Saturday morning hours for 2017………….start this Saturday!

Happy New Year! I am going to make a concerted effort to blog more this year, not just about 'health' but about 'life' in general. Things that I find interesting and want to share. One subject is travel, whenever a patient asks me where I went and I tell them they always say "did you like it?" or "what is it like?" Last year I went to England (my birth place), Spain, Italy, Portugal and St. Lucia and I have so much to tell you about these exciting places. Where better than my blog? If you like to hear about this kind of thing please remember to give it a thumbs up and I will keep it up :) Anyway,stay tuned, I will talk about that in my next blog but the purpose of this one is a little more mundane: Don't forget that we are in the Laurel office on the first Saturday morning of the month………..which means I will be there this weekend. Give us a call for an appointment so you don't have to miss work or get stressed trying to commute.Warm regards and Best wishes for 2017. Dr. Tuakli

The true lesson of Prince and his death

Since the untimely death of the great musician Prince, a lot has been said about how much his estate is worth and which relatives are lining up to get a piece of his mega millions. Unfortunately, I have not heard a word about the real lesson we should learn from his death: What is the point of being rich if you don’t put a premium on your health? As the old folks say “you can’t take it with you” and I say: you will be leaving it even sooner if you don’t make your health a priority. It boggles my mind that someone can have so much money and still be unhealthy. My feeling is that Prince was not as self destructive as some of those like Michael Jackson, Whitney Houston and Amy Winehouse who preceeded him, but still it is clear that being healthy was not top of his priority list the way it should have been. How many times have I harped on the old “Prevention is better than cure” song? When you have that much money and you still don’t look like the picture of health, what is wrong with this picture? Enough said, make your health a priority no matter what your age or income. If you have to skip a little purple rain and glitter to invest in your health then so be it.

Lack of sleep can kill you!

I gave a talk on Sex, Sanity and Sleep yesterday and wanted to share some of the amazing information I found out about sleep. Sleep is one of those wonderful things that we take for granted but it can increase not just the quality of your life but the QUANTITY of it too! One extra hour of sleep a day can decrease your mortality by 50%. Do you forgo leisure and sexual activities and sacrifice exercise because you are "too tired", gulping down caffeine to keep up. Stop! Besides making you tired,lack of sleep severely impacts your health. One in five auto accidents involves drowsy driving. Lack of sleep increases your blood pressure, your tendency to diabetes, arthritis, weight gain,heart disease and premature aging.When you are sleep deprived you are cranky and your decision making skills are reduced which affects your social relationships among other things.Improved sleep improves your thyroid function and immunity which controls your ability to fight off infections and cancer. So insomnia is no joke! Make sleep a priority. As I mentioned in yesterday's blog: It takes great sleep to make a great life. Check out that blog for tips on how to get better sleep and if that's not working, seek help.

Getting more sleep

Here are some tips on how to get better sleep: #1 Make it a priority Allow time for 7 to 9 hours of sleep Exercise regularly (no less than 4 hours before bedtime) Avoid caffeine in the PM and alcohol within 2 hours of sleep Warm bath before bed Sleepytime and other teas Manage stress Watch diet Make your bedroom quiet both noise wise and activity wise Only use the bed for sex and sleep: don’t use it for eating, reading, watching television, studying, work, hobbies Remove clutter Sleep alone, no pets, children, other Try Yoga and Acupuncture TRY HERBAL SUPPLEMENTS: Clinical Sleep, Melatonin, Holy basil, Passion Flower Lower lights change the bulbs outside the door if necessary Keep a regular sleep schedule • Go to bed and get up around the same time • Limit naps Limit stimulating behaviors before bedtime • Limit caffeine after 2 pm • Limit alcohol after dinner • Limit large or spicy meals • Limit vigorous exercise 4-6 hours before bed – De-stress, learn relaxation techniques – Physical and mental – Maintain a regular physical activity routine – Physical activity helps with stress – Do not go to bed hungry or full – Light snack of carbohydrates and foods with tryptophan – Practice stimulus control: – Go to bed when you are drowsy – If you don’t fall asleep within 10-15 minutes • Get up, leave the bedroom • Read or watch something dull • Make your room and bed comfortable • No pets on/in the bed • Temperature Cool • Lighting low, expose yourself to bright lights during day • Bed, sheets, PJ’s comfortable and not binding • – Treatment of underlying problem, with menopause that is the hormonal imbalance (estrogen deficiency) Treat medical conditions like restless legs, sleep apnea and obesity • Obstructive Sleep Apnea treatment options include: – Mouth appliance – Surgery-tonsils and/or adenoids – Weight reduction if obese – CPAP-Continuous positive airway pressure

