Patient Newsletter Archive

November 2010 Newsletter

“Very little is needed to make a happy life. It is ALL within yourself, in your way of thinking.”

Marcus Aurelius

Dear wonderful patients!

The holiday season is upon us and with that comes STRESS!

So, I will take a few moments to ask you to prepare yourself for the holiday season. Stress means different things to different people. Scientists have demonstrated that evolutionarily, we were programmed to have a chain reaction of chemicals released during perceived harm. This response is known as the “flight or fight” response.

In modern times, when we no longer need to fight the bear or kill the snake, our fight or flight response is produced in response to our thoughts. We can raise our blood pressure, our heart rate, and cause ourselves to sweat, just using our thoughts!

Chronic overuse of this fight or flight response leads to disease.

Whether you are angry at the traffic, frustrated with your spouse, or worried about your job and finances, your body does not know the difference between those thoughts and “a bear is about to eat me.”

All of us will have stress. It is a natural part of life. Our goal is to find coping mechanisms that work. What works for one person may not work for another.

I will list several known helpful management techniques for stress. I encourage each of you to choose one and experiment!

The one that works the best for me is laughter. I find nearly everything in life to have a comedic side. I am frequently chuckling to myself all day about different occurrences. I also use morning prayer and meditation.

Another mechanism that I have used a great deal, in the last year, is avoidance. There seems to be a great deal of fear in the media and in most of my medical colleagues. I have been avoiding radio, TV, newsprint, and other doctors and nurses. It has been a most frightening time for people in the medical community and avoidance has helped me enormously.

Many people find a great deal of help for their stress in social support networks. A large number of my patients have reported to me that they have found a great deal of support for their stress within their religious community.

I FIND THE NUMBER ONE GREATEST SUPPORT FOR MOST PEOPLE IS TO LEARN TO STOP NEGATIVE THOUGHTS! PLAN SOME FUN, REFOCUS THE NEGATIVE SITUATION INTO A POSITIVE ONE, TAKE A BREAK FROM THE ENTIRE SITUATION, RELAX AND THINK POSITIVELY.

Just about everyone will improve their stress by physical activity. To decrease your stress, you need a minimum of 20 minutes of aerobic exercise three times per week. Obviously, the longer you can exercise, the more endorphins you will create, and the better you will feel. I found it very helpful to find exercises that I enjoy. I have been ballroom dancing for approximately two years and I found that this has helped me to lose weight, improve my cardiovascular capacity, have fun, and greatly decrease my stress. I recommend that you find an activity that brings you joy and incorporate it regularly into your schedule. Many of my patients have found a great deal of relief in finding a buddy with whom to exercise. Many people feel that it is more fun to have a partner. Many of my patients walk with their spouse and have found this to be a great stress reducer. I have many patients who go to the gym. About 50% of them will actually have their stress reduced by the gym. But, another 50% become very critical of themselves, competitive, and anxious or angry. The gym does not help that group.

Nutrition: If you are still not certain what to eat, go to MyPyramid.gov. This site has detailed advice on how to eat. If you eat the right amount of food and the right kind of food on a regular schedule, it will decrease your stress. Too much sugar in your diet can elevate your insulin levels and can lead to fatigue and anxiety.

Relaxation is an important part of stress reduction. Learn to listen to your body, take mini vacations, take time for your personal interests and for your hobbies. Learn some type of relaxation technique. I have had patients receive great help with guided imagery, listening to calming music, practicing mild yoga or Pilates, and meditation. For me, the most relaxing thing that I can do is a long slow swim.

I strongly encourage this holiday season that all of us let go of perfectionism. Try to love our relatives and try to let go of doing everything perfectly. Buy fewer gifts, cook less food, and focus on loving the people with whom you have contact. Don’t spend money you don’t have and don’t run around like a chicken with your head cut off trying to do absolutely every activity available. Do less, eat less, love more!

As I write this advice to you, I am also writing it to myself. I feel the pressures of “Martha Stewart” and the “Hallmark holiday card” just like everyone else. But, I am blessed because I see sick people with real problems everyday. Seeing those sick folks helps to remind me of what is really important in life. Guard what you are thinking, avoid toxic people, and practice gratitude.

I hope to see all of you in January with reports of how fabulously stressless your holiday season has been.

Warmest regards,

Martha B. Boone, M.D.

Doctor Boone is going to ask professionals that she deeply respects to add to her newsletters. This month, we are privileged to have Mrs. Jenny Hunt, a Physical Therapist with specialty training in the pelvic floor, to educate us. Enjoy!!

This is National Bladder Health Month

Physical Therapy for Stress Urinary Incontinence

By Jenny Hunt, PT

One very common cause of stress urinary incontinence is weakened muscles within the pelvic floor. With less than normal strength of the muscles, loss of control of urine may occur to varying degrees. Many complain of occasional leaking of urine with coughing, sneezing, or laughing, and others leak with various types of exercise or lifting. No matter what the activity is or whether the leaking is a few drops or enough to fill a pad, appropriate strengthening of the pelvic floor muscles is often very successful in improving the quality of life of individuals with stress incontinence.

What are the main functions of the Pelvic Floor Muscles?

• Provide support to the organs within the pelvis;
• Work voluntarily and/or involuntarily to close the openings of the urethra, vagina, and anus;
• Control of urine or feces;
• Prevent flatulence;
• Allow normal sexual response.

When the pelvic floor muscles become weak, any or all of the above mentioned functions may be affected as a result.

Why do these muscles become weak?

There are many possible causes of loss of pelvic floor muscle function. The most common known causes are:

• Pregnancy, due to the significant strain on the muscles and other supportive structures by the enlarged uterus;

• Muscle trauma during delivery from vaginal tear or episiotomy;

• Disuse. If one is not sexually active and does not exercise to keep these muscles strong, weakness may develop over time.

How can you strengthen the Pelvic Floor Muscles?

Named after Dr. Arnold Kegel, specific exercises (“Kegel Exercises”) that focus on strengthening these muscles are effective as long as the individual is able to actively contract these muscles. If the weakness is severe enough that a contraction is unattainable, then other means of gaining function are necessary.

How does one know if she can actively contract these muscles? One way to test this is to try to stop the stream of urine. If able to do this, a pelvic floor muscle contraction (Kegel) is being performed.

IMPORTANT NOTE: Do not do this as a regular exercise, but only as a one- time test. It is not appropriate to contract the pelvic floor muscles on a regular basis while urinating.

Follow these steps to perform the Kegel Exercise:

• Sit down with good posture and feet flat on the floor.

• Tighten the pelvic floor muscles (close the openings to the urethra, vagina, and anus) and imagine the floor of the pelvis lifting up inside the body as high as possible.

• Hold the contraction for a slow count to 5.

• Relax the muscles and imagine the floor of the pelvis coming back down to the starting position.

• Stay relaxed 5 seconds.

• Repeat contraction/relaxation cycle 10 times.

• Work up to holding the contraction for 10 seconds with a 10 second rest period in between contractions.

• Work up to performing 2 sets of 10 contractions, 3 times per day.

• It is also important to be able to contract and release these muscles quickly. These “Kegels” are called “quick flicks”. Simply contract the muscles and release quickly 10 times in a row. Rest and repeat, working up to 3 sets of 10, 3 times per day.

What can be done if one is unable to effectively contract the pelvic floor muscles?

Physical therapy may be helpful to “re-educate” the muscles of the pelvic floor. There are various treatment techniques that are used to restore function to these muscles:

• Manual techniques (tapping, stretching, etc.) for cueing and/or re-education of the muscles;

• Electrical Stimulation (the stimulus causes the muscle to contract);

• Instruction in strengthening of other muscle groups that act as accessories to the pelvic floor; and

• Progression to use of biofeedback which is a tool that gives information about how well the muscles are functioning and assists in the strengthening process.

The best way for one to know whether or not physical therapy and/or strengthening exercises would be appropriate for treatment of stress urinary incontinence is to be evaluated by a physical therapist who specializes in pelvic floor dysfunctions.

For more information about how Physical Therapy might help in treatment of Stress Urinary Incontinence, contact:

Jenny Hunt, PT.
Provenance Rehabilitation
North Crescent Medical Building
11975 Morris Rd, Suite 320
Alpharetta, GA 30005
Phone 678-205-3124 and Fax 678-205-3134

October 2010 Newsletter

Update on Interstitial Cystitis

Every year, Dr. Boone reviews the world’s literature on this topic. Below you will find her “notes” from the 2010 review.

