Men’s Health Blog

Kegel exercises have been helpful for women with urinary incontinence and have been used for years with favorable success.  Recently, these same exercises have been useful for men suffering from erectile dysfunction, urinary incontinence, and premature ejaculation.

Kegel exercises focus on the muscles of the pelvic floor, which supports the bladder, the prostate gland and the bowel and is made up of layers of muscle that stretch from the tailbone at the back to the pubic bone in front.  Exercising these muscles will increase the support of the prostate gland, the bladder, and improve the blood supply to the penis, and increase the tone of the urinary sphincter or the muscle that surround the urethra and helps control urination.

By regularly performing Kegel exercises men report improvement in their erections and even in the quality of their orgasms.  Perhaps the most dramatic finding was the improvement resulting from pelvic floor exercises compared to the use of Viagra – the results were the same.

Approximately 10% of men will have some mild urinary incontinence after surgical removal of their prostate gland for prostate cancer.  This is usually temporary and subsides after several months.  The period of incontinence can be significantly shortened if the men practice Kegel exercises before the surgery and immediately after the surgery.

Pelvic floor rehabilitation is also effective for premature ejaculation, the condition when ejaculation occurs within seconds after vaginal penetration.  This is a condition that is very common and is a source of anxiety and disappointment for the man who has the problem and also for his partner.  Men who do Kegel exercises can expect a 50% improvement in time from vaginal penetration to ejaculation.

How to find and use the muscles of the pelvic floor

The muscles in the pelvis support the bladder, prostate gland, the urinary sphincter which is responsible for control of urination.  As men age, or after surgery, especially for prostate gland surgery, these muscles become weakened and men will have problems controlling urination and\or erectile dysfunction.  This group of muscles can be strengthened by performing Kegel exercises.

In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter, as the anus is the main area contracted when a Kegel is done.

How to find the pelvic floor muscles

To find your pelvic floor muscles, you should sit or lie comfortably with the muscles of your thighs, bottom and stomach relaxed.  You should then tighten the ring of muscle around your anus without squeezing your bottom. To feel these muscles, try to stop your flow of urine mid-stream, and then restart it.  Although the exercises have to be learned (possibly over a matter of days), with practice they can be carried out while watching TV or while waiting for the light to turn from red to green.

Getting started.

First, go to the bathroom and empty your bladder.  Next tighten the pelvic floor muscles as if you were preventing gas from escaping from your rectum and hold for a count of 10.  Then relax the pelvic muscles completely for a count of 10.  Repeat this cycle 9 more times.  Do this same exercise 3 times a day (morning, afternoon, and night).

You can also identify the pelvic muscles when you are urinating over a toilet by starting and stopping the flow of urine.  You can do the same exercise when you are not urinating.

You can do these exercises at any time and any place. Most people prefer to do the exercises while lying down or sitting in a chair. After 4 – 6 weeks, most people notice some improvement. It may take as long as 3 months to see a major change.

Bottom Line:  Erectile dysfunction, premature ejaculation, and dribbling after urination are all amenable to strengthening the pelvic floor muscles.  This can be accomplished by performing Kegel exercises.  Remember a Kegel 3 times a day, keeps the doctor away!

A middle age bike rider, who was perfectly potent, noted that his penis went numb at the end of a two-day, 200 mile charity ride.  The numbness continued for nearly six months and was accompanied by the inability to achieve an erection adequate for sexual intimacy or impotence.  After a work-up revealed arterial damage at the base of the shaft of the penis, his potency returned after treatments that increased the blood supply to his penis.

To understand the relationship between bicycle seats and impotence, you need to know a few things about male anatomy. The penis is a hydraulic system. During sexual stimulation, its twin chambers fill with blood until it’s firm and erect. After stimulation ends or there’s ejaculation, the blood leaves and the penis softens again. The trigger for this increased blood flow is nerve impulses that originate in the brain and race down the spinal cord to the penis.

When you’re riding a bicycle, your weight is being focused on the perineum, the area between the rectum and the scrotum, and that’s where the arteries and nerves that feed the penis are located. Since the arteries are essentially unprotected, they’re prone to damage from constant  pressure from the bike seat.   When a man sits on a bicycle seat he’s putting his entire body weight on the artery that supplies the penis.

