Thursday, January 27, 2011

Addiction

Today, I would like to discuss a subject that affects a large percent of the public, not to mention their families and society at every level. No ethnic or socioeconomic group, except possibly those with very strict religious beliefs, seems immune to this problem. In the US, one in four people smoke cigarettes (25%), one in twenty are "alcoholics" (5%), one in 70 have a "drug" problem (1.4%). This post deals primarily with drug and alcohol issues, although tobacco is obviously a larger problem.
Addiction is believed to be a chronic disease of the brain. The dysfunction in addiction leads to biological and psychological changes as well as social issues. This is reflected in the individual pursuing reward and/or relief by substance use or other behaviors. Over a period of time, the substance or activity is then needed to feel normal. The addiction is then characterized by an inability to control the craving, an inability to abstain, and poor recognition of the problem with one’s own behavior. Many professionals now mean 'addiction' to include activities such as gambling, shopping, sex, food, Internet, pornography, work or exercise.
Addiction researchers cite evidence that the brain is dramatically affected by chemical substances and can be permanently altered as a consequence. PET ("positron electron tomography", like a CT) scans have shown how cocaine and other abused drugs have profoundly reduced brain activity. Patients attempting recovery who need to be able to make rational decisions could no longer count on their rational brain to guide them. So, no matter how much willpower they may have to conquer their addictions, it becomes very difficult to repair the damage their brains have endured.

Common issues associated with addiction:
Stress, anxiety
Irresponsibility, carelessness
Deception, lying
Criminal behavior (stealing)
Relationship issues
Emotional problems
Depression
Bereavement
Health issues
Sexual problems
Phobias
Child rearing problems
Poor hygiene
Family conflicts

Treatment
Drug detox is the first step you must take when preparing to withdraw from alcohol or drugs. While withdrawal is considered to be the process where the patient abolishes his or her dependence on a drug, detoxification is the initial step to prepare the body and mind for that process. This process often requires inpatient intensive therapy involving medications and counseling. Therapists perform a comprehensive analysis of their clients issues helping them to pinpoint their troubles, worries, and problems as well as implementing coping strategies. Issues examined include childhood events, current behavior, emotions and thoughts until the often unconscious influences are acknowledged. Upon recognition of their typical or repetitive behavioral responses, patients are then able to make changes.

Inpatient drug and alcohol rehab programs typically offer both short term and long term treatment options that generally range from 28 days to 6 months. Inpatient rehabilitation services are recommended for moderate to severe drug and alcohol problems that have adversely affected their health, relationships or work. Inpatient treatment may take place in a hospital or rehab unit. It is best to start with the less restrictive level of care but still provide structure, supervision and medical intervention. If treatment is discontinued at an early stage, the likelihood of relapse is extremely high.

Psychotherapy is used to:
Uncover the reasons for their condition so that they can better address it.
Identify and modify thoughts or behaviors that negatively impact their life .
Learn more effective coping and problem-resolution skills.
Explore experiences and relationships.
Increase their self-love and love for others.
Improve their self-confidence and self-esteem.
Heal old wounds.
Remove psychological blocks and break old habits.

Psychotherapy may be short-term or take several years. They may undergo individual, group, couples, or family sessions. Research has shown that psychotherapy coupled with medication provides greater benefit to patients than medication alone.

Medical treatments for addiction:
Opioids: Methadone, buprenorphine (Suboxone) and naltrexone (Depade, ReVia)  are effective medications for the treatment of opiate addiction.
Tobacco: A variety of formulations of nicotine replacement therapies now exist—including the patch, spray, gum, and lozenges. In addition, two prescription medications are used: bupropion (Wellbutrin, an antidepressant)  and varenicline (Chantex, works well but has some strange side effects).
Alcohol: Three medications are currently available: naltrexone (Depade, Relistor, ReVia), acamprosate (Campral), and disulfiram (Antabuse, makes you very nauseous and "sick"). A fourth, topiramate (Topamax), is showing encouraging results in clinical trials.

Addiction can be a lifelong issue requiring multiple attempts to overcome the substance or other abuses. The most important thing about addiction therapy appears to be the continuation of treatment after a person becomes "clean" and the support of family, friends and medical professionals.

Wednesday, January 26, 2011

Body Dysmorphic Disorder

Dear reader, thank you for visiting my blog. Today I decided to write about a disorder that affects only one or two percent of the worlds population and it gets little attention unless a public figure such as a celebrity is stricken by it. Unfortunately, those individuals with this disorder will often withdraw form society over time and the symptoms may progress.

Body dysmorphic disorder (BDD) is sometimes referred to as body dysmorphia and  is a psychological condition in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her body image. The onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one's appearance usually occurs. Individuals with BDD obsess that there is something wrong with how they look, even though the perceived appearance flaw is often minimal or nonexistent. They may describe themselves as looking unattractive, deformed or even hideous. The appearance preoccupations are difficult to resist or control, and on average consume up to 8 hours a day. BDD is often misunderstood to affect mostly women, but research shows that it affects men and women equally. The disorder is linked to significantly diminished quality of life and can exist with major depression or social phobias. Some individuals may become obsessed with plastic surgery believing this may help or cure their psychological issues. BDD also has a suicide rate more than double that of major depression and a suicidal ideation rate of around 80%. A person with the disorder may be successfully treated with psychotherapy, medication or both.