As many of you are aware, interstitial cystitis is associated with irritable bowel syndrome, fibromyalgia, drug and environmental allergies and sensitivities, autoimmune diseases, chronic fatigue syndrome, endometriosis, TMJ disorders, and vulvodynia. In men, these symptoms can be associated with chronic prostatitis. All patients, male and female, with interstitial cystitis can have a high incidence of pelvic floor muscle dysfunction. Migraine headaches are also seen more commonly in this group. Many theories abound. But, everyone agrees that the nerves to the pelvic organs and lower body all originate at the same place. Many researchers believe that irritation of one of these nerves can lead to many of the above syndromes.

The connection between IC and other conditions remains a mystery!

Many of these conditions appear to run in families. So far, genetic research has not found a common gene. Because many people with IC do have more allergies and autoimmune diseases, many researchers have thought that an “out of balance immune system” may be at the base.

Some of the latest research points to problems with pain transmission centers. Some promising research points to the brain itself as a possible problem for processing pain signals. A recent article in the ICA update magazine listed endometriosis and IC as the “evil twins.” Most women with endometriosis will have severe pain for one week every month. Endometriosis is a very puzzling hormonal and immune disease that affects girls and women from as young as 8 to postmenopause. Endometriosis can form on the bladder and is sometimes diagnosed by the urologist. If your pain is worse before and during periods, you may certainly wish to be evaluated for endometriosis. If you find that this pattern applies to you, you may want to visit www.EndometriosisAssn.org.

If you believe that you have symptoms of fibromyalgia, you may find the following two web sites helpful, www.niams.nih.gov (National Institute of Arthritis and Musculoskeletal and Skin Diseases) and www.painfoundation.org (the American Pain Foundation).

If you have symptoms of irritable bowel syndrome, there are many wonderful gastroenterologists in Atlanta. Dr. Cynthia Rudert is my gastroenterologist. Her number is 404-943-9820. Dr. Lori Lucas and Dr. Diane Wisebraum at 404-252-9307 are also excellent. If you have a gastroenterologist with whom you are happy, by all means please stay with him or her. I am simply giving resources to those of you who may not currently have a GI doctor.

If you are a male with symptoms of IC or chronic prostatitis or chronic pelvic pain syndrome, you may find the following web site helpful, www.prostatitis.org.

If you are plagued with allergies, there are many wonderful allergists in Atlanta also. I have used three that I particularly recommend. Dr. Alan Redding at 404-355-0078, Dr. Robyn Levy at 404-255-8080, and Dr. Paul Rabinowitz at 404-255-9286. I have found that many of my patients with interstitial cystitis will have worsening of their bladder symptoms during the time that their other allergies are in a flare. Often, getting the other allergies under control, will help the bladder symptoms. If you have an allergist that you love, please do not change! But if you feel that allergies may be a part of your problem and you do not have a doctor, please do not hesitate to contact any of these three lovely physicians.

About one-quarter of all women with interstitial cystitis will also complain of vulvar symptoms. Among women who have refractory vulvodynia, about 68% have been found to have interstitial cystitis. If you have a history of vulvar pain, you want to be very certain that your gynecologist or urologist has cultured you for yeast and bacterial infections of the vagina.

If your symptoms are specific to the vulvar area, you may find the following web site helpful, www.nva.org. This is the National Vulvodynia Association.

Most patients with chronic interstitial cystitis need psychological assistance to deal with the fact that they have a chronic illness. This has been one area in which I have been very frustrated in Atlanta. When I practiced in New Orleans, I had a hypnotherapist, a psychologist, and a psychiatrist. All three were very knowledgeable about chronic pain and chronic disease patients. I have had a great deal of difficulty finding good support in these three areas in Atlanta. If any of you has a hypnotherapist, psychologist, or a psychiatrist that you think is stellar in helping with chronic disease, please send me their information! Three books that you might find helpful: Patient to Patient: Managing Interstitial Cystitis and Overlapping Conditions by Andrew Sandler, Ph.D. The second book is a Delicate Balance: Living Successfully with Chronic Illness by Susan Wells and lastly, You Don’t Look Sick! Living Well with Invisible Chronic Illness by Joy Selak and Steven Overman, M.D.

NEWS! The drug Namenda (used for Alzheimer disease in United States) is being used by some IC physicians to treat pain with great success. We have not used it, but some pain doctors are using it.

A group from Portugal has demonstrated that the injection of Botox at the time of hydrodistention of the bladder is giving much better results to decrease frequency and urgency, than hydrodistention alone.

As you are fully aware, I frequently recommend that my IC patients have acupuncture. A recent study out of England shows that with only three sessions of acupuncture, many IC patients received a 75% improvement in their symptoms. We use Metro Acupuncture, Dr. Anna Kelly, at 404-255-8388.

Two researchers in China have shown that the Chinese herbal preparations, Keisi-Kajutsu-Buto and Mao-Bushi-Saisinto were effective in decreasing bladder pain and in increasing bladder capacity. This information came out of the University of Yamanashi in Japan. Several studies are pointing to the concept that chronic prostatitis and interstitial cystitis may be the same disease. Several detailed studies of foods that bother IC patients showed the following:

Foods most likely to irritate the bladder:

1. Grapefruit juice.
2. Spicy foods.
3. Caffeine.
4. Chili.
5. Alcohol.
6. Hot peppers.

Things most likely to soothe the bladder were: Prelief, baking soda, water, aloe, Metamucil, and FiberCon.

Unfortunately, there is still no definitive diagnostic test for IC. It remains a clinical diagnosis made on the basis of the patient’s symptoms.

Dr. Moldwin, who has been a long term well respected researcher in IC, recommends that most patients have a bladder instillation as both a diagnostic and therapeutic technique. He believes that “putting an anesthetic agent into the bladder via the bladder cocktail will help the physician better know if all of the symptoms are coming from the bladder or not.”

The “big three” drug therapies continue to be Elmiron, Elavil, and Atarax. Vistaril is still recommended as the most common pain medication.

My favorite combination for treatment of interstitial cystitis is Elavil 12.5 to 25 mg every night with pelvic floor physical therapy and meditation. People who do not do well with medications will frequently do well with bladder cocktails. Our protocol uses the Rescue cocktail once a week for 12 weeks. I have used every interstitial cystitis therapy known to the medical community. Many of the patients that I see have often been recalcitrant to other therapies. Recently, several patients have asked for Valium suppositories and we have prescribed them with varying success. At this time, I am more enthusiastic regarding physical therapy of the pelvic floor than I am about using Valium vaginal suppositories.

The IC patients that I have seen have the most success are those who recognize that there is a strong connection between the mind and the body. When stress is managed, toxic people are removed from the environment, and low level exercise is instituted, almost all patients will get better. The few IC patients that I have seen really get into meditation, have received great benefit. Unfortunately, most patients would not take the time to learn to do meditation.

Many urologists are requiring all of their patients with IC who have other allergies to consider taking either Vistaril, Atarax, Singulair, Tagamet, or Cysta-Q.

One allergy researcher has suggested that 40% of IC patients have food allergies. This would definitely point to the concept of being evaluated by an allergist in addition to a urologist.

The elimination challenge diet:
If you suspect that you may be having food allergies, go to the IC web site and see which foods you eat frequently. Take those foods completely out of your diet for four weeks. Do not eat or drink anything in that food family. Add the foods back one at a time with one food per week. Eat the food that you miss the most first. You should see within several days of ingesting the food if it is something that you are allergic to. If you see that this food repetitively causes you difficulty, then you should avoid it completely.

A food allergy is different from eating a food that aggravates your bladder. Foods that are high in potassium or vitamin C, or acid can irritate you bladder. This may not be a true food allergy. Foods that merely irritate your bladder, should do it within about 2-4 hours of ingestion. If you want more clarification about food allergies, go to the IC web site or visit an allergist. There has been some evidence in the pediatric literature that taking probiotics can decrease food allergies. There is no definite evidence to this statement, yet. But, since probiotics have not been shown to cause any problems, if you think that you have food allergies, you may wish to try taking probiotics. Dr. Boone recommends two:

1. Culturelle every 12 hours.
2. VSL-3 (which can be purchased on the Internet) once per day.

Many researchers report excellent results with the stimulators that are implanted into the S3 sacral foramen.

I have found the stimulators to give excellent results for frequency and urgency. But, my experience has been that they are of very little benefit for pain. If you are interested in a spinal cord stimulator for pain, I would recommend that you see one of my anesthesia colleagues who is an expert in pain management. Dr. David Rosenfeld at 404-257-1101. (www.paincenterofatlanta.com).

Many of my IC patients have read on the Internet about compounded drugs that are used in the vagina to help IC. I have found some of my patients to get relief from B&O vaginal suppositories, and the previously mentioned Valium suppositories. I have had many patients have worsening of their burning by using compounded intravaginal drugs. Since many IC patients are sensitive to medications, I think we have to be very careful what kinds of compounds we put in the vagina.