There are a number of things you can do to protect your potency:

• Penile numbness and excessive genital shrinkage are warning signs that there may be too much pressure on your perineum. The nerves in the perineum are being pinched, which means the artery that feeds the penis is also being compressed.

• Make the following changes in your riding style and/or your positioning on the bike: 1) Make sure your saddle is level, or point the nose a few degrees downward. 2) Check to see that your legs are not fully extended at the bottom of the pedal stroke. Your knees should be slightly bent to support more of your weight. 3) Stand up every 10 minutes or so to encourage blood flow.

• There are a multitude of anatomic racing saddles on the market, ranging from ones with a flexible nose to models with a hole in the middle. You may want to experiment with a wider, more heavily padded brand or a “double bun seat” that places the weight on the bones and off of the perineum.

• Heavier riders may be more at risk of arterial compression damage because of the greater weight that’s placed on the perineum. If you’re in this category, you should consider a wider saddle with extra padding.

• When riding a stationary bike, the tendency is to stay seated and grind against big gears for long periods. Get off of the seat as frequently as you would on your regular bike and be certain that it’s set up the same in regards to riding position.

•  Get off of the seat when riding over rough or irregular terrain. Use your legs as shock absorbers.

Most men are not aware of the relationship between their bike and their erections. My final advice for good health is that men shouldn’t necessarily ride farther but ride a lot smarter.

Erectile dysfunction is a common condition affecting nearly 30 million American men.  It wasn’t long ago that most cases were thought to be do to psychological causes.  Now we know that most men have a physical cause.

Erectile dysfunction occurs with greater frequency after age 40, although it is not inevitable consequence of aging.  The condition can result from complications of chronic conditions, such as coronary artery disease, high cholesterol levels, high blood pressure, and diabetes mellitus.  Side effects of surgery, medications, and psychological influences are also associated with impotence, as are lifestyle factors such as high-fat diet, drug abuse, excessive alcohol consumption and smoking.

Since July 1995, prostaglandin (Caverject) has been approved by the Federal Drug Administration for the treatment of impotence.  Prostaglandin offers men and their partners hope for a problem for which there was previously no approved medication.

Caverject is administered via a small needle through the skin on the top of the penis.  The drug works by relaxing smooth muscle tissue, which, in turn, enhances the blood flow into the penis, creating an erection.  The drug is used for the treatment of erectile dysfunction, whether the cause is neurological, vascular, or psychological.  Men who choose this treatment option receive an initial injection from their physician to determine the optimum dosing.  Then the patient can administer prostaglandin once he has been trained in the technique of self-injection.

Prostaglandin is only available by prescription.

An erection usually occurs 3-5 minutes after the injection and will last for 30-45 minutes.  Men are able to enjoy orgasm and normal ejaculation using prostaglandin injection.  However, the recommendation is to limit the use to twice a week.  Side effects include slight pain at the site of the injection, occasional bruising, and less than 3 percent will have an erection that requires medication to reverse the drug effect.

The results of using prostaglandin are favorable since more than 80 percent of patients diagnosed with erectile dysfunction who use prostaglandin experience an erection adequate for sexual intimacy.

If you suffer from erectile dysfunction, it is a good idea to see your physician so that the proper diagnosis can be made and the appropriate dose of prostaglandin can be selected.  It is now possible to find an effective treatment for most men who suffer from this common medical problem that significantly impacts a man’s quality of life.

Bottom Line:  If you have tried one of the oral medications for erectile dysfunction and you are not receiving the result you would like, consider self-injection therapy with prostaglandin

Having problem with erectile dysfunction and you want to end this misery right now? Then end this misery through erectile dysfunction drugs.  Erectile dysfunction is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. However, anyone should not worry since this problem can be treated using erectile dysfunction medication.

There are only three oral erectile dysfunction drugs approved by the FDA to treat erectile dysfunction, all of which are available at ErectileDysfunctionDrugs.net. The approved erectile dysfunction medications are Cialis, Levitra, and Viagra. All of these medications work by increasing the flow of blood into the penis so that when a man is sexually stimulated, he can get an erection.

