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October 05, 2013 01:37 PM PDT
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With all the advertising during Football games about LOW "T".....the topic is becoming increasingly on the mind of men, and women.

It all began several years ago when Oprah said she was using some testosterone cream to improve her sex life, and that she 'swears by it'....and the floodgates opened.

Testosterone is the 'male' hormone, as estrogen is the 'female' hormone. Men and woman have both of these hormones in their bodies, with women...99% is estrogen and in men 99% is testosterone. Still, there is a small amount of the opposite hormone in them as well, for a variety of reasons and with a variety of effects.

As women age, estrogen levels drop off at the time of menopause...but there is no equivalent dropping off of testosterone in men---there is no 'male menopause'. Why that is, is not certain, but one presumes it relates to evolutionary effects on fertility and the fact that women cannot bare children at later and later ages without sustaining significant health risks; whereas men, with the smaller contribution to fertility and gestation, can maintain fertility into their later years without sustaining health risks.

Low testosterone levels, truly low levels, are manifested by lack of body hair, lack of any sex drive at all, and is characterized by extremely low levels of testosterone that are barely measurable. Such patients don't complain about no sex drive...it's their wives and girlfriends who do the complaining. Why is that? Because the men don't know that they don't have a sex drive and without hormone to stimulate their libido....they don't care!

These men may have a particular health issue causing such low testosterone. Failure of the testes or the pituitary gland...or some other hormonal imbalance that causes this.

On the other hand, the more common 'low T' patients has levels that are just below the normal range, or at the low end of normal. They do not suffer greatly with symptoms, but can note a variety of milder variations in how they feel (see this quiz to get an idea of the various symptoms related to this.)

What to do about truly low T? We do a thorough evaluation by an endocrinologist and work-up for specific diseases, then supplementation with either topicals or injections (pills are not allowed as they bother the liver).

For the 'borderline low T' the patient will try a supplement as above, and we will observe for improvements in symptoms. Of course, there is a great deal of 'placebo effect' wherein the man may get a sense of well being just from knowing they are getting treated, but we try to monitor levels and see if there is truly a correlation between symptom relief and higher testostone levels. I must say that in my own experience, most of these men to do not feel a great deal of improvement. Some do...and for those, we continue on supplementation, but for those who do not feel any improvement, the supplements are stopped.

Nowadays, there a clinics opening up on the street corner talking about 'fixing' the low-T problem for men. I think one should be wary of this as there is a lot of unknowns both in the diagnosis and treatment of this borderline issue. Much of the concern, having been generated by Big Pharma, educating patients about testosterone and in the process attempting to create a market for their $300 per month treatments.

So....low T is a complicated subject. If you have questions about this we need to talk, do some bloodwork , and then talk again about the results and their implications, with an honest discussion of the value of trying to improve testosterone levels and a healthy amount of skepticism about the treatment regimens.

March 17, 2012 02:12 PM PDT
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Rectal and groin irritation are commonplace. This Podcast gives you 4 simple steps for TCB (Taking Care of your Bottom)

March 17, 2012 02:33 PM PDT
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Hemorrhoids & TCB (Taking Care of your Bottom):

Hemorrhoids can be very bothersome if they become painful or if they start to bleed a lot. If you are reading this, it’s likely that you’ve finally had a ‘run in’ with this problem and can now better understand what all the fuss is about when people mention hemorrhoids or complain about them. Before that, you probably wondered why all the talk and advertisements.

Hemorrhoids are swollen veins in the rectal area and can occur inside the rectum (bottom portion of the colon) or outside the anus (the opening from the rectum). Typically, then occur during times of changes in bowel habits…in particular with constipation or straining to move the bowels. That said, they may come on ‘out of the blue’ or related to other issues that irritate the backside (sitting for prolonged periods, sitting on an irritating surface).

If you’ve tried on your own and failed to achieve resolution of this issue, I have listed below the simple methods you should use as the next steps in treatment.


1. DO NOT USE SOAP. This may come as a surprise, but this is not a problem OF your ‘cleanliness’. There is no way to sterilize the area and generally speaking, your bottom is happiest when it has some germs around, as this is its normal situation. Trying to use soap will irritate the hemorrhoids, which are only veins that are covered with a thin layer of skin.
2. WASH YOUR BACKSIDE WITH EITHER PLAIN WATER OR CETAPHIL LIQUID CLEANSER (available over-the-counter at any CVS, Waglreens, etc.….) Avoiding soap will prevent harsh irritants from perpetuating the irritation in the area and it will prevent the area from getting ‘dried out’ as soaps often do.
3. DRY YOUR BOTTOM THOROUGHLY. Probably the best way to do this is to use a hair blower on medium heat. Alternatively, you can ‘pad’ the area dry with a dry towel or air dry by leaving your bottoms off and letter nature dry things up.
4. SOAK IN A BATH OF PLAIN WARM WATER. This is the simplest and most effective method to stop pain, irritation, and bleeding. Sitting in a plain tub of warm water (or a sitz bath….a device that goes in the toilet bowl) will provide immediate relief that is impressive. Do this one to several times a day…as often as you need. You cannot do this too much. Do realize that a hot tub is not good for hemorrhoids and will cause increased symptoms due to the chemicals in the water. As well, a warm pool will not do well either.
5. APPLY A TOPICAL CREAM, such as ANUSOL HC (prescription) in a small amount to the inflamed area around the rectum. This works much much better than Preparation H (a product that I think is not very effective). If you would rather use a home cream, you can try a mild cortisone cream such as CORTAID 10 Cream, which is available at any pharmacy or grocery store.
6. KEEP THE BOWEL MOVEMENTS SOFT. Use either a softener such as Colace (Docusate Sodium), Metamucil (fiber product), or Mirilax (over the counter constipation aid) to keep the bowels moving easily. This prevents straining at movement, which can perpetuate the hemorrhoids.
7. USE SUPPOSITORIES IF SYMPTOMS OR BLEEDING IS MORE BOTHERSOME. These are ANUSOL HC SUPPOSITORIES (prescription) and they are sometimes necessary for more vexing cases of irritation or bleeding.