Management of erectile dysfunction (ED)

Here is a brief synopsis of treatments available for erectile dysfunction and what tests should be done. As always start with history, issues like how long you have had the problem, whether your partner is interested in correcting the problem. What medications do you take that could be aggravating the problem. Are you a smoker of cigarettes or marijuana, abuser of alcohol all these cause ED. Have you had Diabetes or Hypertension and so on. The history should be extensive. Next is the Physical exam and lab tests for hormones and diabetes. Six hormones are tested for as well as standard blood tests.If you are physically normal and have no problems with desire then your doctor may prescribe the PDE5 inhibitor drugs like Viagra. If your hormones, such as testosterone are found to be low these can be replaced. Medical issues can be addressed and any offending medications removed. If these don't work there are medications like "Muse" which the man can put directly into his penis, this will give him an erection that could last 4 hours. A variety of medications can be put into the urethra or injected directly into the penis, by the patient or the doctor. If these are not satisfactory or unacceptable there are surgical remedies which include inserting rods into the penis some of these are firm in consistency and some have to be inflated. My urology colleagues tell me that for the people that have to get implants the satisfaction rate is 90%. If you have more questions please call for an appointment, I would love to go into more detail.

Bringing sexy back!

Last weekend I gave a talk on men's sexual function, actually men's sexual dysfunction to be precise. A lot of couples don't realize that men's sexual function does decrease with age even when the desire is still strong. Hence the immense popularity of Viagra and Cialis kinds of drugs. My talk involved the natural decline in sexual function and how to restore it even if these drugs don't work. Before I switch subjects, many are not aware that if a man has had Cialis within 48 hours he cannot take nitrates for a heart attack or chest pressure. I want to give that little piece of information so that people remember to mention the use of these medications should they find themselves in an emergency room. As it happens the conference called 'Bringing Sexy Back' was for married women only and they had a myriad of concerns about their husband's sexual function. The rest of the 2 days was spent 'getting sexy' with workshops and advice that I think would be hard to find elsewhere. Suffice to say it was 'live' and pretty wild (by my standards at least). I would certainly be happy to discuss either female or male sexual dysfunction with any patients who have an interest in the subject. This conference underscored the very important role that sexual intercourse plays in a marriage and how it reinforces bonding, intimacy and even friendship between the spouses. Here's a heads up: On April 30th at 11 AM I will be speaking at the Howard county Womanfest on "sex, sanity and sleep". The subject matter in this case will be strictly about women and it is free.. More on that in future blogs, in the meantime put some thought into spicing up your sex life and if its not working come and see me.

Happy New Year! Another year has rolled around and we are once again making resolutions. Don’t worry I am not going to talk about weight ☺ suffice to say our patients lost a total of over 500 pounds last year and we are hoping for more this year! I don’t generally believe in resolutions because they seem to be so easily broken, instead set yourself some targets that you can achieve at your own pace. Continue to be positive and try to achieve what you find self fulfilling regardless. I would mention that no one can achieve their full potential if they are not healthy, so hopefully one of your goals will be to strive for optimal health. But no pressure, enjoy the New Year and may you achieve all your heart desires. Stay well. Sincerely, Dr Tuakli

Babies, babies, babies!

