Acupuncture and Men's Health

Did you know that men are 24% less likely than women to visit a doctor for routine care? Men, not unlike women, should take care of their health during all life stages. It may be uncomfortable to discuss prostrate, erectile dysfunction, or infertility issues with your physician, however it is in your best interest to be honest. These conditions impact your overall health and affect your sex life, relationships, and emotional health.

Acupuncture and Traditional Chinese Medicine (TCM) can help you reach your best health.
The following are men's conditions that can be aided through acupuncture:

• Prostatitis is inflammation of the prostate, causing pelvic pain and urinary symptoms. Prostatitis has unknown causes, and therefore, can be difficult to treat. Symptoms include pain or burning when urinating, pain in the pelvic area and lower back, and a frequent need to urinate. Studies have shown that herbal therapies and acupuncture are effective in relieving chronic bacterial prostatitis.

• Prostate cancer affects roughly 1 in 6 men in the United States. It is suggested that all men over age 50 get yearly screenings, as the disease responds well to treatment when caught early. Symptoms can include lower back or hip pain, blood in the urine or semen, and urinary problems. TCM and acupuncture can relieve the side effects and boost the health of men with prostate cancer.

• Benign prostatic hyperplasia (BPH) occurs when the prostrate compresses the urethra. It is a very common concern and affects about 50% of men over 60. Symptoms may include difficulty starting to urinate, slowness of the urinary system, frequent urination, and the need to urinate in the middle of the night. Common treatments include medication, self-care techniques, and surgery. Acupuncture supports overall urinary system health and can help restore and rebalance.

• Erectile Dysfunction (ED) is a condition that occurs in most men at some point in their lives; however, ongoing problems may indicate a more serious issue. Causes of ED include diabetes, clogged blood vessels, and heart disease, as well as medications, anxiety, depression, and stress. Treatments include medications, medical devices, and surgery. The benefit of acupuncture is that it can boost a man's sexual stamina.

• Infertility usually occurs in men because of poor quality or movement or a low concentration of sperm. Acupuncture has been shown in conjunction with Western medicine to improve sperm quality and production and increase the chance of success. Acupuncture and TCM also may help both the man and woman handle the emotional stress when having difficulty conceiving.

• Male depression can manifest itself through feelings of irritability, frustration, fatigue, loss of interest in work and social life, and sleep disturbances. Stress and anxiety can be reduced and the mind and body calmed through acupuncture.

• Male menopause (MM), also known as androgen decline, includes symptoms such as mood changes, depression, sexual problems, and fatigue. Herbal therapy and acupuncture can help men as they age and alleviate signs of MM.

What can you expect during your treatment?

Your practitioner will note your health history and perform an exam to determine the cause of your health concerns. A treatment plan will be designed for you to restore your body to its natural balance.
Fine, sterile needles will be inserted at specific points of the body during treatment to restore the balance of energy. In addition to acupuncture, your practitioner may include nutritional and herbal remedies in your treatment plan.

© 2012 Deborah Farley, L.Ac, CHHC, DOM

What Are The Warning Signs of Prostate Cancer?

What Are the Most Common Warning Signs of Prostate Cancer?

Because of the prostate's location in the body (located just below the bladder in the lower pelvis), urinary symptoms are common warning signs that something is wrong with the prostate.
As urine empties out of the bladder, it travels through a thin tube called the urethra. At the very beginning of the urethra, just as it exits the bladder, it passes directly through the prostate. As the prostate enlarges due to cancer or another problem, the urethra is pinched tighter and tighter within the prostate. As the tube narrows, urine has a much harder time making its way through the urethra and out of the body.

Urinary warning signs that something could be wrong with the prostate include:

• Frequency - urinating much more often than normal.
• Urgency - having a sensation that you need to urinate immediately.
• Nocturia - getting up to urinate multiple times during the night.
• Hesitancy - difficulty starting the urine stream.

Prostate cancer is not the only disease that can cause the prostate to swell, however. In fact, benign prostatic hyperplasia (BPH) is a much more common cause of an enlarged prostate, and thus, of urinary symptoms. BPH is not cancer, but is still an important condition that should be treated by a physician.

