What is the prostate?
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine and semen pass out of the body. The prostate releases fluid into the urethra to help make up 70% semen volume which buffers and lubricates the urethra and the vaginal canal to allow for sperm cells to pass through at the point of ejaculation.

What is prostatitis?

Prostatitis is a frequently painful condition that affects mostly young and middle-aged men. It has been described as a headache in the pelvis, an ache, or “blue balls”. Doctors often have difficulty diagnosing prostatitis because the symptoms are not the same for every patient, and many of the symptoms—such as painful or burning urination and incomplete emptying of the bladder, painful ejaculation, dribbling after voiding, ejaculating after voiding—could all be signs of another  problem

It is  estimated that 12 percent of men experience prostatitis-like symptoms at some point in their lives. The term prostatitis means inflammation of the prostate, but the term is also used to describe four different disorders.

There are 4 official types of prostatitis:

1) Acute bacterial prostatitis is the least common of the four types and is potentially life-threatening. Fortunately, it is the easiest to diagnose and treat effectively. Men with this disease often have chills; fever; pain in the lower back and genital area; urinary frequency and urgency, often at night; burning or painful urination; body aches; and a demonstrable infection of the urinary tract as evidenced by white blood cells and bacteria in the urine. The treatment is an antimicrobial, a medicine that kills microbes—organisms that can only be seen with a microscope, including bacteria, viruses, and fungi. Antimicrobials include antibiotics and related medicines.

Now the confusion begins:

2) Chronic bacterial prostatitis, also relatively uncommon, occurs when bacteria find a spot on the prostate where they can survive. Men have urinary tract infections that seem to go away but then come back with the same bacteria. Treatment usually requires the use of antimicrobials for a prolonged period of time. However, antimicrobials do not always cure this condition.

3) Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of prostatitis. It may be found in men of any age. Its symptoms go away and then return without warning, and it may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and prostatic fluid contain the kinds of cells the body usually produces to fight infection, but no bacteria can be found. In the noninflammatory form, not even the infection-fighting cells are present.

4) Asymptomatic inflammatory prostatitis is the diagnosis given when the patient does not complain of pain or discomfort but has infection-fighting cells in his prostate fluid and semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.
How is prostatitis diagnosed?

How is prostatitis diagnosied?

Step 1: A primary care provider or urologist performs a digital rectal exam (DRE) by inserting a gloved and lubricated finger into the patient’s rectum, just behind the prostate. The doctor can feel the prostate to see if it is swollen or tender in spots.

Step 2: A urine sample is sent to a laboratory to perform a culture. In a urine culture, the bacteria are allowed to grow so they can be identified and tested for their resistance to different types of antimicrobials.

Step 3: To confirm the prostate infection, the doctor may obtain two urine samples—before and after prostate massage. To perform a prostate massage, the doctor will insert a gloved and lubricated finger into the rectum, as in a DRE, and stroke the prostate to release fluids from the gland.

Interpreting the results of expressed prostatic fluid, and urinalysis 

The post-massage urine sample will contain prostate fluid. If that second urine sample contains bacteria or infection-fighting cells that were not present in the premassage urine sample, this suggests the prostate contains infection.

To diagnose chronic prostatitis/chronic pelvic pain syndrome, the doctor must rule out all other possible causes of urinary symptoms, such as kidney stones, bladder disorders, and infections. Since many different conditions must be considered, the doctor may order a full range of tests, including ultrasound or magnetic resonance imaging (MRI), biopsy, blood tests, and tests of bladder function.

When the tests are inconclusive:

If all other possible causes of a patient’s symptoms are ruled out, the doctor may then diagnose chronic prostatitis/chronic pelvic pain syndrome. To aid in understanding the symptoms and measuring the effects of treatment, the doctor may ask a series of questions from a standard questionnaire, the NIH-Chronic Prostatitis Symptom Index.

