Erectile Dysfunction: Something Worth Talking About

erectile dysfunction

The Little Blue Pill

Viagra has come under scrutiny lately with a study showing that it may be associated with an increased risk of developing melanoma. Erectile dysfunction (ED), the inability to achieve or maintain an erection, affects more than 18 million men over the age of 20. It’s well known that men don’t typically like to go to the doctor, let alone discuss their genitourinary health. This can leave many men with ED undiagnosed and untreated.

In my experience, many male patients presenting with ED will usually ask for a prescription of Viagra, without wanting to disclose any further information. What many people don’t realize, is that erectile dysfunction is not an “Oh by the way” kind of diagnosis, and can be a sign of serious underlying disease in the body.

Erections and Erectile Dysfunction

Erections occur when blood flow in the penis increases as a result of penile nerve stimulation. Smoking, diabetes, and cardiovascular disease are just a few things that can affect blood vessels and/or nerves, in turn affecting the ability to have an erection. Hormone imbalances, increasing age, depression and certain drugs (SSRIs) can also cause erectile dysfunction. Nowadays with the increased prevalence of some of the causes mentioned above, it’s no wonder why so many men are affected by ED.

ED Treatment

Phosphodiesterase type 5 (PDE5) inhibitors such as Viagra, Cialis and Levitra dilate blood vessels, allowing blood flow to increase in the penis. What these medications don’t do, however, is work on the underlying causes mentioned above. Cardiovascular disease is the number 1 cause of death in Americans. It is caused by smoking, high cholesterol, diabetes and hypertension; all which can be reversed with simple lifestyle changes. A healthy diet, exercise, managing stress and not smoking, will not only decrease the risk for heart attacks and stroke, but will also contribute to a healthier sex life. Many young men with depression are also faced with ED and treating depression will also improve overall quality of life as well.

The “little blue pill” like most pills, won’t fix things. Pills are a tool in the healing process, which also have risks and side effects associated with them. With any disease, it’s important to not only identify and treat the underlying cause, but to find out the deeper reasons causing an individual to engage in unhealthy habits in the first place.  

Don’t suffer in silence

If you or a loved one has erectile dysfunction, make sure to bring it up to a healthcare professional.  It’s less about the ability to perform sexually, as it is a sign that something more serious could be going on. If you can intervene sooner rather than later, it may be enough to prevent permanent damage. Doctors are here to help, and the only way we can do this is if we talk about it.

5 Surprising Things You May Not Know About Doctors

Times have definitely changed 1946 Camel Cigarette Ad Source: http://tobacco.stanford.edu/tobacco_main

Times have definitely changed
1946 Camel Cigarette Ad
Source: http://tobacco.stanford.edu/tobacco_main

 

“Oh, you’re my doctor? A woman?”

Who do you picture walking through the exam room door at your new doctor’s office? Is it the Norman Rockwell depiction of an older, jolly looking male with white hair? After residency I was alarmed at how many patients commented on my age and gender:

“<Expletive>, how old are you, 12?” or, “Oh, you’re my doctor? A woman?”

I know that I lived under a rock during my medical training but I am pretty sure Scrubs, the Mindy Project and Grey’s Anatomy were on TV then. (Scrubs is the most realistic medical TV show by the way.) This got me thinking about misconceptions people have about doctors, and I thought I could share a few things you may not know about your favorite neighborhood doc.

1. We are young

According to the Association of American Medical Colleges (AAMC), of the active physicians in the US in 2012, about 60% were under the age of 54. With baby boomers retiring, someone has to take over the roles of older doctors (who by the way, were at some point young too.) Physicians fresh out of residency have had several thousands of hours of experience in addition to seeing several thousands of patients. Yes, while more experience is an advantage, so is knowing about the latest health guidelines and technology. In fact, a study published in the Annals of Internal Medicine in 2005, showed that younger physicians are more likely to order necessary tests and appropriately counsel patients on preventive health than their more experienced colleagues.