Babies, babies, babies! People often comment that there are so many baby pictures in my office. That’s because I love babies and they are pictures of children I have taken care of over the years, many of whom have graduated from college already. Over the years we have less and less babies in our practice. This may be because of all the anti-aging signs in the office, perhaps mothers think you have to be walking and talking to be a patient of mine! The average age of my adult patients is also increasing so not as many are getting pregnant. Be that as it may, we love our littlest patients as much as the older ones. I am still certified by Johns Hopkins with privileges in the newborn nursery and I take care of many small people. Many people do not realize that Family physicians do 3 years post graduate training in pediatrics just like pediatricians. Their focus tends to be more on out patient healthy children than sick hospitalized ones. A common question asked is why someone would choose a family physician (board certified of course) over a pediatrician to take care of their children. Here are some of the reasons: A family physician knows the whole family and what history may be relevant to the baby. The child doesn’t have to find a new doctor at 16 and has someone who has followed them and their family all their lives. With female children family physicians can answer questions about periods and gyn issues. Girls are developing much earlier these days. Family physicians generally have less children in their practice so they know and care about the intricacies of each individual child. We know all our babies by their first name. In our practice we have a dedicated room for babies so they don’t have to wait in the waiting room. And they don’t have to compete for space. In many cultures it is assumed that the person who takes care of the mother is able to take care of her whole family, it is more the norm than the exception, family practice is a holistic specialty that encompasses everyone. It is the one specialty that specializes in you whatever your age. In this country there is a push to use specialists for everything, for example I know my patients are often surprised when I treat their rash and it goes away yet they thought they would have to go to a dermatologist because they have something on their skin. Everyone should really think through their options, as always knowledge is power, and then do what makes sense for them, their family and their personal aspirations. ‘My’ last baby was born the week before Xmas rounding out a family of five and 2015 for us. Looking forward to 2016 and more babies to love and care for!

Go Ravens, there's always another chance

GO RAVENS! Last night I had the privilege of speaking to a group of people at the Ravens Performance Center in Owings Mills. This is a huge (200,000 sq ft) facility with 3 outdoor and one full sized indoor practice fields, TV studio, offices, basketball court, the world’s largest gym, you name it. Not your average home away from home. All very interesting and their wonderful PR guy Edward Burchell, Jr. described the Ravens philosophy and how the Ravens are creating their brand. He even let me hold his super bowl ring. “Wait a minute! Are these real diamonds?” Wow, that is quite a ring and I am not even a football fan! So after all this fun, we got down to business it is always so interesting to realize the importance of health to everyone no matter who they are. The popular and very charismatic sportscaster Gerry Sandusky shared with me how some of the topics I raised were relevant to him and his family. A celebrity chef described his strategy for managing what sounded like a grueling travel schedule. Isn’t it a wonderful thing to know that using today’s technology and knowledge we can all live a long healthy life without illness weighing us down? It’s right there within your reach but you do have to take charge and grab it. I am passionate about passing on this simple message. It may not have the ‘wow factor’ of that ring but it’s really powerful when you think about it. As the New Year beckons I would like to share some of the tips I gave last night on how to stay healthy. Take charge, you know your body better than any doctor. Form a partnership with your doctor with open communication. Once the two of you have come up with a game plan, stick to it. Pencil in at least 2 ‘health days’ on next year’s calendar right now! If you are over 35 get your hormone levels checked. Control your weight, draw a line in the sand that can’t be crossed under any circumstances. Be in tune with your body and don’t put things off. Remember that mental health is just as important as physical health and put in the time and energy to optimize your health and ultimately your life. You can change your health and achieve your goals if you really want to. Season’s Greetings, Go Ravens!

Need more time with your doctor?

Need more time with your doctor? In today’s hurried world both the doctor and the patient can feel frustrated by the amount of time available to speak with each other. Did you know that the insurance company rarely pays for more than a 15 minute visit with a primary care physician (PCP) unless the patient has a diagnosis they think should take longer. Even then extra documentation is required to show why it would take so long. Its ironic that they pay specialists for more time (even when it is a pop in and “keep taking the same medicine” visit) than they do for PCP’s who are supposed to be on the frontline and have a deeper understanding of you and your family’s overall health. I recently admitted a critically ill patient who had just returned from overseas and the insurance company refused to pay for my hospital visits to take care of him. Even though they saved a bundle by not having to pay specialists. They said his care is covered by the $20 a month they pay me for capitation. Small wonder most doctors don’t bother to take care of their own patients in the hospital anymore. They simply turn them over to a hospitalist who doesn’t know anything about them, kind of like a mechanic who only handles exactly what is in front of him. I recently returned from a conference (way out in the Boonies!) on alternative medicine and once again learned fascinating information I would love to share with my patients. But where is the time? While I am at conferences I keep thinking “wow! So and so may really benefit from that”. “I wish I had known that before so and so had that surgery” “I have a zillion patients who complain of fatigue, fibroids etc…If only I could have more time with them” When I come back I always like to meet with my VIP patients to discuss how new information may help them and what changes we can make to their vitamin regimens. Unfortunately I cant do that with everyone, however, if you feel that you would like to schedule a private self pay consultation with me please call the office. I am bursting to share the great news of how to improve health with everyone. Believe me my own regimen changed last weekend! Here’s to real health and vitality.

