Tuesday, April 30, 2013

ED & Heart Disease: It's All in the Plumbing Part 4

It's interesting that when it rains, it pours.  Well, maybe.  Or maybe it's more of the blind squirrel finding the occasional nut.  In this particular case, while I was nosing around yesterday regarding the link between erectile dysfunction and heart disease, I stumbled upon yet another review published last August in the Mayo Clinic Proceedings.  In fact, this review was a consensus statement of the third Princeton Consensus Conference held in November 2010 (notice how long it takes to get something published?).

Specifically, erectile dysfunction was linked to an increase risk for coronary heart disease, stroke & all-cause mortality.  The group went so far as to recommend a cardiac evaluation for any man complaining of organic ED (a question raised at the AAFP's Geriatric Medicine conference last week).  

More importantly, the authors pointed out a total of 9 studies linking low testosterone (or hypogonadism) to increase mortality.  Granted this does not prove cause & effect, but it does compel us to set up a randomized controlled trial to address that possibility.  And finally, the authors went so far as to suggest that all men w/ED should have their T level checked and replacement considered when appropriate.  Wow!  What a turn around!



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Monday, April 29, 2013

Q&A Session at HealthTap.com

Phone number for dr. joel l. adams?



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My cervix is inflamed i also have an std does that mean i have. PID?



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My daughter just had a tongue tie release surgery, and the doctor put stitches. What will happen next? What should she eat/do? She says it hurts.



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ED & Heart Disease: It's All in the Plumbing Part 3

I apologize for the absence but it's been quite the week.  I had the honor & privilege of serving as the chair of the AAFP's Geriatric Medicine conference held this past week in Albuquerque (actually Santa Ana Pueblo), NM.  While there, I spoke on several topics including erectile dysfunction, hypogonadism & heart disease, and had the opportunity to point out 2 recent studies linking erectile dysfunction to heart disease.  In looking through my personal stash of studies, I found over a dozen more looking at the link between the two.

With that in mind, I wanted to point out another review looking at erectile dysfunction in the cardiovascular patient published early online last week in the European Heart Journal.  I found it to be quite complete, comparing psychogenic vs "organic" ED.  The former is found more commonly in younger men who are much more concerned about performance in their search for a life partner while the latter is more common in the middle age to older male.  This review also includes a copy of the Sexual Health Inventory for Men (SHIM), also known as the International Index of Erectile Function (IIEF-5) which helps objectively stratify just how bad one's ED is.

Most important, this review includes a few graphics to explain the difference between penile, heart, brain & extremity blood flow.  In other words, while a blood vessel is a blood vessel is a blood vessel, the relative size of these various blood vessels helps explain why ED might serve as the canary in the coal mine.  So use this review for yourself or to help your patients better understand what's going on.  And in case you're wondering, the review quotes a 3 year lag time between diagnosis of ED and incident heart disease.  Get working improving your health!



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Sunday, April 21, 2013

Q&A Session at HealthTap.com

Why do I have constant cramping that travels across my lower stomach it comes andy it goes?



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Why does low bp occurs?



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I take the pill, have unprotected sex very often and sometimes miss or take late my bc. I've been getting real bad cramps lately. What could it be?



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I want to lose 20kgs,in a span of three months is it safe to lose such massive weight?



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Does Lipitor cause swelling in the lip and tightness in lip?



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Is everybody in doctor's office entitled to know about my medical history?I only wanted my doctor to know, not the staff.I get calls from others too.



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Saturday, April 20, 2013

Q&A Session at HealthTap.com

All my life been disoriented in buildings, even familiar ones. Problems retracing steps from bathroom or finding exit, etc. Husband notices. Help?



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I always want to have sex. Do I just have a high libido or is it a testosterone imbalance? or something else?



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Please answer the testosterone level 2.4 ng/ml is low or high? Is there any treatment ?



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Friday, April 19, 2013

Q&A Session at HealthTap.com

I am sexual active and recently I have been having this weird smell from my vagina, also I feel like it is more wet then normal maybe.



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I ejaculated inside my gf and she took the plan b pill within an hour. We had safe sex again shortly after will this affect the effectiveness of pill?



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I have degenative disc disease badly and my chiropractor wants to put me on nutrihcg diet. Is this a safe diet to be on?



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Dietary Supplements: Is the Fox Guarding the Hen House? Part 5

It's been a while since I talked about the fox guarding the hen house.  You know how that story ends and it's not good!  In truth, neither Big Pharma nor the dietary supplement industry are without blame.  Several pharmaceutical companies have been fined for illegal marketing while a industry subset recently set the nation abuzz by selling a contaminated product leading to infection & death.

And in a research letter published early online this past Monday in JAMA Internal Medicine, the authors noted that over the last 5 years, over 200 dietary supplements have been recalled for containing unapproved pharmaceutical ingredients.  As Disraeli is quoted to have said, "There are lies, damned lies, and statistics."  Thus, the dietary supplement industry would point out that since 2010, there has been a decrease in the number of recalls.  