What Are Other Less Common Warning Signs of Prostate Cancer?

The urinary problems discussed above are among the most common experienced by men with prostate cancer. However, they are not the only ones. Other less common warning signs include:

• Blood in the urine
• Blood in the semen
• New-onset erectile dysfunction (impotence)
• Bone pain (especially in the lower back, hips, or ribs)
• Loss of bladder control

When Should I Go to See My Doctor?

The answer to this question is simple. Visit your physician and explain your situation whenever you first begin to experience any of these symptoms. It is especially important for African-American men and those with a family history of prostate cancer to see their physicians, as these two groups have much higher rates of prostate cancer.

The warning signs listed above are almost always abnormal and all need to be evaluated by a physician. This is especially true if these warning signs appear suddenly. Your doctor can use very simple examinations and laboratory tests to determine whether your symptoms are due to prostate cancer, another serious disease, or a less dangerous condition.

What Are the Positives and Negatives of Prostate Cancer Screening?

Prostate cancer screening involves the use of testing in men who have no symptoms of the disease. Screening for prostate cancer is now much more widely used than in the past and has gained broad acceptance by many physicians in the United States and a number of other countries. Despite it’s extensive use, it is still important to weigh the pros and cons of screening.

In the past, the only tool that doctors had at their disposal to detect prostate cancer in its early stages was the digital rectal examination (DRE). Today, with the easy availability of the PSA test, men throughout the United States and many other countries can now be screened using two very different and complimentary tests. More information about these two tests and their role in diagnosis.

What Are the Benefits of Prostate Cancer Screening?

1. Many men who have early-stage cancer without any symptoms will have their disease detected before it has had time to spread. This is, by far, the most important argument in favor of prostate cancer screening. When cancer is caught while it is still confined to the prostate, nearly 100% of men survive. When it has spread elsewhere, this number drops significantly.
2. Both the DRE and PSA test are very easy to perform, require little time, and are not associated with any significant risks.
3. The percentage of men who die annually of their prostate cancer has declined significantly over the past few years. This is thought by many physicians to be due in part to better screening in addition to improved treatment options.

   What Are the Potential Disadvantages of Prostate Cancer Screening?

   Many men will have high PSA results, but not actually have prostate cancer. These men then undergo further, ultimately unnecessary, testing to determine if cancer is present or not.
   Occasionally men will have low PSA levels and a normal DRE, but actually have prostate cancer. In this situation, men will simply be missed by the screening examinations and go longer without needed treatment.'
   
   Some men will have an abnormal PSA or DRE, be correctly diagnosed with prostate cancer, and then appropriately treated, but will actually have disease that would have never spread fast enough to cause them harm. It is a fact that some men have prostate cancer that is never aggressive and will not kill them. Unfortunately, it is currently not possibly to tell who these men are in advance.
   

   So What’s a Guy to Do?

   Overall, the majority of primary care physicians and prostate cancer specialists favor the use of prostate cancer screening because they feel that the huge benefit of detecting prostate cancer early in many men outweighs the disadvantages listed above.
   
   Most physicians agree that all men over 50 and men over 45 who have significant risk factors should undergo prostate cancer screening. Some men, however, such as those over the age of 75 and those with significant health problems, likely will not benefit greatly from screening because they are far more likely to pass away from a cause other than prostate cancer.
   
   In order to make an educated decision about whether screening or any other aspect of diagnosis is right for you, you should talk with your physician.

_{Sources:
Screening for prostate cancer. American College of Physicians. Ann Intern Med 1997; 126:480.
Screening for prostate cancer: recommendation and rationale. Ann Intern Med 2002; 137:915.
Tchetgen, MB, Oesterling, JE. The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration. Urol Clin North Am 1997; 24:283.
Thompson, IM, Ankerst, DP, Chi, C, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2006; 98:529.}

Smoking With Liver Disease - A No-No

In patients who have chronic liver disease that is due to alcohol or viruses, the damage to the liver is primarily caused by the alcohol or virus. However, other factors can modify, or aggravate, the amount of liver damage. An interesting study published in the July issue of the journal, Hepatology, focused specifically on the effect that smoking cigarettes has on the liver damage caused by a common chronic liver disease, hepatitis C.

