Nocturnal Tumescence

Morning Wood,” has always been a source of jokes, but medically, it is very telling if a man has morning erections or not. Loss of morning erections could be a sign of aging or low testosterone, which often accompanies aging but also premature aging.

Whenever a man comes into my office complaining of erectile dysfunction, the first thing I ask is, “Do you get morning erections?”

That’s because loss of morning erections usually indicates a physiological versus a psychological cause. However, loss of morning erections doesn’t prove you have a physiological problem. You could be still experiencing normal nocturnal tumescence. So how do you know if you are having normal periodic erections while you sleep? Well, there is something called the tape test.

During my urological rotation, I remember one urologist instructing a patient to place tape on the shaft of his penis before going to bed. If the tape was broken when he woke up that would indicate he had normal nocturnal tumescence. The tape test also works by using a stamp.

So you see, “Morning Wood” isn’t just some cosmic punch line. It actually means something.

Phoenix-Based Entertainer & Activist Victim of Hate Crime

Austin Head, a Phoenix-based entertainer, activist and star of LogoTV’s Positive Youth documentary, was assaulted early Friday morning by two assailants who targeted him and a friend as they were headed home and walking down Central Avenue in downtown Phoenix.

Following an evening out at the popular LGBT nightspot Charlie’s, Austin and his friend were attacked by two men, ages 24 and 21 respectively. As the men approached Austin and his friend, they yelled homophobic slurs and attacked them physically.

Knocked unconscious, Austin woke up later Friday morning with multiple head injuries, including a Maxillary Sinus Fracture, Lateral Orbit Fracture, eyebrow laceration and severe swelling on the left side of his face.

The two suspects were immediately tracked down by the Phoenix Police Department, identified by a witness, arrested and jailed.   It is not known if the two assailants were still in police custody.

Dr. Stuart Sperry of St. Joseph’s Hospital, who took charge of Head’s recovery, warned that further plastic surgery may be needed to restore the fractures caused by this assault.

I met Austin for the first time several years ago through a mutual friend, Michael Lyon. Austin and I were both featured in the documentary, Positive Youth where he openly discussed his HIV status as well as his struggle to maintain his health due to the high price of healthcare.

I wish him a speedy recovery.

Robotic Prostatectomy for Prostate Cancer

 

Scott Tully, MD, of Urology Centers of Alabama, describes the surgical process for robotic prostatectomy. He explains the various phases before and after the procedure, and how this new technology is more advantageous than the prior 2-D flat screen approach. This advancement in visualization allows his team to perform more accurate and precise procedures.

Prostate cancer, a malignancy that develops in the prostate gland, is often treated successfully in its early stages with surgery. Surgeons who treat prostate cancer have two goals: eradicating the patient’s cancer while safeguarding the nerves that control urinary and sexual function. Surgeons with the most extensive experience performing robotic prostatectomy are more likely to achieve these goals.

Robotic prostatectomy, also know as robot-assisted laparoscopic prostatectomy, is the most advanced treatment option for patients who are candidates for surgery. Operating through five or six tiny holes in the abdomen, surgeons remove the cancerous tissue while preserving the vital nerves and arteries that control bladder and sexual function. This nerve sparing prostatectomy approach helps men retain their urinary control and sexual function.

In the past year I had three patients undergo this procedure with great results.

