Obstetrics & Gynecology in Augusta, GA
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Is Health Care Reform Really Necessary?

    Health care reform is about as hot a topic as pepper sauce on Texas armadillo meat.  The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform.  It is politically and philosophically prudent to be on the side of some type of change in the health care system.  No one disagrees that the system is unsustainable in its present configuration.  I concur that the situation is dire; the patient is in cardiac arrest and something has to be done.  However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over.  I realize that sounds somewhat contradictory – simpler yet impractical – so let me explain.

    First, it is important to understand that we have two separate but intertwined problems: health insurance and health care.  As I am not an insurance expert so I will only opine about health care.  We will never cure this country’s ills without a strong dose of personal responsibility.  The government, politicians, insurance magnates, and even doctors are not only inadequate to change the system but incapable of effectively bringing about change because the change has to begin from within.  It has to come from the individual; the man in the mirror.  The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or lack of insurance; it is people not choosing to live their lives in a healthy manner.  Until we as individuals start adopting the things we know to do to stay healthy, we will persist as a nation in need of sick care delivery instead of health care. 

Part of the problem is one of education.  For example, many feel that getting regular mammograms and doing self-breast exams are excellent preventive tools for breast cancer.  They are not!  They are simply tools of early detection. The cancer already exists when the utility of mammograms and self-breast exams are realized.  These tools prevent nothing other than higher morbidity and mortality, which is a good thing!  But we have to move back one level if we are to prevent breast cancer.  For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat, can reduce the occurrence of breast cancer 40%!  Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer.  Are mammograms and self-breast exams important?  Of course, they are, but our focus should not only be on early detection but also prevention.  There are multiple factors that go into disease development, many of which we don’t understand.  My point is that, in general, a skinny vegetarian has a lower incidence of breast cancer than an overweight couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.

Another example from the field of women’s health is cervical cancer.  The Pap smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus.  Pap smears can pick up changes in the cervical cells long before they develop as a cancer, but the Pap only detects the changes once they are there.   Two things can prevent HPV infection (and thereby most cases of cervical dysplasia): an HPV vaccine and monogamy.  Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer.  Again, prevention is different from early detection.  If you want to prevent cervical cancer, develop effective programs supporting vaccination, abstinence, and monogamy.  How many politicians are willing to handle that hot potato? 

     These are but two examples illustrating that the answer to our health care crises begins at home.  Providing health insurance to everyone will only reduce the number of uninsured, a noble undertaking, but it will do little to solve the problem of reducing and preventing disease.  At the beginning of this diatribe I stated that the answer was simple; personal responsibility.  I also said it was impractical.  An individual has every right to live the life they choose.  I have no moral authority to tell anyone that they must stop smoking, for example.  They choose their lifestyle, but they, in turn, must take responsibility for their actions.  Here is where the hypocrisy arises.  We clamor for personal rights but we cower from accepting personal responsibility.  Do we as a society have a moral imperative to take care of the sick and helpless?  Absolutely!  But that is paralleled by a moral responsibility of the individual to make decisions that improve their health.  I am my brother’s keeper, but in turn, it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.

    Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.                 

Diabetes and Sex

Distressed Desire

Diabetes and Sex

After the publication of my book, A Woman’s Guide to Hormone Health, I had the opportunity to speak around the country to audiences of women about some very “feminine” subjects.  I was in San Diego speaking to a group called The Red Hot Mammas (sort of a cross between a menopause support group and a motorcycle gang) and during the question and answer session a grandmotherly octogenarian sheepishly raised her hand and asked, “Doc, my sex drive has driven off and I don’t have a map!  What do I do?”  I heard an audible “thank goodness” from several other folks in the audience as they wanted to ask the same question but didn’t have the courage of my blue haired inquisitor.  Over the ensuing years I don’t think I have ever hosted a forum where this topic didn’t raise its libidinous head.

