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December 2011 Newsletter

To our Valued Patients:

DR. BOONE HAS BEEN MADE AWARE OF A FABULOUS WEBSITE FOR THE EDUCATION OF PATIENTS WHO HAVE KIDNEY STONE DISEASE. THE WEBSITE IS www.stonedisease.org!!

As most of you are well aware, Dr. Boone approaches kidney stone disease slightly different than some urologists. She is very interested in the prevention of stones. She certainly does all of the surgeries and procedures that are necessary for stone disease. But, she approaches the entire problem from more of a prevention standpoint.

The biggest “thought leaders” in kidney stone disease worldwide are Dr. Margaret Pearle, Dr. Glenn Preminger, and Dr. Charles Y. C. Pak. Dr. Boone has studied with each of these physicians through continuing medical education courses. She was happy to find that their website is also available to patients at no charge.

We have recently come across some information to indicate that the branded (non-generic) version of potassium citrate is better tolerated by many patients. We have had numerous people complain that “they cannot take the potassium citrate because it irritates their stomach or causes diarrhea.”

The non-generic version of the drug has the pill encased in a wax coating that prevents the drug from being released all at once.

We currently have some savings coupons which could save the patients nearly $500 per year on their prescriptions for potassium citrate. If you have been seen in the last year, or a kidney stone former, and have been prescribed potassium citrate, please contact our office to see if you are a candidate for one of these savings cards.

Many of our interstitial cystitis patients received benefit from a drug called Uta. This medication turns the urine blue and is a urinary tract anesthetic. We have had patients complain that after a few months, the pill falls apart and we have also had patients complain that they cannot find the pill in the pharmacies.

The drug Uribel is very similar to Uta. We have a large number of coupons that can save the patients money on this drug. Again, if you have been seen in the last year and have been prescribed either Pyridium, AZO, Uta, Prosed-DS, or Uribel, you may be a candidate for one of the coupons.

We are trying to get samples of both the Urocit-K and the Uribel. So if you call to get a coupon, please inquire as to weather we have gotten the samples and you may be eligible.

We hope that the new kidney stone website is helpful and would love to receive feedback on anything that you find particularly supportive.

ATTENTION MEDICARE PATIENTS!!

Medicare has recently notified us that we will be given a steep fine if we do not begin doing prescriptions via e-mail. So, as of this month, we will begin to send some of your prescriptions to your pharmacy via e-mail. Should any glitches occur, please notify our office as soon as possible during office hours. If any of you would like to volunteer to be the test guinea pigs for our new prescribing pattern, please notify us via e-mail.

I have steadfastly thought of adding another layer of communication to our already intrusive system as regards Medicare. But, our fine could be as high as $5000 this year. So, we are once again forced to comply with a Medicare standard to which we are not in support.

Warm personal regards,

Martha B. Boone, M.D.

We wish you and your family a safe and joyous holiday season.

October 2011 Newsletter

Dear Valued patients,

The end of the year is upon us!

Everyone will be trying to get everything done before the end of the year because most deductibles have been met.

I would like to share with you the days our office will be closed for the holidays. We will be closed for Thanksgiving on November 24th and 25th.

For Christmas, our office will be closed on December 23rd and 26th.

For the New Year, our office will be closed on December 30th. We will have a full day in the office on January 2nd.

Please plan your schedule around these dates.

Radiology, the operating room, anesthesia, and our office will all be heavily booked during the last quarter of the year as we are trying to accommodate everyone who has paid their deductible and wants to get in.

Book early to be sure that you get you care that you need.

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WebMD personally invited Dr. Boone to be used in some of their educational videos. I am attaching a direct link so that you can watch for yourself.

http://www.webmd.com/urinary-incontinence-oab/america-asks-11/default.htm

Click on the link above, then use the arrows at the bottom to get to the following videos:

• Age and Incontinence
• Daytime Urinary Frequency
• Exercise and Incontinence
• Menopause and Incontinence
• Physical Therapy for Incontinence

September 2011 Newsletter

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 1/2 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! Another very informative website is www.KnowYourStats.org. Please send this to all of the men that you love.

IMPORTANT NOTICE TO ALL:

This is a reminder that the end of year will be coming up quicker that we realize. Everyone who had paid their deductible will be trying to get everything done at the end of the year. Please make any necessary appointments early so we will be able to accommodate everyone. Dr. Boone will be taking a vacation in October, our office will be closed around Thanksgiving and we will also be closed around Christmas.

A SPECIAL OFFER:

We have samples of Ellura, a cranberry supplement that promotes urinary tract health. If you have seen Dr. Boone within the past year, please call our office to request your 1 month supply of Ellura. We can not mail this out to you. If you would like to read more about Ellura, please visit the website www.myellura.com.

Enjoy Football Season!

Dr. Boone

August 2011 Newsletter

Dear Patients,
Our newsletter this month will focus primarily on Urinary Tract Infections. Dr. Boone will also feature an article on “Pelvic Organ Prolapse” provided to us from Christi The’, Physical Therapist.

