Doing It, or Not?
July 6, 2009 by Dr. Manny
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One reason—if not the main reason—we diet and exercise is that we want to look good to the opposite sex (or maybe the same sex).
And, of course, one reason—if not the main reason—we want to do that is to be attractive to our (real or imagined) sexual partner.
Now, what does any of this have to do with health, you wonder? The answer is, plenty. A healthy sex life improves your overall quality of life. It improves your immune system because it significantly relieves stress. Good physical exercise burns calories, and it improves your mood by pumping endorphins into your bloodstream that make you feel good. It also plays a key role in keeping couples together, so the benefits of sex are innumerable.
But once you get on into your forties, you might find your sex drive shifting into a lower gear. This diminished or lack of sex drive is more common in women than it is in men. Even men with erectile dysfunction usually have a normal sex drive. While libido problems can be either physical or psychological, the root causes tend to be the same in both sexes. Alcoholism is the main physical factor responsible for a decreased libido; another is drug abuse, of cocaine, for example.
Obesity and anemia are other potential physical problems. And there are certain tumors of the pituitary gland that increase the hormone prolactin, which lowers the libido. Some prescribed medications, especially antidepressants, lower the level of the hormone testosterone, which is needed by both sexes to maintain an adequate sex drive. Psychological factors influencing libido include depression, stress, and confusions about sexual orientation.
Anyone with a lack of sexual desire should first try to take these factors out of the equation. So if you’re drinking excessively, overweight, depressed, or taking medications, these issues need to be dealt with to resolve a flagging libido. Counseling can help with the psychological problems of sexual hang-ups, depression, or stress.
There is no magic remedy for the loss of sexual libido. Though testosterone has been identified as a key hormone that improves sexual appetite in women, doctors who have been giving women testosterone supplements for the past 30 years have found that it has little effect on their libido, while it sometimes causes facial hair growth, a deepened voice, and an enlargement of the clitoris.
I have no doubt that one day there will be a libido pill for women and men, as I’m sure the drug companies are hard at work on this potentially lucrative solution.
There are a number of other sexual problems that women may experience at any age. One is dyspareunia, or painful sexual intercourse. Any part of the genitals can cause pain during sex, including the skin around the vagina. Vaginal infections, like yeast infections or viral infections, are a common cause, and the pain can be felt when either a tampon or penis is inserted into the vagina. It can also occur from just sitting or wearing pants. To treat dyspareunia, physicians may recommend hormone creams, dilators to help stretch the vagina, Kegel exercises, or, in rare cases, antidepressants.
Another potential cause of dyspareunia is vaginismus, an involuntary contraction of the vaginal muscles that may prevent insertion of the penis during intercourse. The diagnosis of vaginismus is usually problematic because it’s often difficult to separate the physical pain with the emotional anxiety of experiencing that pain; in other words, just the fear of the pain can cause vaginismus.
Any woman complaining of these symptoms should be taken seriously. A doctor must conduct a physical examination to eliminate the possibility of such physical causes as infections, fibroids, or anatomical deformities of the uterus, ovaries, or vagina. Even vaginal dryness can cause painful sex. A decrease in estrogen at menopause can cause the vaginal walls to become dry, creating a discomfort or pain during intercourse.
If there are no treatable physical conditions, it’s important to discuss the woman’s feelings as well as the physical situations that lead to this type of discomfort. Some women have a very positive attitude toward sex; other women have had negative sexual experiences that play a significant role in their fears and negative feelings about sex.
Some women may have a history of sexual abuse, rape, or trauma, for instance; these things need to be identified in a very delicate way. Treatment of vaginismus usually involves practicing relaxation techniques and doing Kegel exercises to relax the vaginal muscles. At home, one exercise that may prove beneficial is to have your partner gradually insert a dilator into your vagina. This must be done at a pace with which you feel comfortable until the pain and discomfort are overcome. Partner, doctor, and patient all have to be in sync for this type of therapy to be successful.
Many women experience discomfort or pain at the time of their period. This pain is caused by contractions of the muscle of the uterus during menstruation that occur due to the release of the prostaglandins, which are hormones that are produced in the lining of the uterus. For most women these menstrual contractions are neither severe nor disabling. But some women experience significant menstrual pains called dysmenorrhea.