Cialis is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men that should be taken no more than once a day.

Levitra is an oral therapy for the treatment of erectile dysfunction.  This should be taken as needed about 1 hour before sexual activity

Viagra is an oral medication for erectile dysfunction (ED). It helps most men with ED improve their erections.

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When the phrase “biologic clock” is mentioned, most think this is in reference to women who experience a loss of hormone production at the time of menopause.  But men also have a clock that starts to slow down around age 35.  It is at this time that men experience decreasing hormone production, decrease in fertility potential, as well as an increase risk of genetic problems in children born to men who are older.

The theory that men go through a change in life, similar to what women experience, could be taking hold. We know for certain that the cause of the slowing of the biologic clock in women is due to a decrease in the production of estrogen.  If less estrogen in women leads to the end of menstruation, moodiness, hot flashes, loss of sexual interest and osteoporosis, couldn’t male versions of these symptoms be caused by less testosterone?

How common is male hormone deficiency?  Currently in the U.S., at least 6 to 10 million men suffer from the effects of extremely low testosterone levels in their bloodstream.  Sadly, only 1 out of 6 of these men will ever receive treatment to resolve this problem.

Infertility and aging

It has been noted that more men, and women, are deferring parenting until they are older, finished their education, and are more financially stable.  As a result the number of children born to fathers older than 35 years has increased considerably in the past few decades.  This creates a problem as there is a decrease in fertility in men with increasing age.  Since it takes longer to achieve a pregnancy in older men, they should be counseled and may consider starting their family sooner before their clock completely winds down.

Since there is evidence of the existence of a male “biological clock,” the likelihood of taking more than a year to conceive doubles when the man is over 35. The implication is that a man’s age should be another factor that is taken into account when looking at the chances of conception in couples who are having difficulty conceiving.

In addition, as men age, the genetic quality of their sperm declines significantly. According to the Centers for Disease Control and Prevention, the number of babies born to parents older than age 35 more than doubled from 1970 to 1999, from 6 percent to 13 percent. This trend has led to the rise in the rates of infertility in the past decade, and to increased miscarriage rates and the possibility of a baby born with Down Syndrome (in addition to other genetic abnormalities).

When testosterone levels drop

In women, menopause generally marks the end of youth, hence the idea of a “mid-life crisis.” Some women get hot flashes, are moody, irritable and/or depressed. Male menopause, or andropause, is not as clearly defined for men as it is for women.  There probably is a syndrome of testosterone deficiency in aging men, and that testosterone deficiency is manifested by a diminished sexual drive, difficulty in getting or maintaining an erection, lack of energy, even irritability and grumpiness.  There are even changes in a man’s height, caused by bone loss and osteoporosis.

If a man is experiencing any of the symptoms of testosterone deficiency, they need to see their physician and undergo an evaluation which includes a blood test to measure the testosterone level.  Not all male mid-life crises are a result of testosterone deficiency.  First, the doctor must be sure that the symptoms are not due to depression.  Many of the issues in testosterone levels could be confused with the effects of depression. If you’ve got symptoms that may be suspicious, the first thing is to have a thorough physical and laboratory work and make sure you rule out other medical conditions such as diabetes, which also affect testosterone levels. Treat those conditions first, before you consider looking at testosterone.

There is also a useful questionnaire, ADAM-Androgen Deficiency in the Aging Male, that is helpful for men to identify testosterone deficiency.

The ADAM questionnaire asks you to check for the following symptoms:

1. Decrease in sex drive

1. Lack of energy

1. Decrease in strength and/or endurance

1. Lost height

1. Decreased “enjoyment of life”

1. Sad and/or grumpy feelings

1. Erections less strong

1. Deterioration in sports ability

1. Falling asleep after dinner

1. Decreased work performance

Men experiencing Loss of morning erections depression, tiredness, memory loss, decreased muscle mass and increased weight, more fragile bones, or a diminished sex drive might be candidates for testosterone replacement therapy.  Treatment of testosterone deficiency is easily accomplished with injections of testosterone, patches placed on the skin that transmit the medication from the skin to the blood stream, or topical gels applied to the upper arm or lower abdomen can quickly restore a man’s libido and sex drive.