Next to questions about losing weight, a declining or absent sex drive is one of the top complaints heard in gynecologist’s offices nationwide.  A recent report from the National Institutes of Health states that 43% of women will experience some form of sexual dysfunction at sometime in their life.  A majority of these problems, especially in perimenopausal and menopausal women, is a lack of desire.  Loss of libido is defined by the Diagnostic and Statistic Manual (the book doctors use to categorize diseases) as “persistently low sexual desire resulting in distress or relationship dysfunction, where lack of desire is not due to another condition or circumstance.”  There are two important parts of this definition that are cogent to understanding the causes and treatments of this problem.  First, the lack of desire must cause a problem either in the person’s psyche or in their relationships.  So, for example, a woman with a low desire who is purposefully abstinent may not view that lack of desire as bothersome.  Secondly, the low libido should not be due to a physical problem or medication.  A common example of this in the menopause is the woman who experiences pain with intercourse due to vaginal changes in lubrication.  It only makes sense that if it hurts, consciously or unconsciously, you are going to avoid intimacy like Republicans avoid taxes.  Also various medications can have libido squashing side effects.  For example, many of the anti depressants such as Prozac and Zoloft can flatten libido like a steamroller on asphalt.

The causes of a low or non-existent sex drive are legion, but they can generally be divided into four categories: physical, psychological, relationship, and hormonal.

Physical reasons include many nonsexual diseases such as arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.  Think of poor sex drive as side effects of these disease processes, and often once the physical malady is remedied, the libido returns.  In addition, a glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive.  Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex.  A huge secondary cause is fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.

I already alluded to the role of hormones, and any major hormonal shift such as menopause, pregnancy, and breast feeding can affect desire.

There are many psychological causes of low sex drive such as anxiety, depression, poor body image, low self-esteem, and a history of physical or sexual abuse.  One of the most overlooked but common causes of poor libido is stress.  This can be stress related to work, finances, kids, or just life.

We all know that much of a satisfying sex life originates as much above the neck as it does below the waist; therefore, relationship issues are huge in dissecting libido malfunction.  For many women, emotional closeness is an essential prelude to sexual intimacy. If you are having problems between the sheets, don’t pull the covers over your eyes!

So what can be done about this tsunami of libido lack?  Obviously if there is an underlying issue, such as medications or hormone problems, they must be addressed first and often sex drive creeps back.  If stress and relationship issues are paramount then talking with a counselor skilled in addressing sexual concerns can help with low libido. Therapy often includes education about sexual response, techniques, recommendations for reading materials, and couples exercises.

  In women suffering from painful intercourse, vaginal estrogen may markedly improve vaginal elasticity, lubrication, and response. Testosterone, present in females at a much lower concentration than males, has a libido enhancing effect for women; however, testosterone supplementation is controversial and should be closely regulated by a knowledgeable clinician.

It is critical to remember that libido can’t be separated from the context of a relationship. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.

Don’t go gently into that dark night

    The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully passing away. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today!  The seventy-five and older age group is the fastest growing segment of our population.  These are folks who are not satisfied with the status quo.  They are not happy to go gently into that good night.  We (and I must include my rapidly aging self) want to grow old with gusto.  We want to come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us.  We want to age without becoming aged!

   In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”.  They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”.  In other words, they lived to the max and then had a rapid demise. 

     One of their key points was that there was not a way to prevent aging or reverse the aging process.  Human’s will always age, that is a given of biological and cellular processes.  The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging.  The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”.  We tend to think of this as aging gracefully, yet I believe that is much too passive.  We must, as the study found, take an active role in doing some things and avoid doing other things.

     So what did these scientists conclude?  They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life.  It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled.  They further defined active engagement as having relationships with people and behavior that is productive.  They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics. 

   The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained.  For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.

  Here are my top ten keys to successful aging culled from the MacArthur Study and my own research.

   1. Exercise.  Whether you are 10 or 100, exercise is the key to getting and staying healthy.  Surprisingly the studies indicate that only a minimum of exercise (20-30minutes a day) can have a marked effect in lowering your risk of a number of diseases such as cancer, diabetes, and hypertension.

2. Get regular check ups.  One of the secrets to successful aging is either preventing risk factors or identifying problems very early.  Both of these tasks are facilitated by regular exams.

3.  Stay current on routine screenings.  Somewhat linked to regular checkups, availing yourself of things like mammograms, Pap smears, prostate exams, colonoscopies, bone densities, and blood screenings can be a lifesaver and allow you to enjoy a disease free old age.

4. Don’t smoke.  Enough said.  You would have to be a total fool to not realize the damage that this does to your system.

