Mens Health Blog. Medical Blog

WHAT REGULATES BLOOD PRESSURE?

admin — Thu, 21 Jul 2011 17:29:10 +0000

Your blood pressure varies throughout each day. When you are exercising and your body requires greater blood flow, the pressure increases. When you are resting, blood pressure decreases; it is lowest when you are asleep. It may change when you become excited, when you have a sudden injury, or after you smoke a cigarette. Many factors cause changes in the amount of blood your heart pumps as well as the state of the arterioles.If you increase the amount of water flowing through a garden hose, you will increase the pressure in the hose. And if you decrease the diameter of the nozzle of the hose, you will increase the pressure in the rest of the hose. The quantity of blood being pumped and the diameter of your arteries are regulated by hormones secreted by various organs and glands and by your nervous system. Some hormones cause the diameter of your arterioles to decrease. They act on the thin layers of smooth muscle cells surrounding each arteriole, causing them to constrict, or squeeze together. Other nervous system and hormonal factors (parasympathetic nervous system and its hormones) cause arterioles to be less constricted and more dilated.Your arteries and heart react to hormones and your nervous system and cause your blood pressure to go up or down. One hormone that causes squeezing of the smooth muscle cells of your arterioles is norepinephrine. You may recall reading about this hormone in psychology books. Together with epinephrine, this hormone is produced as a defense mechanism in what has been called the “fight or flight” reaction. When you are excited or more active more of it is secreted. As part of the body’s alarm system this hormone goes directly to the arterioles to do its work.
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GENDER AND BDD ACROSS THE LIFE SPAN BDD AND GENDER: BDD ACROSS THE LIFE SPAN – EFFECTIVE TREATMENT FOR BDD

admin — Fri, 15 Jul 2011 17:22:55 +0000

People who get effective treatment for BDD (SRIs and/or cognitive-behavioral therapy) tend to do much better than this over time. In a study of people I treated in my clinical practice, all of whom received medication and some of whom also received cognitive-behavioral therapy, 58% had attained partial or full remission from BDD (i.e., they no longer met full DSM-IV criteria for the disorder) at the 6-month point and/or at the 12 month point after beginning treatment. After 4 years of treatment, 84% had attained partial or full remission at least one of the assessment points (study assessments were done every 6 months during treatment). Those with milder BDD symptoms, and those who didn’t have major depression or social phobia at the beginning of treatment, did better over time.More rigorous treatment studies also yield encouraging findings: in all of the medication studies that have been done so far (which lasted for 8 to 16 weeks), half to three quarters of people improved with an SRI. Similarly, studies of cognitive-behavioral therapy show significant improvement in BDD symptoms. So taken together, data from patients treated in my clinical practice and from treatment studies are encouraging, indicating that a majority of treated patients do well.It appears that BDD symptoms often wax and wane over time; that is, when they’re present they may be more severe at some times than others. Symptom severity may fluctuate for no apparent reason, or in response to stress or triggering events, such as skin picking or being in a social situation. Women not uncommonly say that BDD worsens premenstrually. Here, too, we need prospective studies to better understand how BDD symptoms fluctuate, and what factors seem to influence this. Ultimately, if we can better understand why BDD improves, we can use this knowledge to alleviate suffering.*151\204\8*