My new book!

Happy Spring at last! What a long winter that was, fortunately it gave me ample time to work on my book. My book is entitled "Lifting the veil of menopause, A more natural solution"............................. As I see it the veil refers to both the fact that a lot of people are not interested in talking about menopause but also the veil that comes down when I tell people (who upto that point were excited) what my book is about. Usually I get an off handed "Oh....that's interesting". Actually, they are absolutely right,menopause is a fascinating subject. Everytime I got into the research papers I would get so engrossed it was hard not to get off topic. Everyone knows that hot flashes are the commonest symptom of menopause in the US but did you know that the commonest symptom in 15 countries in Latin America is joint pains and muscle aches? That women in Iran complain that sexual dysfunction due to menopause is affecting their marriage? Well, its not my intention to write another book about my book :). The book will be available in June. You can buy it from all the usual outlets like Amazon and E Books.I will be talking about my book at the Face Place Spa in Columbia on May 9th 2915.Make sure you call ahead because space is limited. If you would like to order an autographed copy at pre-publication pricing please call our office.Time to get out there and exercise in that wonderful weather;) Yours in health Dr. Tuakli

Detox 2015!

Happy new year!!! Its that time again, Detox time :) Now that the gorging and partying and sitting around of the holidays is over, this would be a good time to consider a detox program and of course revamping your exercise program. Get into a healthier mind set for the spring. I am at your service and here to help if you need me. As an added incentive for the rest of January all detox and weight loss products along with the sauna will be 10% off, let's get started :)

New Year VIP program 2015

Happy New Year! Welcome to those who joined our VIP program this year.*********** This blog is to discuss the program in more detail and to explain how it may be particularly helpful for various people.****************** In a nutshell the program is one which requires an annual one time fee. For this fee patients enhance their already VIP status :) ****************** BENEFITS: VIP's get immediate same day appointments.************** Extended visits on special days. ************ No waiting time in the office. ************* Direct telephone access to the doctor as well as email. ************** Courtesy Hospital visits throughout the Baltimore Washington Area.**************** Same Day prescriptions.******************* 10% off all products.********** $60 maximum for office visits including those for people already enrolled in the HRT and Anti-aging programs Free blood draws in the office. ********************* One free Executive Physical with memory testing etc annually.*********************** Home visits when you are unable to come to the office. *************************** WHO SHOULD DEFINITELY CONSIDER ENROLLING: People who travel a lot, you will have access to your doctor wherever in the world you are. International patients.*********************** Terminally ill patients and the elderly. ************** People who have a hard time leaving the house and dont want to get sick from sitting in urgent care and emergency room centers.*************** People with high insurance deductibles.************** The office visits will still count towards your deductible but you will know that you never have to pay more than $60 in the office. This way you can get affordable care but you will have insurance should something catastrophic happen like needing surgery or hospitalization.********** If you like the idea that whatever healthcare facility you end up in your personal physician is monitoring your care and watching out for your best interest. This can save many extra days in the Hospital and unnecessary medication and tests because I know my patients and can tell the physicians what you may or may not need.******* If you have a cafeteria plan, put it to good use to improve your health throughout the year.*************** Let's have a healthier 2015 than 2014 in all ways, I am at your service!

Please dont go to the Dominican Republic!