The Interstitial Cystitis Association has a toll free support line which is available Monday through Friday, 8 a.m. to 5 p.m. Eastern Standard Time. The phone number is 1800-HELPICA.

I will be going to the Society of Urodynamics and Female Urology this spring. There will be hundreds of urologists from all over the world who see mostly female patients. I am always looking for newer and more innovative methods to treat my patients.

Wish me luck!
Martha B. Boone, M.D.

Doctor Boone is going to ask professionals that she deeply respects to add to her newsletters. This month, we are privileged to have Mrs. Jenny Hunt, a Physical Therapist with specialty training in the pelvic floor, to educate us. Enjoy!!

IC and Pelvic Floor Dysfunction
By Jenny Hunt, P.T.

What is Pelvic Floor Dysfunction, and how might it be associated with the symptoms of Interstitial Cystitis?
The “pelvic floor muscles” are a group of muscles that are arranged within the pelvis like a sling or hammock, connecting the front, back, and sides of the pelvis and sacrum. The main function of these muscles is to provide support to the organs of the pelvis, including the bladder, uterus or prostate, and rectum. They also make up part of the urethra, rectum, and vagina. These muscles must be able to effectively coordinate contraction and relaxation to allow normal functioning of the bowel and bladder. Moreover, the ability of these muscles to relax is essential to allow for normal urination, bowel movements, and, in women, sexual intercourse.

The term "Pelvic Floor Dysfunction," or PFD, refers to these muscles when they are too relaxed or when they have too much tension. This loss of normal muscle tone can affect urinary and bowel functions, sexual function, and can cause pain. PFD may cause some or all of these symptoms:

• urinary urgency, frequency, hesitancy, stopping and starting the stream of urine, painful urination, or inability to empty the bladder;
• constipation, straining, pain with bowel movements;
• unexplained lower back pain or pain in the pelvic region, genital area, or rectum;
• pain during or after intercourse, orgasm, or sexual stimulation; and
• uncoordinated muscle contractions causing the pelvic floor muscles to spasm.

How may PFD be associated with IC?
Abnormal muscle tension within the pelvic floor can “refer” pain to the bladder, and the bladder pain associated with IC can cause protective muscle guarding and/or abnormal tension in the pelvic floor muscles. Because of this relationship between the muscles in this region and the bladder, persons with bladder pain often are relieved of symptoms by addressing the dysfunctional muscles of the pelvic floor.

Many people have PFD without having true IC, but it is very common for persons with IC to have PFD. Persons with PFD, with or without a diagnosis of IC, may find significant relief of their IC-like symptoms with specialized physical therapy to address the pelvic floor dysfunction.

Before appropriate physical therapy treatment may be rendered, an evaluation of the pelvic region must be performed by a pelvic rehabilitation specialist to determine the condition of these muscles. Once the evaluation is completed, the therapist will recommend an appropriate treatment plan to address dysfunction that is found.

Possible treatments for this condition include:

• Manual therapy: Various methods of manipulating the muscles and connective tissues in the abdomen and pelvic region are used to promote relaxation in muscles that hold tension and restore normal mobility in other tissues that are restricted.
• Modalities such as electrical stimulation, ultrasound, cold laser, ice, heat, and TENS unit application are sometimes helpful to address pain associated with PFD and/or IC;
• Education: Instruction in self manual therapy and/or teaching a partner how to work on the tissues externally or internally is often very helpful for maintaining relief of symptoms;
• Stress management/relaxation techniques/deep breathing exercises: Symptoms of IC are often exacerbated by stress; therefore, anything that helps reduce or eliminate stress can be helpful in preventing a flare of IC or worsening of existing symptoms; and
• Biofeedback is a tool that can be helpful in training the muscles to relax. Sometimes it is necessary to eliminate certain exercises that can promote abnormal pelvic floor muscle tension. For example, Kegel exercises, or active contraction of the pelvic floor muscles, are often NOT recommended for IC patients or those with PFD, as these specific exercises sometimes aggravate the symptoms. The types of exercise that are appropriate can be determined by the physical therapist who assesses the muscle tone upon evaluation.

How do you know if your symptoms of IC may be improved by physical therapy?
You must be evaluated by a physical therapist who specializes in pelvic floor muscle rehabilitation. Ask your physician for a list of local pelvic physical therapists and for a referral for evaluation and treatment. Hopefully, by addressing any dysfunction of the pelvic floor muscles, your symptoms of IC may be diminished, and your quality of life may be improved. For more information, please contact:

Jenny Hunt, PT
Provenance Rehabilitation
11975 Morris Rd, Suite 320
Alpharetta, GA 30005
Office: 678-205-3124 | Fax: 678-205-3134

September 2010 Newsletter

Dear Patients:

The newsletter this month will be Part-2 on our series about hypogonadism (low testosterone).

Signs and symptoms of low testosterone.

• Diminished libido.
• Erectile dysfunction.
• Fatigue.
• Decreased energy.
• Irritability.
• Depression.
• Diminished motivation.
• Sleep disturbances.
• Poor concentration.
• Memory loss.
• Hot flashes.
• Decreased overall sense of wellbeing.
• Decreased bone mass.
• Increased breast mass.
• Diminished muscle mass.
• Diminished muscle strength.
• Height loss.
• Regression of secondary sexual characteristics.
• Low sperm count.

Interesting facts:

• 39% of men diagnosed with erectile dysfunction also have hypogonadism.
• There is a growing body of literature suggesting that hypogonadism and metabolic syndrome (obesity, type 2 diabetes, hypertension, and elevated blood lipids) are also related.

There are many benefits of testosterone replacement.

• Improvement in libido.
• Improvement in erectile function.
• Improvement in mood.
• Improvement in muscle size and strength.
• Improvement in bone density.
• Improvement in wellbeing.

THERE ARE ABSOLUTE CONTRAINDICATIONS TO TAKING HORMONE REPLACEMENT!

• Current prostate cancer.
• Breast cancer.
• Serum hematocrit greater than 55.

Relative contraindications (can be safely administered if closely under doctor’s care) include:

• Hematocrit greater than 50.
• Untreated sleep apnea.
• Severe obstructive urinary symptoms from BPH.
• Advanced congestive heart failure.

Although I have listed current prostate cancer as an absolute contraindication to taking hormone replacement, there is a growing body of evidence in the literature that this may turn out to be incorrect.

The journal of the American Medical Association showed that in a randomized Double-blind, Placebo-controlled Study, hypogonadal man treated with intramuscular testosterone for six months when compared to those with placebo had no increased incidence of prostate cancer.

In the Journal of Urology in 2006, there was an article demonstrating that low testosterone may actually be associated with increased risk of prostate cancer and an increased risk of higher grade disease.

So, this is an area in which we need to closely follow the literature to make our best decisions.

As far as side effects from taking testosterone, I have seen very few in my practice. Symptoms that are reported in the literature are acne, worsening of BPH, elevation of PSA levels, increasing hematocrit, liver function abnormalities, and swelling.

As stated above, I have not found these to be problematic in my practice.

If the patient decides to take testosterone therapy, what is involved? There are several methods of administration including shots, patches, pellets, gels, and buccal therapy.

The monitoring of a patient on testosterone therapy includes checking their blood levels of testosterone and their blood levels of PSA, CBC, lipid panel, and hepatic panel. I also recommend a rectal exam every three to six months until the dose is stabilized.

Once the patient is established on the testosterone dose and is completely stable, the monitoring can be done every six to twelve months.

PLEASE ENCOURAGE YOURSELF, YOUR RELATIVES, YOUR SPOUSES, AND YOUR COLLEAGUES TO GET THEIR YEARLY DIGITAL RECTAL EXAM AND PSA FOR EARLY DETECTION OF PROSTATE CANCER! THERE HAS BEEN A GREAT DEAL OF CONFUSING INFORMATION IN THE MEDIA OVER THE LAST YEAR. BUT, WE CURRENTLY HAVE NO BETTER WAY TO DIAGNOSE PROSTATE CANCER THAN THE COMBINATION OF THE RECTAL EXAM AND THE PSA BLOOD TEST.

I am looking forward to some cool weather and hope that each of you will have a safe and happy fall.

Respectfully,

Martha B. Boone, M.D.

August 2010 Newsletter

Dear valued patients,

The "newsletter" this month will be very short.
You might remember that Dr. Boone’s house burned down last July 4th, 2009.
Well, happily, she is moving back into her rebuilt home this month!!
We have a home. Now, all we need is some furniture!!
So, she is busy, busy, busy.