Recurrent Urinary Tract Infections

Aids for treatment of recurrent urinary tract infections:

1. Please drink plenty of water. If you are not exercising, drink your body weight divided by 2 in ounces every 24 hours. Your fluid intake should be ________ ounces in 24 hours.
2. Example: If you weigh 120 pounds, divide 120 by 2 = 60 and drink that much water every 24 hours.
3. If you do cardiovascular exercise, drink an additional 8 oz. for every hour of exercise.
4. Please consider taking TheraCran supplementation.TheraCran is a high quality cranberry supplement that you take every 12 hours. MANY patients have gotten great help from this product. To learn more and to order the product, either go to their website www.theralogix.com or call 1-800-449-4447. You will need my doctor number to place the order and that is #41029. Drinking cranberry juice is of little benefit, as you would need to drink nearly a gallon per day to get the benefit that you get from TheraCran.
5. If you have ANY element of constipation, that must be treated. Please use Miralax (an over the counter product). Most patients need 17 grams in 10 oz. of water at night. If you tend to get diarrhea, cut the dose in ½. (8 grams in 10 oz. of water). This will fully clean out your lower bowel, every day and that will decrease the amount of bacteria near your perineum.
6. Chronic use of antibiotics is not healthy. Most patients will greatly benefit from replacement of their normal flora by using a probiotic. We recommend VSL-3 every 12 hours, if you can afford it. This can be purchased at Costco or Sam’s Club with a prescription from Dr. Boone. You do not need to be a member to use the pharmacy and the cost is much better at these facilities. (see www.vsl3.com or 1-866-438-8753) A less expensive and also efficacious probiotic is Culturelle. This can be purchased over the counter. It should also be taken every 12 hours. The least expensive place that we have found to obtain it is Costco.
7. Testing that you may be required to have: a) evaluation of your kidneys with either CAT scan or renal ultrasound or both. B) evaluation of the function of your bladder with either urine flow studies, urodynamics, pelvic ultrasound or any combination of these tests c) anatomic evaluation of your bladder with cystoscopy. (We have a pediatric scope and can usually do this in the office with minimal discomfort!)
8. After you have been FULLY evaluated, you may be eligible for antibiotic refills for up to a year, without further office visits.
9. Some patients will be placed on a “preventative” low dose of either Macrodantin or sulfa based antibiotics.
10. Some patients will have a stronger antibiotic to keep on hand, at all times, to take for three days.
11. Every patients work up is tailored to what Dr. Boone thinks is necessary in your PARTICULAR case. Our goal is to get you off as many antibiotics as possible and to keep your office visits to a minimum.
12. PLEASE BE CERTAIN THAT YOU UNDERSTAND ALL OF THE ABOVE BEFORE LEAVING THE OFFICE. PLEASE CALL FOR REFILLS DURING OFFICE HOURS, ONLY.
13. Some patients will need the assistance of an infectious disease doctor. We will be happy to refer you.
14. Some patients will need topical estrogen to their vagina. And some patients will need a referral to a gynecologist. We will also be happy to assist with that referral.
15. No doctor will be able to completely prevent you from ever having a urinary infection again. Our goal is to decrease the frequency and the severity of your infections and to rule out any serious cause of the infections.

Pelvic Organ Prolapse

Each newsletter, Dr. Boone likes to feature articles from various specialists that she thinks you might find helpful as well as interesting. This month Physical Therapist, Christ The’, has provided us with the following article.

So, What is Pelvic Organ Prolapse?

A pelvic organ prolapse occurs when one or more pelvic organs are pressing down or through the vaginal opening. The organs that are most susceptible to prolapse are the bladder, uterus, and rectum. If you have a prolapse, your medical provider can tell you which organ is prolapsed.

Symptoms of prolapse can vary among women. Symptoms can include pain, pressure, bleeding or spotting in underwear, increased vaginal discharge, and cramping. These symptoms are generally worst at the end of the day or after standing for an extended period of time.

The cause of a prolapse can be the combination of several factors leading to overstretching of the tissues that supports the pelvic organs. When these tissues are stretched, it allows the organ to fall down into the vaginal opening area. The common contributing factors leading to pelvic organ prolapse are pregnancy, vaginal delivery, constipation, menopause, smoking, heavy lifting, obesity, and previous pelvic surgery. Some risk factors can be modified to allow for prevention of pelvic organ prolapse. Key preventative measures include weight loss, smoking cessation, and managing constipation symptoms.

Having good support under these organs is also helpful for prevention and having strong pelvic floor muscles can provide this support. Increasing pelvic floor muscle strength cannot fix the overstretched connective tissues, but it may decrease the symptoms associated with pelvic organ prolapse. It may be helpful to work with a physical therapist to improve the strength of the muscles and support of the pelvic organs.

Intravaginal devices are another way to support the pelvic organs. These devices are often referred to as pessaries. A pessary is placed into the vaginal canal to support the pelvic organs and can decrease prolapse associated symptoms. Fitting a pessary can be difficult and pessaries are not always an appropriate treatment option. Use of a pessary is generally considered a temporary solution to the problem. Speak to your health care provider to determine if pessary use is appropriate in your situation.

In some cases a surgery may be needed to decrease symptoms and maximize function of the pelvic organs. There are different surgeries used for specific types of prolapse. Your surgeon should discuss the appropriate surgical option for your situation.

Speak to your health care provider to learn more about pelvic organ prolapse and specific treatment options. Please remember that all medical treatments have corresponding risks and benefits associated. Make sure all of your questions are answered before proceeding with any treatment.