Common symptoms of BDD include:
 Obsessive thoughts about perceived appearance defect(s).
 Obsessive and compulsive behaviors related to (a) perceived appearance defect(s)
 Delusional thoughts related to perceived appearance defect(s).
 Social and family withdrawal (agoraphobia).
 Anxiety; panic attacks.
 Chronic low self esteem.
 Feeling extremely self-conscious in social environments.
 Strong feelings of shame.
 Dependant Personality.
 Poor work performance due to preoccupation with appearance.
 Problems initiating and maintaining relationships.
 Alcohol or drug abuse. 
 Repetitive behavior such as constantly  regularly checking appearance in mirrors.
 Perfectionism

Studies have found that Cognitive Behavior Therapy (CBT), also known as psychotherapy, has proven effective. BDD symptoms decreased significantly in those patients undergoing CBT. BDD may be eliminated in more than 70% of cases after treatment. Antidepressant drugs such as Prozac, Celexa, Zoloft and other SSRIs  can be of great help in up to 50% of patients.

The bottom line is that this disorder can often be treated with great success if diagnosis and treatment begin at an early stage. I hope this post brings awareness of a often overlooked disorder affecting a small be significant percent of the population.

Tuesday, January 25, 2011

Chronic Yeast Infections

Often described as candidiasis, yeast infections are extremely common in women. However, chronic yeast can be a very difficult and often debilitating condition. Many factors will lead to recurrent and chronic yeast infections including prolonged antibiotic use, tight clothing, obesity, or excess sugar in the diet. Other conditions which lower the immune system such as diabetes, leukemia, AIDS, and other types of cancer or chemotherapy will also contribute to chronic yeast infections.  Common symptoms of vaginal yeast include itching, burning, a white discharge, redness or irritation, and pain with intercourse or tampon use. Other medical conditions may mimic the symptoms of yeast including several sexually transmitted diseases. Yeast is generally found either in the gastrointestinal tract or the vagina in women and will cause symptoms when it becomes overgrown. A number of medical therapies may be used to treat yeast infections and many can be purchased without a prescription. Chronic infections will often require prescription medication for more than one course of treatment.
Preventing yeast infections is probably just as important and a number of steps will help decrease the chances of having candidiasis. A diet low or absent in cheese, mushrooms, refined carbohydrates (“white foods”), alcohol, and baked breads will often help. Supplements such as acidophilus, fish oil(DHA/EPA), vitamins C and A, zinc and Echinacea will provide natural immunity to yeast. Sugar free yogurt and especially yogurt containing lactobacillus acidophilus is often helpful. A low glycemic diet combined with proper weight management is vital for optimal health and prevention of yeast infections.

Monday, January 24, 2011

Simple Diet Protocol


Diet Protocol 

Here is a reprint of our simple diet protocol for weight loss. The total number of calories and fat grams per day depends on the amount of weight loss desired, gender and body type.

Total Calories per Day: ? 1200-1400 per day (depending on amount of weight to lose)

Total Fat Grams per Day: ? 30-35 grams per day  (depending on amount of weight to lose)

Depending on your activity level, 40-50 % of your calories should come from carbs, 30-40 % from protein and 20 % from healthy, unsaturated fats.

Eat five or six times daily with 75% of your calories consumed in the first 8 -10 hours of
awakening and do not skip breakfast.

Drink 8 glasses of water per day (64oz). You may use flavoring in your water such as lemon or Crystal Light.

Plan meals in advance and avoid grocery shopping when hungry. Remember to “perimeter shop” (as most of  the healthiest foods are located on the perimeter of the grocery store) for the healthiest foods.

Foods to eat: 
 
Fruits and Vegetables
    You should have around 4-5 servings of each daily. Fresh or frozen vegetables are    
     preferred. Canned foods should generally be avoided.  
  Lean Meats and Fish
    Trim lean meats and fish which should have no more than 10-15 grams of fat and 150
     grams of cholesterol in each serving.
 Other:
     Plain oatmeal
     Whole grains
     Legumes
     Berries
     Nuts

Foods to Avoid: 
  
 White Foods
   These are high glycemic, high calorie foods. Examples include rice, bread and
    tortillas.
 Fast Foods
   Almost all have high fat content. Avoid fried foods and “cheesy” foods.
 Junk Foods
  Most have high caloric counts and are what we called "empty calories".
 Sugared Beverages
   Soft drinks, juice, sweet tea, and energy drinks are loaded with calories.
Avoid butter, margarine and cream sauces.
Avoid "high fat" foods.
Limit “starchy” fruits such as bananas and grapes. 

Combine the above dietary principles with a moderate exercise program of 30 minutes most days of the week. Start slowly and increase your intensity on a daily to weekly basis. A morning routine will usually have the highest compliance rate. Try to walk 10,000 steps daily and take the stairs!

Supplements  _______How they help you____________________

5-HTP                   Herbal supplement from a plant in Africa.
                            Increases serotonin levels in body and brain
                            Important for hunger and craving control

Chromium             Helps maintain even blood sugars by increasing sensitivity
                            to your insulin. Also helps with sweet cravings and increasing
                            metabolism to burn fat stores.

Magnesium           Helps with sweet cravings by changing the taste of sweets              
                            and also helps to maintain blood sugar levels.