The authors examined the liver biopsies from 310 patients with chronic hepatitis C who were being hospitalized for their first liver biopsy. They compared the biopsies from patients who were current cigarette smokers (176 patients) or former cigarette smokers (56 patients) with biopsies from patients who had never smoked cigarettes (77 patients). They found that current and former smokers had more inflammation and scarring of their livers than did nonsmokers. This finding could not be explained by other factors, such as concurrent alcohol use, that are known to aggravate the inflammation and scarring in hepatitis C. The authors concluded that patients with chronic hepatitis C should be informed that smoking cigarettes could worsen their liver disease.

Chronic hepatitis C can seriously damage the liver. Any study that suggests a way of lessening the damage is potentially important. As always, however, the question must be asked, how well does the study support the conclusions? How strong is the association between smoking cigarettes and greater liver damage? As we have done several times in other articles, let's look critically at the study.

The study was published in a first tier journal and authors are well-known and respected in the field of liver disease. However, the design of the study, referred to as an observational study, is not the strongest.

In observational studies, observations are made--in this case, a history of smoking and examination of liver biopsies--and then associations are looked for among the observations. Although this is a good way of looking for relationships between observations, it is a weak method for determining cause and effect. For example, the authors suggest, on the basis of the association they found, that smoking cigarettes worsens the liver damage. The same association might also occur if patients with more severe liver disease are more likely to smoke!

This study by itself provides limited support for an association between smoking and more severe liver damage. However, the authors cite several other studies in patients with chronic liver disease that show a similar association. These other studies with similar findings add support to the conclusion of the Hepatology study that there is an association between smoking cigarettes and liver damage. (The other studies also suggest that smoking cigarettes is associated with liver damage in chronic liver disease due to alcohol and hepatitis B.)

A type of study that offers the strongest support for a causal association between two observations is called an interventional study. For example, patients who havechronic hepatitis C on a liver biopsy could be randomly assigned to smoke or not smoke, and then additional biopsies could be examined at a later time. If cigarettes are damaging, the biopsies from the smokers should be worse than the biopsies from the nonsmokers. For ethical reasons, such a study cannot be done. (It could be done in animals, however.)

Is there another type of study that could be done to more strongly support the association and a causative relationship between cigarettes and greater liver damage? A controlled, prospective study might be feasible. For example, biopsies could be done in smokers and nonsmokers (control biopsies), and the biopsies could be repeated at a future time. If smoking is detrimental, the biopsies from the smokers should show a greater progression of liver disease than the biopsies from the nonsmokers. This type of study gets around the problem of knowing which comes first: that is, if smoking causes greater liver damage or if greater liver disease causes patients to smoke (since the smoking precedes the damage.)

What do I conclude? I would feel more comfortable if there were a better-designed study to more strongly support the hypothesis that smoking cigarettes damages the liver in patients with chronic liver disease. Until such a study appears, however, I believe there is enough support to advise patients with chronic liver disease to refrain from smoking.

What You Should Know About Prostate Infection

Prostate infection, or prostatitis, can cause a number of severe symptoms, can lead to dangerous complications, and can mimic the symptoms of more serious conditions such as prostate cancer.

Where Do Prostate Infections Start?

Prostate infections most commonly spread upward from the urinary tract. When bacteria, viruses or other organisms enter the urethra, the thin tube that carries urine through the penis, it is sometimes possible for them to migrate upward to the area of the urethra that is surrounded by the prostate. They can then invade the prostate and cause an infection.
Prostate infections can also occur after any kind of medical procedure that involves the prostate. Prostate surgery or prostate biopsy can both result in a prostate infection.

What Are the Most Common Symptoms of a Prostate Infection?

A prostate infection can cause a wide variety of symptoms depending on how long it has been present.

The most common symptoms have to do with problems with urination. Problems with ejaculation are also quite common.

The fact that problems with urination and ejaculation are common makes sense, given that both urine and semen pass through the prostate as they travel out of the body. Inflammation or infection in the prostate results in difficulties with the passage of either of these fluids.