This combination of treatments will generally handle most mild to moderate hemorrhoids when used consistently for a few to several days. If symptoms continue despite these efforts, then its time to come in for a check and possible referral to a proctologist (rectum specialist).

So…try these simple steps before worrying about coming into the office for a check on things; if it resolves the situation….you’re all set.

Elvis lived by the moniker TCB….Taking Care of Business. Now you too can TCB (only a in a little different way!)

Advice on Constipation....Simple Efforts....by Doctor Lakin
January 02, 2012 06:42 AM PST
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This short podcast describes the simple methods for dealing with this common issue.

Below are some links to other sources of information, including my video on constipation...which has a good bit of humor as well as useful information.

A like to Sphinx Date Ranch....as I love dates as a great source of natural fiber and Sphinx is 'the place' for the Medjool Dates here in Scottsdale.

And....some good information on Fiber from the University of Wisoconsin.

February 04, 2012 08:02 AM PST
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This is a summary about diverticulosis and diverticulitis. Commonplace, but something you would know nothing about if you've never had a case of it, it is important to recognize the symptoms and get treatment early to avoid a more complicated infection.

Lots of resources of information for you on this topica, primarily on the disease itself:

and also information on preventing constipation, one of the sources of developing diverticulitis. So....learn about preventing constipation and high fiber foods below:



MRSA (Resistant Staph) infections....Information on Treatment and Prevention
January 13, 2012 01:04 PM PST
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MRSA infections do get patients worried, but generally, they are readily managed and not a cause for concern.
They do require proper treatment and follow-up.
Prevention is also important and see this CDC site for additional information.


February 22, 2013 03:44 PM PST
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Bladder infections, also called urinary tract infections (UTI), are commonplace in women. Although they may occur in men, this is very rare.

Risk Factors:
Most urinary tract infections occur spontaneously and are not the result of personal habits of hygiene. Risk factors for recurring infection include:

Previous UTI
Sexual intercourse
Lack of hormone (post-menopausal state without hormone supplementation)

Most people are aware of these, but if you’ve not had a UTI previously, here is the list
Frequent urination
Burning with urination (painful)
Cloudy urine
Blood in the urine
Fever (low grade or high temperature)

If possible it is best to have a urine specimen checked for infection. This is the simplest way to diagnose a UTI. If you have had UTI’s in the past and are familiar with the symptoms, then testing the urine is not required. Typically, the urine specimen shows the presence of white blood cells or red blood cells. Culture can confirm the specific bacterial germ involved


Antiobitcs are the required treatment. As most antibiotics concentrate in the urine, as they are cleared by the kidneys, antibiotics tend to be very effective for treatment and a virtual ‘guaranteed’ cure, so long as the causative bacteria is not resistant.

Antibiotics include:
Keflex (Cephalexain)
Cipro (Ciprofloxacin)
Macrobid (Macrodantin
And others

In addition to an antibiotic, we often prescribe an anesthetic agent called Pyridium. This medication provides immediate relief as it acts directly on the surface tissues of the bladder. It turns the urine an orange color, so do be aware of this. Treatment with Pyridium requires that an antibiotic be used as well, or the Pyridium will suppress symptoms but let the infection progress unabated


Symptoms of UTI resolve quickly, often within 12-24 hours. Certainly symptoms should be markedly improved by 48 hours. If they are not, please call and the antibiotic selected will have to be changed.


There are not perfect methods of prevention but here are several that are used, depending on the situation:

Voiding (urinating) after intercourse
Antibiotic (single dose) after intercourse
Antibiotics daily to prevent recurrent infections
Use of hormones (pills or topical) to reduce the changes of germs entering the urethra (bladder drainage tube)

December 18, 2012 04:46 PM PST
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Managing wounds is critical to healing. Having the proper materials is key and in this podcast we discuss what is needed for various situations.

This is all included in the upcoming Minibuk, THE GUIDE, which will be available on our website in January.

February 12, 2017 11:37 AM PST
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Flu season is very mild this year. Hear the latest update from Doctor Doug.

October 18, 2014 07:36 AM PDT
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Cathy Kurth, AUD is one of the great medical resources here in Scottsdale. She is a superb audiologist, and in her interview we talk about the importance of hearing and the benefits of hearing testing and augmentation.
See Cathy's website HERE>>>>

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