Thursday, October 31, 2013

Q&A Session at HealthTap.com

Is erectile dysfunction a side effect of taking clomid?



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Q&A Session at HealthTap.com

Do very low free testosterone levels (below 100) usually go along with infertility in a male?



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Dry hard mole scratched off in my sleep, should I be worried?



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Wednesday, October 30, 2013

Q&A Session at HealthTap.com

Ive had a cough and sore throat for 3 weeks, whats wrong?



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Sore throat, coughing up mucus, ears hurt, possible cause?



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Should I work out if i'm coughing up green phlegm?



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Tuesday, October 29, 2013

Q&A Session at HealthTap.com

Sir I'm following a healthy diet but becoming weak.daily 3times Im going for potty. No energy by evening what should I do ?? Plz help me



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Orexin is needed to produce brown fat which burns fat.so people with Narcolepsy have Orexin deficiency ,so can people with narcolepsy still burn fat?



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I haven't had sex in 3 months and have had 2 periods since. I haven't been stressed but I'm late for this period. Could I be pregnant?



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Glucose Control vs Memory: When Good Enough Isn't

Don't ask me why or how but I must've stumbled upon a treasure trove dementia related studies recently, not unlike the blind squirrel finding the occasional nut.  In any case, I want to offer you an analogy to explain my philosophy towards health care.  When I was in grade school, then high school, and then college, the typical grading system went something like this: F = failure, D = low pass, C = average, B = high pass & A = honors.  Or something like that.  In other words, if all you wanted to do was pass, you could get by with a D grade.  After all, that D grade was good enough to move you on to the next grade or even towards graduation.  But for some of us, good enough just wasn't good enough.  If we wanted to become a doctor, we needed to get straight A's in college which meant straight A's in high school, etc.  Even a B grade wasn't good enough.

So think about Hemoglobin A1c, the running 3 month measure of sugar control.  I liken it to your average trip speed on a long drive whereby you speed up & slow down & speed up again, perhaps coming to a complete stop due to traffic, stop lights or stop signs.  Glucose, whether random or fasting, is represented in this scenario by your speedometer which tells you how fast you're going at that precise moment in time that you glance at it.  However, that very same speedometer tells you nothing about how fast you were going a minute ago, 5 minutes ago, 30 minutes ago, an hour ago, etc.  

Well, back in the day, "normal" A1c was any value less than 6.  Well controlled for a diabetic was 6-7 while poorly controlled diabetics had values greater than 7.  A few years ago, we tightened our perspective and declared normal as less than 5.6.  At risk for diabetes (also known as pre-diabetes) is now 5.7 to 6.4.  And greater than 6.4 is now considered consistent w/diabetes.  Notice the semantics as well as the reference ranges (which will vary slightly depending upon your lab).

With all this in mind, a cross-sectional study was published early online last week prior to print next month in Neurology in which the authors concluded that lower A1c within the normal reference range was associated w/better memory & larger hippocampal volume, a structure linked to Alzheimer's disease risk.  Now, before you go out and ask your doctor for insulin to lower your sugars, notice that this conclusion is based upon 141 participants, half of whom were women, average age 63yo.  This study says nothing about what happens if you lower your blood sugar.  It's not a double-blind, placebo-controlled, randomized trial.  Instead, the authors compared various domains of memory & cognition to A1c, blood glucose, insulin and magnetic resonance imaging scans.  Even in those without diabetes or impaired glucose tolerance, lower A1c was linked to better delayed recall, learning ability & memory performance.  Think about that before you take that next bite of food.



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Monday, October 28, 2013

Q&A Session at HealthTap.com

I am a renal transplanted man, nowadays i am suffering the disc extrusion of c6-c7 compressing spinal cord. what is the medication?



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If you are fertile seven days before ovulation and you are intimate four days before ovulation can you get pregnant ?



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How to conceive twins next year?



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Fluke or Trend: Blood Pressure Lowering Medications vs Alzheimer's Disease

Just 3 days ago, I pointed out a study published in Neurology in which the authors concluded that beta blockers lowered one's risk for loss of cognitive function but that angiotensin converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics & vasodilators did not.  Ironically, in that very same issue, a secondary longitudinal data analysis of the Ginkgo Evaluation of Memory Study was published in which the authors concluded that ACE inhibitors, angiotensin II receptor blockers (ARBs) & diuretics reduced risk for Alzheimer's disease.