Portion Tips:  (try not to eat more than half of a restaurant portion)


Meat, fish, or poultry = deck of cards (3 ½ ounces)
Peanut butter = ping pong ball
Cereal = fist
Rice, pasta or potato (cooked) = half of a baseball
Bread, cornbread = small bar of soap
Pancake = CD
Cheese = 4 stacked dice or 2 slices
Margarine or spread = 1 dice
Baked potato = fist
Fruit serving = ½ baseball ( 1/2 cup)
Vegetable serving = 1/2 baseball (1/2 cup)
Salad (greens) = baseball

Remember to:
Avoid: fast food, junk food, fried foods, white foods, deserts and sugared drinks.
Increase: fruits, vegetables, grains, fiber and water.


                                The Food Pyramid

 

Wednesday, January 19, 2011

Anti-aging Part 3-Hormone Therapy and Supplements

Hormonal therapy is often controversial in anti-aging treatment. These therapies center around two distinct treatments. The first is the use of replacement hormone therapy for those hormones levels becoming deficient due to age, disease or previous surgery. These hormones include estrogen, progesterone and often  testosterone for women and primarily testosterone for men. Other hormone replacement therapies include thyroid (especially in women, who have a 10% risk of being low), melatonin and DHEA (dehydroepiandrosterone). The goal is to replace the deficient hormones to achieve a "youthful level." You may want to view the articles entitled "Menopause" and "Andropause" to familiarize yourself with the use of hormone replacement therapy in both men and women. DHEA is a major steroidal product of the adrenals and is also produced by the testes.  DHEA is the most common steroid in humans. It acts on numerous steroid receptors and can be converted into estrogen and testosterone. Melatonin, produced by the pineal gland, acts to regulate the wake-sleep cycle (circadian rhythm) and is a powerful antioxidant. Melatonin may also help improve the immune system, thereby helping to fight infections. Lastly, thyroid (mainly T3 and T4) hormone regulates metabolism and affects many areas of the body such as the gastrointestinal (GI) tract and hair growth.
The second type of anti-aging treatment involves the use of human growth hormone therapy (HGH) to "reverse the aging process." HGH, also known as somatotropin, has been called the "fountain of youth". It is produced in the anterior pituitary and peaks in the twenties. HGH is secreted in a pulsitile fashion at a level of around 700-800 ng/dl in the 20s and drops to around 300 ng/dl after age 50. Also of note, one fourth of individuals will have a level less than 200 after age 50. It promotes growth of muscle and bone as well as reduces fat stores. You may be aware of what are called "anti-aging/life extension" centers as they now seem to be quite common. If so, you have probably seen the "miraculous" transformations shown in the advertisements. The core treatment protocol in most of these centers consists of growth hormone therapy (HGH) combined with replacement bio-identical hormone therapy, a low glycemic diet rich in anti-oxidants and phytonutrients, a variety of supplements, vigorous exercise and a reasonable amount of rest. These transformations require a significant commitment and can be quite costly.

HGH has a number of positive effects on the body including:
1. Increases bone density
2. Increases muscle mass through muscle enlargement (sarcomere hyperplasia)
(note that muscle strength is not necessarily increased, size is by increased by lengthening of the muscle fibers )
3. Promotes the destruction of fat cells (lypolysis) 
4. Increases protein synthesis
4. Increases the secretion of androgens (anabolic steroids) from the testes and adrenals
5. Contributes to the function of the pancreas
6. Promotes glucose formation in the liver for energy
7. Improves the immune system
8. Growth of the long bones during development ( a deficiency in childhood will lead to dwarfism)

Negative effects of HGH on the body:
1. Prolonged HGH excess thickens the bones of the jaw, forehead, fingers and toes (this leads to a condition known as acromegaly) and is irreversible.
2. Other problems can include sweating, heaviness of the jaw, pressure on nerves, muscle weakness, type 2 diabetes and possibly sexual dysfunction.
3. Other reports include an increased risk of cancer including colon and prostate (the theory is that HGH may speed up cells leading to abnormal cell turn over).

HGH must be administered by injection once or twice daily. It is somewhat expensive, about $500.00 per month now with recombinant DNA technology (it used to be much higher). There is no doubt that you will look better and probably feel better with growth hormone therapy. The risks of long term use must be evaluated carefully. Anti-aging/life extension centers will typically use growth hormone therapy (HGH) combined with replacement bio-identical hormone therapy. They will also prescribe a low glycemic, anti-oxidant and phytonutrient rich diet, vigorous exercise and plenty of water and rest.

  
Anti-aging Supplements: (only the most commonly used)
 Vitamins A, C, B Complex and E
 Co Q10, Ubiquinol
 Green Tea
 Resveratrol
 Grape Seed Extract
 Krill Oil (Omega 3/Fish Oil, DHA/EPA)
 Coconut Oil
 L Arginine, L-Carnosine, L-Carnitine and L-Glutathione (amino acids)
 ? Telomerase (expensive)

There are numerous supplements (too many to list) available and honestly, I cannot tell you which may prove to be superior. I firmly believe a proper diet, plenty of water and exercise will give you most of what you need to improve health, vitality and the aging process.