5. Take an aspirin a day.  The evidence is mounting that a 61 mg aspirin a day can reduce the incidence of heart disease, stroke and colon cancer, especially in older folks.  Remember that some people should not take aspirin, so check with your doctor before starting something new.

6. Get appropriate vaccines.  For older folks the pneumonia and flu vaccines are important as these infections are responsible for thousands of deaths every year in people over 65.

7. Eat fewer total calories.  The studies are conclusive that decreasing your total calorie intake is associated with lower rates of disease and longer lives.  Specifically try to increase the protein and reduce the fat, but keeping the overall amount of calories lower is the most important guideline.

8. Develop social networks.  As the song goes, people who need people are the happiest (and healthiest) people.  An expanding network of family, friends, church membership, and social activities have all been associated with longer, less sickly aging.

9. Stay mentally engaged.  Retire only if you must and if you must, find something else to keep you mentally active and challenged. 

10. Be continually productive.  By that I mean participate in either voluntary or paid activities that generate goods or services of economic value.  That is a broad calling, but studies indicate that those who continue to find purpose, find health.   

     Remember, the goal is not just to live long, but to live long and well!

    

Estrogen and the brain women's health Augusta, ga

Estrogen and the Brain

A middle aged woman came into my office the other day telling a tale of woe that sounded like a bad country song.  Her husband was fooling around, her son was in prison, her daughter was pregnant, and her dog had the mange!  She said she was depressed and then commented, “I suspect it’s my hormones.”  I looked at her incredulously and told her it had nothing to do with her hormones. It was her life!

Hormones, or lack thereof, have been blamed for everything from hot flashes to homicides.  While the mystery of female hormones in particular are ripe with misinformation, we are learning every day of the impact of estrogen, progesterone and testosterone on the female body and mind.  In previous columns I have expanded on the use of hormones in the menopause, the impact on PMS, and the importance in PCOS but I want to address some recent findings on the amazing interaction of estrogen in particular on the female brain.

A study out of the University of Southern California has come to the conclusion that women have better brainpower after menopause if they had their last baby after age 35, used hormonal contraceptives for more than 10 years, or began their menstrual cycle before turning 13.  For years obstetricians have talked of the risks involved with having a baby after 35, yet over the past decade the number of women giving birth in their third and forth decades has dramatically increased.  Now this study helps offset many of those fears by reassuring women that if they are older mothers they may actually be smarter later in life!  Roksana Karim, lead author of the study and assistant professor of clinical preventive medicine at the Keck School of Medicine of USC, states, “the study provides strong evidence that there is a positive association between later age at last pregnancy and late-life cognition.”

The authors speculate that this effect is due to surges of estrogen and progesterone experienced by mothers during pregnancy.  Interestingly, this beneficial effect seems to exists for women who had additional estrogen exposure during various times in their life, like with birth control pill use and early onset of puberty.  Much has been made of the known risks of prolonged estrogen exposure like breast cancer and uterine cancer, but the effect of estrogen on the brain has been less publicized. 

Estrogen has long been known to effect such brain functions as memory, mood, and mental state, showing, in many incidences, a profoundly positive impact.  For example, there are noted to be many estrogen receptors in  the areas of the brain responsible for memory and both naturally produced estrogen and estrogen taken as a medication has been shown to improve memory.  Some of the most exciting research to date is looking at the impact of estrogen in reducing the onset or progression of neurodegenerative diseases like Alzheimer’s and senile dementia.  It is way to early to make any assumptions about using estrogen therapeutically for these problems, but it looks promising.

Don’t worry guys, what is fascinating about some of this research is that the positive effect of estrogen on brain function applies to males also.  In rat and monkey models, aging males given estrogen showed improvement in mental functioning and a decrease in brain cell deterioration.  Granted, there are a number of problems associated with men using estrogen, so the hope is that the research will lead to the development of treatments that will maximize the benefits and minimize the downsides.

Whenever hormones are often touted as a treatment for anything, caution is to be advised.  These are powerful substances that have multiple and profound effects on many body systems.  All we have to do is look at relatively recent past history to understand the consequences of acting too aggressively.  In the 50s and 60s estrogen was marketed as a “feel good” pill that kept a woman sexy and young for decades.  Only later did we learn of the risks involved, and as a result many women developed diseases as a direct result of unopposed estrogen use.