"Before the Shot" by Norman Rockwell Source nrm.org

“Before the Shot” by Norman Rockwell
Source: nrm.org

2. We exist in female form (Shocking I know!!!)

While 70% of physicians in the US are male, the number of females entering the medical field continues to grow. Not only do females have to jump through the same hoops as their male colleagues when it comes to medical training, they may even have a slight edge. A study done by the University of Montreal showed that female doctors score higher on quality and care measures and are more likely to follow evidenced-based guidelines. Another study showed that female physicians tend to show more empathy and are better listeners. NOTE: This is not meant to bash male physicians. There are very talented male physicians practicing medicine. The whole point is that female physicians are also good at what they do.

3. We are not as rich as you think

It’s true that doctors make a salary that is well above the national average. However, after about 10-15 years of education and training, making little to no money, we find ourselves in hundreds of thousands of dollars in debt. It takes about double that amount of time originally invested to repay a debt, which can end up costing more than twice as much due to accrued interest. It’s no wonder why doctors are fighting health care reimbursement cuts. I tell people all the time, don’t become a doctor if you are trying to be rich. Become a doctor because you can’t see yourself doing anything else and you are willing to put in the sacrifice. Believe me, there are a lot of easier ways to become rich.

4. We know more than medical websites

It’s wonderful when people are involved in their own health and want to be informed. While there are many great medical websites out there, there is also a lot of false medical information on the Internet, and believe me, nothing replaces a formal medical education. Doctors learn the information you read about online at an advanced level and take it a step further by applying that information to each individual. A cough in Mr. A who smokes, may be related to something completely different than a cough in Mrs. C who may have other health problems and be taking different medications.

Scrubs: One of the best medical TV shows ever! Source: http://www.tv.com/shows/scrubs/

Scrubs: One of the best medical TV shows ever!
Source: http://www.tv.com/shows/scrubs/

5. We are human

Believe it or not, doctors are people too. I hate getting my blood drawn and I also happen to do a mean robot dance. In all seriousness, doctors have a lot of responsibilities placed on their shoulders, which is why becoming a physician is not easy; we are dealing with human lives after all. That being said, doctors don’t always have all the answers either. It’s called the “practice” of medicine for a reason. Sometimes we have to try a few things and rule some things out, which may require a few tests, additional appointments or even referrals to other physicians.

The stone age has passed…

Regardless of our age, gender, skin color, nationality, student loan debt, USMLE, NBME, board exam, or state license, doctors have all taken an oath. An oath promising to value and respect human life, do no harm, maintain confidentiality and ultimately do what is best for patients and our community.

So the next time a young doctor walks into the room, give her the benefit of the doubt. She may be 20-something, driving a 2000 Toyota, with half of her paycheck paying off student loan debt. If you look hard enough you may see the “age lines” she and the next generation of young doctors acquired through the many sleepless nights and delayed gratification invested in taking care of you and your loved ones.

 

 

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Why Jealousy is Bad for Your Health

Jealousy is a terrible disease, get well soon.Jealousy, envy, hating, whatever you want to call it. It all implies one thing: You don’t value yourself.

Think about it. Those with money or accomplishments weren’t sitting around worried about what someone else had. They believed that they too could achieve their dreams. They didn’t knock their colleagues. They collaborated with the best for even better. No one who values themselves has the need to devalue someone else. Confident people know that no one person is better than anyone else, but that everyone has strengths and even weaknesses to bring to the table.

Jealousy works the opposite way you want it to

From Lululemon Athletica

Unfortunately jealousy is rampant. Social media is laced with nasty comments about celebrities and even non-celebrities. How many actually personally know those people? How many actually deep down wish they could have what those people have? How many could have used that time spent with hatred and negativity doing something better with their lives? Why not just take a neutral stance or be supportive of someone else’s accomplishments? Jealousy is different than preference, however. Certain pop stars (a few quickly come to mind), for example, may do things that annoy us, but even then it’s just something you let roll off your shoulders.