The most common urinary symptoms of prostate infection are:

• Painful urination: specifically, a burning sensation
• Urinary urgency: experiencing an urge to urinate immediately
• Urinary hesitancy: dribbling or difficulty starting the urine stream
• Urinary frequency: needing to urinate more often than usual
• Nocturia: needing to urinate several times per night

Painful ejaculations, pain in the groin or pelvis, and pain in the testicles are all common symptoms of prostate infection as well.

Symptoms such as fever, chills, malaise (feeling generally ill), and fatigue can also occur during a prostate infection.

If the prostate infection lingers (becomes chronic), then intermittent urinary tract infections may occur. Urinary tract infections are generally uncommon in men, and recurrent urinary tract infections in a man should prompt an evaluation for chronic prostatitis or other causes.

What Else Can Result in the Same Symptoms as Prostate Infection?

The most common symptoms of prostate infection, as listed above, are not specific to prostate infection. They can also be experienced when other problems of the prostate are present, including
prostate cancer or benign prostatic hyperplasia (BPH), also known as “enlarged prostate."

Because the symptoms of prostate infection can be identical to those of prostate cancer, it is essential that you see your doctor if you develop these symptoms, especially if the symptoms persist.

_{Source:
Kumar, Robbins and Cotran: Pathologic Basis of Disease, 7th ed. 2005.}

Protect Against Prostate Cancer

The Prostate Problem

If you're a man who has ever gotten a prostate-specific antigen (PSA) screening, you know it's a "must-have" test for guys over 50. But there's a debate that's been raging for years over the test's ability to save lives. And now, two opposing studies have muddied the waters on the value of this routine test even more - leaving American men wondering if the test is really worth taking.
While an elevated PSA reading may indicate a life-threatening cancer, it may also detect slower-moving tumors that would never cause death. Because doctors can't yet tell the difference, treatments are often ordered that can impair men's quality of life - causing many experts to worry that the PSA test is overused.

The Problem With PSA

If you've never had a PSA screening, here's the 411 on this popular prostate test. The prostate produces a substance known as Prostate Specific Antigen (PSA). A small amount of this antigen continuously leaks into the bloodstream, and levels can be easily measured. Since high levels of PSA can be associated with prostate cancer, most doctors rely on this test, combined with a rectal exam, to screen their patients for prostate cancer.

Routinely measuring PSA levels as a way to spot potential prostate cancer began in the early 1990s and quickly gained status as the "gold standard." The logic behind the simple blood test was that the earlier you could spot prostate cancer, the better the chance of survival. It's a belief most doctors still subscribe to.

On the other hand, the American Cancer Society does not currently recommend routine PSA screening for all men. Here's why: Raised PSA levels simply indicate there's a problem with your prostate. While that could mean cancer, it could also be a sign of a prostate infection or an enlarged prostate. Or it could mean nothing at all since PSA levels also go up after some medical procedures, particularly after a digital rectal exam. Smoking, your diet, weight changes, and the use of calcium supplements an also cause unreliable PSA readings.

Unfortunately, too many doctors automatically schedule a biopsy based on just one PSA screening. This is totally unnecessary. PSA levels, like your blood pressure, can go up and down based on a variety of factors. Scientists at the University of Texas found that men who are overweight or obese typically have lower PSA counts - even if cancer is present. Bladder infections can also upset PSA levels. Certain medications, like the hair loss drug finasteride, can lower your PSA level, while stress can raise it. And something as simple as changing your diet can impact your PSA.

To get the whole picture, several PSA screenings should be done before more radical measures are taken. And that's where these two studies come in.

Study Stupor

While both studies appeared in a recent issue of the New England Journal of Medicine, that's where the similarities end. The first study, which followed more than 76,000 American men for seven years, found that getting regular PSA screenings did not reduce prostate cancer deaths. But the other study, which included 182,000 European men, found that getting tested reduced the risk of dying from prostate cancer by 20 percent.