Quick reminders:

1. Keep drinking that water if you are a kidney stone patient. Getting dehydrated can cause stone formation, very quickly. This is kidney stone season and no matter what kind of stones you make, AVOIDING SALT AND DRINKING LOTS OF WATER will help prevent them. If you are well hydrated, your urine should be very pale yellow. If it gets darker than that, you are getting dehydrated. Remember the lemonade recipe on our website, if you are not a water lover.

2. We are quickly approaching the time of the year when everyone looks up and realizes, "I’ve paid my deductible and I need to get everything done before the end of the year."

   PLEASE, remember that everyone else in Atlanta (except the Medicare patients), are doing the same thing! Surgery, radiology, anesthesia, the lab and all doctors’ offices are usually swamped during the last four months of the year.

   So, if you have things to do that are medical, book now. Or, you may not get it done before the end of the year. If you have a low deductible, you might want to consider setting your appointments in January or February.

   To help you plan, listed below are the days that our office will be closed, or the doctor will be away:

   1. We are closed for Labor Day. Dr Boone is away that Friday, Saturday, Sunday and Monday. There will be a doctor covering, for emergencies only. (Drink your water, or you might get to meet him! LOL!) His number will be on our office message.

   2. Dr. Boone is away Oct 15-31. She has had no vacation this year and is taking it all during the last quarter of the year. The office will be open during this time. You’ll be able to have nurse visits. There will be doctors available for emergencies. But, NO routine care involving the doctor will occur during that time.

   3. Our office has limited service the week of Thanksgiving. November 22-26. So, plan well that month.

   4. Dec 17-Jan 3rd our schedule is also abbreviated. We will the closed Christmas Eve, Christmas Day, New Year’s Eve and New Year’s Day. We will have the office partially staffed most of the last two weeks of the year. Mid December until Jan 3rd will be mostly emergencies.

   So, this is the busiest time of the year and the part of the year with the most holidays. If you have to get something done before Jan 1st, plan now, as the services you desire may be “booked up”, if you wait too long.

   Have a lovely, hot, end of summer,
   Dr. Boone and Staff

   July 2010 Newsletter

   The Sexual Medicine Society of North America met in November 2009 and the meeting was on Better Sex Through Better Living! This month's newsletter is committed to making my patients aware of some of the findings at that meeting.

   TESTOSTERONE AND VASCULAR DISEASE

   One topic was the role of the hormone, testosterone, in a man's vascular health.

   Testosterone regulates metabolism of carbohydrates, lipids, and proteins. It modulates muscle and fat tissue physiology and body composition. Many physicians at the meeting felt that testosterone was a very important independent determinant of blood fat level.

   The people at the meeting determined that "middle-aged men with symptoms of testosterone deficiency are at a high risk for both carotid and heart disease". The likelihood of having a cardiovascular event (heart attack) in a patient with a low serum testosterone was four times higher compared to patients with normal testosterone.

   Taking serum testosterone appeared to decrease the risks for heart disease and to reduce total cholesterol. This is a novel idea that has not been widespread in medicine. Several studies suggested that testosterone may have a protective affect on the development of atherosclerosis and that low testosterone accelerates plaque formation when in combination with elevated cholesterol.

   Several doctors had studied this theory in the animal model. They were able to demonstrate that in animals, testosterone replacement therapy showed a markedly inhibited development of atherosclerosis.

   What does all of this mean to my male patients?

   If you are a middle-aged man and have low testosterone, it may be more difficult for your internist to manage your diabetes, insulin resistance, obesity, hyperlipidemia, and metabolic syndrome.

   Our office is happy to participate in checking your testosterone and happy to work with your internist to maximize your hormone therapy.

   SMOKING AND ERECTILE DYSFUNCTION

   Another topic at the meeting was smoking and erectile dysfunction. The World Health Organization has estimated that about five million people die worldwide every year due purely to tobacco use.

   A little known fact is that 50% of all bladder cancers are related to cigarette smoking. Nicotine appears to cause vasoconstriction through epinephrine and norepinephrine release; what this means is that you have decreased blood flow not only to your heart and other vital organs, but also decreased blood flow to your penis. If you have been or currently are a smoker you have a three time greater chance of developing erectile dysfunction! More importantly, erectile dysfunction in a smoker is a large predictor of vascular disease.

   The take-home message is if you want to keep your erectile function, throw away the cigarettes!

   Another hot topic at the meeting is something called the metabolic syndrome. What is the metabolic syndrome? It is postulated that increasing abdominal obesity leads to increased activity of an enzyme called aromatase. This is present in fat tissue. It converts testosterone to estrogen. The result is low testosterone, which increases triglycerides and can further lead to increasing obesity and insulin resistance. Patients with metabolic syndrome will frequently have problems with managing their diabetes, their insulin resistance, and their hyperlipidemea, all these things lead to atherosclerosis, cardiovascular disease, and poor quality of life. Ultimately, mortality is increased.

   Studies presented at this meeting showed that replacing testosterone has helped to improve the ability to manage blood sugar and lipid levels in patients with metabolic syndrome.

   Of great interest is the combination of diet, exercise, and testosterone; when these things are combined in a middle-aged, overweight male patient, a great increase in life satisfaction can be seen.

   We have known for quite a while since the articles came out in The New England Journal of Medicine, that diet appears to have a great deal to do with health. The Okinawans have the lowest death rate from cancer, heart disease, and stroke and the highest life expectancy for both males and females. We also know that the Sardinians have the second best longevity and that in America, the Seventh-day Adventists have the best longevity. Throughout these three groups most people do not smoke. Most people put family first and remain socially engaged. Lastly, each of these groups is known to eat a lot of fruits, vegetables, and whole grains. All three groups also appear to have a high rate of exercise and a much lower rate of smoking.

   There was also data presented at this meeting that there is a significant association between beef consumption and fatal heart disease. An increased rate of beef consumption was considered to be more than three ounces in eight days.

   The Mediterranean diet, which we have all heard so much about, has a high consumption of olive oil, vegetables, legumes, whole grain products, fruits, and nuts. The intake of saturated animal fat is extremely low. Moderate fish consumption, moderate red wine consumption, and moderate calorie intake in general, also comprised the diet.

   This diet, when transferred over to the standard American, appeared to work!

   So from this meeting, much of what we already knew about health was confirmed. We did learn a new piece of information regarding testosterone level and how it might affect metabolic syndrome.

   Information about cigarette smoking and erectile dysfunction has been known for a long time. Please pass the word that cigarette smoking causes bladder cancer!

   All of this research was done in males.

   I hope that you find this information interesting and our next newsletter will be on testosterone deficiency.

   Have a great, hot July.

   Respectfully,

   Martha B. Boone, MD, LLC

   ---

   June 2010 Newsletter

   Dear Fabulous Patients,

   Please remember that we are moving our office June 3rd and June 4th. Our new address is: 960 Johnson Ferry Rd., Suite 245, Atlanta, GA 30342.

   Also, please remember that the primary cause of kidney stones is DEHYDRATION. If you are a kidney stone patient, drink, drink, drink, during those hot months. Or, you'll get to see my new office earlier than you had hoped!

   Yesterday, I saw a gorgeous 94 years old woman who looked about 70. I asked her, "How did you do it?"

   I thought I'd share with you, her responses:
   1) LAUGH A LOT
   2) DON'T EAT TOO MUCH
   3) EXERCISE A LITTLE EVERY DAY
   4) DO SOMETHING COMPLETELY NEW EVERY YEAR!
   5) PRAY
   6) SAVE MORE MONEY THAN YOU SPEND, SO YOU DON'T HAVE TO WORRY WHEN UNEXPECTED THINGS HAPPEN, BECAUSE THEY ALWAYS DO!
   7) Don't be afraid of a little plastic surgery! (LOL)

   THIS LOVELY WOMAN HAD SURVIVED BREAST CANCER, THE DEATHS OF HER SON AND HER HUSBAND AND MOST OF HER FRIENDS. SHE WAS HAPPY AND GRACEFUL AND POISED. (I actually caught her "flirting" with Corwin, my male receptionist!)

   Her words reminded me of the "simplicity" of a really good life.

   I hope that they help you too.

   Fondly,
   Dr. Boone

   ---

   May 2010 Newsletter

   Dear Valued Patient,

   Topical Treatment for Vulvodynia /Post Coital Pain (Post Sex Pain)

   There is an over-the-counter product with capsaicin 0.025% gel or cream that can be applied to the vulvar area two to four times per day. This medication has been shown to down regulate pain receptors. In layman's terms, that means it can make the pain receptors on the vulvar area less sensitive.

