Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Erectile Dysfunction

In this post I am discussing a common condition that I see at my clinic: erectile dysfunction. Let me repeat that last part- a common condition. If you suffer from erectile dysfunction, you are not alone. Those two words can make any man nervous. It affects all men but becomes increasingly prevalent as we age. At least 12 million U.S. men between 40 to 79 years of age have it, but can occur at any age. Older individuals are more likely to experience health conditions that require medication, which can cause or even worsen ED. It is a very emotional and sensitive topic to discuss.

Anatomy & Physiology

The penis consists of two parallel cylinder-shaped tissues called the corpora cavernosa that run the length of the penis, a hollow tube called the urethra that is responsible for expelling urine and ejaculate, erectile tissue surrounding this tube, and various arteries and veins. The process of erection involves increased blood flow and pressure to the penis, and those cylinder-shaped tissues mentioned above become engorged and expand- thus an erection. Erectile dysfunction (ED) occurs when those tissues fail to become engorged or the penis fails to maintain rigidity and resumes a normal shape.

Essential Components for Function

How ED is affecting one male may not be the reason for you. Your doctor will help to differentiate which components are affecting you and this is important in differentiating treatment options.

• Your interest and desire for sexual activity (libido)
• Ability to obtain and maintain an erection
• Ejaculation (orgasm)
  

Select Causes of ED

Male sexual arousal is a complex subject. Discussing in broad terms, ED can generally be separated into two categories: physical and mental health. Many instances of ED may involve causes from both categories.

Physical Causes

• Medications: Take a look at your existing medications. Several medications may lead to ED. As example, anti-depressants like SSRIs (citalopram, fluoxetine paroxetine, sertraline) used to treat mental health concerns and Beta-blockers (metoprolol, carvidilol, labetalol)  used to treat blood pressure can cause ED. Review all your medications with your doctor.
• Smoking: Compared with men who have never smoked, the risk of ED is increased by 51% in current smokers and 20% in ex-smokers. Ask your doctor for help in quitting.
• Diabetes: If you’ve ruled out other causes, there’s a chance your ED is due to diabetes. Patients with diabetes are three times more likely to develop ED. Review your risk for diabetes or work with your doctor to bring your sugars under control.
• Low Testosterone: Also called hypogonadism, is a condition that generally occurs to all men as they age. By age 80, 50% of men will have testosterone levels in the low range, however the decline is faster in some men than others. Testosterone levels can affect  a man’s overall health including sex drive and sexual function.
  

Mental Health Causes

• Sexual Performance Anxiety: This happens when a man anticipates a problem during the sexual encounter and, as a result becomes anxious while attempting to have sex. Doubt and insecurities may take over your thoughts: “Will I get hard enough?” “Will I maintain an erection?” “How do I compare?” “What if I can’t finish?” These pervasive questions can ruin any performance. Talk to your doctor because once people understand the mental that cause anxiety and how to reduce or eliminate them
  

Treatment

• Exercise and Nutrition: A change in eating and drinking habits can potentially reverse the contributing causes.
• Therapy: Seeing and talking to an accredited sex therapist can lead to an overall happier sex life for men and their partners.
• Medications: The availability of oral medications such as Viagra, Levitra, and Cialis, make it much easier to treat erectile dysfunction. However, medications should be part of a more comprehensive long-term plan. At Beyond Primary Care, we wholesale generic Viagra 100 mg, 10 pills to our patients for $4.20.
• Testosterone Replacement Therapy: For men experiencing sexual frustration and have low testosterone, testosterone replacement therapy is a safe and effective way to return T-levels to the normal range.

Cold and Sinus Infections invariably go hand-in-hand with winter. Snow isn’t bad for a month or so, and living in Michigan I do tolerate brief stretches of freezing temperatures. But for complete honesty, my favorite part of winter is that it always ends. Yet, for those days and months with freezing weather, everyone tends to huddle inside together and germs and viruses are increasingly spread. This can lead to the common cold or sinus infection.

Fortunately, the possible solutions for people with an infection have never been better. Now, before you rush to get antibiotics, consider some important points from this well-written piece:

• Between 90-98 percent of sinusitis infections are viral and won’t respond to antibiotics.
• At least 200 viruses can cause the common cold. None will respond to antibiotics.
• Only 5-10 percent of sore throat cases in adults are caused by strep throat.

Remember that coughs ad other URI symptoms can take between 7-21 days to resolve. The average duration of a cough is 18 days. You may just have to be patient. But do NOT get discouraged! The goal during this time is symptomatic care.

What can you do for symptomatic care? Ahem, FREE ADVICE!

1. Minimize exposure! I am not talking about locking yourself in your house until winter ends, but keep washing your hands or using hand sanitizer as frequently as possible.
2. Contain that cough and/or sore throat. Studies show that honey that is either by itself or mixed with a liquid works just as well- or sometimes better- than leading (and drastically more expensive) anti-sore throat/cough medications. Honey can safely be used in any children > 1 yr old.
3. Nasal Steroids. When symptoms are bad enough to need a daily medication, these medications do a great job on reducing overall inflammation in the nasal cavity.
4. Dunk your head in the ocean! Ok, just kidding. We are in Michigan. But make your own saline rinses and use the suction bulb as I detailed I while back.
5. Hydrate. Your body will interpret hydration as fatigue. With all that mucous you are producing, you need to replenish it.
6. Antihistamines. These are what most people think of as ‘allergy medicine.” While they aren’t quite as effective as nasal steroids, they act more quickly and usually work well.

The picture is a plastic suction bulb, or ‘booger sucker’ as newborn parents like to say. You can find these in most stores, typically in the newborn section for $1-2. Why am I posting about this you ask? Suction bulbs allow us to do nasal rinses. The traditional method has been the net pot, but I prefer the suction bulb. Nasal rinses are an ancient practice that has been shown to have benefit relieving both allergy and cold symptoms.

Essentially, it involves sending a stream of saline (salt-water) solution up one side of your nose and back out. No, I do not believe it has to go in one nostril and out the other. Gag! The act of bathing the turbinates and sinuses in saline water is all this is required, along with a thorough blowing of the nose afterwards.

You can buy individual packets to mix with water, but because my readers are thrifty- I suspect they want to make their own. To make your own:

1. In any container, combine 2 tablespoons of household table kosher salt (iodine free) or sea salt, 1/8 teaspoon baking soda, and 1 cup (8 oz) of lukewarm sterile or boiled (but cooled) water.
2. To do the rinse, stand over the sink.
3. Place the tip (not entire nose piece) of the nozzle into the nostril aiming slightly away from the septum (the midline wall the divides your nostrils).
4. Lean your head forward, and squeeze the saline water aiming for the back of the eyeballs.
5. Repeat with the other side, allow the water to drain, and blow your nose with tissue.

Yes, what comes out is disgusting and you may get a salty taste in your mouth, but you will feel better. I typically advise people to rinse x4-8 per day. The bottom line is the more you do this, the better you will feel- quicker.

Did Beyond Primary Care mention that we have an in-house medication dispensary that saves money to our patients? Check out the pricing comparison of a common antibiotic, Penicillin, that is used for many ailments such as strep throat. Don’t worry if you have a penicillin allergy, we have affordable alternatives also! This can save our patients hundreds, if not thousands of dollars a year. How you may ask?

We buy medications wholesale. We then have our drug control license, that many traditional doctor offices refuse to get either due to contractual or logistic limitations. Another advantage of enrolling with a Direct Primary Care doctor. We then of course pass the savings on to you!

If you want to think differently about health care come join us! Not only are we personable, we work hard to save our patient’s $$$$.