Meningococcal Meningitis

MENINGITIS
CASES: There have been 13 cases of Neisseria meningitidis reported in MSM in New
York City since 2010; eight of these cases were in 2012. All cases were men between
21 and 59 years old. Eight cases are HIV-infected. Four patients have died, 3 were HIVinfected.
This is neither a gay – specific disease, nor it is a sexually transmitted disease.
BACKGROUND: A bacteria called Neisseria meningitidis, also known as
meningococcus can cause a range of diseases, and the illness most people are familiar
with is meningococcal meningitis, often called just “meningitis”. This usually means the
lining of the brain and spinal cord have become infected with these bacteria. But these
bacteria can also cause other severe illnesses, like bloodstream infections.
TRANSMISSION: Meningococci are carried only by humans in the nasopharynx—their
only reservoir. Overall 5%-10% of the population carries the bacteria. Meningococcus
bacteria are spread through the exchange of respiratory and throat secretions like spit
(e.g., living in close quarters, kissing). Transmission occurs when close, face-to-face
contact permits the exchange of salivary secretions from people who are ill or are
carriers. Fortunately, these bacteria are not as contagious as what causes the common
cold or the flu. Also, the bacteria are not spread by casual contact or by simply
breathing the air where a person with meningococcal disease has been.
CLINICAL: Symptoms are usually sudden onset of fever, headache, and stiff neck. It
can start with symptoms similar to influenza (flu), and will often also cause nausea,
vomiting, increased sensitivity to light, rash, and confusion. Quick medical attention is
extremely important if meningococcal disease is suspected.
VACCINE: Meningococcal vaccines protect against most types of meningococcal
disease, although they do not prevent all cases. There are two kinds of vaccines that
protect against Neisseria meningitidis available in the United States: (1) meningococcal
polysaccharide vaccine (Menomune®) which is recommended for individuals aged over
55 years, and (2) meningococcal conjugate vaccine (Menactra® and Menveo®) for
persons 9 months–55 years of age.
RECOMMENDATIONS by NYC – DOH (10/4/2012): Meningococcal vaccine should
be administered to HIV-infected men who are NYC residents and who had
intimate contact with a man met either through an online website, digital
application, or at a bar or party since September 1, 2012. HIV-infected patients
should receive two doses; the second dose should ideally be administered eight weeks
after the first dose but no less than six weeks.
These vaccines are available to our patients at 155 West 19th
Street, 4th Floor, NY, NY. Call 212/929.2629
For
more
information
http://www.cdc.gov/meningococcal/
http://www.nyc.gov/health

National Gay Men’s HIV/AIDS Awareness Day

Gay Men’s Health Crisis commemorates National Gay Men’s

HIV/AIDS Awareness Day;

Launches New HIV Testing Campaign, “Address the Stress Around the Test”

New York, NY–National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD) on Thursday, September 27, helps to raise attention to the critical issues faced by gay and bisexual men, and other men who have sex with men (MSM), who are living with and at risk of HIV.

Last year, the Centers for Disease Control and Prevention released its estimates of HIV incidence in the United States for the years 2006-2009. MSM represent approximately 2% of the US population, but accounted for 61% of new HIV infections in 2009. Blacks/African American MSM represent approximately 14% of the US population, but accounted for 44% of new HIV infections in 2009. Hispanics/Latinos represent 16% of the US population, but accounted for 20% in 2009.

These estimates also markedly showed there was an estimated 21% increase in HIV incidence for people aged 13-29 years, driven by a 34% increase in young MSM–the only group to experience a significant increase in incidence in this age range. Among MSM aged 13-29, HIV incidence among black/African American MSM increased significantly (48%) from 2006 through 2009 with a 12.2% estimated annual percentage increase.

“Gay men, especially those who are young and black, continue to face a serious uphill battle in the fight against HIV/AIDS,” said Marjorie J. Hill PhD, Chief Executive Officer of GMHC.  “We must develop more targeted and empowering HIV prevention messages, tailored to these populations.”

GMHC recently launched a public service campaign, “Address the Stress around the Test,” noting that staff members in the David Geffen Center for HIV Testing and Health Education offer stigma-free counseling about feelings such as fear, anxiety and shame that may be connected to taking the HIV test, and are sensitive to the particular issues about sex, relationships and health related to gay men (as well as heterosexual women).

Also for NGMHAAD, GMHC partnered with Amida Care to update our HIV prevention campaign “Kiss & Tell” initially targeting young black and Latino gay men, but now reaching older black and Latino gay men.

“At GMHC, we work with our clients and program participants to create social marketing campaigns that highlight our target populations with visual messages emphasizing they are important and they matter,” added Hill.

 

Veria TV

I am so excited to be working with Veria TV on a series called House Calls with Dr. Frank. I will be taping ten episodes to air on Veria TV throughout the year along with ten accompanying segments for the web. Topics will include the following just to name a few:

1. Sleep

2. Depression

3. Migraines

4. Healthy Heart

5. Healing Power of Good Sex

I’ll keep you all posted with a full report after we shoot these interstistials on Thursday along with some photos.

Women and heart disease

We all know that Rosie O’Donnell is one tough cookie but last week we almost lost the Queen of Nice. In her own blog, O’Donnell wrote that she developed chest pain but didn’t call 911. The next day she went to a cardiologist who confirmed that she had an acute coronary event and was immediately sent to the hospital where a stent was placed in her left anterior descending (LAD) coronary artery because it was 99% blocked.