So if you are over 35 and are feeling less than your best, you should talk with your doctor about your symptoms. A complete medical examination that includes laboratory tests can help show whether testosterone supplements might help you feel better. If treatment is suggested, then I encourage men to try it for a period of a few months while keeping track of the changes. If low testosterone is the cause of their symptoms, men will not have to wait long to see the effects of treatment.   Bottom line…men, you may not be able to turn back the clock of time but you certainly can reset your biologic clock with hormone replacement therapy.

Dr. Neil Baum is a urologist at Touro Infirmary.  For more information, contact Dr. Neil Baum at (504) 891-8454 or go to his Website, www.neilbaum.com

Part One + Part Two + Part Three

4.

Now you might be thinkin’ that I, for bein’ a warmonger and makin’ money off death in fights that I caused sometimes, that I died badly: somebody coming after me for revenge or the like. You might even feel I deserved that, and I wouldn’t argue with you. But that ain’t what happened. I had a heart attack in my sleep.

My wife Caroline had passed on a couple years before, and my oldest son and his wife and children had come to live with me in my mansion. I’d been ailin’ for a while, “declinin’”, as the doctor put it, and I had been coughing and feeling poorly before I went to bed. I didn’t know, though, that it was my last night on earth. I’d known, I woulda told my sons and his wife and his kids all that I loved ‘em. They knew, but you know, I still woulda wanted to say it, just one last time.

Sometime, in the middle of the night, I felt it. My heart skipped, stopped, skipped, stopped, skipped, stopped, stayed stopped. Afore I could fully wake up and move, it was too late. My body felt just real heavy all of a sudden and I started feelin’ cold and I thought, well, if this is how it ends, I ain’t gonna fight it. I had a good life. And I didn’t fight it.

I had a feelin’ like I was in a boat, rockin’ back and forth, to and fro, gentle at first, then harder, and then. . .Well, I ain’t got no way to put it ‘cept this: my mortal soul had shook loose of its shell, and I was floatin’, more like fadin’, into somewhere else. All this time, I hadn’t dared to open my eyes.

When I did, I was floating somewhere dark. Absolutely black. I was wearin’ these clothes and floatin’ on nothin’. I wasn’t scared, or worried, or excited; no, none of that. I just felt peace, as calm and comfy as a cat with a tummy full of fish. If I felt anything, it was a little happy. I mean I knew, I just knew I was goin’ up to Heaven and see my Caroline again, my mother and father, and my little boy Stephen what had died of the cough when he was six. I knew I was such a good person.

Then I heard this. . .well, sayin’ it was a voice is like sayin’ that a bucketful of ocean water is the Atlantic. Technically, it’s true, but the scale is vastly different, you see? But “voice” is the only word I have for it. It called my name.

“Weston Aloysius Smythe.”

I tried to say somethin’, anythin’, but I had no voice. Instead, I felt weight, even though I was still just floatin’ in nothing. It was my life, weighin on me, everything I’d ever done, all at once pressin’ on my soul. . .and it was heavy. It was the heaviest thing I’ve ever felt. And then the voice spoke again, tellin’ me about me.

“Father. Husband. Gun Maker. Business Owner. Millionaire. Inventor.”

I smiled. It felt good to hear the good parts of me, given in judgment. I felt a warm feeling. . .and then it spoke again, and what it said chilled me to the bones I didn’t have no more. It was one word. Just one word.

“Murderer.”

Even though I had my eyes closed, closed ‘em soon he said the word, I saw ‘em all, every single one of ‘em, in a second. Every single person killed on the raids I paid for, every person killed in the battles that followed, everybody killed by me. I finally understood what I’d fought off knowin’ in my life: all that blood was on my hands. I’d start fights to sell guns without carin’ if folks got hurt or killed, and I denied to myself that I’ve ever set a foot wrong. I wanted to say somethin’, anything, to speak up for myself, to explain it, to beg forgiveness, whatever all I could do. But I had no voice, just an open mouth makin’ a silent scream in the dark. And the voice kept talking, that awful, terrible voice that shook the dark and put cracks in my soul with every word.

“You Will Bear Witness.”

I was confused. I didn’t know what it meant by that. I wanted to ask, but still ain’t had a voice.

