Housecall with Dr. Denise
urban NDN - August 2008 - issue 3
My 62 year-old grandpa has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Your grandpa is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your grandpa’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your grandpa visit his physician to be examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your grandpa not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember: your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Take care, and mind your health! Meegwetch!
Showing posts with label Housecall with Dr. Denise. Show all posts
Showing posts with label Housecall with Dr. Denise. Show all posts
Saturday, August 23, 2008
Wednesday, July 23, 2008
A Kookum Has an Embarrassing Question
Housecall with Dr. Denise
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis and possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
I have a new sexual partner who told me to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis and possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
I have a new sexual partner who told me to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
Monday, June 23, 2008
Loving in a Dangerous Time
Housecall with Dr. Denise
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
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