I’d like to think that medical researchers and clinicians are wiser today and are looking at these exciting developments through the lens of unintended consequences.  If there is a way to improve memory, reduce dementia, help depression, and decrease the incidence of Alzheimer’s disease using estrogen, then full speed ahead with the caveat that the negative side of the equation be adequately explored.

As we all learned in medical school, “First, do no harm.”    

Save

Human Body

Be Thankful and Be Amazed

body   

We take a lot for granted.  In these months devoted to celebrations and new beginnings, take a moment and ponder your own amazing human body.  Now many of you may wish you had a sturdier chassis, a bigger motor, a smaller bumper, or a flashier exterior, but the reality is that the model you operate within is nothing short of extraordinary.  Consider the following:

  • The average human brain has about 100 billion nerve cells.
  • Nerve impulses to and from the brain travel as fast as 170 miles per hour.
  • Your stomach needs to produce a new layer of mucus every two weeks or it would digest itself.
  • It takes the interaction of 72 different muscles to produce human speech.
  • The average life of a taste bud is 10 days.
  • The average cough comes out of your mouth at 60 miles per hour.
  • Relative to size, the strongest muscle in the body is the tongue.
  • Human thigh bones are stronger than concrete.
  • Our eyes are always the same size from birth, but our nose and ears never stop
  • growing.
  • The average human blinks their eyes 6,205,000 times each year.
  • Your skull is made up of 29 different bones.
  • The average surface of the human intestine is 656 square feet .
  • 15 million blood cells are destroyed in the human body every second.
  • The average human will shed 40 pounds of skin in a lifetime.
  • Every year about 98% of the atoms in your body are replaced.
  • Every human spent about half an hour as a single cell.
  • There are 45 miles of nerves in the skin of a human being.
  • The average human heart will beat 3,000 million times in its lifetime and pump 48
  • million gallons of blood.
  • During a 24-hour period, the average human will breathe 23,040 times.

As a physician I am perpetually in awe of our incredible body.  Even when it doesn’t function well, such as in disease, it has an uncanny ability to attempt to rectify the malady.  While the rest of the universe spirals away towards increasing chaos and entropy, the human body strives for homeostasis.   Modern medical and scientific research has explained many of the previously unknown mechanisms driving this tendency towards self preservation; however, there is still a vast depository of components and interactions that are still wrapped in a cloak of mystery.  Even knowing how something works on a cellular level, like the immune system or the blood clotting cascade, can only give one pause to contemplate the precision and perfection it embodies.

Understanding the physical properties and dynamic interaction of our body is only a small part of what makes us human.  We are so much more than our physical beings.  The mind and spirit of each person is so amazingly unique and pervasively interactive that they have to be praised and acknowledged along side the biochemistry.  Ever since man could ponder he has speculated about this interaction between mind, body, and spirit and those much wiser than I conclude that this triumvirate so intertwined as to be enmeshed.   The only logical conclusion is that true health is a balance of these three entities.  You can be physically fit but emotionally tattered, or you can be a spiritual giant and physically decrepit.  To fulfill the miracle that is your health, a balance must be achieved.

The ancient Greeks knew that balance was the ideal.  Socrates, prior to his Hemlock cocktail, said, “Everything in moderation,  nothing in excess.”  This advice is often overlooked in our contemporary society where we are often defined by our excesses.  Get more bling – run farther – close more deals – take more vitamins – all promulgating the idea that more is better.  It’s not, especially when it comes to your health.  For example, eating balanced meals of moderate calorie intake is more healthy than either eating too much, too little, or too restrictively.  It is hard for me to accept, but even exercising to an extreme can have some negative consequences.  Severe emotional extremes, high highs and low lows, is actually a psychological disorder. Embracing balance is the best way to allow mind, body, and spirit to flourish.

Let me give you a personal example to illustrate this point. I like to run marathons and, in the midst of training, inevitably I will come down with a cold.  This happens almost always after a long training run when my body hasn’t had a chance to recover and it’s resources are devoted to damage control instead of immune surveillance.  A healthier approach would be to take the necessary rest days between long training runs to allow my body to compensate.  Sometimes taking my own advice is akin to getting a root canal with pliers!