“And They Will See You.”

I was cryin’ somehow, and I wanted to beg for forgiveness, for mercy. I still didn’t know what it meant, but I knew it had to be somethin’ right terrible.

“Bear Witness.”

And I was fallin’, not floatin’ no more, fallin’ fast, faster than anything I’d ever seen, and tryin’ to scream and couldn’t, just fallin’, fallin’, and then I opened my eyes and I was layin’ on a hardwood floor. It wasn’t in my house, but it was still a pretty nice one. There was a big white canopy bed, lace and frilly cloth hangin’ off the top rail, over to my left. There was a spot wide enough for three of me where I fell, ‘tween the bed and what I think they call a “armoire.” Off on the far side of the bed was one of them big vanities, the kind what takes up the whole wall, has about 50 drawers and a big oval mirror on the top. Real nice, real expensive. I knew; Caroline had one.

I picked myself up, looked myself over, saw I was wearin’ the same clothes you see me in now, my favourite suit back before I died. I was wondering if maybe I’d just been havin’ some kinda bad dream, and if I did, how I woke up from it dressed my Sunday best in somebody else’s house. I didn’t get to wonder too long, though, afore I realized I was hearin’ a thumpin’ noise, gettin’ closer to the door, over beside the vanity. I ain’t ashamed to say I got scared, thinkin’ maybe I was still dreamin’ and some sort of monster was comin’ for me. It might seem silly now, but I was still pretty scared outta my mind, remember. I’d been alive, I would have heard my heart thuddin’ in my chest like it was fixin’ to break though, but the silence was even scarier.

And then I saw what was makin’ the noise.

A woman came in the door, half-crawlin’, half-draggin’ herself along. Her head was down, so all I could see of it was just a big mass of redheaded curls and the pink pale skin of her neck and the top of her back. She wore a white dress, one of the ones with the big puffy skirts, and I could tell she was wearin’ a corset under that she really didn’t need. I tell you true, she looked like a beautiful flower of womanhood, and I started to think maybe I’d gone to Heaven after all.

Then she looked up, and I felt my stomach sinkin’ back to Hell.

She had had a gorgeous face, before whatever his name was started workin’ on ‘er. She had a little dimple in her chin, a button nose, and full, sexy lips. She had some pretty ice-blue eyes, too. . .well, I say “eyes,” but I could only see one. The other was swollen shut from a fresh shiner; had a little cut under her eye that had opened up and was bleedin’. That cute button nose was bruised, crooked, leaking blood like there was no tomorrow and her sweet lips were split, wellin’ up blood like oil. She opened her mouth, let out a little whimperin’ sound and I could see she had a couple top teeth missing, so fresh out the nerves were still hangin’.

I recoiled from her at first, so surprisin’ was the sight of that pretty face all beat to shit. Then I remembered to be a man, and I went to help her up. . .and my hands passed right through her. I fell back away from her, away from the door, starin’ at my hands like they hadn’t been born with me, and gave a yelp. She didn’t notice me, so I tried to talk to her, ask her what was goin’ on, but she didn’t hear a word I said, she just kep’ on tryin’ to go wherever she was goin’, I didn’t know where. I doubt she knew anything other than she was just tryin’ to get away. It dawned on me she couldn’t hear me or see me, and that shocked me so’s all I could do was watch her crawl and drag on the floor, towards the bed, leaving a trail of ropey blood behind her. I was still starin’ when I heard heavy boots in the hall, walkin’ with a unsteady-soundin’ gait.

All I could do was stare when the man showed up in the door. He was dressed in nice black pants that were open and fallin’ down and a real nice white shirt that was unbuttoned and untucked and a half-undone necktie. His black hair was wild on his head and his brown eyes looked crazy, real glassy, like he’d been drinkin’ a lot, like he wasn’t just a angry drunk but a crazy one too. He called her all kinda names, too, he was on a good crazy rant, callin’ her a whore, a slut, a cunt, blamin’ his whiskey dick on her, from the sound of it. My guess was she’d called him on his manly inadequacy and he was pissed about it.

And he was yellin’ still – yellin’ “your fault, you fuckin’ whore, you bitch, your fault, you get it up” – when he pulled out the gun from his belt and aimed at her back.