Monday, January 17, 2011

Anti-aging, Part 2-Diet and Nutrition

In this article, I would like to discuss diet and nutrition. One saying you may hear is that purple is the new green. That simply means the darker colored foods and especially the purple foods are high in nutritional value and antioxidants. I have used the term "Perimeter Shopping" for a number of years to mean the healthiest foods are usually found on the perimeter of a grocery store. Anything in a can or box is usually much less healthy. In general, the more processing a food has, the less healthy it is for you. Typical foods found in your local grocery store have often been through many transformations and have been subjected to a number of additives by the time they make it to the shelves or freezers. The most important thing about the food you eat is the nutritional value, the glycemic index (see the post "The Rules of Eating Healthy") and perhaps the level of antioxidants. You may have herd of the term "phytonutrient." Phytonutrients are the organic components of plants and these components are thought to promote health. Fruits, vegetables, grains, legumes, nuts, and teas are rich sources of phytonutrients.
The total caloric content is important as total calories should be monitored. One theory is that the more calories you consume, the more fuel you give your body to speed up metabolism and cell turn over. This in turn may increase the aging process. Obviously avoid fried foods as much as possible. Try to avoid margarine and other foods with trans-fatty acids. You should avoid large amounts of red meat, processed meats, high fat dairy products, sugary cereals, high salt foods, and of course most deserts in significant quantity. Have you ever heard of the trick of squeezing your hand tightly for 3-5 seconds when you want a desert? Try it and you may be surprised. Most of us eat only a couple times per day. The correct thing to do is to graze and consume most of your calories by mid day. Drink plenty of water and limit sodas, caffeine and alcohol. Do not eat within a few hours of bedtime. One thing you may gleam from this post is that eating healthy is more time consuming and unfortunately can be more expensive.

Here are some guidelines, from webmd, for foods known to have more nutritional value and antioxidants:



  • Fish. Follow the guidelines of the American Heart Association and eat twice weekly, especially the fatty kind that is rich in omega-3 fatty acids. This is a powerful anti-inflammatory food that offers a multitude of health benefits.


  • Fruits and vegetables are powerhouses of antioxidants. Aim for a variety of colorful produce. Enjoy at least 5 servings per day for the maximum benefits.


  • Whole grains provide soluble fiber to help lower blood cholesterol levels, and also have phytonutrient content equal to any fruit or vegetable. Strive for at least 3 daily servings.


  • Legumes are unsung heroes, packed with nutrients similar to fruits and vegetables and with very few calories. Add them to your diet 3 to 4 times a week.


  • Yogurt has all the benefits of dairy foods, plus probiotics that help add healthy bacteria to the intestines to improve bowel function.


  • Nuts are a great source of B vitamins that are good for your heart and your brain. The healthy fats in nuts benefit the elastin and collagen in skin helping to keep it resilient. Small portions are advised, as nuts are high in calories.


  • Here is a list of  "super foods" for their anti-oxidant/anti-inflammatory properties.
    1. Soy
    2. Allium vegetables: garlic, onions, leeks, scallions, chives, and shallots
    3. Berries
    4. Calciferous vegetables: broccoli. cabbage, cauliflower, sprouts ...
    5. Tomatoes 
    6. Beans and lentils
    7. Hot peppers
    8. Nuts and seeds
    9. Salmon and Tuna 
    10. Yogurt and kefir
    Here is a list of healthy foods from Worlds Healthiest Foods.org: (note, none of these should come in a box or a can)

    Vegetables                                                                              
    Seafood

    Sunday, January 16, 2011

    Anti-aging, Part 1-Overview

    I am presenting this in multiple parts as this topic is a little long. I hope it will shed a little light on what you can do to improve your health and possibly your longevity. Most of us would love to turn back the clock a little as we age. Since that is not possible, we should concentrate on slowing down the process. Most importantly, changing your lifestyle can have a tremendous effect on your health as well as how you feel and look. This translates into more energy, better sleep, less sick time, less risk of significant illness and a more youthful appearance.
     Genetic factors certainly have an effect on aging. Recent scientific studies have revealed that one critical part to the aging process is connected to the shortening of small bits of cellular DNA on our chromosomes called telomeres. As our cells divide and replicate, the telomeres begin to shorten thus forming our natural biological clock. The ability to change this complex interaction may be the future of anti-aging therapy. Scientist have discovered the enzyme telomerase which may lengthen our telomeres (this research is still very experimental). Since we have no control over the genetic factors, we must concentrate on the things which may slow down aging and improve quality of life. My goal in this post is to bring awareness to the things we have control over and can change. I also would like to point out the point of this article is not necessarily to live longer, but have a better quality of life.
    The "science" of anti-aging revolves around a few  principles. The first has to do with the lifestyle you lead. This involves exercise, sleep patterns, stress levels, and psychological factors such as happiness and contentment. Exercise is vital to health and vitality. Our lifestyles may have become a little too sedentary with modern technology even though we now live much longer. Aerobic exercise will have a profound effect on our bodies by strengthening the muscle groups, improving bone strength, decreasing free radical formation and improving heart health. The second principle relates to the foods you consume. We have all heard the saying you are what you eat. This is true in regard to your health. Our society consumes a lot of genetically engineered foods with added steroids and preservatives (as does our family). It was not that long ago when people grew their own foods and ate in a much more healthier way. The third principle has to do with our decreasing hormone levels as we age and the way we use these hormones in a less productive way. All of these factors will contribute to the aging body. The good news is that there are a number of things we can do to slow down the process and decrease the production of free radicals and inflammation in our bodies.
    Free radicals are unstable molecules formed by a process called oxidation, which is sort of like rust in your body. Oxidation will steal an electron from the molecule thereby making it unstable. This process in turn cause the unstable molecules to try and re-balance itself by stealing an electron from another molecule thereby causing inflammation and damage (your brain cells may be particularly susceptible to free radicals). The normal cells will then be damaged as the process will intensifies and cascades. What causes free radicals? A number of factors may contribute to free radical formation.