For many, good health is a choice.  Choose wisely.

Diabetes and Sex

Diabetes and Sex

Diabetes and SexHere is some more uplifting statistics.  Women who have had gestational diabetes or have given birth to a baby weighing more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.  The prevalence of diabetes is at least 2 – 4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with ag e. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing.

     And to top all this off, when glucose isn’t under good control, a woman’s sex life can suffer.  If your sugar is up, your libido may be down!  Most of us associate diabetes and sexual problems with hubby, and indeed it is (hence all the TV commercials), yet women are effected, albeit somewhat indirectly also.  Diabetes educator Ann Albright, PhD, RD says, “It’s not diabetes per se that harms your intimate life. It’s the complications of uncontrolled blood sugar levels that cause problems for both men and women — the only difference is that many women simply aren’t as aware of this complication as men are.”

This problem was not widely recognized until a landmark study in 1971 showed, “35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn’t have diabetes.”  The mechanism was thought to be a decreased lubrication that may arise from elevated blood sugars.  This dryness may mimic what is commonly seen in menopause where lubrication also declines which results in decreased sensitivity and even pain with intercourse. Let’s face it, if it hurts it’s hard to find pleasure.

Another area affected is the tiny blood vessels that supply the vaginal and vulvar area, especially in the region of the clitoris.  These vessels can become damaged by high sugars and limit the sensitivity and response from these areas.  This results in both a decline in response but a definite decrease in desire.  Prolonged elevation in blood glucose can also lead to nerve damage called neuropathy and this can also affect the pleasure sensation.

Women with diabetes are also prone to two types of medical problems that also can interfere with intimacy: Yeast infections and urinary tract infections.  Whenever I see a patient with recurring infections, I always check for diabetes.  Frequent infections can make sex uncomfortable and unfortunately the longer you go without, the more painful it may be to resume.

Dr Albright also reminds women that “The demands of the diabetes itself can affect you emotionally and if you’re a woman the stress of those demands is simply more likely to play out in the bedroom.”

So what is a woman to do?  If you think this may be an issue with you, talk about it.  Not to just anybody of course, but mainly your husband and especially your doctor, both your internist/endocrinologist and your gynecologist.  Many of the problems can be reversed by better sugar control.  There are both over the counter and prescription medicines that can enhance lubrication and increase tissue sensitivity.  If you are having problems between the sheets, don’t pull the covers over your eyes!  Remember, sexual functioning and libido are complex and multifactorial so focus on the big picture, get it out in the open, and ask about solutions

aging successfully

How to Age Successfully

The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully dieing. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today!  The seventy-five and older age group is the fastest growing segment of our population.  These are folks who are not satisfied with the status quo.  They are not happy to go gently into that good night.  We (and I must include my rapidly aging self) want to grow old with gusto.  We want to come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us.  We want to age without becoming aged!aging successfully

      In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”.  They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”.  In other words, they lived to the max and then had a rapid demise.

One of their key points was that there was not a way to prevent aging or reverse the aging process.  Human’s will always age, that is a given of biological and cellular processes.  The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging.  The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”.  We tend to think of this as aging gracefully, yet I believe that is much too passive.  We must, as the study found, take an active role in doing some things and avoid doing other things.

So what did these scientists conclude?  They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life.  It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled.  They further defined active engagement as having relationships with people and behavior that is productive.  They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics.

The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained.  For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.

Here are my top ten keys to successful aging culled from the MacArthur Study and my own research.

1. Exercise.  Whether you are 10 or 100, exercise is the key to getting and staying healthy.  Surprisingly the studies indicate that only a minimum of exercise (20-30minutes a day) can have a marked effect in lowering your risk of a number of diseases such as cancer, diabetes, and hypertension.

2. Get regular check ups.  One of the secrets to successful aging is either preventing risk factors or identifying problems very early.  Both of these tasks are facilitated by regular exams.

3.  Stay current on routine screenings.  Somewhat linked to regular checkups, availing yourself of things like mammograms, Pap smears, prostate exams, colonoscopies, bone densities, and blood screenings can be a lifesaver and allow you to enjoy a disease free old age.

