Prairie Doc Perspectives Week March 3rd, 2024
“Sexual function and aging”
By Dr. Lauren Wood Thum and Dr. Dennis Joseph Thum
As husband and wife urologists, we talk a lot about sex (mainly at work). There are several issues that commonly arise in our patients that can lead to a less than satisfactory sex life. The great news is many treatment options exist.
There are many factors affecting men and women as they age that can interfere with sexual relations. In women, vaginal dryness, prolapse and incontinence are most common. A decrease in circulating estrogen in peri and post-menopausal women leads to atrophy, or dryness, of the vagina that can result in pain. Symptomatic pelvic organ prolapse can create physical barriers to intercourse. Embarrassing urinary incontinence is another reason some shy away from intimacy.
Nearly all women who are experiencing painful vaginal dryness or dyspareunia (pain with intercourse) can be safely treated with a vaginal estrogen cream. Unlike hormone replacement therapy (HRT), vaginal estrogen poses few risks and can safely be administered without fear of cancer, stroke or clotting problems. The cream is placed in the vagina several times weekly at night, helping to improve tissue quality and relieve symptoms of pain and dryness.
For women who struggle with a vaginal bulge, many options exist to maintain sexual function. A pessary can be fitted in some women who are able to remove it themselves. More often, outpatient surgery is used to restore normal anatomy and maintain sexual function if desired.
Incontinence, the involuntary leakage of urine, has many causes and several treatment options exist depending on the type.
Diagnosing and treating male urologic factors are also key to maintaining intimacy. Erectile dysfunction (ED) is common in aging men for a variety of reasons including but not limited to vascular, hormonal and psychologic issues. Certain treatments for an enlarged prostate or prostate cancer can also lead to ED. The backbone of therapy for erectile dysfunction includes pills like Viagra or Cialis. For some men who do not respond well to these medications or have side effects that are intolerable, penile injections provide a simple and effective solution. As a last resort, surgical options are also available.
Peyronies disease is another issue we frequently see in men that affects sexual quality of life. This is caused by deposits of scar tissue in the penis. This scar tissue can frequently cause curvature with erection, which makes sex difficult or painful. Excellent non-operative and operative treatments exist which can restore a couple’s sexual quality of life.
Whether sexual intercourse remains a priority in your relationship as you age is a very personal decision and is ultimately up to you. If you are suffering from conditions interfering with your ability to be sexually active, many treatment options exist and we encourage you to speak with your doctor about these issues.
-D. Joseph Thum and Lauren Wood Thum are both board certified Urologists at Urology Specialists in Sioux Falls, SD. Dr. Joseph Thum also sees patients in Worthington. In their free time, they enjoy the outdoors and spending time with their sons and German Shepherds. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.
Prairie Doc Perspective For the Week of February 25th, 2024
“The Nagging Cough”
By Kelly Evans-Hullinger, MD
“I’ve got this cough that just won’t go away,” my patient says, and I know this story all too well. Chronic cough, a cough that lasts more than two months, is a common ailment which in most cases is benign. But for the patient it is both bothersome and worrisome.
If your cough has lasted for less than two months it may just be the residual effect of an upper respiratory infection. Dry cough after having one of many viruses can last for weeks and weeks, and the only cure is time.
In patients who do have chronic cough, my first task is taking a good history. Are or were they a heavy smoker? If so I will be more apt to rule out cancer and consider lung imaging. I will also be suspicious of chronic obstructive pulmonary disease (COPD) which can be diagnosed by breathing tests. But many of these patients have no or little smoking history so are at low risk for those things. Why are they coughing? I can think of a few common reasons.
Mild asthma often causes cough at nighttime, in the cold, or with activity; it isn’t always accompanied by wheezing. Simple breathing tests in the office can help us diagnose asthma, and it can be greatly helped with inhaled medications.
Post-nasal drip is extremely common, and we have probably all experienced it with a cold or allergies. For patients who have this chronically, the mucous produced in the nose drains down the throat, causing irritation to the upper airway and an annoying cough. If this seems likely, I suggest the patient tries a steroid nasal spray every day for a month or two, and if that resolves the cough we have our answer.
Gastroesophageal reflux disease, or GERD, doesn’t always cause classic heartburn. As the stomach acid creeps up the esophagus, especially when lying flat at night, it can get high enough to irritate the upper airway and cause cough. As with post-nasal drip, sometimes we just try treating this ailment with an acid reducing medication for a couple months to see if this cures the cough.
Finally, a commonly used type of medication can actually cause benign cough as a side effect. ACE inhibitors like lisinopril are excellent drugs for hypertension and heart disease, but around 5-10% of people will get a dry cough with it. If so, the cough resolves when we stop the med.