    Factors related to free radical formation :
    The body's metabolic process (especially as we age)
    Environmental toxins
    Pollution
    Smoking
    Alcohol
    Immune responses to infections
    Foods high in unsaturated foods
    Food preservatives (nitrites and nitrates)
    Prolonged sunlight
    Prolonged stress/anxiety
    Sleep deprivation
    High cholesterol levels

    Exercise
    The two most important things you can do to improve health and vitality are probably exercising and having a proper diet. Exercise relaxes our bodies, increases circulation, helps to detoxify our bodies and  improves sleep patterns and stress levels. Exercise will also improve your mood, help maintain weight, help combat chronic diseases such as high blood pressure, diabetes, osteoporosis and atherosclerosis. Aerobic exercise uses large muscle groups repetitively for a sustained amount of time and you should exercise for at least 30 minutes three or four days a week. Start slowly if you do not already have a protocol established. Vary your routine so your body does not become too efficient at a particular exercise. Stay well hydrated when you exercise and don't forget to add electrolytes to your diet if you sweat. Before you begin, make sure you have no health issues which could be worsened by vigorous exercise. Stretch before you begin and cool down afterwards. Yoga may also be of benefit. Exercise can also be fun. Activities such as dancing, biking and group walking will often take the drudgery out of your routine.

    Stay tuned as I will discuss diet and nutrition, supplements and hormone therapy in the upcoming parts.
    Chris Neill

    Friday, January 14, 2011

    Low Libido

    Libido is synonymous with sexual desire; therefore a low libido is a decrease or loss of sexual desire. Women are known to suffer, if that is the correct term, much greater from this condition than men. Also of note, women usually have their highest level of libido around the time of ovulation, when their natural hormonal levels are at their highest. I have often heard it said that women need a reason to have sex and men only need a partner. This phrase demonstrates the great differences between men and women in this reguard. Low libido can be broken into three general categories, hypoactive sexual desire (decreased libido), anorgasmia (failure to have an orgasm) or asexual desire (never really had a desire, most difficult to treat). This topic may cause great marital discord or possibly lead to infidelity. The causes are extensive and often difficult to diagnose and treat. Since women have this issue more often, I will focus on their causes and treatments. Treatment may also take several modalities and a significant amount of time.

    Causes can be broken down as follows: (this is an incomplete list as it would be quite long)

    Medical Causes-
       Low thyroid
       Hormone imbalances such as menopause or andropause
       Obesity
       Alcohol abuse
       Drug abuse
       General pain issues
       Vaginal spasms(Vaginismus)
       Pain with intercourse (endometriosis, fibroids, adhesions etc...)
       Urinary incontinence
       Vaginal atrophy-thinning of the tissue (usually menopause)
       Fatigue, sleep deprivation
       Multiple Sclerosis (may cause decreased sensation) 

     Medications
       Antidepressants
       Long term birth control use( increases sex hormone binding globulin-SHBG)
       Tranquilizers/Mood stabilizers
       Certain blood pressure medication
       Narcotics
       Numerous other herbs and meds may also contribute
      
    Psychological
       Sexual abuse
       Relationship issues-anger, trust, resentment, ect...
       Stress/Anxiety
       Depression
       Cultural and Religious issues
       Body dysmorphia-self image issues
       Mental disorders
       ? Other

    I have always believed libido and sexuality starts in your mind. This is probably much more true where women are concerned. Women generally want romance and need security in their relationships to further intimacy. I often recommend that couples get more alone time since children can have much more of an effect than women often realize. As a matter of fact about half of women will lose their desire after having children. This may be to hormonal issues, body image issues, kids sleeping down the hall or the new role a woman has as a mother. Parents should not feel guilty taking time to themselves as moms should not feel guilty taking some me time. Couples who can openly discuss this issue will often resolve many of the causes themselves. Hysterectomy has not generally been shown to cause low libido unless the ovaries are removed prior to menopause. Medical therapies such as hormones and Wellbutrin, lubricants, changing or stopping certain medications, and possibly biofeedback or physical therapy may help. Some couples will greatly benefit from counseling and better communication.
      
      

    Sexual Abuse in Children

    My goal of this blog is to bring awareness to real life issues. Today I was reminded, yet again, of a real problem in our society and that is sexual abuse in children. I cannot tell you how many times I have heard the story of (usually) a young lady who experienced this tragedy as a child or young adult. By the time I hear their tale, they hopefully have been through therapy and have grown into well functioning adults. Fortunately, most of these individuals have conquered their demons and have moved on with their lives. I was also reminded of the strength most people have within themselves although they will always carry the scars. So I wanted to present a few facts about this very serious issue to bring awareness and possibly prevention.

    In the U.S., the literature reports that approximately 20% of women and 10% of men have been sexually abused as children. About a third of sexual abuse offenders are relatives of the child and most often brothers, fathers, uncles or cousins; around one half are babysitters, family friends or neighbors (and occasionally teachers). Strangers are the offenders in only 10% of cases. The majority of sexual abuse cases are committed by men; studies show that women commit about one fourth (25%) of offenses reported against boys and 5% of offenses reported against girls.

    The longer term effects of child sexual abuse include anxiety, depression, poor self esteem, adult sexual dysfunction and post traumatic stress disorder (PTSD). These problems then further lead to other issues including self destructive behaviors such as substance abuse, alcoholism, eating disorders and cutting. These victims also have higher rates of medical conditions, conflict in romantic or interpersonal relationships and higher rates of suicide If you see suspicious physical signs such as irritation or trauma to the genital area then you should have a degree of suspicion.