Its Mothers Day and I finally got the chance to write about a subject that has been troubling me for years. If you are thinking about a trip to the Caribbean please don’t go to the Dominican Republic. I know the rock bottom pricing is amazing and tempting but you should understand that your tourist dollar is promoting modern day slavery. I do not intend to get into a long dissertation on the subject but hopefully it will stimulate your interest to read about the subject some more. All the hard back breaking work of construction and sugar cane harvesting in the Dominican Republic is done by people of Haitian descent. There is a documentary called “Black Sugar” you may wish to watch. I haven’t watched it myself because I know it will just upset me and besides, I have been there, many times both as a tourist and as a Health Care Volunteer. On my last visit a gentleman who was the administrator for ILAC, a center run for US students by the Catholic church, proudly took us to his farm and showed off his farm workers. “Haitians are like dogs” he said. He certainly housed them as if they were. He happily told my husband to demonstrate the point that since Dominican girls are not allowed to sleep with Haitians and there is a relative shortage of Haitian women he hires a Haitian prostitute to ‘service’ his workers. He said they would form a line outside the hut and you could hear the person inside shouting ”Next!”. I didnt think this was a particularly appropriate story to tell in front of a lady but then again perhaps he did not view me as such. If you are of Haitian descent no matter how many generations before you cannot obtain Dominican citizenship. This means you have no passport and are trapped inside the country with no opportunity for an education or health care. I offered to pay for a Health Canter for the people in a batey (ghetto for Haitians) in Santo Domingo and the staff of ILAC told me it would be a waste of time because all doctors are paid by the government and they would not send a doctor there regularly. They told me instead to use the money to build a school for Dominican children because “Haitians don’t appreciate an education”. Even the United Nations has not been able to convince the Dominicans to change. Last year the Dominican High Court stripped more than 200,000 Haitians of any claim to citizenship making them legally stateless and denying their children the right to receive education, health care or any basic human rights. Many Haitians were actually kidnapped and taken to the Dominican Republic to work, if they run away they are beaten and returned. Sound familiar? It is convenient for those of us who are comfortable and free, to ignore the plight of those human beings who are basically slaves. Can you really lounge on the beach and raise that Pina Colada with a clear conscience, pretending you don’t know just because you got a deal?

Hair, Skin and Nails

Hair tends to be less lustrous as we get older, Nails more brittle and Skin more saggy. Is there a common thread? Of course, not just the obvious generic aging syndrome but also deficiencies that we can actually point to (and replace). Here are some basic tips: Use an antimicrobial shampoo before you use the fancy, nice smelling, super conditioning stuff. make sure the producte you use dont cause build up. Consider massaging coconut oil into the scalp before washing, leave on for a minimum of 20 minutes. Get the supplements on our list for whichever is problematic for you, hair, skin, nails or all of the above. If you notice rapid aging check for hormone imbalances, thyroid etc and vitamin deficiencies. Maintain your internal anti-oxidant levels and of course use the Stop-Aging Skin therapy twice a day. This would be a good time to stock up on maintenance items for the New Year, if you were registered for today's seminar because of the 10% discount. Yours in health Dr. Nadu A. Tuakli

PREVENTION, CONTROL AND CURE OF ARTHRITIS Have you ever heard that there is nothing that can be done about Arthritis? Its not true! An Aunt of mine was having a terrible time earlier this year with bad arthritis of her spine causing so much pain she couldn’t move. Unfortunately she is not in the States and I could not get to her. She told me she was hospitalized and was put through the ‘usual’ paces. MRI’s, Spinal taps and injections, pain medications and anti-inflammatories and then the usual ‘nothing can be done’. My first thought was: that’s a lot of money, time, energy and pain to end up with “nothing”. My second was : Of course something can be done, they are just staying with the same old paradigm. One of the most magnificent things about the body is its ability to heal itself, those of us who practice traditional medicine just need to learn to tap into that ability. If we do, the sky is the limit, we will even ‘find’ the cure for cancer! As always prevention is better than cure but what do you do if you are already afflicted? I have read 9 books on Arthritis over the past month (I am happy to share the titles with anyone who is interested) and I am so excited about the information I was going to discuss it this afternoon at my ‘Skin” seminar! Not that arthritis and skin are not related because they are, but it certainly is a stretch on the ‘looking great for the holidays’ theme! (By the way for those of you who keep asking me ‘when is your next seminar’, arranging a huge seminar like the last one is really time consuming so I will be doing mini-seminars at my office and sharing new information periodically.) So why the excitement? I do believe that arthritis can be prevented, contained and cured! But not by managing it the way we are taught in medical school. i.e take anti-inflammatories to decrease the inflammation while your joints get worse and you suffer from the side effects. Oh, and then when it completely breaks down replace the joint with an artificial one. I now believe that the non pharmaceutical measures you can take are much more powerful than drugs for the treatment and prevention of arthritis. These do not suppress the symptoms while the disease gets worse, they stop it. So here’s a summary of what may be needed: Oral Hygiene measures. Dietary changes. Healthy Oils Supplements Vitamins Exercises Maintain a healthy weight Antimicrobials when indicated Allergy testing Balance your Hormones Nothing invasive! If you have an interest in generating a personalized program for arthritis treatment then please feel free to schedule a consultation. If you have arthritis personally or in your family I would strongly encourage you to do so SOONER than later. (Those of you who signed up for today’s seminar will be mailed the supplement sheet we prepared for today). Yours in health Dr. Tuakli