4. Don’t smoke.  Enough said.  You would have to be a total fool to not realize the damage that this does to your system.

5. Take an aspirin a day.  The evidence is mounting that a 61 mg aspirin a day can reduce the incidence of heart disease, stroke and colon cancer, especially in older folks.  Remember that some people should not take aspirin, so check with your doctor before starting something new.

6. Get appropriate vaccines.  For older folks the pneumonia and flu vaccines are important as these infections are responsible for thousands of deaths every year in people over 65.

7. Eat fewer total calories.  The studies are conclusive that decreasing your total calorie intake is associated with lower rates of disease and longer lives.  Specifically try to increase the protein and reduce the fat, but keeping the overall amount of calories lower is the most important guideline.

8. Develop social networks.  As the song goes, people who need people are the happiest (and healthiest) people.  An expanding network of family, friends, church membership, and social activities have all been associated with longer, less sickly aging.

9. Stay mentally engaged.  Retire only if you must and if you must, find something else to keep you mentally active and challenged.

10. Be continually productive.  By that I mean participate in either voluntary or paid activities that generate goods or services of economic value.  That is a broad calling, but studies indicate that those who continue to find purpose, find health.

Remember, the goal is not just to live long, but to live long and well!

Five ways to jumpstart your love life

Libido or sexual desire is a complex drive that doesn’t lend itself to quick fixes.  Because it is so multifaceted; however, it does lend itself to a variety of behaviors that may enhance an individual’s sexual appetite.  Not all of these will work for everyone, but most will at least see some improvement if adopted.

Exercise.

Studies that have looked specifically at libido and physical activity show a very positive correlation.  Simply stated, the more you move, the more you can improve your sex life.  This encompasses many aspects of low desire such as poor health, lack of energy, and emotional stress.  Physical activity can help alleviate many of the causes of a low sex drive, so it acts in a domino effect: exercise improves some factors that lower libido thus indirectly improving your love life.  And it doesn’t mean that you have to suddenly train for a marathon (actually too much exercise can have a negative effect) but simply walking 45 minutes a day is enough to get your groove back!

Take a look at your medicines.

A surprising number of medications can markedly affect sexual desire.  A prolific example is a class of medicines known as the SSRIs.  This includes such antidepressants as Zoloft, Prozac, and Paxil, as well as others.  These medicines can damper desire in up to 50-60% of folks who take them, many of which were completely unaware of this side effect.  The good news is that often there are substitute medicines that can help with the depression but have less of an effect on libido.  Other medications that can effect both desire and function are  blood pressure meds (B blockers) and antihistamines.  An important category to consider, especially for women, is birth control pills.  Many of these formulations cause the liver to produce a protein that binds up testosterone, the female hormone that contributes to desire,  thus making less of it available to stoke the fires.  Some pills are less likely to do this than others, so it’s worth looking at your options if this is a problem.

Get happy.

A massive number of people who suffer from depression, anxiety, and other mood disorders experience a poor sex drive.  The relationship between your mental functioning and libido is complex, but remember that how you feel emotionally can drastically effect your desire.  There are physiological as well as psychological reasons for this but the bottom line is that as you improve in your mental functioning, often you improve in libido.  Noting that some anti depression meds can inhibit libido, sometimes this improvement can be masked or erased, yet there still is a positive connection between improved mood and improved desire.

Get a good night’s rest.

This may be counterintuitive as most sexual activity occurs in bed at night, but studies have shown that fatigue is one of the greatest inhibitors of libido, and one of the greatest influencers of fatigue is poor sleep.  People who get restful sleep are more likely to have an improved mood as well as more energy, both of which can enhance desire.  One caveat however is that those who use chemical sleep aids generally don’t see as much an improvement, even if they seem to sleep better.  It probably has to do with the medicines themselves having a bit of an inhibitory effect and not so much with the quality of sleep. The truth remains that a regular good night’s rest may provide the energy and desire for a healthy sexual appetite.