Christi Thé PT, DPT
Department of Rehabilitation Services
Northside Hospital Atlanta
1000 Johnson Ferry Rd, NE Atlanta GA 30342
(404) 851-8912

Final note:

A patient of Dr. Boone’s has recently made her aware of a web site that you might find interesting. It serves as a source of inspiration and help to all who pursue wisdom. www.thegiftofwisdom.com.

July 2011 Newsletter

In the June 2011 addition of the Journal of Urology, there was an article demonstrating that onabotulinumtoxinA (commonly known as Botox), can be effective in the bladder of patients who have failed all other conventional overactive bladder treatments.

Dr. Boone has been very slow to get on the Botox bandwagon. There have been extremely rare cases of botulism mentioned in the dermatology literature. There have been urologists putting Botox in the bladder for nearly a decade now. This recent article has shown that 100 units of Botox to the bladder every three months times 2-3 injections can aid patients with severe frequency, urgency, and urge incontinence.

There appears to be an overall 80% improvement of OAB symptoms with the Botox.

Dr. Boone has studied the protocol and finds it to be a very simple procedure.

Unfortunately, Medicare and most insurances do not pay for the Botox itself. They pay for the actual injection process, but not for the drug. Even though this procedure has been widely used throughout the United States, the FDA has not approved this treatment yet for the bladder.

If any of you have failed all conventional treatments and would be willing to try this procedure, Dr. Boone would be willing to perform it on a case by case basis.

The conventional treatments for overactive bladder are the following:

1. Diet modification to remove bladder irritants from the diet.
2. Pelvic floor physical therapy.
3. Biofeedback.
4. Timed and double voiding.
5. There exists a plethora of overactive bladder medications.
6. Peripheral neuromodulation with Uroplasty.
7. Central neuromodulation with InterStim.

Dr. Boone encourages all patients with overactive bladder to seek treatment if it is causing you to modify your life. People who have untreated overactive bladder can have depression, social isolation, and impairment of their general health due to lack of activity. If your overactive bladder is not causing you to change your lifestyle, it probably does not need treatment at this time.

RECOMMENDATIONS:

Dr. Boone has found a wonderful OB/GYN practice that is in the Johns Creek area. Dr. John Reyes and his wife, Ingrid Reyes, have opened a lovely practice at 6335 Hospital Parkway, Suite 204, Johns Creek, GA 30097. They are a full service OB/GYN practice and they do take Medicare!

So, if any of you find yourselves in need of a good OB/GYN, Dr. Boone strongly recommends the Doctors Reyes.

* * *

One of our patients has reported that there is a portable cushioned seat that has been developed to help pelvic pain from either interstitial cystitis, pelvic floor dysfunction or prostatitis. It is called the G-seat and it can be obtained at the Relax Your Back store. You may also be able to find it at other locations on the Internet. The number to locate it is SKU#WMAX001. This cushion may be particularly helpful if you do prolonged sitting in your job. The price for this gel seat cushion is approximately $60.00.

Sincerely,

Martha B. Boone, M.D.

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June 2011 Newsletter

MEN'S HEALTH MONTH

There is a great deal of confusion out there about PSA screening (prostate specific antigen). The latest literature by Dr. William J. Catalona, who is considered by most urologists to be one of the world's experts on prostate cancer, states the following:

1. In the United States there has been a 75% reduction in metastatic disease at diagnosis since PSA screening has become widely used in 1992.
2. In the United States there has been a 40% decrease in the age-adjusted prostate cancer deaths since 1992.
3. In the United States 22,000 fewer men have died of prostate cancer each year since the PSA test has been widely used.

Similar trends have been reported in other countries where PSA screening is practiced.

There has been a great deal of discussion particularly in the media regarding the idea that the PSA test has led to over diagnosing prostate cancer and over treating otherwise harmless prostate cancers.

PLEASE BE AWARE THAT NO SCREENING TEST OF ANY TYPE IS PERFECT AND THE PSA TEST IS CERTAINLY NO EXCEPTION!

False positives (having an abnormal PSA when there is really nothing wrong with you) can occur from the following:

1. Prostatitis.
2. BPH.

False negatives can also occur with PSA (having the PSA that looks normal when in actuality you have a prostate cancer):

1. Hypogonadal conditions.
2. Some medications.
3. Very high-grade prostate cancers that produce no PSA.

So in summary, some harmless prostate cancers get treated and some lethal prostate cancers do not get diagnosed.

To add confusion to an already confusing scenario, a man's PSA changes with age. A normal PSA on most studies should be about 0.7 when the man is in his 40s, 0.9 when the man is in his 50s, 1.3 when the man is in his 60s, and 1.7 when the man is in his 70s.

Dr. Boone currently believes that PSA testing is quite valuable in combination with the yearly digital rectal examination. The future will lie most likely in genetic testing.

But, until we have reached that goal, the yearly PSA and digital rectal exam is the best that we have and those tools have greatly improved the plight of men with prostate cancer.

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ANNOUNCING A NEW TOPICAL TESTOSTERONE GEL FOR MALE PATIENTS WITH LOW TESTOSTERONE

A new drug has come onto the market known as Fortesta. It is a gel with a one-month supply in a pump bottle that is small enough to take in an airplane through the TSA line.