Dont discount doing a pap smear

A patient said to me last week “I do believe you saved my life for the second time Dr. Tuakli” And I thought Wow! You know what, she is right. People thank me for saving their lives from time to time and not to sound cavalier but I often think that it is nice to hear but I was just doing my job. Any qualified physician could have been credited with doing the same thing. But this time was different and very stark. This 50 something year old lady has been in my practice for perhaps 3 or 4 years. She has a variety of medical issues that we have been working on and from time to time I would suggest she have a pap. She had told me previously that she had been told that she didn’t need one because she had had a hysterectomy. Interestingly enough whenever I probed further she never seemed sure about exactly what had been done. Was the uterus completely gone including the cervix? How about the ovaries? Why was the surgery done in the first place? It never ceases to amaze me how many times I ask those questions and the answer is “I don’t know”, particularly in over 40 year old women. I eventually convinced her that it would be a good idea to just do a routine check up even though she had no symptoms and so I did a pap. As soon as I started her pap I knew from the look of the lesion in her vagina that it was cancerous. Putting cells on a slide and sending it to the lab quite frankly was a formality and I had her schedule an appointment with a gynecology oncologist pending the results. She told me when she came in last week that the specialist walked into the room and the first thing he said to her was “What is a women your age doing still getting pap smears?!” (I wont be referring any more patients to him). The arrogance dissolved when he saw the cytology report and the patient has since had the appropriate surgery. So why do I tell this cautionary tale? Well, for one thing, the current guidelines imply that she did not need a pap smear, simply based on her age. Secondly, I think that many women are walking around thinking that because they have had a hysterectomy they are immune to genital cancers. Thirdly, standard recommendations are just that, written for the common good but not by someone who knows you. Do not take them as gospel. You could argue that this is the exception to the rule and that is probably true but it also means that someone’s mother and sister will still be alive 3 years from now and she also managed to avoid the trauma of cancer therapy that would have resulted had she found it later. In medicine it is not always easy to argue with “official recommendations” and specialists who don’t know the patients. I believe that I taught myself something with this case, not everything has to be rational, and care must be individualized regardless. I am a strong believer in learning from past experience even if its not written anywhere. I derive no satisfaction from my patient being diagnosed with cancer but I am sure glad I followed my gut. When in doubt get a pap, it sure beats the alternative!

If you do get a high PSA level it might be worth doing another test

As I mentioned before there is a lot of controversy about the PSA test. But what happens if you get an abnormally high PSA, should you automatically move to the next step of treatment? There is the old saying that more men die with Prostate cancer than die from it. No one wants the cure to be worse than the disease. So the good news is that there is a new genetic test that can help assess how aggressive a prostate cancer might be. This may be a useful adjunct if you are unfortunate enough to do a PSA and end up with a high value. This test is not in common usage yet but it is becoming more common.

A test for cancer............... do you want it?

