colored fruits and vegetables are good clues as to the presence of high levels of anti-oxidants—berries, cantaloupe, cherries, grapes, mango, papaya, apricots, plums, pomegranates, tomatoes, pink grapefruit, watermelon, carrots, broccoli, spinach, kale, squash, etc.—are all loaded with anti-oxidants as well as fiber. A Mediterranean diet is also high in omega-3 fatty acids, a type of polyunsaturated fat present in oily fish including salmon, herring, and sardines.  Nuts—particularly walnuts—have high omega-3 fatty acid content.  Research has demonstrated that these “good” fats have numerous salutary effects, including decreasing triglyceride levels, slightly lowering blood pressure, and decreasing the growth rate of fatty plaque deposits in the walls of our arteries (atherosclerosis), thus reducing the risk of cardiovascular disease, stroke, and other medical problems. Mediterranean cooking almost exclusively uses olive oil, a rich source of monounsaturated fat, which can lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. It is also a source of antioxidants including vitamin E.  People from the Mediterranean region generally drink a glass or two of red wine daily with meals. Red wine is a rich source of flavonoid phenols—a type of anti-oxidant—which protects against heart disease by increasing HDL cholesterol and preventing blood clotting, similar to the cardio-protective effect of aspirin.

The incorporation of a healthy and nutritious diet, such as the Mediterranean diet, is a cornerstone for maintaining good health in general, and vascular health, including sexual health, in particular.  The Mediterranean diet—my primary diet and one that I have incorporated quite naturally since it consists of the kinds of foods that I enjoy—is colorful, appealing to the senses, fresh, wholesome, and one that I endorse with great passion. Maintaining a Mediterranean dietary pattern has been correlated with less cardiovascular disease, cancer, and sexual dysfunction.  And it is very easy to follow.  It contains “good stuff”, tasty, filling, and healthy, with a great variety of food and preparation choices—plenty of colorful fresh fruit and vegetables, a variety of fish prepared in a healthy style, not fried or laden with heavy sauces, healthy fats including nuts and olive oil, limited intake of red meat, a delicious glass of red wine.  It’s really very simple and satisfying.  Of course the diet needs to be a part of a healthy lifestyle including exercise and avoidance of harmful and malignant habits including smoking, excessive alcohol, and stress.  So if you want a sexier style of eating, I strongly recommend that you incorporate the Mediterranean diet into your lifestyle.  Intelligent nutritional choices are a key component of physical fitness and physical fitness leads to sexual fitness.

Andrew Siegel, M.D.

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Enhancing Male Sexual Function: An Update

January 24, 2014

Blog #138  Andrew Siegel MD

“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

—Tom Hickman
God’s Doodle: The Life and Times of the Penis

The term ED (Erectile Dysfunction) is commonly bandied about these days. There are plenty of men who do not have a dysfunction, but simply do not have quite the function they had when they were younger. Their “plumbing” is intact and they function without complaint from their partner, but things are just, well… different from the way they were.

Simply stated, change is to be expected coincident with the aging process. Performance ability with respect to virtually any physical activity will decline with aging and this explains why most professional athletes are in their twenties or early thirties. Everything eventually goes to ground, but hopefully does so slowly.

Young men can achieve a rock-hard erection simply by seeing an attractive woman or thinking some vague sexual thought. As we get older, it is not uncommon for erotic thoughts or sights to be insufficient to provoke an erection, with the need for direct “hydraulic” assistance through touch. Some of the common male sexual changes that occur with aging are the following: diminished sex drive; decreased rigidity and durability of erections; decrease in volume, force, and trajectory of ejaculation; decreased orgasm intensity; and an increase in the time it will take for recovery before being able to get another erection (refractory period).

Altered sexual function can present in various forms, dimensions and magnitudes.  Some men can achieve a very rigid erection readily capable of penetration, but then, much to the bewilderment and dismay of its owner, display a short “attention” span and deflate before business is fully conducted—one might refer to this as penile attention deficit disorder (PADD).  (See Urban Dictionary for full definition—guess who coined this term!)

http://www.urbandictionary.com/define.php?term=penile+attention+deficit+disorder+%28padd%29

Other men are capable of obtaining, at best, a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating. For some, an erection is but a pleasant memory lodged deep in the recesses of the mind.  So what can a man do?