   One important caveat is that this medication can burn on application. So, if you choose to use this form of therapy, please apply a topical agent to numb the vulva prior to application. The most common numbing agents are lidocaine, Xylocaine and EMLA cream.

   If your past treatments for vulvadynia have failed, you may be interested in learning more about this new therapy.

   Post Coital Pain (Post Sex Pain)

   Do you suffer from post coital pain? Dr. Kristene Whitmore, Medical Director of the Pelvic and Sexual Health Institute in Philadelphia, PA, suggests her "Sex Pack":

   1. Oral Antispasmodic (Levsin SL)
   2. Valium Suppository (to vagina)
   3. Lidocaine Gel (to urethra)

   If no relief, B & O suppositories may help.

   Sincerely,

   Martha Boone, M.D.

   ---

   April 2010 Newsletter

   Dear Valued Patient,
   
   URINARY TRACT INFECTIONS/ PASSING KIDNEY STONES

   UTI

   Recent research has shown the following regarding Recurrent Urinary Tract Infections in Women:

   1. Theracran reduces the incidence of infections by 35%! THIS IS NOT TRUE OF ALL CRANBERRY PRODUCTS.
   2. Increasing fluid intake above 60ozs. In 24 hours has not decreased the incidence of infections.
   3. Vaginal estrogens in the peri and post menopausal woman have been shown to decrease the incidence of infections by 75%!!!! This treatment is not approved for young women.
   4. Use of spermicide DOUBLES the incidence of infections!

   The immunotherapy URO-VAXOM decreases the incidence of UTI by 50%.BUT, IT IS NOT CURRENTLY AVAILABLE IN THE USA.
   PLEASE KEEP YOUR EYES PEELED IN CASE THIS BECOMES AVAILABLE IN THE USA! AND, WRITE THE FDA TO LET THEM KNOW THAT YOU WANT THIS DRUG FOR AMERICA!!

   SO, the "take home message" for ladies suffering from recurrent urinary infections is to take theracran every 12 hours, drink no more than 60ozs. of water per twenty four hours, avoid spermacide as a birth control method, get a vaginal estrogen product if you are 40-80 years old and write the FDA to help get the Uro-Vaxom in America!

   Please use every prevention method available to you. For the first time in 25 years, I know of NO urinary tract antibiotic that is in development. What that means for my patients, is that when you become "resistant" to all currently available oral antibiotics, you will need intravenous antibiotics! So, it behooves us to use as few antibiotics as possible.

   Kidney Stones

   Evidence from the University of Michigan demonstrates that the drug, Flomax, can greatly increase the chances of your passing a kidney stone that is coming down your ureter!

   So, any patient who is actively passing a stone should consider taking an alpha blocker medicine at night until the stone passes!

   "ADVERSE EVENTS" were decreased by 30% by using the drug to help pass stones!

   HAPPY SPRING!

   Dr. Boone

   ---

   March 2010 Newsletter

   Dear Wonderful Patients,

   January was a difficult month at our office. I diagnosed more patients with bladder cancer during the first two weeks of January, than I usually diagnose in 7 months! To my great horror, I diagnosed a 19 year old with a large bladder cancer. Previous to finding this cancer in this very young adult, the youngest person that I had ever diagnosed with bladder cancer was 34 years old.

   This surprising diagnosis has caused me to rethink what I have learned in 24 years of treating bladder cancer.

   Subsequently, I have spoken to two very well known uropathologists (one is from the Mayo Clinic) who have told me that "they have seen bladder cancer in people as young as 11"! But, bladder cancer in people younger than 40 remains a "rare" phenomenon.

   I am writing to you, to remind you that the ONLY warning that we get of bladder cancer is a little bit of blood in the urine. This is usually found by your doctor on your yearly urine analysis. Please make sure that you and your loved ones get your urine checked every year with your yearly physical. The blood would be found under the microscope, by your doctor. As urologists, we check everyone's urine for blood on every visit.

   Please remember that 95% of people who have blood in their urine, do NOT have cancer. And, please remember that you need to be checked by a urologist if you ever have blood in your urine.

   Let's focus on PREVENTION. What can you do?

   1. DO NOT SMOKE. Do not allow people to smoke around you. The number one cause of bladder cancer is exposure to Cigarette smoke. Please, Please, stop smoking!! If you have ever smoked for more than five years, even if it was 25 years ago, you will carry a higher risk for bladder cancer, your whole life. So, blood in the urine (hematuria) in a current or past smoker should be carefully evaluated by a urologist.
   2. Since I am diagnosing more and more people with bladder cancer who have never smoked, there must be other factors. I have found evidence that taking vitamins and supplements can help decrease the reoccurrence of bladder cancer in people who have had them. So, it may be worth your while to consider taking those supplements as a preventative.
      I am recommending that all of my bladder cancer patients and any of my patients who have smoked at any time in their lives ( for over five years), consider taking the supplement, Bladder 2.2 which is produced by the Theralogix company. You can go to our website www.femaleurologists.com and access their website to read about the supplement. Please use my doctor number when ordering the supplement, so I can track which patients are taking it.
   3. Also, if limiting red meat is very helpful with other types of cancer, maybe it might be helpful with bladder cancer. If you have been diagnosed with bladder cancer, you might wish to consider limiting red meat in your diet.

   I have had three patients who have ovarian cancer make a couple of recommendations of things that were helpful to them.

   1. Dr. Bernie Siegel's CD "Meditations for Enhancing Your Immune System". There is evidence that meditation increases the powerful chemicals that heal our bodies of disease.
   2. "Love is Letting Go of Fear" by Gerald Jampolsky has been recommended to decrease negative emotions which creates "stress" reactions in the body.

   As always, early detection is the key to curing cancer. And as for preventing it, I am a big believer in managing your stress, exercise and excellent nutrition.

   On a positive note, rarely do we have to do any invasive surgery for bladder cancer. Most of our patients are detected early and can be treated with "out patient" and minimally invasive procedures.

   Of our many patients diagnosed in January, only one person will have to have a major surgery. Everyone else was detected early and appears to be "cured".

   Please check our website for new videos on blood in the urine (hematuria) and please send them to your family and friends!

   Have a great spring,

   Dr. Martha Boone

   ---

   February 2010 Newsletter

   News from the world of urology!

   Dr. Boone has reviewed the meeting from the latest International Continence Society meeting for you.

   Researchers have found:

   1. Young women with poor bladder emptying (Fowler's syndrome) are responding well to sacral neuromodulation. So, if you are between 18 and 40 and are having trouble emptying your bladder, there may be new help for you. Go to our website and read about the Interstim device.

   2. Botox to the bladder continues to show efficacy in patients who have failed all conventional over active bladder treatments. So, if you have "tried it all" and are still going to the bathroom too frequently, Botox to the bladder may help you.

   3. The latest overactive bladder drug, Toviaz was shown to work better for urge incontinence than does the drug Detrol-LA. A large study of >1700 patients showed this finding. So, if you are on an overactive bladder drug and are not completely happy, please come in, as you may be a candidate for the new drug.

      For more information, go to Toviaz.Com

   4. An Italian group of researchers has shown that patients with interstitial cystitis (IC) have a very interesting phenomenon known as central sensitization. Essentially, this means that the brain "turns up" the pain receptor response in these patients. (IC patients are more "sensitive" and prone to heightened pain response than other people) This finding is exciting, because it can help explain the connection between IBS, fibromyalgia, and IC.This is also very exciting for the possibility for new research on the IC patient.

      Finally, the National Cancer Institute has definitely shown a link between volume of red meat eaten and PROSTATE CANCER. In a ten year study of over 175,000 men, there was definitely an increased risk for prostate cancer based on red meat consumption.

      SO, PLEASE HAVE ALL THE MEN YOU LOVE DECREASE THEIR RED MEAT CONSUMPTION!! (They have not yet determined how much you can safely eat. So, the less, the better.)

      HAPPY AND HEALTHY 2010.

      WARM REGARDS,
      Dr. Martha Boone

      ---

      January 2010 Newsletter

      HAPPY NEW YEAR TO OUR WONDERFUL PATIENTS!!

      I am not one to make "New Year's Resolutions". I am already "doing the best that I can".

      But, the end of one year and the beginning of another has always been a time of reflection and gratitude for me.

      This past year, I have seen an unpatrolled level of "fear" in my patients. The job market, the healthcare bill, the economy, and international politics have really had many of my patients very concerned, all year long. I share your concern and we are most definitely "not out of the woods" yet.

      But, "worry" over these things will not improve our health. And our health is the "well spring" of our lives.

      So, without making any sweeping resolutions, what can we do to be "younger next year"?