So which study is right? Who knows? What I can say is this: The never-ending debate over the virtues of PSA screenings is enough to make any man crazy! But there are some guidelines that can help you decide if you really need to get tested. The most important is family history. You have a higher risk of developing prostate cancer if the men in your family had the disease, especially if they were diagnosed before they turned 55. If your father or brother developed prostate cancer, your risk is doubled.

Race can also be a risk factor. More African-American men are struck by prostate cancer than their Asian counterparts. Blacks also have a higher risk of dying of the malignancy. If you have either of these risk factors, you should definitely schedule a PSA test by the time you celebrate your 45th birthday.

What if you're an older man? Some cancer experts say that, if you have had normal PSA readings in the past, you can stop testing at age 70. But, if previous tests show rising PSA levels, keep getting screened at least annually. If you're eventually diagnosed with prostate cancer, be aware that most prostate cancers are confined to the prostate itself and grow very slowly. If you're over 75, consider "watchful waiting" - a situation where your doctor keeps very close tabs on the cancer's progression. It can be a good alternative to aggressive treatment, which can carry the risk of incontinence and impotence.

Pro-Active Protection

In the midst of all this confusion, there is some good news. Mother Nature has provided men with an arsenal of tools to protect against prostate cancer. Here are three of the most effective:
Vitamin D:  A growing number of studies link the "sunshine" vitamin to a lower risk of prostate cancer. One observational study of 19,000 men found that those with the lowest levels of vitamin D have a 70 percent higher risk of developing prostate cancer than those men who got enough of this nutrient. Without enough vitamin D, prostate cells can multiply too quickly and promote both prostate enlargement and cancerous tumors. Yet between 20 and 80 percent of all Americans have low enough levels to classify them as vitamin D deficient. Make sure you're getting enough by taking 1,000 IU of supplemental vitamin D per day to help prevent cancer.

Lycopene:  This nutrient is a powerful antioxidant and the source of the red coloring in tomatoes. In a study of over 40,000 health professionals, Harvard researchers found that lycopene slashed the risk of prostate cancer by 35 percent. In another study, researchers discovered that the risk of developing prostate cancer - especially aggressive cancer - decreased in men taking 50 mg. of supplemental lycopene daily. They also noted that a high level of lycopene in the blood was associated with low PSA levels. To boost your lycopene levels, take at least 6.5 mg. per day.

Beta-Sitosterol:  This compound is found in a wide variety of plants, including prostate-friendly herbs like saw palmetto, pumpkin seed, and Pygeum africanum. A study of malignant prostate tumors showed that beta-sitosterol decreased cancer cell growth by 24 percent and boosted the rate that the cancer cells died fourfold. The researchers concluded that beta-sitosterol worked both directly and indirectly to halt the growth and spread of prostate cancer cells. To get the most protection possible, take 130 mg. of beta-sitosterol daily. Just be aware that plant sterols can interfere with beta-carotene and vitamin E absorption. Make sure to take a multivitamin to avoid a deficiency.

One Last Thing

If you do decide to get a PSA screening, it's also smart to have some idea what the results mean. What's high? What's low? The National Cancer Institute has created the following four categories to help your doctor determine your risk of prostate cancer.

Normal   0-4 ng/ml
Slightly Elevated  4-10 ng/ml
Moderately Elevated  10-20 ng/ml
Highly Elevated  20+ ng/ml
ng/ml = nanograms per milliliter

If your levels are elevated, don't panic! And don't let your doctor automatically schedule a biopsy. As I mentioned earlier, there are a lot of reasons your PSA may be higher than normal.

A higher-than-normal PSA reading simply means that two things need to happen. First, if your doctor hasn't done so, make sure he conducts a digital rectal exam (DRE). During a DRE, your doctor inserts a lubricated, gloved finger into the rectum and feels the prostate for hard, lumpy, or abnormal areas. Pressure may be applied with the doctor's other hand to the pelvic area so that he can feel for tenderness or abnormalities such as enlargement or growths. There can be some mild discomfort or pain during a DRE, since the doctor must press firmly on the prostate. This pressure can also make you feel like you need to urinate. But, even though it may not be on your "Top 10" list of fun things to do this year, it beats the heck out of getting a biopsy, which can be painful, risky, and potentially unnecessary.