How is prostatitis treated?
The bacterial forms of prostatitis are treated with antimicrobials. Acute prostatitis may require a short hospital stay so that fluids and antimicrobials can be given through an intravenous, or IV, tube. After the initial therapy, the patient will need to take antimicrobials for 2 to 4 weeks.

Chronic bacterial prostatitis requires a longer course of therapy. The doctor may prescribe a low dose of antimicrobials for 6 months to prevent recurrent infection. If a patient has trouble emptying his bladder, the doctor may recommend medicine or surgery to correct blockage.

Antibiotics will not help nonbacterial prostatitis. Each patient will have to work with his doctor to find an effective treatment. Changing diet or taking warm baths may help. The doctor may perscribe a medicine called an alpha blocker to relax the muscle tissue in the prostate.

No single solution works for everyone with this condition. For this reason some patients benefit from a combination of treatments including warm baths (hot tubs), prostate massage and drainage, anti-inflammatory medications, stress management.

No treatment is needed for asymptomatic inflammatory prostatitis.

The information presented here is not meant to replace the advise of your personal health care provider that knows you. This is meant for general education purposes only.

1. Treat It

An important part of diabetes management is knowing when and how much medication to take.

2. Feed It
Another cornerstone of diabetes management is healthy eating.

• Eat balanced and varied foods every day.
• Do not skip meals.
• Avoid snacks.
• Don’t over eat.
• Eat foods high in fiber (20 to 35 grams per day.)
• Stay away from desserts and sugary drinks that have empty calories.

3. Move It
A regular exercise program can improve blood sugars, decrease the risk of heart disease, and help you lose weight. Exercise at least three to four times a week for 20 to 40 minutes each session.

4. Don’t Do It
Avoid smoking and alcohol. Alcohol interferes with the liver’s ability to release stored sugar.

5. Drink It
Drink plenty of water.

6. Coordinate It
Match your mealtime schedule to your insulin schedule as explained by your doctor or Nurse Practitioner.

7. Get Your ZZZs
Get plenty of sleep. Keeping a regular schedule and getting enough sleep will help you keep your blood sugar levels in good control.

8. Manage It
Manage stress as best you can. Keeping your stress under control helps to keep you blood sugar under control.

9. Check It
Practice good foot and skin care. Check your feet and skin for discolorations, cracking and swelling. If you have concerns, contact your doctor or Nurse Practitioner.

10. Learn It
Continue learning about diabetes to maintain and improve your health. The more you know, the better you can control it.

Metro Medical Direct’s new membership plan helps you proactively, conveniently, and affordably manage your chronic care needs.

• Medical care that comes to you – wherever you are in our service areas
• Free phone consultation and follow-up – dedicated clinical resource to answer questions
• Online scheduling of in-person, phone, web camera visits – customized treatment plans that you can live with
• Electronic prescription medication management
• Referral to specialists when needed – actively include other providers when needed
• On-line access to health information – medical histories, labs, visits, Rx meds, etc.

Breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler.

• Breastfed infants, and those who are fed expressed breast milk, have fewer deaths during the first year and experience fewer illnesses than babies fed formula.
• Some of the nutrients in breast milk also help protect an infant against some common childhood illnesses and infections, such as diarrhea, middle ear infections, and certain lung infections.
• Some recent research also suggests that breast milk contains important fatty acids (building blocks) that help an infant’s brain develop.

The benefits of breastfeeding for the mother:

• In response to the baby’s sucking, the mother’s body releases a hormone that makes her uterus contract and get smaller.
• Many mothers also get emotional benefits from breastfeeding because of the closeness of this interaction with the baby and from the satisfaction of helping to nourish their babies.
• Some research suggest that mothers who breastfeed their babies have fewer episodes of post-delivery depression.
• Reduced risk of  breast, uterus, and ovarian cancers.
• More rapid weight loss and increased metabolisim.

 Trouble breastfeeding?

Even though breastfeeding is a natural process, it’s not always easy. Many health centers, clinics, and hospitals have lactation counselors on staff. Also peer support  from mothers who have recently breast fed may be able to offer some assistance. Ask your health care provider for more information about getting help with breastfeeding. Even with help, though, some women still have trouble breastfeeding or cannot breastfeed. Pumping your breast milk counts as breastfeeding, and some is better than none.