      1. Let's really make an effort to MOVE MORE. Let's not let those skinny Europeans get the better of us. Let's work towards not being the fat, overindulgent Americans that we have been in the past. Get out there and walk. Take the stairs when you can. Park the car, well away from the door. Take a ten minutes stroll in the neighborhood after dinner. MAKE SOME COMMITMENT TO MOVING MORE!!

      2. OK, GANG, IT IS TIME TO DECREASE THOSE PORTIONS! Supersizing everything has given us a nation of obese children who are on "dialysis" more than any country in the world. Let's decrease our portions. You can do it. Eat on a salad plate for a while. You can only "pack" a small plate, so full. Get out a deck of playing cards and realize that the size of a card is the size of a portion of protein! Your steak or your chicken should fit into the area of that playing card. Split your usual meal in half and eat the other half at lunch the next day. Or, share one meal between two people. And, all of us knows that the less animal protein, the better. EAT MORE BEANS!!! In my family, I replaced two "meat meals" per week with beans. There was a great deal of complaining from my husband, the carnivore, but one year later, he does not miss it at all. Our food budget is less and our blood fats are lower.

      3. Cut out the snacks. If you cut out one snack per day, you would lose ten pounds in a year, from that alone. The sugar and crabs are killing us!

      4. DRINK WATER! If you are urology patient, chances are you should be drinking plenty of water. Unless your internist has told you otherwise, you should drink about your body weight divided by two in ounces. (If you weigh 150 pounds, you need 150/2=75 oz. per 24 hours of water)

      5. If you are a patient with kidney stones or interstitial cystitis, follow your diet. If not, put more fruits and vegetables in your diet. When you have a choice to make, choose the fruits and vegetables. Our lives are made up of all the little choices that we make every day. Make better choices and you will have a better life and better health. Most people do not need to make big sweeping changes. Most people can make many small changes per day and see great improvement in their health, over a year.

      6. Do your preventative care. Make a list of all that you need to do and make it your top priority. My list looks like this:
         1. Clean teeth= January and July
         2. Pap smear=October
         3. Mammogram=August
         4. Eye exam=September
         5. Bone density=July
         6. Routine Gynecology evaluation =October
         7. Dermatologist=February
         8. Blood work =January and July

         Nothing is more important than your health. Plan for it. DON'T WAIT UNTIL THE END OF THE YEAR. EVERYONE HAS PAID THEIR DEDUCTIBLE AND IT IS JUST CRAZY AFTER NOVEMBER 15TH. DON'T DO THAT TO YOURSELF. PLAN WELL FOR GREAT HEALTH.

      7. Your mind controls your body. Like it or not, that is the truth. Try to find some peace. Watch the news less. Email less. Read the news less. ALL of these things are full of fear based information and HORROR. Try to limit your exposure to these things. Constantly scaring yourself raises your "stress hormones" and can decrease your health. Learn to quiet your mind. Things like yoga, meditation, tai chi, swimming, walking (long and slow) .I do ballroom dancing to quiet my mind. Just trying to get my body where it is supposed to go, takes everything that I have! I can't worry about that healthcare bill while trying not to bust my butt! LOL.Try to find some quiet time in every day. It will be hard at first, but persist and I promise that the health benefits will amaze you. There are tools for this on our website www.femaleurologist.com

      8. Whatever your spiritual beliefs, cling to them. Sometimes, our world seems that it is crazy. I can't tell if the fear mongers and 24 hour news agencies make it seem that way, or if everything really is "much worse" than it used to be. But, what I know for sure is that there is something bigger than us and it (he or she) has bigger and better ideas than I do. I have patients of all types and I deeply enjoy the diversity. Whether you are Christian, Jew, Muslim, Hindu, Buddhist, agnostic or atheist, prayer will work for you. I pray for my patients everyday. I believe that quiet desire for a better life is heard by God (whatever you deem god to be) and answered. Try it. It surely won't hurt you.

      9. Practice gratitude. No matter what is going on here, we are still "better off" than 90% of the world. If you find yourself feeling fear or anger, try to think of things about which you are grateful. With my stepdaughters, if they are complaining, I will make them name things that they are grateful for and it always gets them going in the right direction. The mere "threat" of the gratitude list will "straighten them right up".

      10. Plan for your health. I have read all of the health care legislation. We still don't have a final bill. But, what I am sure of is that all of the middle class Americans will be spending more on healthcare. I can promise that. So, don't drive yourself crazy when it starts. Go ahead and plan now. Put some money aside, out of every check and create a little savings for whatever they do end up sending our way. Know that taxes are going up. (Even though they say that they are not, I am sure that we can't cover more people and not spend some tax money. It does not make sense) Know that premium costs are going up. Know that out of pocket expenses are going up. Try to carve out a small portion from all of your other budget items for additional healthcare costs. I truly do not see any other way to do it, in the current climate. NOTHING that I have seen in either bill is going to make healthcare cheaper for the middle class. I am sorry for the bad news, but it is affecting me too. Planning well can keep it from turning into an emergency.

      11. Take your vacation time. Use every single bit of it and spread it out over the year to give yourself breaks. A change of scenery is so good for your soul.

      12. Try to create harmony everywhere that you go. Try to make all of your relationships as peaceful and harmonious as you can make them. Guard your thoughts and be sure that you send love to those people around you. It will come back to you, multiplied abundantly.

      I am so happy to have each of you as my patient. I hope that 2010 is your best and healthiest year ever!!!

      Dr. Martha Boone

      December Newsletter

      Recent events of mass murder and berserk behavior make us wonder why a person would act this way...

      What is happening in this country? The evidence of emotional dysfunction and personal discomfort is apparent on every level from the school room to the board room of major corporations.

      Most people believe that emotions are caused by events. They are in fact caused by our interpretations of events, sometimes so fleeting and fast as to be beneath the level of consciousness. Our pre-conscious, split-second thoughts give rise to automatic emotional reactions. We then have a choice as to how we behave, what we say, and how we handle a situation. The appropriateness of our actions and the effectiveness of our communications make up our emotional intelligence. A person who is highly-developed emotionally becomes sensitive to pre-conscious thoughts, questions their validity and appropriateness, and is able to directly influence feelings, thoughts and behaviors.

      Most people have trouble managing situations that are emotionally charged, especially when the emotions aroused are anger and anxiety. When this difficulty is accompanied by, or causes, poor communications skills, then people really do get into trouble. Those individuals who are able to handle their emotions, not just the expression or regulation of them, but who are also able to generate the kinds of emotions that are productive and efficient, are indeed emotionally intelligent.

      Social scientists have long been aware that IQ tests are inadequate for predicting success in life. IQ scores account for as little as 25% in predicting future success in college. In the work environment, technical savvy and knowledge may contribute as little as four to ten percent towards performance effectiveness. Over ninety percent of effectiveness at work is attributed to one's emotional intelligence. EQ, a term coined to express the measure of one's emotional intelligence, has been proposed as the answer to why some people with average IQs end up more successful in life than some with brilliant IQ scores.

      How Emotionally Intelligent Are You?

      There is no way yet to accurately measure one's emotional intelligence, and all tests purporting to do so are really measuring one's self-perception. Nevertheless, such information can be useful in designing coaching programs and planning goals for personal and professional growth.

      Tests that propose to measure EQ allow an individual to chart strengths and vulnerabilities on emotional intelligence components, including:

      • Emotional self-awareness and managing one's own emotions
      • Using emotions to maximize intellectual processing and decision-making, including self-motivation, developing empathy, and the art of social relationships and managing emotions in others.
      • Adaptability (Problem Solving, Reality Testing, Flexibility)
      • Stress Management (Impulse Control)
      • General Mood

      Ten Steps for Improving Your Emotional Intelligence

      1. Know yourself well through the use of assessment tools to understand your strengths and vulnerabilities.

      2. Work with a mentor or personal coach to improve your EQ.

      3. Identify the causes of feelings: become aware of split-second, preconscious thoughts and their possible distortions.

      4. Become aware of your emotional style: what do you do to avoid discomfort?

      5. Learn to differentiate between emotion and the subsequent need to take action.
         1. The need to promote action in response to avoidance, withdrawal, and sadness.

         2. The need to inhibit action in response to anger and hostility.

      6. Acquire the skills of "learned optimism". What is your personal explanatory style? How do you explain events to yourself, both good and bad? Increase your optimism when appropriate and beneficial.

      7. Listen for the "lessons" of feelings: turn mistakes into energy.

      8. Use "somatic markers" in decision-making: trust your gut and use it.

      9. Develop listening skills and in asking open-ended questions: "listening is the best way to get your point across."

      10. Increase positive feedback to yourself, to others. Learn to reframe negatives. Increase your appreciation of yourself and others.