To arrive at their conclusion, the authors reviewed over 6 years worth of data for 1,928 adults w/normal cognitive function, who were older than 75yo at study entry.  Some benefit was noted w/calcium channel blockers and even beta blockers, too, but w/o statistical significance.  Ironic, isn't it then, that last week's study suggested benefit from beta blockers but not ACE inhibitors.  

So what are we to make of this quandary & contradictory evidence.  First, let's recall that science is never that clear cut & transparent.  Second, in the big scheme of things, 5-6 year studies of 800-1900 participants is neither long nor large enough.  Third, observational studies such as these are useful for developing hypotheses but not for proving cause & effect.  But with all that said, I can't think of a single reason (aside from anaphylactic allergy) not to lower one's blood pressure and pray for secondary benefit, even as we wait for more definitive proof.



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Sunday, October 27, 2013

Q&A Session at HealthTap.com

What happens if whenever drinking or eating you start coughing?



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No hard cough but there is blood in the phlegm, is this serious?



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Brownish cough in the morning, what does it mean?



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I'm on levothyroxine. Can you tell me about T3 replacement for many persistent hypothyroid symptoms even with normal TSH blood test results?



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My boyfriend suffer of heart ache is not something that he was born with so if we hav a baby does da baby gonna hav problems wit its heart too??



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What are the best natural substitutes for anabolic steroids? At 47yrs i have low production of testosterone but still train



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How to cure cough with phlegm in throat urgently?



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Q&A Session at HealthTap.com

Is it a bad sign when I don't have an erection in the morning?



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Saturday, October 26, 2013

Q&A Session at HealthTap.com

My mother has a big black purple ish spot on her leg. I dont think its a bruise. I remember my freind said to ask a docotor cause it might be a clot?



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Does green tea really help with weight loss ?



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Will my Dysarthria eventually go away?



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Can you take viagra on the hcg diet?



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Male FSH 42High. testosterone normal. Small testes 6ml. No sperm. Doc suspect puberty problem. Any other hope/test to consider? Tese?



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Persistant cough with a cold two weeks ago have had acute bronchitis before do u think i have it again and also i feel winded at times?



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Friday, October 25, 2013

Q&A Session at HealthTap.com

I've coughed more than 4 months, sometime also cough up blood, and I have injected for many time already. What should I do next?



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Q&A Session at HealthTap.com

Is it ok to blend 5 different fruits or more together and drink as juice..



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Sharp constant pain upper right abdomin worse after eating, with muscle spasms over all stomach, naseua vomiting fever and dizziness? Not pregnant



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Fluke or Trend: Beta Blockers vs Alzheimer's Disease

Back in August, I wrote about the possible link between centrally acting angiotensin-converting enzyme (ACE) inhibitors and risk for dementia.  Which of course raises the question about the existence of a link between non-centrally acting ACE inhibitors and dementia risk.  Then you could expand to ask whether the cousin class, angiotensin II receptor blockers (ARBs), show any benefit, after which you could apply the same query to other medications.  Judging by the title to this post, I would like to direct your attention to a prospective, community-based cohort study published last month in Neurology in which the authors linked beta blocker use to a lower risk of developing cognitive impairment.

To arrive at their conclusion, the authors followed for close to 6 years 854 men average 77yo at study entry to the Honolulu-Asia Aging Study.  All participants had hypertension but were without dementia or any cognitive impairment at baseline.  Those who were taking beta blockers had a 31% lower risk of developing cognitive impairment compared to those who didn't take any blood pressure medication.  So perhaps the benefit was due to lowering of hypertensive blood pressure?  However, in contradiction to previous studies, use of ACE inhibitors alone was not linked to benefit, nor were diuretics, calcium channel blockers, or vasodilators.

Two steps forward, one step back, right?  Was this study a fluke or a trend?  You decide after reviewing the earlier studies.  But more importantly, does this study apply to you?  Perhaps if you're an elder male of Japanese heritage as were these participants.  On the other hand, you might take a look at the bigger picture, which is that blood pressure lowering in general appears to be a good thing.



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Wednesday, October 23, 2013

Q&A Session at HealthTap.com

Hi. I am a teenager and have decided I will take steroids. What is the safest option?



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Does more body hair means more testosterone?



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How many mgs a day of clomid should men take to boost natural testosterone?



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