Unless someone personally harms us whether it be physically, mentally or emotionally, there is no reason to hate. Even in those cases, we can choose to forgive and move on and keep people out of our lives.

So how can jealousy affect one’s health? Anytime someone does not value themselves, there is a chance they may not value their health either, and in turn not take care of themselves. A lack of self-appreciation will inevitably show up in different areas of our lives, whether it be relationships, jobs, or our health. Constantly complaining about our health issues or bringing others down because of their healthy lifestyles does nothing to improve our own lives. Having a positive attitude not only creates a stress-free, emotionally/mentally healthy life, but allows us to focus on the measures we can take to create the lives we want.

Your outlook on life is a direct reflection of how much you like yourself.

From Lululemon Athletica

So anytime you feel jealous, take a step back and try to find out why you don’t believe you have the capability to have or be what you want. Don’t judge these feelings but do find the strength to shift your attitude in that moment. Whatever is within, will inevitably reflect without.

 

 

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Skinny Fat: When Looks Can Kill

draunna.comskinnyfatSkinny-Fat

No, I’m not talking about the pop culture oxymoron that describes thin yet flabby physiques. I’m talking about something more serious. Which brings me to my next point: SKINNY DOES NOT MEAN HEALTHY!

I REPEAT, SKINNY DOES NOT MEAN HEALTHY!

While some people may look deceivingly well in clothes, there may be something even more dangerous going on underneath the skin.

Why You Can be Skinny but also Fat

There is actually a scientific word for skinny-fat people: Metabolically Obese- Normal Weight (MONW). A thin person with a normal weight may actually be obese based on the amount of fat contained in his or her body. In fact, studies have found many people with normal weight to have a high percentage of body fat. So the number of obese people in the USA may actually be a lot higher than what is known now just based off the BMI values in our population.

Obesity Statistics

In 2013, of US adults over 20 years of age, 35.1% were found to be obese and 69% were found to be overweight (including the number of obese people). Think about that, more than half of US adults are overweight, and what’s even more sad is that this number continues to grow. Along with obesity comes the growing number of obesity-related diseases like high blood pressure, high cholesterol, diabetes, stroke, heart attacks and even certain cancers, eventually leading to early death.

Overweight vs Obese

Being obese means having excessive body fat, whereas being overweight means weighing too much. The statistics mentioned above are based off of the body mass index or BMI of an individual. A BMI is a measurement of relative weight based on someone’s mass and height (weight in kilograms divided by height in meters squared).

BMI greater than 25= overweight
BMI greater than 30= obese

The higher the BMI is, the higher your potential risk for developing debilitating diseases and even death. The problem, however, is that the BMI does not actually measure body fat. Muscles and body water are just a few other things that influence a person’s weight. A healthy and fit male who weighs 200 lb at 6 feet tall would be considered overweight based on his BMI of 27.

Why Being Skinny-Fat is So Dangerous

MONW individuals, as compared to people with normal weight and healthy fat levels, have been shown to have an increased risk for pre-diabetes, high blood pressure, high cholesterol and risk of dying due to cardiovascular disease. It is thought that these individuals also contribute to the high prevalence of these diseases in our country.

Dangerous Fat

So we have determined that it is not so much about how much you weigh, as it is about how much fat you have. So where is all the fat hiding? It turns out what’s more important is where the fat is located in your body. There are many different types of fat in the body. While subcutaneous fat (the fat you can pinch) may not be aesthetically pleasing, it’s the visceral fat, or the fat that surrounds the organs that is detrimental to our health. It’s this visceral fat that is associated more with the diseases I mentioned above. It’s true that people who are overweight are more likely to have a higher visceral fat content, as well as a larger abdominal circumference, which is also associated with obesity-related diseases. MONW individuals with smaller waists however also have a high content of this visceral fat as well. 