There is a test for cancer you want it right? Eh...... Maybe! I had heard that the US preventive task force had recommended that we stop doing PSA Tests a couple of years ago. Despite the fact that I was personally affiliated with the very first task force in 1989 thru my residency at Johns Hopkins I really did not pay much attention to the recommendation . In 1989 when the government commissioned the first task force we residents were given unlimited library resources to research every article ever written on whatever subject we were assigned. A friend of mine researched the effect of dietary fat on cancer development, my subject was malignant melanoma. At that time the task force was unheard of and preventive medicine was not a field that many people were interested in. The first book was released without a lot of fanfare and controversy but now it is a quotable reference and considered the 'last word' on preventive measures. Despite this I paid minimal attention to their recommendations, maybe because having seen the inside I was less than impressed, that and the fact that some of the recent recommendations they made didn't seem to make sense to me. For example, a few years ago they changed the recommendations for mammogram screening, I was called by a reporter from Goodhousekeeping magazine for their breast cancer awareness month she wanted to know how the new recommendations were going to change my routine practice. I told her "not at all" because I have seen too many women in their 40's diagnosed with breast cancer to recommend starting mammograms at 50. So when the recommendations regarding PSA came out, I thought it was the same thing. If there was a test that could pick up cancer in the early stages why would we not want it? Why not indeed. I did not change my views until earlier this year. In March I attended a session on the use of PSA and prostate cancer at Temple University. On stage was a Family Physician,a regular Urologist, an Oncologist and a Reconstructive Urologist. The only person who thought that doing PSAs was a good idea was the 'regular' urologist. The first guy had tables of all the complications of treatment for prostate cancer and studies that showed no difference in mortality in patients who had the test and those who didn't. The most shocking was the reconstructive guy who simply declared "I clean up the mess left by urologists who unnecessarily treat the prostate cancer. Oh, you know, urinary incontinence, erectile dysfunction, pain and so on!" I have since thought about two patients I have had in my practice, the first one was a guy I did the test on when it first came out. I always remember having to call him on Xmas eve with the news because I was leaving the country. He was 39 at the time (earlier than the recommended age for screening). He started with a PSA of 16 (normal being under 4), several years and many procedures later the number continued to climb. He was one of only two men I have ever sent for a mastectomy (side effect from the treatment). The primary could never be found but his number just kept going up, eventually a year before his death it was found spread to his nervous system. He always said if he knew then what he knew 10 years later he never would have had the surgery or the hormonal therapy. He said the cure was way worse than the disease. Another gentleman who's PSA I checked around the same time had a level of almost 5, he and his wife were moving to Gettysburg, Pennsylvania, I gravely advised them to get it rechecked when he found a new doctor, they did not. They showed back up in my office almost a decade later saying they had not been seeing any doctor but he had to have a level done 3 weeks before for life insurance and it was 54. I moved into overdrive, immediately repeated the level (it was 65), got him a same day appointment with a urologist and shuttled him into treatment. He is doing well, having chosen some minimally invasive modalities. I wonder what the outcome would have been if we had detected the cancer earlier. Would we have improved the quality of his life over the past 12 years or would modern medicine have hastened its demise? I do know I wish I had found the first patient's elevated PSA much later, even though at the time I thought I was being diligent. For news about the updates on Prostate Cancer diagnosis see the next blog. Be Well!

How does Gun Violence affect your health?

What do guns have to do with health? Actually a lot. Health is measured in two ways: Mortality (Duration of Life) and Morbidity (Degree of Illness) both of which are being severely impacted by Gun Violence. I actually started this blog a while ago but the events in the Navy Yard today caused me to resurrect it. Are we not yet tired of this violence and the thing that begets it : Uncontrolled Access to weapons? There are age groups were gun violence is the leading cause of death and young people have more to fear from Gun Violence than actual diseases we can be immunized against. The incidence of gun related suicide is directly related to ease of gun access.I'm not a politician and I am not trying to be one but let's get real, look at the numbers, Gun Control has become a Public Health issue and is working its way to the top of the list. Soon we will be more concerned about stopping a bullet than getting cancer. Nail me to the stake if you have to but as a Public Health professional allow me to say what needs to be said. More important PLEASE stop and educate yourself on the situation and be glad it wasn't someone in your family who got killed this year. However would you not rather act before it hits closer to home? I was initially moved to write this blog earlier this year when I read about a University of Maryland student who got killed by another student over some frivolous incident. The first thing that came to mind was: "Yet another parent who thought they had finally got their kid in college, only to turn around and they are gone in a puff of smoke" (How many since Virginia Tech?) Just food for thought. Please Be Well, Oh, and stay alive !