‘Course, I recognized it right off, it was a Smythe Model 17 Revolver, came out a couple years ‘fore I died. The last one I designed before my ailin’ health made me step down and turn the company over to my son. I was proud of that gun. It represented everything I’d ever learned about makin’ guns, all in one pretty package. Right then, though, it was the last thing in the world I wanted to see ’cause I knew what he was about to do with it.

I yelled out “NOOOOOOOO!” and I moved, tried to cover her with my body, fell right through onto the floor. Nobody else even noticed me. I rolled over right quick, and I was looking her right in the eye, the still-open one, when he shot her twice in the back.

I’d fired thousands of guns in my life, and I swear they’d never sounded so loud, so scary, so final as when he shot her and I saw the light in her eyes go out ‘fore the shots had even finished echoin’. I saw her eye roll back and she fell, right through me, right onto the floor. I tried to pick her up, but couldn’t touch her. I screamed at him, some shit, I don’t rightly recall what, and course he didn’t hear me. He turned around and walked out like he’d just sent his kids to bed, not like he’d just killed a good woman.

I cried. I knelt beside her, closed my eyes, and cried.

When I opened my eyes again, I was out somewhere west. I could tell by the scraggly pine trees on the hills and the golden dirt on the ground. I was still kneelin’, right next to a railroad track, looked and saw nothin’ but tracks, some tents up in the hills a bit away, and more Chinamen than I’d ever seen in my life, layin’ ties and nailin’ down the tracks.

One Chinaman, the one right in front of me, was old, real old, had his hair in a long gray ponytail, wearing the a plain, dirty grey shirt and plain, dirt-crusted gray pants like all the other ones were. I couldn’t feel the temperature, but there wasn’t no shade where we was and I could tell from the sweat drippin’ off all of ‘em that it was hot out. That old Chink in front of me, he dropped his hammer all of a sudden and stood up in a slump and said “No more, no more,” and I could tell by lookin’ at him they’d just plumb worked him to exhaustion. All the other ones stopped and looked at him, some of ‘em were whisperin’ at him in their native tongue, and I couldn’t tell what they said but it seemed urgent. The old Chinaman didn’t hear ‘em or didn’t care, ’cause all he said was “no more, no more.”

A white man came over to him, a blond-haired white man wearin’ clean cotton pants and a frilly white shirt and didn’t have none of the sweat-stains on his clothes like all them chinks did, he came over to him and said, “No more?”

The Chinaman raised his hands up like he was surrenderin’ and shook his head. “No more,” he said, “no more, no more.”

“All right,” the white man said, and quick as a flash pulled a pistol from his pants and shot the old chink in the back of the head. A Model 15. “The gun that won the West,” we used to call it. Just like that. Quicker than it took me to say it. The old chink fell and died with his head layin’ on the rail, a big hole in forehead, his face lookin’ like he wanted to beg forgiveness for his brain spillin’ out and makin’ a mess on the tracks. The white man looked up and down the line at the others and said, “Anybody else can’t work no more, you just let me know.” Nobody made a sound. They all went back to work without a word, just left his body out there in the hot sun, and the white man went back to the shade of a couple pines not too far from the tracks, where he’d been sittin’ in a chair ‘fore he shot that Chinaman.

I turned away from the body, from the blood and brain spillin’ out on the rails and ties and dirt, ready to cry out to God to let me out of this Hell, I didn’t wanna see people get killed with my guns over and over again for the rest of eternity. That was my plan, but when I turned around and saw what I saw, well, my mouth just dropped open.

The murdered woman was behind me, still in her pretty dress, her face still all bruised up, two bloody holes in her beautiful chest. The old Chinaman stood next to her, his forehead damn near gone, his skull and widow’s peak collapsed into the hole and half his brain hangin’ down his face.

They were staring at me. No words, no pointing, no accusin’, no screamin’, just starin’. Straight at me. Didn’t respond when I screamed and jumped, just kept starin’.

They been there ever since.

***************************************************************************************************

I don’t know what happened to Samuel Colt in the afterlife, but this probably wasn’t it.

The two scenes are completely made up, so no credit due to David Milch here.