When Not to breast feed:

In certain situations, health care providers may advise a woman not to breastfeed:

• A woman with certain health conditions, such as HIV or active tuberculosis, should not breastfeed because she risks giving the infection to her infant through her breast milk.
• Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, may also be advised not to breastfeed.
• Certain medicines, including some mood stabilizers and migraine medicines, can also pass through the breast milk and cause harm to the infant.

Please note: engorgement, hardening of the breast, “breast abscess,” fever, and use of pain medications or antibiotics are NOT reasons to stop breastfeeding. In fact, in some cases, such as breast abscess or breast hardening, emptying of the breast helps to relieve the problem.

If a mother stops breastfeeding before the child is a year old, then she should feed her infant iron-fortified, commercially available formula. Health care providers advise women not to give their infants cow’s milk until the child is at least a year old.

Breast feeding is most difficult for the first 6 weeks, and this is also the most common time that most women give up on breast feeding. It  can be very difficult to stay persistent especially if you are not getting adequate sleep. This phase will pass, and you and your baby can reap the rewards.

Reference: The National Institute of Child Health and Human Development

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your health care provider with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your health care professional.

If you would like a pre-post partum follow up visit in New York City in the comfort of your home contact Raymond Zakhari, NP

Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. The most common form of dementia among older people is Alzheimer’s disease (AD), which initially involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes Alzheimer’s disease, and there is no cure.

Abnormal clumps in the brain (called amyloid plaques) and tangled bundles of fibers (called neurofibrillary tangles) are considered signs of Alzheimer’s disease.

Scientists also have found other brain changes in people with Alzheimer’s disease. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. Alzheimer’s disease may impair thinking and memory by disrupting these messages.

How long can a person live with Alzheimer’s disease?

Alzheimer’s disease is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, people with Alzheimer’s disease live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.

What causes Alzheimer’s disease?

Physicians do not yet fully understand what causes Alzheimer’s disease. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for Alzheimer’s disease. The number of people with the disease doubles every 5 years beyond age 65.

Family history is another risk factor. Scientists believe that genetics may play a role in many Alzheimer’s disease cases. For example, “early-onset familial” Alzheimer’s disease, a rare form of Alzheimer’s disease that usually occurs between the ages of 30 and 60, is inherited.

The more common form of Alzheimer’s disease is known as “late-onset”. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. The only risk factor gene identified so far for late-onset Alzheimer’s disease is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of Alzheimer’s disease. It is likely that other genes also may increase the risk of Alzheimer’s disease or protect against Alzheimer’s disease, but they remain to be discovered.

What are the symptoms of Alzheimer’s disease?

Alzheimer’s disease begins slowly. At first, the only symptom may be mild forgetfulness, which can be confused with age-related memory change. Most people with mild forgetfulness do not have Alzheimer’s disease. In the early stage of Alzheimer’s disease, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.

The Seven Warning Signs of Alzheimer’s Disease

• Asking the same question over and over again.
• Repeating the same story, word for word, again and again.
• Forgetting how to cook, or how to make repairs, or how to play cards—activities that were previously done with ease and regularity.
• Losing one’s ability to pay bills or balance one’s checkbook.
• Getting lost in familiar surroundings, or misplacing household objects.
• Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
• Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

As the disease goes on, symptoms are more easily noticed and become serious enough to cause people with Alzheimer’s disease or their family members to seek medical help. Forgetfulness begins to interfere with daily activities. People in the middle stages of Alzheimer’s disease may forget how to do simple tasks like brushing their teeth or combing their hair. They can no longer think clearly. They can fail to recognize familiar people and places. They begin to have problems speaking, understanding, reading, or writing. Later on, people with Alzheimer’s disease may become anxious or aggressive, or wander away from home. Eventually, patients need total care.

What happens during each stage of Alzheimer’s disease?

