Tweet
Saturday, August 4, 2012
Q&A Session at Avvo.com
Are there any supplements that I can take with androderm 4mg to speed up feeling better?
Follow @alvinblin
Tweet
Tweet
Friday, August 3, 2012
Fall Risk vs Major Bleeds While Anticoagulated
Could it be that, counter-intuitive as it may be, falling does not make an impact on risk of major bleeding (however you may define this)? In a prospective cohort study published in this month's American Journal of Medicine, the authors concluded that use of oral anticoagulation did not increase the risk of major bleeds in those patients at high risk for falling when monitored over the next 12mo.
Bottom line, risk of falling has no impact on bleeding risk so given this current study & others, we need to avoid using fall risk as an excuse to avoid anticoagulation. High risk HAS-BLED score exceeding CHA2DS2-Vasc score, I can understand. But otherwise, we need to give our patients the best chance to avoid function loss (while not exposing them to excess bleeding risk).
Tweet
Thursday, August 2, 2012
Better Vision = Lower Fracture Risk
As much as I try to ignore it, I'm getting older. I put on old monovision prescription contact lenses yesterday morning while in a rush. If ever I needed proof that I have presbyopia, I got it in spades. My arms just weren't long enough for all the fine print & paperwork that I had to deal with. Initially, I wasn't convinced a few months ago but I guess those bifocal contact lenses really do work!
I mention this because one of the risk factors for falls in the elderly is poor vision. Well, in a retrospective study published in JAMA yesterday, the authors concluded that those elderly who underwent cataract surgery had a lower risk of hip fracture compared to those w/cataracts who did not have surgery.
The authors arrived at their conclusion by looking at a random sampling of 5% of Medicare beneficiaries and locating 1,113,640 w/cataracts. They then compared those who'd undergone cataract surgery to those who hadn't, specifically with regards to hip fracture in the subsequent year. Notably, they found a 16% reduction in risk in those who underwent cataract surgery compared to those w/cataract but elected against surgery.
Tweet
Wednesday, August 1, 2012
Competitive Cycling: Not So Good for Female Genital Structures Either
In women's road cycling, the individual time trial final is sometime today. Just as with any sport, you can drop some serious cash on equipment, what with aero rims, carbon fiber frames, lightweight components, etc. If you think back a few years, the saddle was the topic du jour for the men as seat (time) was linked to erectile dysfunction. Obviously, it's a bit more complicated than that as manufacturers attempted to come up with all manner of saddle options to address this new issue.
In fact, the worse position was described as handlebars positioned lower than the saddle or vice versa, the saddle elevated above the handlebars. Either way, the authors noted increase in perineal pressure & decrease in genital sensation in 48 female competitive cyclists who rode at least 10 miles/week 4 weeks/month.
Tweet
Tuesday, July 31, 2012
Diabetes Affects Female Sexual Function
I'm a guy, so I think a lot about sex. I'm also older, so I don't think about sex as much as I once did in my youth, say only once every 5 minutes these days. Given my predilection towards posts on male sexual function, one might think that I'm a misogynist. Far from it (I hope!) as I think I'm more a typical physician: we address issues for which we have (easy) solutions. We never really talked about depression until the SSRIs hit the market. We never spoke about urge incontinence & overactive bladder until we developed viable antimuscarinics. And we never asked about erectile dysfunction until the PDE-5 inhibitors arrived.
Luckily, we now have validated questionnaires with which to assess female sexual function, for instance the Female Sexual Function Index, which was used in a study published in next month's Obstetrics & Gynecology, commonly referred to as the Green Book. The authors concluded that women w/diabetes are more likely to report lower overall sexual satisfaction. In fact, insulin use was associated w/difficulty w/lubrication & orgasm.
Bottom line: because this was an observational study and clearly not a randomized controlled trial, we can only develop hypotheses from the conclusions, rather than draw causal relationships. However, given that diabetes has a cause & effect relationship w/heart disease, stroke, kidney disease & peripheral neuropathy, it's not a big stretch of the imagination to add female sexual function to the list of reasons why women need better glycemic control. And while we wait for such a randomized, double-blind, placebo-controlled trial, we can still advocate for better control on the basis of better health outcomes plus the possibility of an added bonus.
Tweet
Monday, July 30, 2012
Guys, Lower Your Heart Disease Risk & Improve Your Erections
Well, I've been pointing out the proof in the pudding w/numerous studies demonstrating how physical activity lowers our all-cause mortality. But apparently that's not enough motivation. So I'd like to point out a review article published last November in the Archives of Internal Medicine directed at male readers (and those whose partner(s), friends & family members are male) in which the authors concluded that lifestyle modifications to reduce cardiovascular risk factors improve sexual function in men w/erectile dysfunction. Use of statins to lower cholesterol also led to improvements in sexual function.
However, it should be noted that this meta-analysis demonstrates one of those statistically significant but not necessarily clinically significant results. For instance, while 4 points' change is clinically significant, the sum of lifestyle & medication to reduce CV risk resulted only in a statistically significant 2.7 point improvement. When analyzed separately, lifestyle alone led a 2.4 point improvement while medication (statins) led to a 3.1 point improvement, both statistically significant but not necessarily clinically so.
Bottom line: don't just sit there, do something (whether you're watching the Olympic games, NFL, NBA, NASCAR, MLB, whatever)!
Tweet
Sunday, July 29, 2012
Subscribe to:
Posts (Atom)