The second thing you need to do is to request at least one more PSA screening before proceeding to more aggressive testing. Since prostate cancer is a slow-growing cancer, most men with higher than average levels can afford to take at least one additional test, preferably a few weeks after the original screening. Overall, PSA is fairly reliable over time, and both you and your doctor can get a much better picture of what's really happening inside your prostate if several PSA tests can be compared.
While you're waiting for your next screening, there are a number of things you can do to improve a troubled prostate. Start by cleaning up your diet. Avoid dairy and highly processed foods, and opt for healthy whole foods. You can also begin to take the supplements mentioned above.

Research Brief

Recently I told you how lutein can protect against age-related macular degeneration. Well, it turns out that this eye-friendly antioxidant can also tackle more mundane problems. A new study from China shows that taking lutein for 12 weeks protected computer users' eyes from becoming sensitive to long-term exposure to the light from computer monitors.

This is great news for folks like me who spend hours in front of their computers. But, to get this protection, the study found that you need higher-than-average amounts of lutein - six to 12 mg. daily. Along with taking a lutein supplement, you can increase your levels by eating more green, leafy vegetables and egg yolks.

Varicocele a common cause of male infertility

Facts about Varicocele

A varicocele is a collection of enlarged, varicose veins that develops in the spermatic cord. Caused by a defective or damage valve that regulates blood flow into the main circulatory system. Blood flow is hampered and enlargement of the vein occurs.

A varicocele can occur in one or both testicles

Most common in the left testicle (85% more common)

More common in men between the ages of 15 and 25 years old (10-20% higher).

 

Varicocele, a Common Cause of Infertility

About 40% of infertile men have a varicocele.

About 80% of men with secondary infertility, who have fathered one child but are unable to do so again, have a varicocele.

Infertility is common because the blood carried in the dilated vein makes the testes warmer. It is this warmth damaging sperm that is believed to be the cause of infertility. 

 

Signs and Symptoms of varicocele

The majority of men with a varicocele do not experience any symptoms.

Most cases are discovered during a physical examination by a doctor i.e. for infertility

The testicle may ache

There may have a feeling of heaviness in the testicle

It may be possible to feel the enlarged vein

here are a number of treatments avaiable to treat a varicocele. Treatment depends on symptoms and seriousness of the condition.

Treatment in Cases with No Symptoms or Mild Symptoms

A scrotal support or supportive underwear may be the only treatment required.
Varicocele Ligation

Surgery is recommended for men with a varcocele where pain, damage to the testicles, atrophy or where treatment is required for sterility. The procedure is surgical ligation (tying off) of the distended veins. This can be carried out under a general or local anesthestic. Keyhole surgery is sometimes available and results in a smaller scar. Surgery takes about 45 minutes and is performed as day surgery.

About two weeks away from work will be required but this depends on the type of work. A scrotal support will be required for some time after surgery.

Treatment Complications following Varicocele Ligation

Complications include infection, hematoma (blood clot formation), injury to the scrotal tissue or structures, injury to the artery that supplies the testicle. Re-emergence of the varicocele occurs in between 0.6 and 45% of cases

Embolization of the Varicocele

Performed under a local anesthetic, a small incision is made into the right side of the groin, through which a small wire is passed into the large vein in the leg. The wire is guided into the veins and drains the left scrotum. A small metal coil is placed in the vein to block it off, effectively doing the same job as surgical ligation. The procedure is usually on an out patient basis. The advantages of embolization include minimal risk of damage to the testicular artery so testicular atrophy is rare. There is a very small risk of developing a hydrocele.
Reocurrance of varicocele after this procedure is between 4% and 11%.

Complications of Embolization of Varicocele

Migration of the coil out of the vein

Allergic reactions to the x-ray contrast dye

Bleeding from the right groin where the wire is inserted

 

Returning to Fertility following Surgical Intervention for Varicocele
It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization.50% of men who have a varicocelectomy to correct infertility father children within a year. 5% to 20% who recieve treatment for varicocele have a recurrance of the condition.