Back to my patient. “Tell me more about your cough,” I say. “I’m confident we can figure out what is going on, even if it takes a little time.”
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.
Prairie Doc Perspective Week of February 18th, 2024
“No Man is an Island”
By Andrew Ellsworth, MD
“No man is an island, entire of itself, every man is a piece of the continent, a part of the main.” This is the beginning of a poem from 1624. In it, the poet John Donne appreciates how humans are all connected. Indeed, humans are social beings, and social connection is a factor in our health.
We all know the importance of a healthy diet and exercise for our health. We are getting better at understanding the importance of mental health. One thing we do not discuss much, however, are the benefits of social connection.
Our relationships with family, friends, people at work and in the community have a major impact on our health and well-being. Those who are socially connected and have stable and supportive relationships can more easily make healthy choices and have better mental and physical health outcomes. Social connections can help us cope with stress, anxiety, depression, and hard times. Rates of most any disease are lower for those that feel a high sense of community. This includes lower rates of heart disease, strokes, dementia, depression, and anxiety. Social connection with others can improve sleep, decrease your risk of death, and reduce your risk of violence and suicide.
Similarly, marriage decreases your risk of disease. While you may not need to get married to have a life-long partner, the benefits of a long-term relationship are well established. Marriage has been found to help with lower rates of cancer, dementia, and increases your chances of surviving a heart attack.
Loneliness is becoming more rampant even as cities grow larger and transportation faster. We seem to have everything right on our phones to keep us company. Somehow, despite all these advances in technology, or perhaps because of them, people can feel ever more isolated and alone.
So how do we build community? How do we foster social connections? One way is to encourage face to face contact, to get people together. Schools, sporting events, churches, grocery stores, coffee shops, parks, concerts, festivals, and more all help to build community. Civic organizations and volunteering can help foster social connections and help us find meaning and purpose.
You can improve your social connections right now. You could call someone. You could consider going to a local basketball game, visiting someone alone in their home, or seek out a volunteer opportunity. When you increase your sense of social connection and community, you can improve your health. When you brighten up someone else’s day, you often brighten your own.
John Donne’s famous poem “No Man is an Island” ends with a warning: “Any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.”
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook and instagram featuring On Call with the Prairie Doc® a medical Q&A show celebrating its 22nd season of health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.
Prairie Doc Perspective Week of February 11th, 2024
“Fundamental Functions: Ear, Nose, Throat”
By Debra Johnston, MD
I confess that occasionally even doctors get squeamish. Or perhaps more honestly, this doctor does. My personal list has gotten pretty short, but one of the things that still makes me squirm is something I nevertheless frequently recommend to my patients.
So what is this mysterious and rather ominous medical recommendation? Nasal saline irrigation.
The practice of rinsing the nose out with liquid probably originated centuries ago in India, and it remains part of spiritual ritual as well as traditional medicine around the world. However, it isn’t something I learned about in medical school. Western medical research into it began in earnest perhaps 25 to 30 years ago.
How does this rather torturous sounding practice help? It physically removes germs, allergen and irritant particles, it loosens thick mucous, and it helps the cilia — the tiny hairs lining our airways— clean things out.
Although the practice is generally safe for almost everyone, there is one very important caveat. Your equipment must be clean, and the solution used prepared with sterile or distilled water, to prevent a very rare, but highly deadly, infection.
When I tell someone I think they should flush a cup or so of salt water into one nostril and out the other one, and then do it again from the other side, they usually react with dismay. I freely admit that the idea sounds pretty awful, and that it makes my toes curl every time I suggest it. Then I tell them a story.
I first recommended this for a patient who was all of 7 years old. Her horrible allergies and chronic sinus problems triggered frequent asthma attacks. She had a collection of inhalers and pills from the allergist, her dad had torn up the carpet, and the family dog was bathed twice a week and banished to the back yard. Parents, child, and doctor were all a little desperate. When I rather hesitantly suggested nasal saline irrigation, her mom was willing to try it.
A month later, my little patient came dancing down the hallway, announcing with glee “Dr. Deb, Dr. Deb, I love my Netti Pot!” The simple act of regularly rinsing the allergens and irritants out of her nose had improved her symptoms so much that she could play outside with her dog. Now I tell my reluctant patients that if a literal child can do it, we can borrow some of her courage and try it too.
If you suffer from chronic sinus problems, or even just the next time a cold or allergies has you stuffed up and miserable, ask your doctor if you should grit your teeth and give it a try.
Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust for 22 Seasons, streaming live on Facebook most Thursdays at 7 p.m. central