For starters, good lifestyle habits are first-line measures. Proper eating habits, exercise, adequate quality and quantity of sleep, tobacco avoidance, use of alcohol in moderation, stress avoidance, and a balanced lifestyle are simple means of optimizing sexual potential.  The “golden rule” is relevant to one’s penis: Be nice to your penis (in terms of a healthy lifestyle) and it will be nice to you; treat your penis poorly and it will rebel…and no one wants a rebellious penis!

Pelvic floor muscle exercises are a first-line measure for helping to manage erectile dysfunction. When the pelvic floor muscles contract, they increase blood flow to the genitals, specifically by the actions of the two musclesthe bulbocavernosus and ischiocavernosus—that become engaged at the time of an erection. Contractions of these muscles help prevent the exit of blood from the penis, enhancing rigidity. With each contraction of these muscles, a surge of blood flows into the penis. Additionally, they act as powerful struts to support the roots of the penis, the foundational support that, when robust, will allow a more “skyward” angling erection. It stands to reason that if you can increase the strength, tone and conditioning of these muscles through pelvic muscle floor training, they will function in an enhanced manner—namely more powerful contractions, and more penile rigidity and stamina.

What to do when one employs lifestyle measures and pelvic exercises, but the rebel-down-below still displays some degree of penile attention deficit disorder?  One should stick to the lifestyle measures and the exercises, but consider adding a pill to the regimen.

The Rolling Stones’ song, “Mother’s Little Helper,” referred to Valium in terms of a little yellow pill. In 1998, a little blue pill was manufactured that could be considered “Daddy’s Little Helper”—aka Viagra.  This medication was discovered by chance. In an effort to treat high blood pressure and chest pain, Pfizer scientists conducted a clinical trial with this experimental medication that caused blood vessels to dilate (open).  It did not work particularly well for the intended purposes, but had a side effect in that it dramatically improved erections.  When the study ended, the participants were profoundly disturbed that the drug was no longer available. The rest is simply history

The PDE5 Inhibitor class of medications includes the following: Viagra, Levitra, Cialis, and Stendra.  Stendra is now FDA approved and available as of last week.

Viagra (Sildenefil). Viagra was born as a fusion of the words “vigor” (physical strength) and “Niagara” (the most powerful waterfall in North America). Viagra is available in three doses: 25 mg, 50 mg, and 100 mg.  It is taken on demand and once swallowed, it will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

Levitra (Vardenefil).  This is an oral medication similar to Viagra, available in 5 mg, 10 mg, and 20 mg doses.

Cialis (Tadalafil).  This is an oral medication similar to Viagra, available in 2.5 mg, 5 mg, 10 mg, and 20 mg doses. The fact that it lasts for 36 hours or so has earned it the nickname “the weekender,” as it can be taken on Friday evening and remains effective for the remainder of the weekend without the need for an additional dose.  This affords a considerable advantage in terms of spontaneity.  In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Who Knew?  Cialis—a pill that helps erections and urination…now that’s a winning combo for the aging male.  Talk about killing two birds with one stone!

Stendra (Avanafril).  This supposedly has the advantage of a very rapid onset of action.  It is available in 50 mg, 100 mg, and 200 mg doses.

These medications are not for everybody and are not effective in everyone. However, for many, they are highly beneficial in treating ED and in improving erectile function that may have diminished a bit over the years.  Many men use a low dosage (typically one-quarter of the full dosage) of these medications “recreationally,” meaning that they can function perfectly well without the medication, but with it their function is enhanced significantly.

BOTTOM LINE: If you are experiencing ED or just some changes in function, there are several courses of action to improve the condition: first-line treatments include a healthy lifestyle as well as pelvic floor muscles exercises to increase erectile strength, endurance, stamina and rigidity. Should these measures fail to restore erections to the degree desired, there are oral medications that can prove beneficial.  And if pills don’t help enough, us urologists have many other tricks up our sleeves, but that is a topic for another day.

TAKE HOME MESSAGE:  Even if you are young and functioning superbly, pursue a healthy lifestyle and do pelvic floor exercises to maintain that functional status!

Andrew Siegel, M.D.

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

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Prostate: Bigger Is Not Better

November 24, 2013

Blog #129

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andrew Siegel, M.D.

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

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