EXTERNAL FEMALE ANATOMY: CLITORIS

admin — Mon, 04 Jul 2011 17:16:28 +0000

The word “clitoris” (derived from a Greek word meaning “small hill”) can be pronounced with the accent on either the first or second syllable, there being no general consensus on pro-nunication, since this term lacks the household-word status of its closest relative, the penis (see Chapter 6, prenatal differentiation). The clitoris is a highly specialized and unique organ; its sole function is for sexual pleasure.The clitoris extends from the hood to the pubic bone, where it is connected by a suspensory ligament. It is composed of two cavernous bodies which are tissues that fill with blood during sexual arousal, causing the clitoris to swell. It has a glans (tip) and a shaft, which feels like a rubbery cord under the skin. The shaft internally divides into two parts which spread out, like a wide wishbone. These parts are called the crura (singular is crus) each of which is three inches long and which attach to the pelvic bone. From the place where the shaft and the crura fork, and continuing down along the sides of the vestibule (area enclosed by the inner lips and containing the urethral and vaginal openings) are two bundles of erectile tissue called the vestibular bulbs. These become congested with blood during sexual excitement. The crura of the clitoris and the vestibular bulbs are surrounded by muscle tissue, which tenses during sexual arousal and which is part of the muscular system that contracts during orgasm.Thus we see that the visible external clitoral structure is like the tip of the famous iceberg or, perhaps more accurately, the volcano (Seaman, 1972); in this case, it is the tip of a complicated internal system of highly responsive sexual tissue. This internal system of the female is in contrast to the male system, where the responsive tissue is mainly external (in the penis). Various African tribes have been known to manipulate the clitoris and labia to enlarge them, since a large size was equated with beauty. However, there is no known correlation between the size of the clitoris and its sexual functioning.*101\265\8*

TYPES OF HEART DISEASE: HEART FAILURE DUE TO CARDIOMYOPATHY – TYPES OF CARDIOMYOPATHY

admin — Tue, 28 Jun 2011 10:40:34 +0000

There are three basic types of cardiomyopathy, which are distinguished by the kind of muscle problem involved:1. Dilated cardiomyopathy, in which the heart muscle becomes weak and the heart chambers subsequently enlarge (dilate).2. Hypertrophic (hyper means “over,” trophic means “nourishment”) cardiomyopathy,^ which the heart muscle itself/is much thicker than normal 3. Restrictive cardiomyopathy, in which the heart becomes stiff and cannot fill efficiently during diastole, the period of the heartbeat when the chambers fill with blood Dilated Cardiomyopathy (Weakened Squeezing Capacity)Charles is a 42-year-old commercial artist who recalls missing 2 days of work 4 months ago because of a “bad cold” with a runny nose, sore throat, and cough. Although these symptoms subsided, he never felt back to normal because he tended to be tired all the time. Six weeks ago he felt distinctly short-winded during a softball game at a company picnic; he stopped playing early so he could sit and catch his breath. Since then he has noted shortness of breath when climbing one flight of stairs. One week ago he began waking up in the middle of the night feeling breathless, which he found he could minimize by propping himself up on three pillows. For the past 2 days his ankles have been conspicuously swollen. Now he has been brought to the emergency room because he awoke gasping from an after-dinner nap and has been unable to catch his breath. The doctor told him and his wife that his lungs are filled with fluid and his heart is enlarged. He was given an intravenous injection of a diuretic to increase elimination of fluid by the kidneys and was admitted to the hospital for evaluation.*86\252\8*

LOGICAL ANALYSIS OF POSTURE: EXERCISE & BACK TO GENESIS

admin — Thu, 16 Jun 2011 10:33:46 +0000

ExerciseIf skeletal or voluntary muscles that participate in lifting, carrying and movement, do not participate in maintaining erect posture, why then exercise them so vigorously to treat and prevent backache and back-related problems? So much money and hype have gone into the fitness industry from the latest gadgets to muscle-building supplements and yet, other than to create muscle tone and a general well-being through improved circulation and such vigorous exercises have little effect in curing and preventing backache. Sports persons, fitness instructors and numerous exercise enthusiasts suffer from the most excruciating backache ever. My honest feeling on the subject is that the fitter you are, the more severe the back problems are when you get them.Back to GenesisWe have to change our attitude towards backache, by understanding the underlying forces and structures that cause it. Only then can we confidently go to the roots and eradicate the problem on a long-term basis and carry out preventive measures throughout our lives. That is the only way forward to solve a potentially debilitating and mostly chronic, not to mention very costly problem.*58\330\8*

NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – RETINOTHERAPY – THE DESIGN OF THE DCCT

admin — Wed, 08 Jun 2011 10:25:41 +0000

The design of the DCCT included a group of recently diagnosed type 1 diabetics with disease duration of 1-5 years and no retinopathy to explore the primary prevention of retinopathy (n = 726 patients). A second group had diabetes of up to 15 years’ duration and only background retinopathy (n = 715 patients). This group afforded the opportunity to study the effect of glycemic control on existing mild retinopathy—a secondary prevention trial.The patients were followed for a mean of 6.5 years (range: 3-9 years), and the appearance of retinopathy was assessed by stereophotographs read by masked observers at a central laboratory. Retinopathy was graded according to a precisely defined 25-step scale. Thus, the primary endpointof the study was objective, unbiased, precise, and clinically significant. Progression of retinopathy in the group assigned to standard therapy was compared with progression in patients treated with intensive glycemic control, and* results in the primary and secondary prevention strata were analyzed separately. The median HbA1c in the conventional group was 9.02% and the median HbA1 c in the intensively treated group was 7.07% at the final visit, demonstrating a clinically significant difference in long-term glycemic control between the two groups.*25\357\8*

THE NEW GERM THEORY OF DISEASE: STAYING HOME

admin — Wed, 25 May 2011 10:17:28 +0000

If sufficient information about the evolution of harmfulness is known and acted on, this approach could eventually lead to pathogens so mild we hardly notice the disease they cause. Imagine the effect of a simple change in our health ethic. What if people were encouraged to stay home if they or a family member were sick?In today’s workplace, someone who does not come in because of illness may be seen as being less dedicated, even though a sick worker may spread illness to the other employees. The advertising of products for symptomatic relief must exacerbate the problem, encouraging us, as they do, to spread our nasty respiratory tract infections. Cold and sore throat remedies are sold with promises to help you make it through your daily routine in spite of having a bad cold or sore throat. We are shown some uninformed victim in an unattractive state, all stuffed up and achy. Then we see the same person out and about after a dose of the peddled product, in the workplace, shopping, or taking care of neighborhood kids. That person, of course, is still infectious and is comfortably spreading misery throughout the community. The advertisements do not actually say, “Feel better fast so that you can spread disease within your community,” but that is certainly their short-range effect. Their long-range effect is just as disturbing. The advertisements encourage the spread of nasty variants, whereas from an evolutionary point of view we need to do just the opposite. If people stayed home when they felt the least bit sick, the pathogens that would be left to circulate in the community would be those that rarely, if ever, made a person feel the least bit sick.The necessary social change should not be too hard. It is in our nature to take it easy when we feel sick, and it is probably even beneficial financially to employers, though not to the companies pushing the get-out-of-bed-and-spread option. We have done this sort of thing before with smoking and drinking. We have countered the irresponsible advertising with responsible messages. Within a decade or two, public attitudes toward drunk driving and smoking changed from permissiveness to social ostracism. Countless lives have been saved. Changing attitudes toward coming to work sick may be easier because we have an inherent revulsion to infectious disease. You don’t have to be taught to be disgusted when someone sneezes or coughs in your face. It should be relatively easy to get across the idea that a sneeze from a person in the chair next to us is almost as dangerous as a sneeze in the face; either may force us into days of bedridden misery. Sometimes it can even mean death, as is the case for elderly people infected with influenza. I doubt that most people would object too strenuously to staying home if they were not going to be criticized for doing it, especially if they would face the opposite: ostracism for going to work sick.From the government and health experts there is silence, perhaps because the scope of the problem is not recognized. This view of the future might have been a pipe dream ten years ago, but today people can often do their work at home and send it in over the Internet. As is the case with drunk driving and smoking, even partial compliance should provide a benefit. The more compliance, the greater the benefit. As is the case with waterborne, vector-borne, and attendant-borne transmission, solving the harmfulness problem should simultaneously ameliorate the problems of antibiotic resistance. Recruit your bosses. If they are unresponsive, punctuate your argument with a well-placed sneeze.*61\225\2*