Alzheimer’s disease develops slowly and causes changes in the brain long before there are obvious changes in a person’s memory, thinking, use of words or behavior. Stages and changes the person will go through are outlined below.

Common Changes in Mild Alzheimer’s disease

• Loses spark or zest for life–does not start anything.
• Loses recent memory without a change in appearance or casual conversation.
• Loses judgment about money.
• Has difficulty with new learning and making new memories.
• Has trouble finding words–may substitute or make up words that sound like or mean something like the forgotten word.
• Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens.
• Forgets to pay, pays too much, or forgets how to pay–may hand the checkout person a wallet instead of the correct amount of money.
• Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
• Constantly checks, searches or hoards things of no value.

Common Changes in Moderate Alzheimer’s disease

• Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
• Mixes up identity of people, such as thinking a son is a brother or that a wife is a stranger.
• Poor judgment creates safety issues when left alone–may wander and risk exposure, poisoning, falls, self-neglect or exploitation.
• Has trouble recognizing familiar people and own objects; may take things that belong to others.
• Continuously repeats stories, favorite words, statements, or motions like tearing tissues.
• Has restless, repetitive movements in late afternoon or evening, such as pacing, trying doorknobs, fingering draperies.
• Makes up stories to fill in gaps in memory. For example might say, “Mama will come for me when she gets off work.”

Common Changes in Severe Alzheimer’s disease

• Doesn’t recognize self or close family.
• Speaks in gibberish, is mute, or is difficult to understand.
• Loses control of bowel and bladder.
• Loses weight and skin becomes thin and tears easily.
• Forgets how to walk or is too unsteady or weak to stand alone.
• May groan, scream or mumble loudly.
• Sleeps more.
• Needs total assistance for all activities of daily living.

How is Alzheimer’s disease diagnosed?

At specialized centers, the diagnosis of Alzheimer’s disease can be made correctly up to 90 percent of the time. Doctors use several tools to diagnose “probable Alzheimer’s disease”, including:

• Questions about the person’s general health, past medical problems, and ability to carry out daily activities.
• Tests to measure memory, problem solving, attention, counting, and language.
• Medical tests, such as tests of blood, urine, or spinal fluid, and brain scans.

Sometimes these test results help the doctor find other possible causes of the person’s symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause Alzheimer’s disease-like symptoms. Some of these other conditions can be treated successfully.

The most accurate way to diagnose Alzheimer’s disease is to find out whether there are plaques and tangles in brain tissue. However, this requires an evaluation of the brain during autopsy after the person has died. Alzheimer’s disease research continues to develop on ways diagnosing Alzheimer’s disease while the person is still alive.

Why is early diagnosis important?

An early, accurate diagnosis of Alzheimer’s disease helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease.

What medication are currently available to treat Alzheimer’s disease?

No treatment has been proven to stop Alzheimer’s disease. However, for some people in the early and middle stages of the disease, Aricept® (donepezil), Exelon® (rivastigmine), Exelon patch® (rivastagmine patch) or Razadyne® (galantamine), formerly known as Reminyl®, may help prevent some symptoms from becoming worse for a limited time in some patients.

In addition, Namenda® (mematine), has been approved to treat moderate to severe Alzheimer’s disease.

Also, some medicines may help control behavioral symptoms of Alzheimer’s disease such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.

What is the outlook for someone diagnosed with Alzheimer’s disease?

The course the disease takes and how fast changes occur vary from person to person. On average, people with Alzheimer’s disease live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.

Where can I learn more?

• Alzheimer’s Association
• Alzheimer’s Disease Fact Sheet (National Institute of Aging)
• Alzheimer’s Disease Education and Referral Center (ADEAR)

To request an evaluation of your loved one request an appointment at Metro Medical Direct (NYC Manhattan Medical House Calls and Elder care).

According to the latest guidelines from the American Diabetes Association:

Glycosolated Hemaglobin also known as HgbA1C

Less than 5.7% Non-diabetic
5.8-6.4% Increased risk of diabetes, formerly known as Pre Diabetes

And now > 6.4 = Diabetes

What does your HgbA1c mean with respect to your average daily blood sugar?