It’s very important to note that this does not mean that it’s ok to be overweight either. People with excess body weight can also run into issues with severe arthritis, physical deconditioning, difficulty walking, difficulty breathing, sleep apnea, chronic pain and overall poor quality of life.  

Are you a Skinny-Fat or MONW Person?

The best way to determine fat distribution is with radiologic imaging such as a CT scan, DEXA scan or MRI. These tests, however, are expensive and not covered by insurance for this diagnosis. An easy estimate of total body fat can be made by skin fold analysis which can be done by a personal trainer or healthcare professional.

Note the increased yellow fat tissue throughout the heavier individual. (I have been unable to find the original source for this picture as it has been widely circulated throughout the web. If anyone is aware of the original source, please contact me with the info)

Note the increased yellow fat tissue throughout the heavier individual. (I have been unable to find the original source for this picture as it has been widely circulated throughout the web. If anyone is aware of the original source, please contact me with the info.)

How NOT to be Skinny Fat… or Fat at all

So far it’s pretty obvious that it is not all about being thin, rather about being fit and healthy. Regardless of how much you weigh, if you feel you have excess body fat and are not fit, there is an answer. Research has shown time and time again that an unhealthy diet and lack of exercise are the main causes for obesity, and that a healthy diet with routine exercise not only decreases the amount of body fat (both under the skin and around the organs) but that it can reverse diabetes, heart disease, high cholesterol and decrease your risk for stroke and heart attacks.

So the next time you get on the scale or look at yourself in the mirror, focus on whether or not you are healthy, rather than skinny. Your life literally depends on it.

Let me know what you think in the comments below. Also a few questions to ponder:
Could you be a skinny-fat or MONW person?
Could you benefit from eating a healthier diet or exercising more?

References

1. CDC. 2014, May 14. Obesity and Overweight FastStats. Retrieved from http://www.cdc.gov/nchs/fastats/overwt.

2. Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol 2010; 115: 982–88.

3. Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld, Y, Boarin S, Korinek J, Jensen MD, Parati G, Lopez-Jimenez F. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010 Mar;31(6):737-46.

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Metallic Mouth Medical Mystery

photo-21

‘Tis the season and pine trees are everywhere. I watch the lights on my tree while eating an apple and find that the apple tastes bitter. In fact, everything I have eaten over the past few days has tasted bitter and the bitterness lasts for about 30 minutes after I have finished eating.    I am scanning my brain for a diagnosis. I’m pretty sure if I had a toxic level of metals in my body I wouldn’t be leisurely watching my Christmas tree. I don’t have any indigestion either. Some people with acid reflux will describe a “water brash” taste in their mouth, which is basically the taste of stomach contents rising up into the throat. I have had many interesting medical complaints thrown my way from people, but nothing about a metallic taste in the mouth. None of my textbooks have an answer, so I do some further investigation on the internet (via reliable sources of course).

It turns out some people who eat pine nuts may experience the symptoms I described above. I happened to have eaten pine nuts in a salad last week, but have never experienced this before, despite having eaten pine nuts in the past. According to the article I read, it’s called “Pine Mouth”, or Pine Nut related Cacogeusia in medical terms. I had never learned about or heard about it until today. What’s interesting is that it was discovered by a physician a few years ago. Dr. Marc-David Munk of the University of New Mexico published a paper in the  Journal of Medical Toxicology about his experience with pine mouth after eating pine nuts on a salad. Scientists are still stumped as to what causes it but think it may be related to a species imported from China. Thankfully it’s not dangerous and the taste disappears after a week or two.