EATING DISORDERS: THE MIXED MESSAGES OF OUR MEDIA – A HUNDRED YEARS OF HATING OUR BODIES

admin — Mon, 16 May 2011 10:01:00 +0000

When did the obsession with slimness start? Peter N. Stearns, author of Fat History: Bodies and Beauty in the Modern West, has studied the history of dieting in Western nations and traces it to the 1890s, when fashion began to dictate the desirability of slenderness (although the meaning of “slim” then would seem heavy by comparison with today’s standards). As corsets went out of fashion and women’s clothing began to reveal more of the body’s natural shape, the premium on slenderness grew. Each decade has seen some oscillations in the ideal, although the overall trend has been toward a greater exposure of the body and greater thinness. While women have been affected most by fashion’s dictates, in recent years men’s fashions have emphasized a move in this direction as well.Further pressure to lose weight began in the 1940s and 1950s, when the connection between cardiovascular disease and weight became more apparent and family physicians started to urge their overweight and with shorter life expectancy have resulted in doctors and insurance companies prodding people toward the goal of leanness.The problem is, meeting rigid weight requirements in Western societies, where food is plentiful and of central importance in so many situations, is no easy task. As Stearns notes: “Modern American history, in this area, is something of a civil war between injunctions for dieting, which lots of people take seriously on the one hand, and the increasingly available attractive presentations of food on the other. And food often wins.”The French, who also place an emphasis on being small and who have the same love of food, have been more successful in keeping their relationship to food healthy, possibly due to a difference in outlook. In America, being overweight has moral implications, while in France it does not. As Stearns explains, “Overweight people are not seen as merely unhealthy or even unattractive, though they are seen this way, but also as somehow immoral.” In this country, weight is taken to be indicative of a flawed character, one characterized by laziness, lack of self-discipline, or slovenliness. Sadly, for many men and women, this belief may become a self-fulfilling prophecy. It has other unfortunate consequences as well. Stearns elaborates: “Various campaigns at different points in time have tried to exclude overweight people from certain job categories, partly on grounds that they were health risks, but more on grounds that they had bad character, that the weight was something that was an index of flaws that would carry over into work.”*56\233\8*

IDEAL MARRIAGE: ROMANTIC LOVE – UNDERSTANDING OF THE FRAILTIES OF HUMAN NATURE

admin — Sun, 08 May 2011 09:54:35 +0000

Those who truly love one another have infinite faith in the durability of their love, and this faith itself contributes to its own realization. An intelligent and genuinely romantic husband and wife will wish each other to have the same freedom of association and action in marriage as before it, and no amount of conviviality of one of them with members of either sex will shake the faith of the other in the supremacy of their love. This freedom may be granted with a full understanding of the frailties of human nature, for however seasoned we may be in the experience of all sorts of disillusionment, it still remains true that the only love worth having is one that is free and based on unlimited faith. And no matter how much we may recognize intellectually that all love is relative to the varying circumstances of life and no matter how mature we may be in the realization that anything can happen to anybody, still, in order to have any chance for happiness at all, we must keep all such knowledge in the background of consciousness, and make a practical absolute out of our love. It is the same as in many ordinary relationships: it is better to have faith and be deceived many times over than to live with no faith at all.*96\275\8*