While I’m at it, I confess no certain knowledge of what happens to anyone in the afterlife, or even if there is an afterlife. I know what I would like to believe, but I don’t know whether or not it is true.  What was the Voice Of Judgment?  God?  Metatron?  Optimus Prime?  I don’t know.  It doesn’t matter.

The rocking sensation that Weston describes is what I have heard being used a description from people that claim to have had out-of-body experiences, or astral travel experiences.  It seemd to fit to me, what a soul would feel like shaking loose of its mortal moorings, so I went with it for Weston’s death scene.

After I wrote this, I went back and re-read Preacher, the wonderful graphic novel series by Garth Ennis and Steve Dillon. It wasn’t until that re-reading that I realized where I may have been influenced for the ghosts behind Weston: in Preacher, the Saint of Killers, the embodiment of the Angel of Death, is followed by the spirits of the people of Ratwater, Texas, the town where he was murdered and which he subsequently murdered after his resurrection. They, too, are invisible to anyone else. I might owe Garth Ennis a beer or something for this one. Meanwhile, Preacher is worth a read if you like modern cowboy stories, gun-toting women, and Irish vampires.

Yeah, Weston’s post-death visions are a little gruesome in the telling, but, you know, TV shows and movies make gunshot wounds look so clean, I had to go the other way and show them to be as messy and horrid as they, in fact, are. I halfway think that the antiseptic portrayal of gunshot wounds in the media is why people seem so cavalier about them in the real world. They don’t just make neat little holes. They make big, nasty, gaping wounds. Be happy I stopped short of describing the smell.

Part Five

VS – 3.8.10

A few years ago I went to the Cooper Clinic in Dallas, Texas for a comprehensive physical examination.  The exam last nearly eight hours and every opening and structure on my body was probed and explored.  Are these costly and lengthy “extreme physicals” necessary or useful?

The main benefit of these extensive examinations is the convenience of one stop shopping or to provide you with an opportunity for a physician to give you a comprehensive exam at one time rather than forcing a you to piece together appointments with a half-dozen different experts.  Many patients say it is worth the expense to get a one-stop, comprehensive look at their health.

For those who aren’t willing or able to spend big chunks of time, there still is a lot to learn from these exams with your primary care physician. A savvy patient can always ask their own physician to perform a selection of such tests. Any doctor can order the blood work, such as C-reactive protein tests or advanced cholesterol screening, that is standard fare during a superphysical. Your family doctor should be able to refer you to a nutritionist or exercise physiologist for additional counseling.

Getting regular physical exams is a great start. To get the most benefit from your visits, you must communicate clearly with your physician, understand the exam’s results, and know what actions you and your healthcare team need to take. Here are some more steps to help you make the most of your physical exam.

1. Be honest with your physician about your behaviors and symptoms. Don’t just tell the physician what he or she wants to hear. For example, if you smoke, say so.  If you don’t exercise, mention that.  If you are sexually active and have multiple sexual partners, indicate this to your doctor even if he\she doesn’t ask.  If you are suffering from erectile dysfunction (ED), volunteer this as there is treatment for this condition and it may indicate other more serious illnesses such as diabetes mellitus, hypertension, high cholesterol levels and even coronary artery disease.

2. Don’t be shy. Many people don’t tell their physicians about depression, incontinence, and sexual problems because they are embarrassed to discuss these issues. It is natural to feel reluctant, but it is not in your best interest. Your physician can give you the best treatment only if he or she knows what is really going on.

3. Tell your physician about changes in your life and any new symptoms you’ve experienced, even if you think that they may not be significant. For example, mention changes in your appetite, weight, sleep, or energy level. Also let your physician know about major changes or stressors in your life such as a divorce, significant financial problems or the death of a loved one.

4. Ask questions. This is crucial to getting the most from your annual examination. If you don’t understand a test, a word or medical term the physician has used, or want more information about your condition, you must ask for clarification. When you don’t ask questions, your physician will assume you understand.  Also ask for educational materials.  Most physicians have brochures and forms related to the most common medical conditions and will be happy to provide it to you.  Also, ask for relevant or credible Web sites so that you can learn more about your condition and learn about healthy habits and life styles.  Whenever possible, have the physician or staff provide you with written advice or instructions.