But I have to agree with the editorialist who noted that these supplement recalls are initiated mainly based upon consumer complaints because the Food & Drug Administration does not have the power to proactively provide oversight.  As such, these recalls probably underestimate the number of contaminated products on the market.  And in fact, the dietary supplement manufacturers are not required to demonstrate either efficacy or safety prior to making their miraculous claims as long as they provide the ubiquitous disclaimer.  But before inciting widespread riot & chaos, let's recall that most manufacturers are out to do the right thing and improve health.  So just beware those promising miraculous improvements.  Caveat emptor.






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Wednesday, April 17, 2013

Q&A Session at HealthTap.com

How to be more exited in a sex relation ?



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I have a really sore throat with red rashes at the back of my throat?



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My Dad needs some anti-inflammatory painkillers but cannot take ibuprofen as he has had stomach ulcers in the past. What would be the best for him?



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Beetlejuice? Oh, Beet Juice! Lowers Blood Pressure

As I was reading this small short proof of concept study published in early online in Heart, all I could think of Tim Burton's 1988 movie, Beetlejuice.  No relation whatsoever, just a random association on my part.  Such is the hazard of reading late at night.  In any case, I'm not fond of natural for the sake of natural.  Many patients seem to want some medication just because it's natural or herbal or organic, as if that, in and of itself, automatically makes it better than any available synthetic.  Of course, they also tend to overlook the fact that unless they're consuming the original plant or animal in its original form, the product in pill form was synthesized from said natural or herbal or organic beginnings.  As an example of the silliness of this natural movement, would you be willing to wipe your bottom w/poison oak or poison ivy?  I thought not.

In any case, the bigger reason for my disinterest in these natural or herbal or organic substances is the lack of published peer-reviewed evidence.  The counter-argument is that Big Pharma won't support this research because they can't patent these products and thus can't profit from them.  Fair enough, but that's where the government steps in via the National Institutes of Health and others of its ilk.  As the story goes, the NIH has nothing to gain except to promote health via sound science.  

So along those lines, let me direct your attention back to the aforementioned study of 8 women & 7 men avg 53yo w/blood pressure >140/90mm Hg who'd never been prescribed any blood pressure lowering medication.  They were randomized to either 250mL of beet juice or water.  The former had an amount of nitrite that had previously been demonstrated to make no difference in normotensive participants.  And yet, in these hypertensive participants, those who received single dose ~8oz of beet juice saw their systolic blood pressures drop by 8.5mm Hg compared to placebo while diastolic blood pressures dropped by an even more impressive 9.6mm Hg.

Now, don't jump to any conclusions since this was only a single dose trial in barely a dozen participants.  But if you're looking to go native, this might be good place to start.  Maybe this will become the next fad diet!  As always, be sure to include your family doc in what you're doing.  After all, we wouldn't want you to pass out!  By the way, in case you don't have a hankering for beets, consider eating other fruits & vegetables rich in nitrites.



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Tuesday, April 16, 2013

Q&A Session at HealthTap.com

If I've had kidney stones in past, is it safe for me drink almond milk or herbal teas such as green, oolong, our-eh!



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I have blood discharge from my lright nipple yesterday and a few pin dot sized today.I had a mamogram and ultra sound January 2013 something was found but it was not maligant I dont know medical term?



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My partner is 50 years old and has lost a lot of weight in the last three months, also has loss of appetite, what could be the cause?



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Statins & Diabetes: What Do the Canadians Know that We Don't Know?

Just last week or so, the Canadian Diabetes Association released the latest Clinical Practice Guidelines for treatment of those w/diabetes.  One of their more controversial recommendations is starting statins in diabetics as they turn 40yo.  Furthermore, those who've had diabetes for at least 15yrs are recommended to start either an ACE inhibitor or an ARB.  While I'm all for individualization, it's been proven that given our druthers, we're not very good at persuading our patients to reach for well known & targeted goals such that barely 13% of all diabetics are at goal in all three risk factors.  Something to think about as you chat w/your patients.



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Sunday, April 14, 2013

Q&A Session at HealthTap.com

How to lower ↑ BP and blood sugar w/o medication?



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I just got off my period for six days and now I started again after. What's wrong with my system? Thought the depo is out didnt get a shot for 7 month



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How long will 1Valium stay in system when also taken with 1naproxen 1morphine 2toradol which was inject in my IV at hospital.Drug test fail a WK later



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What causes lung bacterial infection I am a non smoker?



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Lungs feel like they are burning when i am in a cold aerea why is that lungs feel like they are burning when i am in a clod room



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What does stroke mean?



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Saturday, April 13, 2013

Q&A Session at HealthTap.com

I have been taking bactrim for 9 days. I noticed little red bumps all over my body tonight. They don't hurt or itch. Should I worry?



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Which male enhancement really works?



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Can i become pregnant on the last day of ovulation if i had unprotected sex?



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