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.