      For more about Emotional Intelligence, download the full article pdf for free by clicking here.

      Remember, we are here to serve you and your life goals, whatever they may be! Warmly,

      Jacquie A. Damgaard, Ph.D.

      ---

      August Newsletter

      SEPTEMBER IS PROSTATE CANCER AWARENESS MONTH!

      What do you need to know about your prostate,
      (or the prostate of your loved ones)?

      IF YOU ARE A MALE OVER THE AGE OF 45, Dr. Boone recommends a PSA (blood test for prostate specific antigen) and a DRE (Digital rectal exam), EVERY YEAR! (The American Urologic Association and The American Cancer Society recommend that you do it after age 50) But, Dr. Boone has seen some devastating deaths in young men with prostate cancer and recommends, for her family, and her patients that they begin evaluation at 45. African American men with a family history of prostate cancer should definitely be evaluated at 45, as prostate cancer can be more serious in Black males.

      There is a modicum of controversy in the medical literature about these tests and their validity. But they are the best tests available, currently, for the detection of Prostate cancer and should be utilized until something better is developed.

      FAQ:

      What should I eat to ensure my prostate health? In general, two diets have been shown to improve longevity. The "Northern Mediterranean" and the "traditional Japanese" Diets are very healthy for most people.

      1. Decrease your intake of red meat, full fat dairy products and animal fats of all types!
      2. Add Soy to your diet. Dr. Boone puts tofu in her morning smoothie. For the recipe, see our website www.femaleurologist.com
      3. COMPLETELY remove all trans fats from your diet. They promote cancer growth of all types!
      4. Either eat cold water fish (salmon) three times a week, or take Omega-3 oils in a supplement
      5. Add soybeans and tofu and soy products to your diet
      6. Drink more green tea
      7. Eat red grapes or drink red wine (in moderation of course!)
      8. Eat more green leafy vegetables (cabbage, broccoli and cauliflower)
      9. Add ground flaxseed to your diet. (I put it in my smoothie and in yogurt)
      10. EAT MORE TOMATOES!!!! YOUR PROSTATE LOVES THOSE LYCOPENES!
      11. Use olive oil in salads and cooking.
      12. Eat ¼ cup of almonds per day

      Most of these foods are recommended because they are "anti-oxidants". What is an antioxidant?

      Oxidation produces free radicals which can damage cells. An "anti-oxidant" can hinder this process and prevent cell damage.

      EXERCISE - Sorry, but you must do it!!

      30 MINUTES OF MODERATE CARDIOVASCULAR EXERCISE, FOUR TIMES A WEEK CAN DECREASE THE INCIDENCE OF PROSTATE CANCER BY 30%!!!

      And, in men who already have prostate cancer, being overweight is a big risk factor for cancer reoccurrence.

      Supplements:

      The BEST website that I have found for this information is the following website: www.theralogix.com

      Dr. Boone has read the medical literature on supplements and has found scientific evidence to support the following:

      If you don't eat a lot of cold water fish, omega-3 (Theromega) is very helpful.

      • Vitamin E at 50-100 IUQD
      • Selenium 70-100mcg per day
      • Prostate 2.3(full of E, D-3, Lycopene and selenium)
      • Prostate SR (saw palmetto)
      • Prosteon is a great supplement for men who have prostate cancer and are on androgen deprivation therapy.

      Please remember to have all of your male family and friends tested after age 45. If you wish to donate money for prostate cancer research, the American Foundation of Urologic Diseases (AFUD) does a great job!

      Enjoy Football Season!

      Dr. Boone

      ---

      July Edition

      To our Wonderful Patients,

      We are seeing many patients with Kidney stone "attacks" in our practice. Please remember to drink your water during this hot weather. Nearly all kidney stones could be PREVENTED if everyone would just drink enough water.

      During the cooler months, "enough water" means your body weight divided by 2 in oz. If you weigh 150 lbs., you'd benefit from 75 oz of water every 24 hours.

      (150 divided by 2=75)

      During the hot months, I suggest that you add another 8-10 oz. to that number. If you weigh 200 pounds, you'd want 100 oz +10 oz.=110oz of water every 24 hours. THIS RECOMMENDATION DOES NOT APPLY, IF YOUR INTERNIST HAS SUGGESTED WATER RESTRICTION, FOR ANY OTHER HEALTH REASON!

      Please remember, also, that you can have any beverage in moderation. Any caffeine or alcohol beverage will cause you to lose more water than you take in, due to the diuretic effects of caffeine and alcohol. So, if you drink these beverages and you are a kidney stone former, chase them with water.

      On our website www.femaleurologist.com there is a recipe for lemonade that is particularly helpful for patients with low citrate as a cause for their stone formation. Citrate helps to keep the stone crystals from forming into an actual stone. High urine citrate is a good thing for stone formers.

      Please, also remember, that excesses of animal protein can greatly increase stone formation too. 3-4 ozs per meal is considered a "portion". So, all you gentlemen who like that 10 oz. steak, beware! Your kidney stones LOVE that big protein load! Eat your meat, if you must, but try to decrease the portions.

      If you have made more than one kidney stone in your life, you'd benefit from having a Litholink study. This is a 24 hours urine study to determine exactly what elements are showing up in your urine that might be contributing to your stone formation. This information would lead to our changing your diet to decrease the incidence of stone formation.

      The Litholink is a fabulous way to manage your stone formation and to decrease healthcare dollars! If we can stop the stone formation, you can keep your vacation days for "fun", instead of visiting me!

      And, less kidney stone surgery is better for your body and for our health care crisis.

      If you have not had a Litholink study and have had more than one kidney stone in your life, please contact us and we'll help you to get it!

      As always, I deeply appreciate the opportunity to be your urologist and hope that you find my "nagging" helpful.

      Respectfully,
      Dr. Martha Boone

      ---

      Dr. Boone tries to e-mail any patient who wants to be on our e-mail list (about 3000 people) on a monthly basis with "news" about urology. The following e-mail received a multitude of appreciative responses from our patients. So, we've decided to include a copy of the e-mail on our website.

      "To our wonderful patients,

      I am writing to you in response to a great deal of fear and concern that I am hearing from my patients.

      NONE OF US KNOWS WHAT IS GOING TO HAPPEN TO OUR HEALTHCARE INDUSTRY, BUT THAT DOES NOT MEAN THAT WE CAN'T DO ANYTHING ABOUT IT!!!

      I SAY, LET'S GET INTO THE "SOLUTION" AND STOP BEING AFRAID. LET'S USE OUR WONDERFUL MINDS TO HELP OURSELVES!! COME ON, WE ARE AMERICANS………WE CAN SOLVE OUR PROBLEMS!!

      PLEASE KNOW THAT WHAT I SUGGEST HAS NO POLITICAL MOTIVATION. WHETHER YOU ARE DEMOCRAT, REPUBLICAN OR "OTHER", THESE SUGGESTIONS CAN HELP YOU.

      YOUR BODY IS A BEAUTIFUL INSTRUMENT THAT CAN HEAL ITSELF OF 75% OF ALL DISEASE. SEEK TO MAKE YOURSELF AND YOUR FAMILY SO HEALTHY THAT YOU PUT THE DOCTORS, HOSPITALS, PHARMACEUTICAL COMPANIES, AND INSURANCE AGENCIES OUT OF BUSINESS!!

      You might ask "and how exactly can I do this, doctor?"

      I will tell you how I got off of three of my medications.

      1. Eat smaller portions. I did not stop eating my favorite foods. I just eat MUCH less of them. My husband and I started eating on a smaller plate until we could get our portions under control.

      2. Move more. You don't have to become some huge jock, but get up and move. Get away from that TV and that computer. Go for a walk.

      3. Learn to meditate. Whatever your health issues are, meditation will help them. I lowered my blood pressure by 15 points by quieting my mind. If you have trouble considering this option, then get the CD by Deepak Chopra entitled The Soul of Healing or the CD "The Healing Waterfall" or the Mind spa system. It takes practice, but you will be very much rewarded.

      4. Eat more beans!! Our family replaced two meat meals per week with beans. They are cheap and they are so good for your body. We bought an ethnic cookbook and have experimented with a different bean every week.

      5. Take some news holidays. Every station is full of fear and negativism. Instead of helping us find good solutions, they are trying to create villains and fear. Just say NO to the news. Decrease your news input by 10-20% and I promise you, you will feel better!

      6. Try being more grateful. Honestly, we are the most spoiled people on the planet. Try focusing on the gifts that we have in this country. They are far greater than our burdens, I promise you!