What? Yes, talking with your partner about life, love and everything in between helps libido.  Anything that fosters a sense of intimacy can have a profound effect on desire.  Some experts speculate that they can tell a lot about a relationship by the quality of their sex life, and this goes back to communication, trust, respect, and self esteem.  Probably the most important of those variables, as it relates to libido, is communication.  That is the fulcrum upon which the others turn.  With regular intimate communication couples can foster many of the settings in which desire can be translated into action.  Likewise, poor communication can kill the mood quicker than an Adam Sandler movie.  You communicate with words and actions, so be in tune with your partners needs and express that understanding and watch the sparks fly. 

   

Ten Commandments of Good Health Part 2

Commandment Six
You Shall not Self-destruct:
How You Think Can Keep You Healthy

At times we can be our own worst enemy. Just as it is vital to know what to do, it is almost as important to know what not to do. Seven of the top ten causes of death are accurately described as lifestyle illnesses. This means they are largely triggered by actions and choices. In terms of our health, genetics loads the gun, but behavior pulls the trigger. The top offenders are cigarettes and alcohol, yet more insidious behaviors such as sexual promiscuity and the spread of life threatening sexually transmitted diseases have to be brought into the forefront of the discussion. For the first time in history, our daughters, in particular, are faced with behavioral based diseases that can result in cancer and death at an early age. The epidemic of such STDs as Human Papilloma Virus is no longer simply an embarrassment or inconvenience; it can kill. Choose to avoid behaviors that can significantly increase your risk of illness. This should be appreciated not as restrictions but as opportunities to make wise choices that can have lasting benefits.

Commandment Seven
You Shall Not Fear Cancer:
Simple Steps to Reduce Your Risk

The word itself, cancer, creates a blanket of fear that can smother the most stoic and strong. In particular, breast and ovarian cancer concerns dominate the thoughts of women especially those saddled with a strong family history of either disease. The good news is that seven of the top ten risk factors for these cancers are controllable. There are steps that every woman can take to reduce their risks up to 50-60% of ever hearing the words, “You have cancer.” In the end, we all are at some risk of an aberrant cell forgetting how to stop growing, but it seems only logical that anything we can do to reduce the risk is a good thing. It is, indeed, a good thing to lower chances, especially if doing so also leads to looking better, feeling better, and acting better.

Commandment Eight
You Shall be Heart Healthy:
Just Say No to Heart Attacks and Strokes

Heart disease and stroke combined are the leading killers of women over the age of fifty. Cutting edge research is shedding new light on factors that influence heart heath specifically in women. For decades studies on heart disease and stroke looked almost exclusively at males, assessing risks and treatments. Only in the past decade has medical researchers acknowledge that women are different when it comes to their characteristics and proclivity towards cardiovascular disease. Hormones (both intrinsic and extrinsic), diet, cholesterol levels, and blood pressure are a few of the areas of special note in designing a specific plan for heart health.

Commandment Nine
You Shall Drink…Water:
The Real Fountain of Youth

The human body is anywhere from 55% to 78% water, and virtually all body systems rely on adequate hydration for proper functioning. A leading cause of morbidity is moderate, chronic, inadequate fluid intake. Myths abound regarding the safety and contamination of tap water supplies. The “six to eight glasses of water” mantra we all know and never do is nevertheless true. Our bodies enjoy a well designed, miraculous constitution, but it is our responsibility to be good stewards of this gift by filling it with the “elixir of health”: water.

Commandment Ten
You Shall Worship:
God Wants You to be Healthy

Studies have shown that regardless of your religious affiliation, folks who worship God in whatever fashion are healthier. This basic act of obedience not only fulfills one of our inherent purposes, but also has been shown to be good for our health. Cutting edge research from such institutions as Duke University and Harvard Medical School show the surprising health benefits of worship. Obviously this is not the purpose of worship, and it has been shown that those who practice false religious piety don’t exhibit the same benefits as those who display intrinsic religiosity. Praise and adoration is an end in itself, but it is characteristic of God to add a wonderful “side effect” to worship like improved health. Worship in its many iterations ties together many of the other nine commandments and creates an environment for health and healing. There is no right or wrong way to worship; no template for healing. It is shown that any heart felt act of praise and obedience can result in a harmony of wholeness.

In this turbulent time of change, one thing remains constant; your health is largely a choice. More importantly the health of your family is a legacy that will either bless or afflict those for generations to come. With the full understanding that new resolutions are kept for an average of 36.4 seconds, I challenge you to make 2016 the year of the health nut. Be abnormal! Get healthy!