BIOBOMBS: THE CHAOS OF DISEASE

admin — Fri, 29 Apr 2011 09:45:53 +0000

Though the unpredictability of biological weapons may be less important to terrorists than to war strategists, it may still be a major drawback. Even terrorists need a ballpark estimate of the damage they are likely to cause, and the sources of unpredictability are myriad. When terrorists use weapons, they are looking for a psychological effect, and such effects are likely to vary tremendously depending on the amount of damage inflicted. If a microbial attack fizzles, then the terrorist group would look like incompetent bunglers. If it got out of hand, killing, say, a million people instead of a thousand, then the reaction against the terrorist group might be so strong and unified that the terrorist act would be suicidal for the organization.The scope of damage is particularly difficult to estimate for biological weapons because the rate at which infections spread can increase geometrically. If one infected individual infects ten others, and each of those infects ten others, then a hundred infections will result after two rounds of transmission, a thousand after three rounds, and so on. If such an attack was recognized early enough to curtail the outbreak by only three cycles, the overall number of infected people could be reduced about a thousandfold. Conversely, if people were particularly slow to recognize what was happening, the outbreak could be several orders of magnitude greater. A terrorist therefore has a great chance of causing too little or too much damage depending on whether the outbreak is recognized a few hours earlier or later than planned.Dosage presents another source of unpredictability. Depending on the dosage, the net effect of microbial pathogens in most infections can vary from an infection without any symptoms to lethality. If most people get low dosages, the net effect of an attack might involve something more akin to vaccination than to a lethal epidemic. Those people who get high dosages and who are particularly vulnerable will tend to have very short incubation times. Variation in incubation times contributes to the uncertainty of the effect of a microbial attack by generating a large potential variation in the time of recognition of an outbreak.Dosage depends on all sorts of variables that are out of the control of the perpetrator, variables such as humidity, light intensity, and temperature. Most scenarios for the use of infectious weapons involve respiratory tract pathogens, which tend to be very sensitive to ultraviolet radiation. This sensitivity has several important consequences. It means that transmission of infection and effective dosages will be reduced if weather raises the intensity of ultraviolet light, or if weather causes people to stay outside rather than inside. It also means that the degree of within-building transmission relative to between-building transmission will depend on weather. The transmission dynamics of these two types of spread are bound to be different.Even if terrorists could master all the available knowledge from epidemiology and microbiology, tremendous uncertainty would still be associated with the effects of their actions. The best minds in these areas of science are nowhere close to being able to predict such details with accuracy. Unless terrorists can outclass the best minds in epidemiology, we can safely assume that the use of biological weapons would be a bad move by any terrorist looking to cause a particular severity of infectious outbreak.If attackers underestimated the scope of the outbreak, they would be likely to cause damage to unintended targets. Infectious agents do not restrict themselves to ethnic or national boundaries. Considering the uncertainties, we can expect consequences that may vary by several orders of magnitude. Predictive errors of much smaller magnitudes could subsume not only the targets of the attack but the attackers’ beneficiaries and allies as well, an extreme case of death by friendly fire. Such unintended targets may be in New York City one morning and at any other airport in the world the next day, spreading infection to other unintended targets.Terrorists could try to vaccinate those whom they wish to protect, but germs evolve. A germ generated during an outbreak might change its makeup, especially if it was a laboratory variant. A terrorist cannot tell whether a microbe will rapidly evolve changes in virulence or transmissibility, nor whether a vaccine that was protective against the germ that went into a target population will work against the germ that comes out.The terrorist needs sudden and spectacular devastation. Use of infectious agents compromises this goal because the devastation they can impose is constrained by a trade-off: high transmissibility is generally coupled to reduced lethality. If a pathogen is rapidly lethal, then it is generally not very transmissible. Terrorists attempting to cause a highly lethal outbreak will tend to have a short-lived outbreak. But if an infectious weapon is nontransmissible, it loses much of its fearful aspect, which arises from the prospects of a limited release spreading to engulf a large population. If transmissibility is maintained, virulence is reduced. The smallpox virus—probably the most dangerous transmissible infectious weapon—offers an illustration. The virus can be expected to kill about 20 percent of those who are infected. Although the number of deaths caused by the use of this agent would be horrific, it is important to realize that in the wake of a smallpox battle four out of five victims would survive. If a bomb killed only one out of five of the targets, the terrorist action would be considered a failure. More important for the terrorists, the survivors would be angry. The victims would be ready to take revenge on those responsible for killing their family and friends, and world opinion would be on their side. Draconian measures to root out the responsible terrorists would be all the more likely to be considered justified.*53\225\2*