The Male Room

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

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

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

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

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

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

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

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

Reevaluating family in challenging times…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. Any aspect of male infertility. A small percent of male factor infertility is because of testicular cancer. This is often missed by primary care doctors and totally missed when referred to an IVF fertility doctor.
2. Blood in the urine. Hematuria, whether visible (gross hematuria) or only seen under the microscope (microscopic hematuria) is not normal and can be an early warning sign of a bladder or kidney cancer. The work-up is basic, including urine tests, an x-ray such as CT scan and a look inside the bladder with a fiberoptic scope (cystoscopy). Waiting to see if the blood will go away is not smart. Blood one time is enough to see a urologist.
3. An elevated PSA or change in PSA. The PSA remains one of the most sensitive indicators of prostate cancer of all tests in medicine. The problem is that too many doctors don’t understand what the PSA test is and probably even more and important, what the PSA test is not. Any elevation raises concerns so must be evaluated. Simply telling you to go away and let’s see how high it goes or how fast it climbs is not smart. And if the PSA starts to climb, even if still within “normal “levels, the change may suggest cancer. So any change of significance should be evaluated as well.
4. An abnormal prostate exam. Any abnormality – firmness, small nodules, or irregularities – may be from a prostate cancer and so must be seen by a urologist. Likewise, any changed from prior exams must be seen. This is why it is so important that all men over the age of 40 to 45 get a yearly exam, ideally by the same doctor. As with all potentially serious problems, if detected early the cure rate is high.
5. Any abnormality of the kidney found on x-ray. It must be assumed that these are kidney cancers until proven otherwise. Do not let anyone biopsy a kidney mass unless you have seen a urologist. Biopsies of a kidney mass can actually cause more harm, and often do not provide the information desired.
6. A testicular mass or persistent pain. Because of the rare chances of having an underlying testicular cancer, any masses, firmness or nodules of the testicle must be seen by a urologist. This also includes men with testicular pain that does not resolve within a week or two. If caught early, testicular cancer is one of the most curable cancers in humans.

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Technorati Tags: urology, mens health, male infertility,testicular cancer, prostate cancer, PSA, hematuria, bladder, kidney

Results in seconds. Wow.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Technorati Tags: foreskin, circumcision, sexual health

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

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

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

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

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

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Technorati Tags: chris benoit, steroids, testosterone, tragedy