    Here are some signs of sexual abuse to look for:  (from Prevent Child Abuse.org)
      Fear of a person or certain places, such as showers or bathrooms.
      Clinging, anxious, or irritable behavior.
      Reverting to more childish behavior, such as thumb sucking.
      Sudden self-consciousness about genitals.
      Sudden interest in genitals, sexual acts, and sexual words.
      Sexual behavior that is inappropriate for the child’s age.
      Acting out sexual or abusive behavior with toys, animals, or people.
      Nightmares, bed-wetting, fear of the dark, difficulty falling asleep,
      or other new fears.
      Increase or decrease in appetite.
      Vehement over-reaction when the child is questioned about being touched.
      Drawings that depict frightening or abusive scenes.

    If you suspect a case of sexual abuse please use the following contact:
    http://www.childhelp.org
    1-800-4-A-CHILD

    Thursday, January 13, 2011

    Does HCG Really Work?

    Is HCG ("Human Chorionic Gonadotropin") a fad or does it actually work? The answer is probably yes to both. Although, I don't know if you can call something that has been around for years a fad. I was very skeptical about this diet. I am a true believer in a healthy diet and moderate exercise. I followed it closely for a year or so before I began to use it in my own practice. In theory, HCG works by raising your metabolic set point, eating away at the central body fat and suppressing hunger. Our success rate has been great for the following reasons; we really try to weed out those people looking for a quick fix, those who only need to lose 20 pounds or less and anyone not truly committed to the program. I also consider this diet the begining of a long term lifestyle change. People also need to know what to expect from this diet as women will typically lose around 25 lbs and men up to 35lbs ( not 40 lbs in 40 days) depending on a patients BMI (body mass index). Nothing is without risks and side effects, although they appear to be low.  Insulin dependent diabetics as well as those with gall bladder disease cannot try the diet. Please take a look at the tips and supplement guide if you plan to use HCG. Lastly, many people have used the herbal HCG drops and been successful. My only concern is that this is a true starvation diet and may have a significant rebound effect. Know that real HCG is not that expensive and can only be administered through a cream (transdermally) or injection as it is broken down in the oral cavity and stomach.  Good luck in your endeavors.
    Chris Neill

    Tips for Successful HCG Dieting


    Be committed, you can’t cheat this one.

    Have a comfortable support group. 

    Buy or borrow a precise scale that measures in ounces and grams. They are readily available at many places such as Wal-Mart or Bed Bath and Beyond. Postal scales are also used but not as accurate.

    There are numerous recipes available on the Internet.

    You may also try Walden Farms products (sugar free,fat free). They are popular and can be found at Albertsons, Central Market, and Brookshires.

    Use ‘Ziploc’ type bags for pre-measuring foods. They can be stored in the refrigerator or freezer and cooked at a later date. You may consider a “George Foreman” type grill as a good investment.

    Use “seal a meal” type bags for partially cooked foods such as meats, chicken and vegetables to microwave later. You can also put raw fish in with veggies to microwave later.

    Try an apple in the morning as it will give energy and decrease hunger.  

    Try “Whey” protein powder mix as a substitute for meat to add variety.

    Use allowable spices to enhance the quality of meals.

    Some successful dieters have allowed one diet soda per day. Just remember there is sodium in most sodas.

    If you go off the diet, this is in effect another loading day and you will probably gain weight. It will then take several days to start losing again. However, this strategy may be considered if you stall.

    One recurring recommendation is to consume at least 30 grams of fiber daily through food sources or supplements. This will help to keep your digestive system working properly.

    And lastly, do not eat within two hours of your bedtime.


      
    HCG Diet Supplements



    A daily multivitamin is recommended.

    Nutritional supplements are generally considered ok. Check for any added calories.

     

    Digestive enzymes, available under many names, will often help with absorption of foods and your digestive system.

     

    Consume 400 units or more of vitamin D (D3) daily.

     

    Add calcium to your daily routine.

     

    Probiotics may also be helpful to maintain regular bowel function.

     

    Omega 3 supplements may also be taken daily.

    Wednesday, January 12, 2011

    Insomnia

    The literature states around 10% of the American population has chronic insomnia and one in two has experienced insomnia at some point in their lives. My guess is these numbers are far too low. I see a lot of people who complain of insomnia and have written my fair share of Ambien prescriptions. Perhaps that is because women seem to have a higher rate of insomnia than men. Stress, depression and anxiety will often lead to short term insomnia and then to chronic insomnia. Other factors include alcohol and drug use, health issues, work schedules, caffeine and nicotine use and of course financial concerns. The list of causes seems endless as it applies to each individual in their own unique life. No matter the cause or the individual, insomnia can become a serious problem leading to health issues.

    Types of insomnia:
      Primary Insomnia-not related to other conditions. This type usually has an earlier onset. Often more difficult
      to treat as it may not have a specific underlying cause.
      Secondary Insomnia- due to other identifiable factors such as medications, lifestyle, medical conditions... .

    Other Sleep Disorders :
     Restless Leg Syndrome
     Involuntary Limb Movement
     Sleep Apnea
     Biological Clock Disorders (Circadian Rhythm Disorders)- going to bed too late.

    Treatment is individualized depending on each persons specific causes and lifestyles. That being said, there are a number of helpful and useful options. Of course, the first step is to remove any stressors or causes if known (and if it is realistically possible to do so).