5. Come prepared.  Write down questions or topics you want to discuss before your appointment. For example, include a new symptom you want to mention or a question about a new treatment.

6. Take notes and/or bring someone along with you. If you think that you may not remember what your physician says, taking notes will help. Bringing a family member or friend to your appointment will also help. If you tell your family member of friend what you want to get from your visit, he or she can help you stay on track.

7. Share your point of view about the exam, tests, and treatment. Your physician needs to know what works well for you and what doesn’t, but he or she can’t read your mind. If you feel rushed, worried, or uncomfortable, say so.  If you feel you need more time with your physician, ask when you can return or schedule another appointment to review what is important to you.

8. Before agreeing to proceed with a medical test, ask your physician to explain why it is important for you and what it’s designed to show. When the results are available, make sure your physician explains them and answers your questions. Ask for a copy of the results. If a specialist does the test, ask to have the results sent to your primary care physician.

9. If your physician suggests a treatment and especially a surgical procedure, be sure you understand what it is and what it will and won’t do. If your physician suggests a treatment that makes you uncomfortable, ask about other treatment options and even about getting a second opinion.

10. Ask about your medication’s side effects.  Be sure to let the doctor know what medications, vitamins, herbs and over the counter medications you are taking.  Then ask if the newly prescribed medications have any interactions with food or drugs you are currently using.

Bottom Line:  I can’t insure that every experience with your doctor will be positive.  But I can promise you that if you use these 10 action steps and become pro-active regarding your health care, you will have a more meaningful dialog with your doctor and be on your way to good health.

Dr. Neil Baum is a urologist at Touro Infirmary and can be reached at (504) 891-8454 or through his Web site, www.neilbaum.com

For many men who suffer from erectile dysfunction (ED) or impotence, the new minimally invasive therapy may be just what the doctor ordered.  Men with ED are traditionally treated with oral medications such as Viagra, Cialis or Levitra.  This successfully works in 80-85% of men, at least for a while.  Then the medications may be less effective especially in men with associated conditions such as diabetes, heart disease, high cholesterol levels, or hypertension.

The next level of treatment may be self-injection therapy using medications that increase the blood supply to the penis.  This consists of using a small needle to inject medication directly into the penis 15-30 minutes before engaging in sexual intimacy.  This medication allows an erection to last for 30-40 minutes.  The other option is to use a vacuum device, which is a long plastic tube, applied to the penis.  The air around the penis is evacuated to create a partial vacuum, which allows blood to rush into the penis that is trapped by the application of a thick rubber band at the base of the penis.

If these treatments don’t work, then the man either gives up on his sex life or agrees to a surgical procedure to insert a penile prosthesis.  The most commonly used prosthesis is an inflatable prosthesis that allows a man to have an erection whenever he wants and the erection will last as long as the man wishes to maintain the erection.  After the man has ended his sexual encounter, he can touch a release button on the prosthesis, and the penis becomes soft or flaccid.  The prosthesis is entirely concealed inside the penis and no one can tell that the man has the prosthesis in place.  The insertion of the prosthesis usually requires a general anesthesia and takes 45-120 minutes to perform.  Most men will stay in the hospital overnight and are discharged the day after the procedure.

Now a new technique, which was developed by a Florida urologist, allows the procedure to be done under local anesthesia in less than 15 minutes.  The whole procedure is done through a small opening 1-2 inches long in the lower abdomen.  Men are able to leave the one-day stay surgical facility in a few hours after the procedure or as soon as the man can urinate.  Most men only require an oral pain pill for a day or two after the procedure.  Men can begin using the prosthesis one to two days after the procedure and most men can begin having sexual intimacy in 3-4 weeks afterwards.  Most insurance companies, including Medicare, pay for the procedure.

Bottom Line: If you are suffering from ED and the oral medications are no longer effective, see your doctor, as you may be a candidate for minimally invasive treatment.  You and your partner will be happy you found a treatment that works for you.

Dr. Neil Baum is a urologist who specializes in the treatment of erectile dysfunction.  He can be reached at 504 891-8454 or via his website, www.neilbaum.com