If you are currently a man on a testosterone product, and have been stabilized on a dose, and have seen Dr. Boone for a prostate exam and PSA in the last year, we can prescribe this medication to you. We have obtained 30-day free supplies for interested patients. They will be distributed on a first come first serve basis.

If you feel that you may have symptoms of low testosterone, but have not been evaluated, the following would be required:

1. Genital exam.
2. Rectal exam.
3. Blood PSA values.
4. Blood testosterone values.

If you are a candidate for testosterone replacement, we could begin therapy as soon as those studies are obtained.

PLEASE CONTACT US AS SOON AS POSSIBLE IF YOU ARE INTERESTED IN RECEIVING THIS FREE MONTH LONG SUPPLY.

Unfortunately, this free supply cannot be given to Medicare patients. This does not come from us or from the pharmaceutical company. This decision comes from Medicare.

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FERTILITY ALERT!!

Studies out of the State University of New York at Stony Brook have recently found that putting your laptop computer on your lap for extended periods of time can decrease fertility in the male. It is believed that the mechanism is heating of the scrotum by more than 2 degrees Celsius. It is known that even a 1-degree increase in temperature to the scrotum can damage sperm. Lap pads provided only marginal improvement.

So, if you are a young man seeking to be fertile, please do not put your laptop computer on your lap for any extended period of time, as even 1 degree increases in temperature can lead to decreases in sperm production and quality.

Martha B. Boone, M.D.

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May 2011 Newsletter

NEW VAGINAL "MOISTENING" AGENT AVAILABLE!

Dr. Boone has been made aware of a new vaginal moistening product called Luvena. This is a totally new kind of product. It has several agents that may be of assistance to women patients. It has cranberry extract which may decrease the E. coli living in the vagina. It also has lactate, which may change the vaginal pH and make it a less friendly environment for bacteria. The product would be appropriate for the following patients.

1. Anyone with recurrent urinary tract infections who feels that their infections are caused by intercourse.
2. Any postmenopausal woman who is either unable to use vaginal estrogen or unhappy with the result from their vaginal estrogen. Luvena product contains no hormones.
3. Anyone experiencing pain during intercourse could benefit from this product.

It is preservative free, estrogen free, paraben free and glycerin free. The designers of the product recommend that it be used every three to four days or prior to sexual intercourse.

More than 300 medications that are frequently prescribed to women can cause dryness. This product could help prevent the causes of vaginosis, yeast infection, foul vaginal odor, and urinary tract infections.

The lactoperoxidase component can kill bacteria and fungi. The lysozyme component can split bacterial cell walls. The lactoferrin component can deprive bacteria of their food.

Dr. Boone has no scientific or personal experience with this product, but she has a plethora of patients with vaginal dryness, vaginal infections, urinary tract infections, painful intercourse, and postmenopausal vaginal problems.

After reading about the product in detail, she feels that many patients could possibly benefit from it. We have some samples in the office, if anyone would like to try it. If you have been seen by Dr. Boone and had a vaginal exam in the last year, we would be happy to provide you with some of the product to try. The Luvena will be given out on a first come first serve basis.

MAXIMIZING MALE FERTILITY.

Roughly one couple in five will have difficulty conceiving in the United States; that means more that 6 million couples are currently experiencing fertility problems. The infertility issues can be coming from either the male side or the female side. As an urologist, I am responsible for assisting and determining the male factors. When the patient has had two semen analysis that are collected properly, the urologist needs to look at the following variables if those analyses are abnormal:

1. Varicocele. This is a condition in which the veins around the testicle become swollen and dilated. It is fairly common and can affect one in every seven men. Men with a varicocele have 50% higher chance of having an abnormal sperm count. Treating the varicocele which is usually done with minor surgery can correct the problem. Of note, most men with varicoceles, do not have any fertility issues!
2. Infections of the prostate or epididymis can have a major impact on a man's fertility. Such an infection would usually be diagnosed by the finding of white cells in the semen. If infection is suspected, the urologist may request a semen culture and may recommend treatment with an antibiotic prior to conception.
3. Hormonal problems. Sperm production is under the control of special hormones that come from the pituitary gland (FSH, LH) and from the testicles, testosterone. If the blood levels of these hormones are abnormal, sperm production may be very low or even completely absent. This type of problem is diagnosed with blood test and can be correctable with medication.
4. Genetic abnormalities. We now realize that many cases of male infertility whose causes were unclear in the past are actually caused by genetic abnormalities. These include problem cases in which chromosomes are broken or misshapen, where either a whole chromosome is missing on an extra one is present, and where individual genes on the Y chromosome are damaged. Another type of genetic problem is known as sperm DNA fragmentation. In this condition, the DNA strands which contain the genetic information in the sperm head are filled with many breaks and nicks. This is believed to be due in many instances to oxidative stress.
5. Blockage of sperm flow. Sperm are produced in the testicles and then move out into the epididymis which is a small duct behind the testicle where they fully mature. After several days in the epididymis, the sperm swims up into the tube called vas deferens towards the ejaculatory duct. There are several conditions that can lead to a blockage of the path from the testicle to the ejaculatory duct. Such a blockage could cause the sperm count to be extremely low or even create a condition known as azoospermia, in which no sperm are present in the ejaculate at all. Sometimes a blockage can be repaired and even if repair of the blockage is not possible, a pregnancy could be achievable through IVF.
6. Medications and treatments side effects: Certain medications or medical treatments can interfere with sperm production. Radiation treatment for cancer can impair testicular function. Many chemotherapy drugs will have a permanent effect on production. Some drugs such as testosterone replacement therapy can have a temporary effect that should reverse when the medication is stopped. When taking the medical history, the urologist will ask about any medications or illnesses that have occurred in the past.