    "Natural" Treatments

    1. Cognitive Behavioral Therapy-Controlling or stopping negative thoughts and worries that keep you awake. Sounds simple I know, but this may take a lot of effort. This treatment is the best way to improve sleep. Some examples include:
       a.Sleep hygiene — Taking steps to make quality sleep more likely, such as going to bed and waking up    at the same time each day, not smoking in bed, avoiding drinking too much coffee or alcohol late in the day, and getting regular exercise.
      b. Sleep restriction Matching the time spent in bed with the amount of sleep you need. This is achieved by limiting the amount of time spent in your bed not sleeping. You go to bed later and get up earlier then you would normally, and then slowly increase the time in bed until you are able to sleep all night.
      c. Stimulus control — Using the bed only for sleep and intimacy. No food, television, books etc... . Do not stay in bed for more than thirty minutes if you cannot fall asleep. Keep the temperature, light and noise levels at the appropriate level (often difficult for shift workers).
       d.Relaxation training — Reducing stress and body tension. This can include meditation, soft music and muscle relaxation.
       e.Biofeedback Measuring body actions, such as muscle tension to help you control them.

    2. Herbal Remedies: (this a short list of the more popular ones and are often disputed)
      a. Chamomile tea
      b. Valerian tea or tincture
      c. Kava Kava
      d. St John's wort
      e. Tryptophan-may have adverse effects

    3. OTC Medications:
      a. Diphenhydramine(Benadryl)-avoid the Tylenol pm products as you do not need the extra risk to your liver unless you have pain issues. May give a groggy "hangover" feeling the next day.
      b. Melatonin- may be most helpful with those having difficulty in advanced age.

    4. Prescription Medications:
      a. Benzodiazpines-long used to treat insomnia. Examples include Restoril, ProSom, Ativan, and Klonipin. While they will give relief, they really do not help to fix the underlying problem.
      b. Newer sedatives-These will not have the long lasting sedation effect the benzos will have and are better tolerated during the work week. This class includes Sonata, Lunesta and Ambien (now in generic form).

    5. Other:
      a. Warm Milk
      b. Massage
      c. Warm Bath

    Insomnia is a real problem in this country. We live in a very fast paced and often stressful world. That means we all have to find our own means to relax and enjoy. Good luck and I hope you will gain something helpful from this post.

    Tuesday, January 11, 2011

    Menopause and Hormone Replacement

    This subject gets a whole lot of attention and is still a bit of an enigma. The word "menopause" literally means the "end of monthly cycles" from the Greek words pausis (cessation) and men (month). This article is for informational purposes only but I certainly hope it is helpful to those who are dealing or have dealt with this issue.
    Menopause is a term used to describe the permanent cessation of the function of the ovaries and therefore leading to a permanent cessation of menses. This cessation is somewhat abrupt, however women will typically go through a preimenopausal phase for 1-3 years. The average age of menopause is 51.4 years. The range of menopause is generally between 45-55 years. Premature menopause (1% of the female population) occurs when a woman is less than 40 years of age. Menopause will ofter occur earlier in smokers and women who have had their uterus removed (simple hysterectomy). Menopause occurs due to the depletion of the ovarian  follicles (aka "eggs") as compared to men who simply reproduce spermatozoa. Women are born with a certain number of ovarian follicles and cannot make any more after birth.  Of course if the ovaries are removed, then menopause is then considered a "surgical menopause". A simple blood test or saliva test will usually give the diagnosis in combination with the symptoms of menopause.

    What are the common symptoms of menopause?
        Early: 
          Hot flashes or hot flushes, including night sweats
          Sleep disturbances
          Mood disturbances, fluctuations
          Irritability, anxiety
          Memory loss
          Decreased libido
          Migraine headaches
          Depression
        Later:
          Thinning of the vaginal tissue causing pain with sexual activity
          Decreased lubrication with sexual activity
          Urinary problems including frequency, urgency, incontinence
          Thinning of the bones
          Possible increased risk of heart disease

         
    To treat or not to treat, that is the question.
    After the Women's Health Initiative (WHI) came out many women have stopped hormone replacement therapy (HRT). The study showed an increased risk of breast cancer linked to synthetic progesterone ("Provera"). Estrogen has not shown to have the same risks as synthetic progesterone and continues to be well received by many. Although this study appears to be somewhat flawed, it has caused a great deal of debate for a number of years. The general belief about HRT is that synthetic continuous progesterone will increase the risk of heart attacks, strokes, and breast cancer, while natural progesterone does not appear to have the same risks. Many physicians have continued to prescribe  bio-identical ("natural") hormones. Furthermore, transdermal (patches, creams) hormone replacement appears safer than oral supplementation. So the big question is whether or not to take HRT. The current thinking is to take the lowest effective dose of hormones for the least amount of time. That really means considering taking HRT until age sixty (60) or so. I tell my patients that you are in charge of deciding whether or not to take HRT, the method of supplementing and how long to take them. If a woman stops HRT for an entended period of time, two years or more, she should probably not resume them.

    Treatment:

    Hormones:
    Estrogen and progesterone (especially if you have a uterus) are most commonly used. This may be in the form of a pill, cream or patch.
    Testosterone may be added especially for decreased libido.

    Non-prescription:
    Herbal remedies include black cohosh, Dong quai or licorice root.
    Phytoestrogens are week estrogens from plant sources that may also help.

    Other: (for hot flushes)
    Belledonna (Bellamine)
    Antidepressants such as Effexor
    Clonidine

    So do you take HRT? I simply suggest that women take a objective look at the information available and then carefully consider HRT for quality of life and the prevention of osteoporosis. Also, please note that women without a uterus do not have to take progesterone at all. Good luck in your decision process.