The eAG (estimated average glucose) is obtained by using GLYCOHGB A1C BY  using the formula:

28.7 (HbA1c) – 46.7 = eAGing

So at your next physical exam make sure your primary care provider checks your HgbA1C. You do not have to fast before this test and it will give you an idea of how your blood sugars have been for the last 3 months.

Raymond Zakhari, NP

www.MetroMedicalDirect.com

Primary care medical house call, Manhattan

Nurse Practitioner Raymond Zakhari of Metro Medical Direct.

On an annual basis I recommend and have done myself blood pressure, EKG, height and weight, (unfortunately I weigh more than I should given my height. But I am working on it and am well aware of how difficult it is.) I also have an annual testicular exam to detect cancer, as well as an eye exam to check for early signs of blood pressure damage and glaucoma. I also have blood work done to check for anemia, liver and kidney function as well as cholesterol and diabetes testing. Just because my BP is normal does not mean that it may not be relatively high and unnoticed. So I use the eye exam to corroborate the findings from my physical exam. Also the body can compensate quite well and symptoms of glaucoma can go unnoticed for a long time.

Patients often ask me what I think about body scans. The answer to that question depends on why you want to have the scan done. I really try to avoid body scans (not just because “House hates body scans”) because they usual yield a finding that may not be related to the presenting problem but now present a problem that may need to be investigated. These findings that are not related to a problem are called incidental findings and they may or may not be problematic, but they are always stress provoking. If you think you need a body scan you should speak to your primary care provider (nurse practitioner or physician) and arrive at that conclusion together. There are some imaging studies that can be very helpful without the risk of radiation and have a lower incidence of incidental finding.

Don’t hesitate to contact me directly if would like to request an appointment or have something checked out  (MetroMedicalDirert.com)

These are my thoughts on prevention. If you have any questions or comments please feel free to comment here on the Face Book page for Metro Medical Direct.

Raymond Zakhari, NP

Primary Care Provider

Family members may not realize there can still be an injury even if the skin is not broken or bruised. These injuries can cause irreversible damage if not treated, which is why in most cases nurses may urge you to seek emergency care or contact the primary care provider based on your loved one’s clinical history. Falls must be taken seriously however minimal the injury may appear on the surface.

For example, patients who hit their head while also taking blood thinners, such as (warfarin) Coumadin, lovenox, fragmin or anti-platelet medications like Ticlid, Plavix, agrenox are at increased risk for bleeding. Or, a diabetic client who reports he has fallen due to new numbness or tingling may indicate nerve damage, or neuropathy. In this case, the cause of the fall can also indicate a new underlying problem that must be evaluated by a health care professional.

It may just be an isolated incident or it could signify a greater problem, but a home care nurse practitioner can assist you to determine the appropriate response.

Of course, the best scenario is to not have falls happen at all! Fewer falls equal fewer injuries which equal fewer complications in the future. Many actions can be taken by patients and caregivers to decrease the risk for falls in the home.

• Remove clutter
• Back light the rooms and place night lights in the bathrooms and hallways.
• Add non slip matting to area rugs
• Consider having grab bars installed in the shower and above the towel rack. (Do not use the towel rack as a grab bar).
• Consider slippers with rubber soles and backing. An extra long shoe horn can ease putting on the safe foot ware.
• Keep walkers and canes on multiple levels and consider going upstairs side stepping while holding on to the rail.
• Make sure the walk ways are wide enough to accommodate the width of the walker

For a comprehensive safety home inspection that is tailored to your physical needs and abilities consult a primary care nurse practitioner that can make house calls. This way you can have your physical exam in your home, and the environment can be assessed at the same time. If this is not available in your area ask your primary care provider or doctor for a prescription for a home safety evaluation and occupational therapy/ physical therapy consultation.

Raymond Zakhari, NP

Primary Care by Nurse Practitioners in Manhattan.