While most of what I learned in medical school has not changed, medicine is still ever evolving. Doctors are always learning (and apparently have issues related to pine nuts). I do seriously advise against self- diagnosis especially via the internet, even as a physician, which is why I am going to run it by a colleague. I could do without the metallic tasting holiday treats this week, but I won’t be giving up pesto anytime soon. I hope you all have a wonderful, happy, healthy and safe Holiday. -Dr. A

All Years’ Resolutions

What are your New Year’s Resolutions? The Top 10 New Years Resolutions for 2015 (Updated for 2015) revolved around, yes, you guessed it: health and happiness! During many of my patient encounters, I go over the same things about healthy diet, quitting smoking, starting an exercise regimen, etc. I hear many excuses, but for some reason, it’s during this time of the year when people start making more efforts to try to make changes. Did you know that according to the University of Scranton Journal of Psychology, in 2012, of the 45% of Americans that made New Years Resolutions, only 8% were successful in achieving them? While I do see many people making an effort at the beginning of the year, I would say that by March many people go back to their old routines.

Note: This is not considered exercise.

          Note: This is not considered exercise.

So why does this happen? There is nothing really different about the New Year except for a change in the date. So when my patients tell me they are going to start eating healthy and exercising after the holidays, I ask them, “Why not today?” Naturally the thought of a new year causes many of us to evaluate the past year and think of what we want in our lives for the next. Still, why wait and procrastinate on making changes that benefit our lives?

The following are some tips meant to help ensure your success in achieving your goals.

1. PRIORITIZE

First: Make a list of EVERYTHING you would like to work on, change, have, etc.

Second: Make a new list from the first, prioritizing the most important to the least important in terms of what you would benefit from changing sooner rather than later. Health and financial/legal issues would probably be better listed before “buy brand new car.” Also, is there anything you want to change that is ok the way it is? If so, your efforts would be better spent working on something that you would benefit from improving.

2. GRATITUDE

Take out another piece of paper and write down everything you are grateful for and proud of over the past year. It may be hard to think of things at first because we tend to focus on the negative (Read more on gratitude here). If we try hard enough, however, we will find that there is also a lot to be happy about. The “little” things such as being alive, having our family around us, having basic survival needs are important too.

Compare your lists. How do you feel when you read each list? The “resolutions” list may bring on strong emotions. There is no reason for negative emotions to be dominant over the positive ones, except for what you are focusing on. So even if this time of reflection may bring on negative feelings, make sure to think about all the great things going on as well.

3. INTENTION

It is important to be honest with yourself during this step. Review the first list and ask yourself, “Why do I want this? What benefit will it bring to my life?” and write the answer next to each item.

If there is anything on your list to try to prove something to someone else or make someone else happy, consider whether or not this is actually important to you. For example, if you want to quit smoking because everyone is telling you to do so, you will not likely be successful. I will be the first person to encourage someone to quit smoking, but I also know that most people who quit successfully do so when they are ready. They also often quit cold turkey without any medication or nicotine supplements. Unfortunately it usually takes some type of health crisis to wake some people up; nonetheless, it has to come from within. You will not feel satisfaction in achieving a goal when it is meant to seek approval from others or to make others happy.  If the other parties don’t react the way you want, then you will have spent all your time doing something for someone else and left with regrets and resentment. In the end you will not have done anything to make yourself happy.

Tune in for the rest of the related articles on ways we prevent ourselves from achieving our goals.

Share what your New Years Resolutions are in the comments below!

You are Worthy of Being Healthy

We Hold the Key

We Hold the Key

How often do we all face “obstacles” in our lives that we would like to overcome, but feel some resistance to them? For example, if we are dealing with being overweight, we likely know that we would benefit from a healthy diet and exercise. It’s obvious that taking care of ourselves would eliminate many of our health issues. So then why do we sometimes find ourselves not doing just this? I’ve heard many excuses from people, such as “I’m too tired after work to exercise,” or “I just can’t.”

Why is it that we are so much more willing to take care of others? I personally think it is because of the deep love we have for the ones we care about. Well, what about the love for ourselves? I am not talking about a vain, egotistical type of love, but a true appreciation for ourselves and our well-being.