    Andropause, The Lowdown on Low T


    What is it?
    When does it begin?
    What are the symptoms?
    Can you prevent it?
     
    WHAT IS ANDROPAUSE?
       Essentially it is an age related decline in the male bodily function.This decline occurs over a period of years to decadesThe cause is widely known to be due to a gradual drop in hormone levels, particularly the male hormones.
     
    WHEN DOES THIS OCCUR?
    THAT JUST DEPENDS ON HOW LUCKY YOU ARE
    Men and women both begin to have a drop in their hormone levels beginning by the mid thirties. Women will then have an rapid cessation of their female hormone levels around the age of 51 (Menopause). Men will have a gradual decline in hormone levels, particularly testosterone, from the mid thirties on. They will drop, on average, one percent per year.  Some men, although rare, will continue to produce adequate hormone levels well into their 70’s.
     
    HOW DO YOU FEEL?
    Have you ever had any of these symptoms?
       1. Mental functions including inability to concentrate or focus, sleepiness, depression, decreased clarity, loss of creativity or a decrease in initiative.  
       2. Musculoskeletal conditions such as less physical stamina, strength, or performance. Or perhaps an increase in achy joints or muscles.   
       3. Sexual function will almost always decline with age. Men may notice a decrease in desire, function or quality of sexual activity. 
       4. Physical and metabolic condition will deteriorate with age. Men and women both will see elevated total cholesterol and triglyceride levels, sugar levels, blood pressure and weight gain. Other areas will decline such as bone density, muscle mass, HDL (good cholesterol) levels, visual acuity and circulation.
     
    WHAT ARE THE MALE HORMONES
    The driver of the bus is testosterone. Testosterone is an anabolic (growth promoting) steroids produced primarily by the Leydig cells of the testes and somewhat by the adrenal glands. Testosterone surges in puberty to promote growth and development when levels  rise to a lifetime high of around 1000ng/dl. These levels will stay relatively constant for ten to twenty years, then begin to drop about one percent per year, barring no disease process occurs. The driver of the bus is testosterone. Testosterone is an anabolic (growth promoting) steroid produced primarily by the Leydig cells of the testes and somewhat by the adrenal glands. Testosterone surges in puberty to promote growth and development when levels  rise to a lifetime high of around 1000ng/dl. These levels will stay relatively constant for ten to twenty years, then begin to drop about one percent per year, barring no disease process occurs.
       
    DEHYDROEPIANDROSTERONE(TOO LONG TO PRONOUNCE) 
    DHEA is produced by the adrenals and the testes. This hormone is considered an adrenal vitamin of sorts in that it is converted into testosterone and to some degree estrogen by the adrenal cortex. DHEA acts like a much milder form of it’s parent hormone, testosterone. Levels will begin to drop slowly by the early thirties. Studies have also shown a positive correlation between DHEA and heart disease prevention. Although, sold “over the counter,” DHEA is considered a performance enhancing substance by the Olympic Committee and therefore not allowed.    
      
    OTHER IMPORTANT HORMONES
    Estrogen is produced in small quantities in men. This is accomplished by converting some testosterone to estrogen. Too much will have a negative affect on men.  
    Thyroid hormone controls metabolism and supports many bodily functions. A very common problem for women is a low level of thyroid causing fatigue, cold intolerance, hair loss, and other symptoms. 
    Human Growth Hormone (HGH), made by the pituitary gland is vital for growth and development. It has been called the fountain of youth as it will promote increased muscle, bone and vitality. It may also decrease diabetes, obesity and the aging process. The use of HGH  to treat the aging process is extremely controversial and must be done with caution. This also means a daily shot or two.
    Insulin, produced by the pancreas, in vital for life. It allows our bodies to use glucose as energy for daily living. Insulin resistance is a common problem seen with aging and especially obesity causing an increase in weight, blood sugar, blood pressure and cholesterol.
     
    BY THE WAY, WHAT IS A HORMONE?
     
    Simply put, a hormone is a chemical substance produced in one part of the body which affects an organ or groups of cells in another part of the body.
     
    BENEFITS OF NATURAL TESTOSTERONE REPLACEMENT
     
    Decreased body fat and increased muscle mass, strength.
    Stronger bones, higher mineral content.
    Improved libido and sexual function.
    Improved memory and brain function.
    Higher energy level and stamina.
    Decreased insulin resistance and lower risk of the dreaded “metabolic
    syndrome”.
    Reduced risk of heart disease.
     
    A WORD ABOUT THE HEART
     
    Men have a notorious reputation for heart disease. Most men only get heart disease with advancing age and poor lifestyles. Risk factors include obesity, high blood pressure, smoking, sedentary living, diabetes and family history. Surprisingly testosterone has shown repeatedly to have a protective effect on the heart and  blood vessels.
     
    BASIC SCREENING

    Blood count
    Chemistry profile
    Lipid profile-cholesterol, HDL, LDL
    Thyroid (TSH)
    PSA-a prostate test for men oven 50
    DHEA Sulfate-measures adrenal function

     
    CONCLUSION 
    Everyone ages, some faster than others.
          Many factors are lifestyle dependant and must be changed to improve quality of life. There are also non-hormonal therapeutic modalities to offset the effects
    of aging and hormone depletion. Hormone replacement therapy will improve  many of the effectsof aging and andropause.