You can improve your fertility through diet and lifestyle changes:

1. Do not smoke. Several studies have clearly shown that cigarette smoking lowers sperm count and sperm motility. If you smoke, stop now. If you try to quit without success, please seek help from your internal medicine or family practice doctor.
2. Decrease alcohol and avoid drug use. Excessive alcohol consumption has been clearly shown to impair sperm production. The evidence regarding moderate alcohol intake is less clear but most experts agree it is best to avoid having more than one drink per day particularly if you are trying to conceive a child.
3. Sexual activity. The likelihood of a woman becoming pregnant is much higher when you have intercourse in the three days immediately leading up to and including ovulation. Some experts call these three days the fertility window. You can determine when the woman ovulates either by using basal temperature charts or with an over-the-counter ovulation predictor kit. The frequency of intercourse during the fertile window generally does not matter. Although earlier studies seem to show that several days of abstinence might increase sperm counts, more recent studies indicate that more frequent intercourse may in fact be better. Contrary to popular belief, there is scientific evidence of a best position for conception and finally please avoid the use of all artificial lubricants as they can be toxic to sperm.
4. It is well known that the testicles should be cooler than the rest of the body for sperm production to be at its best. So, you would like to avoid any excessive heat. The harmful effect of a varicocele on sperm production is believed to result from the extra warming of the area caused by the dilated veins. While there is no scientific evidence to support the claim that boxer style shorts are better than jockey type, it is important to avoid other sources of excessive heat such as hot tubs, high temperature work areas and prolonged hot bathing.
5. Proper diet is important in everything. Eating a balanced diet is of course important. If you are trying to conceive consider extra fruits and vegetables along with plenty of fluids as a good idea. It is probably best to avoid high intake of soy products in the male trying to conceive a child as they can contain weak plant estrogens.
6. Exercise. Moderate exercise may be beneficial. Aim for at least 30 minutes of exercise on most days of the week.
7. Caffeine. Try to limit your caffeine consumption to one serving per day. The information about caffeine and sperm production is very uncertain in the literature. Some articles indicate that high caffeine intake improves sperm motility and many others indicate the caffeine intake has no effect or may have a harmful effect on sperm. Suffice it to say, the court is still out on that topic.
8. Environmental hazards. Avoid pesticides, solvents, organic fumes, or radiation exposure. If you are trying to conceive.
9. Harmful nutritional supplements. There is evidence that there are some nutritional supplements that clearly can have a damaging effect on male fertility. In particular any supplement that has a hormone like effect such as DHEA or anything that has any androgen component. If you are taking any of these products to build muscle mass, stop them immediately if you are trying to conceive.

There is substantial evidence to support the benefit of the following supplements in male fertility:

1. Vitamin C.
2. Vitamin E.
3. Selenium.
4. Lycopene.
5. L-carnitine.
6. Zinc.
7. Folic acid (a B vitamin).

In order to learn more about these specifically recommended dosages, either contact my office for the brochure Maximizing Male Fertility or go to the Theralogix web site www.theralogix.com.

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April 2011 Newsletter

DR. BOONE'S YEARLY EVALUATION ON SUPPLEMENTS AND VITAMINS:

Despite vitamins and supplements and herbs being a 3 billion dollar per year industry in America, there remains very little level 1 true scientific data indicating that these vitamins, supplements, and herbs improve our health.

The latest scientific information points to the following three factors being the most important in aiding our bodies in its optimum health;

1. Maintaining our ideal body weight.
2. Excellent nutrition.
3. Regular cardiovascular exercise.

That having been said, 90% of the people who come in my office are on some type of supplement.

CRANBERRY

So, I review this information on a yearly basis to try to aid my patients in making good choices. Most people in America do not maintain their ideal body weight, nor do we have excellent nutrition, nor do we exercise diligently. So, with our stressful lifestyles and our poor habits, maybe supplements do offer some assistance.

For any one who has been plagued with urinary tract infections, it is clear that a very high quality cranberry supplement can decrease the number of infections that you have per year. The cranberry supplements need to be free of additives as an impure supplement can have bladder irritants. The two best cranberry supplements on the market are TheraCran and Ellura. Both supplements contain proanthocyanidins, which is the active compound that decreases urinary tract infections. You cannot drink enough cranberry juice to make a significant amount of this compound appear in your bladder. You would likely gain between 30 and 40 pounds per year if you drank that much cranberry juice.

Should you desire to use TheraCran, the best way to get the supplement is to either go on www.theralogix.com or use their toll free number 1-800-449-4447. If you use my doctor number 41029, you may be able to get a slight discount on some products.

The other cranberry supplement is called Ellura. It is made by a French company and they recommend one pill per day. Their web site is www.myellura.com

I have had far more experience with TheraCran than I have Ellura. I am not certain that taking it once a day is as good as taking it twice a day. So, if you decide to go on the Ellura and it does not appear to be working as well, you may want to try taking it twice a day.