What is holding us back from taking care of ourselves? When I ask this question to people, the response is often, “I don’t know.” If you are facing health challenges, consider reflecting upon that question. Could it be that you have a deep- seated subconscious belief that you are not worthy of good things in your life, such as optimal health and wellness? I think if you truly appreciated yourself, you would make time for a 15 minute walk even when you are a little tired. Just like you would make the time to take your child to a sports practice or to meet up with a friend.

I also encourage you to take the time to change your perspective. Think of all the time you have spent thinking, “I can’t,” and look at what has happened: you couldn’t… because you didn’t. Have you ever thought, “I can!” or “I’m worthy of being healthy and feeling good about myself.” Have you ever thought that the “obstacles” may actually be opportunities to grow?

Just as you are so willing to be selfless for others, doing things that benefit your life will keep you around longer to enjoy time with the ones you love. Give it a try, you are worthy.

The Magic Pill

photo-20

Can I get a side of pills with that?

According to the CDC, 48.5% of Americans have taken at least one prescription drug in the past 30 days. 21.7% report taking three or more prescription drugs. Why is it then that chronic diseases such as diabetes and high blood pressure continue to increase in our population? The answer is complicated, but to keep things simple for this discussion, one main reason has to do with what I call “under-diagnosis” and “over-mistreatment.”

A “Pillemma”

Typically we go to the doctor when we experience a physical symptom, and after a few encounters and possibly some tests, we are often prescribed pills. If we are fortunate enough to afford the medication or compliant enough to take it, we may or may not experience relief of our symptoms. Oftentimes we don’t feel any better, and if anything, worse from the side effect of a pill. Then we may become disappointed that our doctor could not “fix” us.

What if there is something deeper than just the symptom we are experiencing? Let’s take a headache, for example. There are many causes for headaches, but the most common reason I encounter with patients is usually related to stress. When I examine patients with headaches, I find many of them have tense shoulder and neck muscles; hence why it is called a “tension headache.” So yes, while a pill can inhibit the pain, it still is not treating the muscle tension, which is being caused by stress!

Pills are not always the answer. Unfortunately with the limited amount of time doctors have to see patients these days, the only option is the “easy fix”, which is usually a pill. It doesn’t help that our society is always looking for this “easy fix”, so instant gratification wins, but in the end we are often back where we started. So what’s the solution, you may ask? Let’s take a look at how disease is diagnosed: Typically we see illness like this:

Disease Approach

 

We often forget that WE ARE NOT JUST A BODY. WE ARE NOT ROBOTS. Here is a more realistic diagram of a human being’s existence:

 

Holistic Approach

 

The real the dilemma our healthcare system is facing has to do with the following:

Underdiagnosis– Not addressing the whole person

Over-mistreatment- Treating only a part of the problem with a “solution” (pills) that creates more problems (side effects, death, etc.)

While pills are effective at the physical level, they do not address all of the other factors that contribute to illness. Often the underlying cause is related to something completely different than what is seen on the surface (see arrows above). I am not saying that we should all stop taking medication. Medication is effective and has a place in treatment of illness, but it is rather one of many tools to be used. Prevention is the best way to avoid illness in the first place, and many times healthy lifestyle habits are enough to heal.

How to begin healing

Until we address the underlying causes that contribute to illness, will we then find complete healing. Like in the headache example, Aleve or Tylenol can relieve pain, but so can massage and stretching. Nothing will be as effective as managing stress, however.

True health can only occur when the mind, body and spirit are integrated and healthy. It involves more than a pill and what a doctor tells you. It involves healing your body and mind. It involves honoring your emotions. It actually involves YOU. Yes, it’s complicated and takes a little more effort than a pill. But we are complicated creatures, and, in my opinion, some delayed gratification and a commitment to our well-being is well worth it for a happy and healthy life.

Share your health secrets in the comment below.

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