Women suffering from dysmenorrhea should exercise, get plenty of sleep, and avoid stress. Over-the-counter painkillers can minimize the amount of prostaglandins released, and they usually help reduce the pain. If the painkillers are not effective, your doctor will have to look for other things that are causing the pain. And ultrasound is sometimes used in such cases to make sure you don’t have any other medical conditions, like pelvic inflammatory disease, endometriosis, or fibroids.
Hypertension: The Silent Killer
June 23, 2009 by Dr. Manny
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Hypertension is known as the silent killer for good reason. Some 50 million Americans have high blood pressure and one-third of those don’t even know it, despite the fact that it’s very easy to diagnose.
Hypertension kills some 40,000 Americans each year, and another 200,000 die annually of a high-blood-pressure-related illness. People with hypertension are seven times more likely to have a stroke, six times more likely to have congestive heart failure, and three times more likely to develop a heart attack.
In all, hypertension claims more lives per year in the United States than cancer. Those numbers are doubly sad: first, because they are so high, and second, because they could easily be so much lower. More than half of the people with hypertension are not receiving treatment at all, and one-quarter of them are being inadequately treated. Only about one-fifth are receiving the proper treatment to control their blood pressure.
There are two types of hypertension. More than 90 percent of all cases of hypertension involve what is known as essential hypertension, which is high blood pressure without a definite cause. The rest, fewer than 10 percent of the cases, have a known cause; this is known as organic hypertension, or secondary hypertension. Organic hypertension occurs when a specific disease, such as a tumor of the kidneys, vascular disease, or hormonal disease, causes your blood pressure to be elevated.
When we talk about blood pressure, we are referring to a comparison of the blood pressure when the heart is beating versus the pressure when the heart is resting. A blood pressure reading is represented as the systolic (or beating pressure) over the diastolic (or resting) pressure. A normal blood pressure is anything lower than 120 over 80. But if you are 140 over 90 or above, you have high blood pressure. Anything in between the two sets of numbers is considered prehypertensive.
How can you tell you have high blood pressure? Certainly not by your symptoms; most people with hypertension don’t have any. But any qualified health professional can measure your blood pressure in a very non-evasive way using a blood pressure machine. Of course, if your blood pressure is very high, you will have symptoms like nose bleeds, irregular heartbeats, headaches, and dizziness.
Hypertension affects more males than females and more blacks and Latinos than whites. The lifestyle characteristics that can put you at risk of developing hypertension include obesity, lack of exercise, a diet rich in sodium, and excessive alcohol consumption. Smoking raises blood pressure as well. Genetic factors may be involved, too, as some individuals have a family history of hypertension.
In younger women, hypertension is sometimes associated with birth control pills. Other medications that can give you high blood pressure include some nonsteroid anti-inflammatories, cold remedies, decongestants, and appetite-suppressant pills.
Your diet plays a very significant role in blood pressure. Foods high in cholesterol thicken the blood with fat, and that forces the heart to work harder, thereby raising your blood pressure. As the heart works harder to push that blood through, the heart becomes larger because it has to expand more to grab enough volume in order to squeeze the blood out of its chambers. If the heart has to work harder, the heart and the arteries come under tremendous pressure and stress, and this, of course, weakens the heart. It also means that organs like the kidneys and eyes and liver don’t get enough oxygenated blood, which causes cell damage to those organs that ultimately damages them.
A high salt intake also makes you retain more water in your vascular system, and that, too, increases your blood pressure. To reduce your risk of high blood pressure, the American Heart Association (AHA) suggests that you ingest no more than 2,400 milligrams of sodium a day. That’s just one and a quarter teaspoons of salt per day, and it mounts up faster than you think; many foods, especially prepared foods, contain large amounts of sodium. And then there is all the salt we actually add to our food.
Being overweight is also a fundamental factor in developing high blood pressure. Conversely, losing weight is one of the essential ways of improving your blood pressure. Lack of exercise and physical inactivity is another risk factor for heart disease. This means that exercising will improve your cardiac performance, making your heart work better, thus lowering your blood pressure.