      7. Do something for someone else. In my most dire moments in life, I have sought to comfort someone else. And, it NEVER ceases to amaze me, how much pleasure that brings to me. There are opportunities everywhere, just open your heart.

      I will list for you some of the things that I would have you contemplate. Of course, I don't have all the answers, and neither does anyone else. But, the following thoughts have struck me as pertinent.

      1. The doctors and the patients "need" each other. So, we'd best stick together and try to understand each others needs.

         I don"t see the insurance industry, or Pharma, or Medicare, or the government as truly understanding what goes on between the doctor and the patient. It is a sacred relationship built on trust and mutual respect. It can't be legislated or controlled. It is ours.

         What all the "hoop-la" is about, is the MONEY. Everyone is trying to get their piece of the money. So, most of the people involved in the decision process are motivated to get their part of the money. They don't really care about us.

         Some how, we have to rise above that. Your doctor has to run a business. Your doctor has rising costs of running that business every year. Your doctor is being paid less and less every year, by the Medicare and insurance folks. So, how is your doctor responding to this scenario?? Many practices are doing "high volume"= "running them in and running them out". That seems to be working for many. The doctor gets a small amount for seeing many patients.

         I am unable to participate in that kind of scenario. I don't want that, as a patient, for myself, and my family, and I sure don't want it for my business.

         So, what to do?

         My family has accepted that a bigger portion of our family's budget is going to have to go to health care. Three years ago, we bought a 1/3 less expensive home so that I could see 20 patients per day instead of 40. This year, we are shopping at the Farmers market instead of whole foods to decrease our food budget. And, next year, we are shopping for less expensive cars.

         We have decided that housing, food, and medical care are our top priorities as a family. We have a savings account just for "medical surprises".

         All of those actions have decreased our "angst" about what is happening in health care.

         Many patients have asked me the following questions: 1.Why are doctors doing "concierge" medicine? This is an attempt to try to see fewer patients and give better service. These doctors have realized that seeing 40 people a day is not good for the patient or the doctor.

         So far, I have resisted doing this because many of my patients could not stay with me. I have chosen instead, to go "out of network" on the really poorly paying insurances. That way, I collect a little more from the patient without having to over burden my many patients who could not pay a $2000 "retainer" fee per year. I continue to hope to not have to join the concierge medicine group. I really enjoy my police, teacher, clergy and Medicare patients, many of whom could not do the concierge system.

      2. Why are so many doctors not taking Medicare? Again, it is the economics of medicine. Medicare pays so poorly and the paperwork is so exhaustive that many times when we see Medicare patients, we actually "lose" money on the visit. I have tried to pass some of the costs onto the Medicare patient, when the law allows. I also try to educate the Medicare patients about the system, to better serve them. I have nine relatives between 85 and 95 and certainly hope that their doctors continue to take Medicare, but I am a little worried about how all of that will "play out".

      I deeply enjoy the older segment of the population. I love the folks who have lived a long time and enjoy the wisdom and humor that they bring with their visits. I would be deeply saddened to have to stop seeing them, to keep my business afloat.

      So, what else can you do besides taking really good care of yourself and budgeting for ever increasing heath care costs?

      Contact your congressmen and senators! Tell them that you want an insurance industry that you can understand. Tell them that you want your insurance company to be easier to navigate. Tell them that instead of your insurance company paying gigantic "campaign contributions" to the politicians, you want them to pay your medical bills!!! Ask them to reform the Medicare system to be more patient and doctor friendly. Tell them that you care about this issue and that you won't vote for them if they don't address it.

      Make your voice heard.

      I am asked everyday if I "support a national health service"? I can't really answer that question because I don't really know what is meant. What I do know is that health care should not be such a burden for our country and interfacing with the insurers should not be so horrible for the patients and their doctors.

      I also see how poorly the government has managed Medicaid and Medicare and I wonder why they would do any better with another government run health agency???

      So, I don't know. But, I am encouraged that there are things we can and should do. If we focus on what we can do, there will be little time to spend "worrying" about what we can't do. By the time you finish walking, meditating, doing for others less fortunate, cooking those beans and practicing gratitude, it will be time to go to bed!!!

      Forgive the diatribe.

      I hope this helps some of you.

      Much fondness and respect,

      Dr. Boone

      NOTE: Our office will be closed Friday, June 5th for Employee Appreciation Day and a Staff Retreat."

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      News for Overactive Bladder (OAB) Sufferers!

      Dr. Boone is now able to perform Botox® injections into the bladder muscle for people who have urgency, frequency, or urge incontinence!

      If you have failed medication and/or physical therapy and/or neuromodulation (interstim or uroplasty) you may benefit from Botox®!

      So, if you are not satisfied with your therapy for overactive bladder, make an appointment to see if you are a candidate for Botox®.

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      New Stress Incontinence "In-Office" Procedure!!

      Dr. Boone will begin doing the Renessa procedure this Spring, as a treatment for stress urinary incontinence (SUI).

      See www.novasysmedical.com for details.

      Renessa is a system that uses radiofrequency energy to denature and rebuild your "natural" collagen.

      One "In-Office" treatment is done with local anesthetic and very mild oral sedation.

      This is the only SUI treatment that will allow you to have no interruption of your Spring and Summer Fun!

      Call for an appointment to see if you qualify!

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      TLGX Clinical Update - Cranberry for UTI Prevention

      A recent study compared the effectiveness of a 500 mg cranberry extract with daily low-dose antibiotic in the prevention of recurrent UTIs in 137 older women. Although more UTIs occurred in the cranberry group (25) than in the antibiotic group (14), the authors concluded that the antibiotic had a very limited advantage over the cranberry product.

      The time to first recurrence was not statistically different between the groups. The median time to recurrence was 85 days for the cranberry group and 91 days for the antibiotic group. The withdrawal rate was 46% higher in the antibiotic group.

      We cannot determine which cranberry supplement was used in this study, nor can we determine whether it provided the optimal proanthocyanidin (PAC) content for UTI prophylaxis. TheraCran provides 1300 mg cranberry powder in a daily dose, and is standardized to provide at least 2.5% PACs (33 mg), which is approximately the amount found in 10-12 ounces cranberry juice cocktail.

      Read the PubMed abstract.

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      Avoiding iced tea can help men lower kidney stone risk…

      According to the researchers at Loyola University Chicago Stritch School of Medicine, men over the age of 40 years may want to avoid drinking iced tea in order to lower their risk of kidney stones.

      Oxalate, a key chemical in the formation of kidney stones, comes in high concentrations in iced tea. The failure to stay hydrated is a common cause of kidney stones. Summertime heat and humidity, combined with the increased intake of iced tea in the U.S., raises the risk during the Summer. If a patient is prone to developing kidney stones, drinking water with lemon or lemonade can help. Lemons are high in citrates, which inhibit the growth of kidney stones.

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      Attention: Interstitial cystitis patients!

      New chronic pain support group! www.metroacupuncture.com,

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      New Technology & Treatments

      From the American Urological Association Annual Meeting - TriMix Laboratories' TriMix gel is an alternative erectile dysfunction treatment for men who are unsuitable for phosphodiesterase-5 inhibitors and injection therapy. The gel contains FDA approved active ingredients of prostaglandin, papaverine, and phentolamine, but because it is custom-compounded in a pharmacy, it is not FDA approved for treatment of ED. The mixture does not require refrigeration: The patient carries the product on his person at room temperature. At the time of intercourse, the storage device mixes and applies the medication without injection.

      For more information, visit www.trimix-gel.

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      Dr. Boone attended the American Urological Association (AUA) meeting in May and found some wonderful Natural products to help with urinary tract infections (UTI's), prostate health and some types of kidney stones!

      Please make an office appointment to discuss these options or visit the Theralogix® website at www.theralogix.com.

      Theralogix® was created by physicians to formulate safe, effective, evidence-based nutritional supplements which are intended for use under the supervision of a treating health care provider, as one component of a comprehensive health maintenance program.

      Theralogix® supplies safe, effective, evidence based nutritional supplements, recommended for use under the supervision of a treating health care provider.

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      Nutrition & Your Health

      Follow the links below to view information regarding nutrition and urologic health.

      • For Diet, Lifestyle, and Prostate Cancer information, click here.

      • For Herbal Products and Benign Prostatic Hyperplasia (BPH) information, click here.

      • For Diet, Lifestyle, and Bladder Cancer information, click here.

      • For Diet, Lifestyle, and Kidney Stone information, click here.

      • For Cranberries and Urinary Tract Infection (UTI) information, click here.

      Clicking on the links on this page will temporarily leave our site by opening a new web page. These links are provided for informational purposes only and are not advertisements.