O’Donnell went on to write that “50% of women who have heart attacks never call 911 and 200,000 women die of heart attacks each year in the United States. By some miracle I was not one of them.” Blockage of the LAD is referred to as the “widow maker” because near complete occlusion of this artery may result in sudden death.

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. A hard substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of plaque buildup. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and that area of the heart dies.

A heart attack is a medical emergency. If you experience chest pain, call 911 right away. Do not drive yourself to the hospital and do not wait it out like Rosie O’Donnell because your greatest risk of sudden death is in the early hours of a heart attack. Chest pain is the most common symptoms. Pain commonly radiates down your left jaw, shoulder or arm. Other symptoms include sweating, shortness of breath and symptoms suggestive of indigestion.

Risk factors for heart attacks include:

–          Men older than 45 years old and women older than 55.

–          Smoking increases the risk of clot formation and heart attacks.

–          Having diabetes, high blood pressure and high cholesterol increase your chances of having a heart attack.

–          Having a first degree relative who suffered from a heart attack.

–          Other than smoking, two important modifiable risk factors to prevent you from having a heart attack are an inactive lifestyle and obesity. People who get regular aerobic exercise and maintain their weight decrease their risk of heart attacks.

1 in 4 women dies from heart disease. Coronary heart disease is the #1 killer of both men and women in the United States.

Headaches and Migraines

Headaches and Migraines Headaches are either primary like migraines or tension headaches. Secondary headaches are due to underlying conditions like meningitis and temporal arteritis More than 90% of primary headaches are migraines. 18% of migraine sufferers are women and 6% in men. Migraines are recurrent headaches that last 4 to 72 hours.

Symptoms include one-sided, pulsating with associated nausea, vomiting and light sensitivity. 1/3 of migraine sufferers have an aura which consists of a flash of light or some visual symptoms before the migraine begins. A migraine is an abnormal electrical activity of the brain that causes levels of serotonin to rise and then drop suddenly making blood vessels swollen and inflamed. Though most migraines are genetically inherited the triggers are either dietary or environmental.

Triggers of Migraines:

Alcohol especially beer and red wine

Erratic sleep or meal patterns

Artificial sweeteners that contain aspartame

MSG Foods with tyramine like aged chedder or phenylethylamine like chocolate

Cigarette smoke

Stress

Menstruation

High altitude

How to avoid migraines?

1. Maintain regular sleep schedules- don’t sleep in on weekends. Boo!

2. Drink plenty of water when you travel and avoid alcohol during the flight

3. Regular exercise and enjoy other stress relieving time (listen to music, play with your dog)

Dr. Frank’s Tips to treat migraines

1. Lay down in a dark room

2. The herb feverfew available at health food stores

3. Magnesium and fish oils

4. Acupressure – press the web between your index finger and thumb on the same side of your headache for five minutes.

Kristen Stewart take off your scarlet letter

If I listen closely, I can still hear my seventh grade teacher Sister Dorothy telling my class the story of how a group of men were about to punish a woman who committed adultery. Jesus intervened by saying, he who is without sin may cast the first stone.

Several hundred years later, it appears we haven’t come very far when it comes to our views of “sinful” women. When a woman commits an act of indiscretion, particularly adultery, she is treated as the devil herself, and it is the public’s duty to reprimand her so severely that her punishment serves as an example for other women who might be contemplating the same act.

Growing up with two older sisters in an Italian-American family, I saw firsthand how women were treated differently than men. When my older sister divorced her husband to be with another man, my grandfather refused to speak to her. That Christmas he presented her with a gift. Wrapped inside a box, was a red ceramic bull smashed into pieces – a dramatic gesture and fittingly Italian. I watched as her eyes welled up with tears because my grandfather’s gift served as a cruel reminder that adulterous women were not to be tolerated or forgiven.

But what is it about cheating women that propels the public to react so swiftly and harshly?

It’s called misogyny.