Ten Commandments of Good Health


Many years ago a desert dweller climbed a mountain and talked to a bush on fire.  What resulted was a set of laws that was to revolutionize mankind’s behavior.  These were not ten suggestions formulated by a long range planning committee nor were they ten proposals put forth by a strategic consultant, they were commandments from a Holy God.  These laws have become almost universally accepted, even by divergent religions, as wise and worthy of adopting. 

     With all humility and a sincere desire to be unpretentious (I am not even worthy enough to scrape the grasshoppers from Moses’ designer goat skin sandals), I propose the Ten Commandments of good health to serve as a lamppost for your journey down fitness lane.  It seems unfair to hurry through these guidelines, so I will opine in both this month’s and next month’s column to cover them all.

                                                      Commandment One

You Shall Exercise:

Live Longer, Reduce Stress, and Grow Your Brain

     Exercise is the elusive fountain of youth.  If you are heavy, harried or hormonal, moving with purpose is a critical part of the solution. Everyone knows exercise is good for you, but few of us follow through. Exercise begins above the neck with a commitment to self and family.  Part of this motivation lies in the hidden benefits of exercise that are not common knowledge such as the prevention of breast and prostate cancer,  reduction in the onset and progression of Alzheimer’s disease, and as a cure for clinical depression.  Start with a simple walking program and free yourself from the “couch of doom”.

Commandment Two      

You Shall Rest:

A Nap a Day May Keep the Doctor Away

     We live in a hurry-up culture where “Just Do It” supplants “Let It Be”. Busyness has be­come a virtue that is without merit.  Idle hands are the devil’s playthings only in those who haven’t learned the discipline of relaxation.  Certainly there is a place for goal setting and industrious behavior, but there is also a purpose in rest and play. Relaxing on purpose is healthier than just doing something aimlessly. A major area of our lives that is most affected by this culture of chaos is sleep. The average adult requires eight hours of restful sleep a night to function best the next day.  The average adult actually gets around six hours of sleep a night.  This obvious disconnect leads to chronic fatigue and foggy thinking.  40% of Americans (100 million people) are moderately to severely sleep-deprived!

Commandment Three     

You Shall Not Worry:

Make Stress Work For You

     Stress is the little yapping dog biting at the heels of our health.  It is generally an annoyance, but, if it goes on long enough, can become a festering wound.  There are a number of books and counselors that provide a wealth of guidance on effective stress management in a world that oozes anxiety.   Studies indicate that up to 75% of visits to doctors are related to anxiety.  Stress is simply a perception of an internal or external event and thereby can be influenced by our thoughts.  One person’s stress is another person’s opportunity.  You will never be without stress, but you can control and minimize the adverse effects. 

Commandment Four 

You Shall Get Checkups:

                                          Prevention Pays Lifelong Dividends

     A healthy mind and body is dependent on action and education, not passivity and ignorance.  You must be an advocate for you and your family’s well-being by embracing prevention.  Men are especially negligent in this arena, and often decisions regarding family health are delegated (by default) to women in the household.  Seventy percent of health decisions involving the family are made by mom, which includes checkups, vaccines, nutrition, and screening tests.  Most importantly, the woman, by her actions and decisions, sets the tone for current and future health decisions.  A major health care crisis today is not cancer, AIDs, or heart disease, but people not making healthy, proactive lifestyle decisions.  We have to transform a system based on sick care to one that truly embraces well care, and that can only be achieved by practicing individual, responsible prevention.

Commandment Five

You Shall Not Be Gluttonous:

Eat Your Way to Good Health

     

     We are often called a society of consumption.  The talking heads are referring to consumerism; however, the real consumption issue is what we eat.  Our diet has more of an impact on our health and longevity than almost any other activity.  Content and quantity are the evil twins of gluttony.  There are four simple guidelines that, if followed consistently, will provide a foundation of healthy nutrition that will build a legacy of wellness.  Simply stated, eat balanced, low fat, low sugar, and high fiber meals. It is possible to alter the health inheritance of our kids and grandkids by changing how we think about food.  You can spring the family from the prison of poor nutrition and not be held captive by your genetics through a simple and doable eating plan.  We truly are what we eat. 

Next month…what else but six through ten!