Regardless of what is written in the scientific literature, I have seen a great deal of improvement in decreasing the frequency of urinary infection with the use of cranberry supplements. There are no true contraindications to taking these products.But, people who are on Coumadin should check with their internist before using these products. Also, some people who have severe reflux may experience stomach irritation with the cranberry supplements.

As you are all aware, there are all kinds of scientific information indicating that anything that can stop the oxidation process can decrease the incidence of all types of cancers. One of the most respected bladder cancer researchers, Dr. Donald Lamm, published an article in the Journal of Urology demonstrating that a good quality low dose multivitamin product decreased recurrences of bladder cancer. This article was published as early as 1994. There has also been recent information (2008) from the American Urologic Association showing that same information to be true.

VITAMIN D

Your gynecologist, obstetrician or your internal medicine doctor is the best person to prescribe medications for osteopenia or osteoporosis. This is not typically the realm of the urologist. But, if you are taking calcium and taking vitamin D, there is an excellent product offered by Theralogix for that problem also.

One caveat is to be observed. In the postmenopausal female, do not take large doses of vitamin D without being attended by a physician! There is evidence that demonstrates women who have never had kidney stones in their lives can start to make them when they are taking large doses of vitamin D and the level is not being monitored by the physician. If you are postmenopausal, your vitamin D level should be less than 50, in your blood. If it gets much above 50, you are at increased risk for kidney stone formation. So, if you decide to take calcium and vitamin D, please do it under the care of your physician, particularly if you are a postmenopausal female.

When we look at all the different products that are available as vitamin D, it appears that vitamin D3 is the form of the vitamin that is produced by our bodies after we are exposed to sunlight. It is metabolized more slowly than vitamin D2, is less likely to result in vitamin D toxicity and is therefore considered by many to be the most superior supplemental form of vitamin D.

CALCIUM

When considering your calcium supplementation, we believe that the best form of calcium supplementation is calcium citrate and not calcium carbonate. Calcium citrate is absorbed with or without food and is not affected by acid reducing medications such as Protonix, Prevacid, and Nexium.

Citrate is actually a kidney stone blocker. So, if you tend to form kidney stones and are required to take a calcium supplement, calcium citrate is likely to be the best one for you.

If you are a woman over 50 and you desire to take a multivitamin, it is probably best if you avoid one with iron in it. Younger women need iron because they are having periods. Older women do not usually need iron. Taking too much iron can actually be harmful to your body. There are special multivitamins made for women over 50 that do not have iron in them. The Theralogix Company makes an excellent one called 50 Plus Companion which I recommend if you are choosing to take a multivitamin and you are a woman over 50.

OSTEO-ARTHRITIS

There are many supplements on the market for osteoarthritis. Again, your internal medicine doctor, is the best person to advise you about these supplements. But, while we are on the subject, I will give you my opinion. The products glucosamine, chondroitin, and some vitamins (vitamin C, vitamin D, vitamin E), calcium and omega-3 fish oils, may be helpful in managing osteoarthritis. The glucosamine is reported to help grow, repair and maintain cartilage. The chondroitin is thought to improve elasticity and both are thought to help with pain. Most people taking these products will not notice much improvement until four to six weeks after taking them. Again, taking a certified product is important. One study showed that 73% of the pills claiming to have a certain dose of glucosamine and chondroitin did not have that dose. So, if you are going to spend your time and money taking one of these products, be sure that it is certified.

Again, I am a urologist and not a supplement expert. But, most of the orthopedic surgeons that I know who are over 50 years of age are taking these products.

OMEGA-3 FISH OILS

There has been some scientific research that has demonstrated that the risk of heart disease is decreased by taking omega-3 fish oils. There has also been some evidence that omega-3s can decrease the risk the stroke, blood clot and decrease triglyceride levels, blood pressure, and inflammation. Since these diseases are the leading cause of death in people with diabetes, the American Diabetes Association has recommended that people with diabetes eat two to three servings of fatty fish per week. There has also been evidence supporting the idea that omega-3 decreases the incidence of prostate cancer. There has been some evidence in the literature to demonstrate that omega-3s help arthritis, macular degeneration and cognitive decline.

Omega-3s are polyunsaturated fats that are considered essential because they cannot be manufactured by the body and therefore must be consumed through food. If you are able to eat three portions of fatty fish per week, that is probably the most excellent source of omega-3. These can be found in salmon, herring, sardines, tuna, trout and mackerel.

Another rich source is flaxseed oil for the vegetarians. If you are like me and cannot get in that much fish per week, a fish oil supplement may be beneficial. Please be aware that these products vary tremendously! You definitely want to choose a supplement that has been tested and certified for its content, purity and freedom from contaminants. The International Fish Oil Standards program test for mercury and other contaminants. Be sure that your supplement has been molecularly distilled and steamed, deodorized to remove contaminants and decrease the risk of the fishy smell and after taste. Again, the Theralogix Company makes a good product.

If you are pregnant and recommended for a good perinatal vitamin, the Theralogix Company offers the product called TheraNatal. Please be sure that this has everything in it that your obstetrician would wish for you to take before starting the product.

In the spirit of full disclosure, I must tell you that I am a small owner in the company Theralogix. To give you an idea of how small of an owner I am, I made approximately $500 off of the company in 2010. I have been forced to learn about vitamins and supplements by my patients. This was never anything that I was taught in medical school and is considered by most doctors to fall into the category of "voodoo." But, since so many of my patients are taking them, I have been researching this topic for about a decade. I spent five years trying to find a product that I felt I could recommend. It was not until I came upon the Theralogix Company that I felt able to do so.