For centuries men have cheated on women. Most recently, former Governor of California Arnold Schwarzenegger not only carried on an affair with a household staff member, he secretly fathered her son and only admitted to it after his wife Maria Shriver discovered the truth. Schwarzenegger didn’t make a tearful public apology, and he didn’t stop making movies. In 2005, heartthrob Jude Law made a public apology to his then fiancée, actress Sienna Miller once his infidelity with former nanny Daisy Wright was publicized in a tell-all interview she gave to Britian’s Sunday Mirror. In 2003, his former wife Sadie Frost split from Law due to reports of his infidelity. That didn’t stop him from having a successful career either. Why even former President Bill Clinton committed adultery with White House intern Monica Lewinsky. News broke in January 1998, but President Clinton publicly denied the affair while his wife Hilary Clinton stood by his side. It wasn’t until Lewinsky turned over DNA proof that the truth finally came out. Clinton was impeached but then later acquitted.

Unfortunately, the same is not true for women. Actress Kristen Stewart had an affair with director Rupert Sanders during the filming of Snow White and the Huntsmen. Stewart admitted to her “crime.” She even made a public apology (not that I think she needed to). Now I can’t go online or look at a magazine cover without seeing a picture of her appearing forlorn and depraved.

You are no man’s Hester Prynne, Kristen Stewart. You do not live in a 17th Century Puritanical world. Write your own ending to this story. Don’t drop out of film commitments or press junkets. Don’t let public scrutiny dictate how you feel about yourself. You did a bad thing. You apologized. Now move on.

The media is turning Kristen Stewart’s lapse of judgment into a cautionary tale for other little girls. Ms. Stewart is reportedly the highest paid female actress in Hollywood after playing Bella Swan, the title character from a very popular young adult book series, which were made into the highly successful Twilight Saga films. Demonizing her behavior only perpetuates the Scarlet Letter legacy. But Kristen Stewart is not Hester Prynne or Bella Swan. She is an actress and more importantly, a person. Whatever act of betrayal she committed is between her and Robert Pattison to resolve. It’s not for us to judge her, unless of course you are without sin.

Curing HIV with Nature

Bringing HIV Out Of Hiding

Drug Discovery: Bryostatin analogs fight dormant HIV, may be key to HIV/AIDS cure

The synthesis of analogs of a bryostatin natural product could advance the eradication of AIDS by ferreting HIV out of its hiding places in immune cells.

Highly active antiretroviral therapy (HAART), the current standard for HIV drug treatment, fights the virus by attacking it in multiple ways simultaneously. But HAART drugs are toxic and attack only the active virus. People infected with HIV must take the drugs for life because of HIV’s latency—its tendency to adopt a dormant provirus form in immune cells, from which the virus emerges over time to reestablish active infection. If HIV latency could be eliminated, HAART could actually cure patients.

Certain natural products can bring the provirus out of dormancy. Obtained from the bark of a Samoan tree, the natural product prostratin is being considered for clinical testing even though its potency in activating latent HIV is low.

The natural product bryostatin 1 has similar activity and about 1,000 times the potency of prostratin. Coming from an aquatic invertebrate, it is difficult to obtain and hence expensive. Bryostatin 1 also causes side effects such as muscle pain.

Now, Jerome A. Zack, codirector of the UCLA AIDS Institute; Paul A. Wender, a synthetic organic chemist at Stanford University; and coworkers report the synthesis of promising analogs. In vitro tests show that the analogs, dubbed “bryologs, ” are at least as potent as bryostatin 1 in activating dormant HIV (Nat. Chem., DOI: 10.1038/nchem.1395). They are also readily accessible by synthesis, easily modifiable, and seemingly nontoxic. Studies of the bryologs in an animal model are in progress.

The work is “a significant accomplishment, since prostratin is too impotent,” says Douglas D. Richman, director of the UC San Diego Center for AIDS Research. The bryologs are “a promising class of drugs for activating the latent HIV reservoir, but animal and clinical confirmation of the agents’ activity is still needed,” he says.

“The new bryologs are an important discovery, and I am intrigued with their improved potency,” says Warner C. Greene, director of the Gladstone Institute of Virology & Immunology at UC San Francisco. “They could well become part of a cocktail of drugs. Of course, two important issues are whether they will synergize with other agents and have acceptable toxicity profiles.”

“The tour de force complex synthesis of bryologs is a brilliant realization of the goals of function-oriented synthesis,” says synthetic chemist Erick M. Carreira of the Swiss Federal Institute of Technology, Zurich. “This strategy brings the viral terrorists out of hiding, where they can be targeted for destruction. The combination of the new bryologs with other current antiretroviral therapies is highly promising and offers new hope for treatment.”