Stress has also been linked to hypertension: it narrows the blood vessels, thereby causing high blood pressure, so it is vital for people who have high blood pressure to learn how to manage their stress.
The treatment of high blood pressure involves making dietary changes, losing weight, lowering cholesterol, practicing relaxation and meditation techniques, and getting some exercise. If these don’t work, there are medications that can specifically target the kind of hypertension you have.
So how do we prevent high blood pressure?
Number one, watch your weight. If you are 30 percent above your ideal body weight, you’ve got a problem and are more likely to develop high blood pressure.
Second, if you’re drinking excessively—more than three hard drinks a day—this also is a problem.
Third, watch your salt intake; eat fewer processed foods. If you go out to eat, ask your wait person if the kitchen can reduce the amount of salt in your order. Eat a balanced diet. Consume foods that can help lower your cholesterol, like vegetables and grains.
Don’t smoke; nicotine is a major vasoconstrictor.
Exercise regularly; try to do 30 minutes’ worth of aerobic activities three to four times a week.
The bottom line on hypertension is to do your best to prevent it. If you can’t, identify it, and then treat it. Whatever you do, don’t become a statistic like so many other Americans.
Stress Levels Hurting Your Health?
June 23, 2009 by Dr. Manny
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Stress is our body’s ability to respond to our surroundings–how we react to our family, our work, and various events in our lives.
Stress is normal. Everyone is under some kind of stress—every day. But there are two kinds of stress: the good and the bad. Good stress can be something like getting a new job or buying a first home. Bad stress can range from experiencing a difficult financial situation to having a sick family member, to missing a flight to getting a flat tire in the pouring rain.
Short-lived stress rarely affects long-term health. But stress becomes a problem when it’s chronic and difficult to identify. Stress manifests itself through feelings of sadness, anxiety, anger, frustration, guilt, or excitement. Our mood starts to fluctuate. Some people drink or smoke; others opt for healthier outlets such as jogging. Some just go shopping.
Eventually, our body starts to ache here and there, first a little bit, then more and more. Those may seem like “phantom aches” at first, but as time goes by, they can become legitimate physical health threats. If left unchecked, stress can ultimately cause blood pressure oscillations and weaken the immune system, which makes us much more susceptible to illnesses that our body, under normal circumstances, would be able to fight.
People can eventually die from the effects of stress because, at the end of the day, those under stress are going to have more heart disease, more diabetes, more obesity, and more gastric problems like ulcers than people who are relatively stress-free.
One of the most severe types of stress is called post-traumatic stress disorder, or PTSD. PTSD is a psychiatric disorder that occurs after experiencing an extremely stressful situation or witnessing a life-threatening event, like a terrorist attack, a violent personal assault, or a natural disaster.
People suffering from PTSD have symptoms that include flashbacks, difficulty sleeping, mood changes, depression, and the inability to deal with everyday life. These are not those nutty people walking around in ripped and filthy clothes, talking to themselves and their imaginary friends. They are fully functional people, people like you and me, who may be stressed out by the daily media reminders of kidnapped children, serial killers, and sexual abuse. And oftentimes, these people don’t even know they have PTSD.
–Do you tend to race through the day, do everything yourself, and set unrealistic goals?
–Do you make a big deal of everything, blow up easily, and get angry when kept waiting?
–Do you frequently neglect your diet, exercise, and your sleep?
–Do you lack close, supportive relationships outside your family?
–Do you often fail to see the humor in situations that others find amusing?
–Do you ignore symptoms of stress and have no time for questions like this?
If you answered yes to most of these questions, chance are you are STRESSED OUT. Do something about it.
It’s important that you take stress seriously and learn how to handle it.
First, recognize the signs and acknowledge them.
Second, ask yourself: Am I leading a healthy life, exercising, not abusing drugs, including cigarettes and alcohol? If not, you have to make some lifestyle changes. The solution, many times, is right in front of you. But for the most part, if you recognize stress as something that is out there, and if you’re able to manage it adequately, it will have no dire effects on your health. It is only when you ignore it and it becomes chronic and unstoppable that you need to seek professional help.