Warm Regards,
Dr. Boone

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March 2011 Newsletter

Dear Valued Patients:

An article came out in the January Journal of Urology by Dr. Wang that studied the use of low-dose desmopressin in helping patients who are getting up to urinate many times at night.

This is an old medication that has been used for children who wet the bed in the past. This study demonstrated that in people older than 62, the medication can also be effective in decreasing nighttime frequency of urination. The drug appeared to be very safe also.

If you are suffering from nighttime frequency (getting up more than two times during an eight-hour period) and have not received benefit from any of the treatments that we have tried so far, you might be a candidate for this medication. It is desmopressin 0.1 mg approximately 30 minutes before bedtime. If you choose this therapy, we will need to check your blood at week 1 and week 4, and week 12 after institutional therapy.

We are always excited to find treatments that can benefit our patients. If you do not get REM sleep secondary to having too many interruptions due to your bladder, this can greatly damage your overall health. It can lead to depression, fatigue, and can even increase your chance of getting infections due to affecting your immunity.

So, if you feel that this therapy might help you, please do not hesitate to call our office and make an appointment to discuss whether you would be a candidate for this treatment or not.

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We also would like to share with you that one of Dr. Boone's patients, who is a very successful businessman, has suggested the following:

Any patient, who feels that they have had a successful outcome from something that they did with Dr. Boone, could put forth a "testimonial".

He felt that this information would be very useful on our website. He thought that people coming to our website would enjoy seeing some reports from actual patients demonstrating health successes. If you have a short comment (no more than five or six sentences), please send it to us. If you would like to be posted by your name, let us know. Otherwise, we will post them with fake names or list the postings as anonymous.

As always, if you have had any problems with our office, please do not hesitate to contact our manager to discuss your issue.

The following link is a video of Dr. Boone explaining kidney stones:
http://www.youtube.com/watch?v=MpUMbdLXXY4

This link is of Dr. Boone is Washington, D.C.:
http://www.heritage.org/Events/2011/03/Doctors-Need-Repeal

Doctor Boone has asked professionals that she deeply respects to add to her newsletters. This month, we are privileged to have Ms. Elizabeth Kemper, a Physical Therapist with specialty training in the pelvic floor, to educate us. Enjoy!!

Physical Therapy Perspective
By Elizabeth Kemper, MPT, BCIA-PMDB

Do I have incontinence (UI)?

Some feel that if urinary leakage is infrequent or only happens a few drops at a time, then it's not considered incontinence. In fact, urinary incontinence (UI) is defined as experiencing involuntary loss of any amount of urine, at any frequency. Leakage does not result from "just getting older" and should not be regarded as inevitable. It is a physical condition that is treatable. If you find that you are going to the bathroom all the time just to avoid leakage/ Urinary Leakage, Urgency and Frequency – A urgency then you likely fall in the UI category as well.

What is the difference between stress, urge and mixed urinary incontinence?

The most common types of UI are "stress," which involves increased abdominal pressure (sneeze, cough, laugh, etc) and "urge," which is accompanied by urgency and/or bladder contractions. Mixed incontinence has both stress and urge components. This is the most common form of UI, and people will exhibit a higher percentage of one component over the other. For example, you may have frequent, sudden strong urges with leakage most of the time but occasionally also leak with a strong cough. That would be considered mixed UI with urge dominance.

In addition to leaking, why do I have to go to the bathroom more often (urgency and frequency)? Why does almost nothing come out when I get there (hesitancy)?

There are many causes for urinary frequency, hesitancy and urgency. Although they may seem to be opposing symptoms, frequent voiding and urinary hesitancy may actually drive each other.

Regarding urgency/frequency: When the bladder is emptied too often (or not enough), the bladder itself may become less compliant. That compliance, or flexibility within the bladder walls, helps define when the body senses urgency. To clarify: the bladder is really a small muscular sack that stretches as it fills with urine. It needs to be stretched to a certain point to trigger urgency (correlating with bladder contraction). If the bladder is emptied too often (or conversely, not enough), then the ability of the bladder to register that "critical point" is lessened. The body will send signals that it is "time to go" by starting bladder contractions at inappropriate times, either before necessary or way too late. The result may become frequent urinary urges.

Regarding hesitancy: Since the bladder contracts when it should not, it also relaxes inappropriately. This can lead to urinary hesitancy and retention. The bladder starts to release the urine, but then the urethra closes and/or the bladder stops contracting to push the urine out. Included in this scenario may be contractions within the urethra itself, preventing full release of urine. One danger of retention is that some urine may remain in the bladder, leading to an increased risk of bladder infections.

What are some conservative ways I can attempt to reduce urgency, frequency and leakage?

Your doctor will discuss various medical interventions appropriate to your condition that may include medication, surgery, or uroplasty.
Should she prescribe physical therapy for UI, your initial PT evaluation visit will include a thorough history followed by an orthopedic and pelvic examination that determines pelvic floor strength and coordination.
In treating urinary incontinence, physical therapy interventions are directed toward the pelvic floor muscles first. Appropriate use of the pelvic muscles is required to reduce leakage regardless of the cause.
Therefore, your subsequent physical therapy treatments will likely include some combination of the following:

• Instruction in urgency control techniques. There are simple, effective methods for getting those sudden, strong urges under control (often without surgery)!
• Training of pelvic floor muscles (those muscles that surround the urethral/vaginal openings). This may include manual training, biofeedback, vaginal weights, and modalities to increase coordination and strength.
• Instruction in bladder health, dietary considerations, and lifestyle modifications to reduce urinary frequency. It is impossible to treat a condition by only addressing the muscles – dietary influences and years of habitual training may need to be addressed for full success in bladder retraining.
• Training in body mechanics to reduce strain on the pelvic muscles and organs. Increased strain on the pelvic organs and pelvic muscles due to inappropriate body positioning or movements may reduce the body's ability to maintain continence and increase prolapse.
• Instruction in techniques to reduce nighttime frequency, urgency and leakage. Decreased leakage at night is often one of the first areas of improvement noted with conservative measures.

What if physical therapy doesn't completely stop the leakage?

Urge, stress and mixed UI all respond very well to physical therapy interventions, usually with a high percentage of improvement noted - if not complete resolution of symptoms. The outcome of further medical interventions, should they be necessary, will only be helped by strong pelvic floor training. Just as someone having knee surgery is encouraged (or even required) to get physical therapy for a few weeks prior to surgery, the pelvic region also benefits from a little "advance training."

Only you and your doctor can determine the best route for your particular condition. No matter how long it has been going on, symptoms CAN improve! Should you have any questions regarding physical therapy for UI, hesitancy, frequency or other pelvic conditions, please discuss it with your physician.

You may also contact me personally at:

Elizabeth Kemper, MPT
Sovereign Rehabilitation
495 Winn Way, Suite 120
Decatur, GA 30030
PH: 404-389-0077 FAX: 404-389-0082
Beth.Kemper@sovereignrehab.com
www.KemperPT.com

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February 2011 Newsletter

Dear Patients,

A special note to you. If you are struggling with your weight, and think that there might be an "emotional" or "spiritual" cause behind your over eating, you might consider the following book: WOMEN, FOOD AND GOD by Geneen Roth. It was suggested to me by one of my lovely patients who is a life coach.

Announcing the FISH test for hematuria and bladder cancer.

In addition to the culture and urine cytology that we have always done for blood in the urine or hematuria workups, we are now able to offer the FISH test.

What is it? It is a DNA test that detects chromosomal changes with an 81% sensitivity versus urine cytology which is a morphological test with a 58% sensitivity.

FISH can detect bladder cancer by identifying chromosomal changes before a highly skilled urologist can see it in the cystoscope.

FISH is FDA approved for:

1. For detection of bladder cancer in high risk patients with hematuria.
2. Bladder cancer recurrences.

When we combine the FISH test with cystoscopy, there is a 98% sensitivity for bladder cancer.

Currently, the FISH test is covered by most insurance plans.

The ideal patient to have a FISH test:

1. Any patient who has already had bladder cancer and is being monitored.
2. Patients with persistent blood in urine.
3. Patients who are high risk; smokers, other family members with cancer, exposure to toxins.

The FISH test is expensive. We use it sparingly. As it is the duty of all citizens to decrease health care cost in America, we do not do the FISH test on everyone with blood in their urine.

But, if you have had blood in the urine for more than a year, or you have had the bladder cancer diagnosis in the past, or you have blood in the urine and have been a smoker for more than five years, you maybe an ideal candidate for the FISH test. It does not replace our conventional workup.

As you maybe aware, anyone with blood in their urine should get:

1. A urine culture.
2. A urine cytology.
3. A CAT scan of the abdomen and pelvis.
4. A cystoscopy.

The most commonly asked question is "why do I need a cystoscopy if I have had a CAT scan?" The answer to that question is: The CAT scan is excellent for detecting kidney cancer. But, 30% of bladder cancers can be missed on a CAT scan as they are frequently very small.

Please do not hesitate to contact our office if you feel that you may be a candidate for the FISH test and you have not had it.

Respectfully,
Martha B. Boone, M.D.

January 2011 Newsletter

Dear Wonderful Patients,

We have GREAT NEWS!
MANY of you have wanted to take advantage of a technique for overactive bladder called Uroplasty. The technique involves "peripheral neuromodulation" with an augmented acupuncture technique. We used it successfully for many years and then insurance (particularly Medicare) stopped paying for it.

Well, they have agreed to pay for it again! (WILL WONDERS NEVER CEASE!!?LOL!!)

So, starting in January, any of you who have wanted to use the Uroplasty technique for frequency, urgency, urge incontinence or poor bladder emptying, should contact our office. We will begin doing it again in January and Medicare is going to cover it for our Medicare patients. For our other insurance carriers, we will have to investigate on a case by case basis.

This is big news, because MANY of you have not had good results with the OAB (over active bladder) medications and have had the expense and side effects from them.

Please go to our website or you can also visit this website www.uroplasty.com and look under the section about Urgent PC.

IT WAS ORIGINALLY DESIGNED FOR INCONTINENCE, BUT IT WORKS GREAT FOR FREQUENCY AND URGENCY AND POOR EMPTYING TOO.

It is so nice to have "good" news to report!

Warm regards,
Dr. Boone

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