Grumpy Ol’ Man Syndrome

Posted on December 12, 2012 by mcminnclinic

On a given day if you asked my wife, she might claim that they named the above medical syndrome after her own beloved husband. I must admit that I have my good days and bad days on the home front. However, I take some comfort in knowing that I’m in good company. In fact, if my women patients are right, “grumpy ol’ man syndrome” has reached epidemic proportions.

The usual scenario is that the wives drag their husbands in, kicking and screaming the whole way. Of course, the men are in complete denial and are busily hoping that Scotty will beam them up at any moment and rescue them from any event in which “feelings” are discussed. Guys need to have just the right pretense for talking about such things. It’s OK to ask “how’s the marriage” when you’re riding around in a golf cart with a good ol’ buddy, or out in the middle of a lake on a fishing boat. It’s like foreplay; the only acceptable ways to engage in such conversation is if the foreplay is centered around football, golf, beer, fishing, hunting, or NASCAR. Just to cold turkey and purposely sit down and have a talk about sensitive issues such as feelings can seem extremely unmanly and may be down right uncomfortable, even with the doctor.

Fortunately the wives are on the case big time, and they usually have the common sense to come with their strong silent types to the initial doctor’s appointment. Although I know going into it, who is going to be the communicator, I at least show the guy enough respect to address the question directly to him. “How’s it going” I say. “Fine,” or some other one worder is usually about all I get. Then the truth spews forth like an Icelandic volcano from the fairer half. “He’s grumpy, sullen, irritable, moody, depressed, and he has no sex drive. He comes home after work and just crashes into his Lazyboy. He doesn’t have any energy, and he doesn’t want to do anything. He has no interests, no get up and go, no joy in life. He’s totally disconnected. And he’s getting fat and lazy.”

On the face of it such phrases may sound like fighting words. Instead, more often than not, he agrees with her, or through his silence and lack of argument one can assume that she is not too far from the truth. Now we’re starting to get somewhere. Just like when you look up at the summer night sky and see the big dipper, it all comes into focus. He has “Grumpy ol’ Man Syndrome.” Another name for this dreaded and all too common condition is “Andropause.” At that moment, I know that I can help him.

Just like women go through menopause, men go through a similar process wherein their levels of hormones (in this case testosterone) fall to well below the acceptable range. Also just as a woman’s menopause may have dramatic affects on her health, her mood, and her behavior, so too andropause may insidiously choke the life out of even the most macho of men. They often become a shell of their former selves. The men, their wives, family, friends, and co-workers all suffer the dreaded consequences of the decline in testosterone and its accompanying symptoms.

At the risk of seeming to be biased toward men, after all I personally fall into that category, I have to stand up for the guys just a bit and let them off the hook. In many instances they can’t help it. The behavior, as I described above, is not of their choosing, but instead it is often hormonally driven. If only they had a robust and balanced hormone profile they most likely would be their usual lovable and manly selves.

True story: I had a patient in the office just recently who fit this description to a tee. His wife drug him in back about 6 months ago with the classic symptoms of “grumpy ol’ man syndrome.” He was clinically depressed, grumpy, frail, had no libido and was starting to suffer from ED (erectile dysfunction). We did all the appropriate lab testing and found that his testosterone was quite low. I put him on a program of hormone repletion, nutritional supplementation, and life style changes. WOW! He came back in for his follow-up visit and announced that he was feeling fantastic. As he put it, his energy was “through the roof.” He could hardly believe what a difference the program had made for him. The depression was gone. Energy was better. He was exercising again. He was interested once again in sex, and interested in life in general. His ED had magically disappeared, and he was thinking much more clearly. He and his wife were both ecstatic. She had her beloved husband back. He had his life back, and they had their marriage back. There is no antidepressant or any other “drug” in this world which could have achieved this outcome for this patient.

Furthermore, low testosterone and andropause can have even more dire consequences. A study published in the Archives of Internal Medicine describes an 88% increase in mortality in male veterans with low testosterone. Other published studies form reputable medical journals have linked low testosterone with poor cognitive function, Parkinson’s disease, Alzheimer’s disease, osteoporosis, hardening of the arteries, heart failure, insulin resistance, diabetes, and metabolic syndrome. Testosterone decline may also contribute to abdominal obesity, decreasing muscle mass, joint pains, loss of self confidence, fatigue, disturbed sleep, anxiety, and excessive worry. Low testosterone is not just about muscles and libido. It is about optimal health, and even mortality.

Testosterone must be respected. Like all medications it must be used properly and must not be abused or used in excess. Testosterone replacement should never be done if it is not medically indicated. Furthermore, the replacement program must be conducted properly with adequate monitoring to attain optimal levels, while paying attention to possible side effects. If done properly, it is safe and may be profoundly effective. Testosterone replacement therapy is not for everybody. However, in the presence of “grumpy ol’ man syndrome” like with my patient described above, it can make a remarkable difference in the life of the patient and his partner.

Bottom line, if you suffer from “grumpy ol’ man syndrome,” get your T checked, and get it optimized. If your loved one shows signs of this dreaded disease, drag him in and get him checked for “low T.” You’ll be glad you did.

“Good Health Starts in the Gut.”

Posted on August 20, 2012 by mcminnclinic

As I reviewed the long list of initial symptoms, I was happy to hear the patient say that everything was “better, better, gone.”

Dr. McMinn: “How is the fatigue?”

Patient: “It’s much better doctor.”

Dr. McMinn: “How is the brain fog and anxiety?”

Patient: “They’re also much better.”

Dr. McMinn: “How is the diarrhea?”

Patient: “It’s gone.”

This patient had been to doctor after doctor for her various symptoms, but it wasn’t until we addressed her gut issues that she got better.

Old fashioned country doctors used to say that “good health starts in the gut,” and as I have become an older and perhaps wiser physician, I have become abundantly convinced that they were right all along.

Other organs may be “sexier” but the gut is where wellness begins. We marvel at the processing ability of the incredible human brain, and the heart amazes us with it heroic pumping marathon. We manicure our nails, and fuss over our hair. However, we take the lowly gut for granted, as if we’d rather not acknowledge, much less to glorify, a mere poop factory. Yet the oft-ignored gut frequently holds the key to good health, and likewise poor gut heath may manifest in all sorts of bodily havoc. I have seen miracle cures for many different maladies by attending to gut issues. Seemingly unrelated diseases and symptoms such as fatigue, brain fog, headaches, rashes, asthma, arthritis, autoimmune disease, fibromyalgia, ADD, autism, sinusitis and many more health problems may be linked back to poor gut health.

Let’s take a look at some of the issues affecting gut health:

*Diet: Let’s begin with what we put in our mouths. Certainly the MAD diet (Modern American Diet) has not helped the situation. It’s amazing to me that our bodies can survive the daily onslaught of junk food, processed food, transfats, sugar, and toxins as well as it does. The term “garbage in garbage out” frequently applies to computers. However, the same principle is applicable to the human body. We feed our bodies garbage, and yet we expect this to miraculously turn into healthy cells. Instead, our junk diets wreak a heavy toll on gut health, which then dominoes onto other bodily parts and functions.

*Stress: This is one of the main fundamental causes of disease. Stress can take its toll on just about any body part and the gut is no exception. Stress is often associated with issues such as Crohn’s disease, irritable bowel disease, and chronic diarrhea. Ulcers, leaky gut, cramps, poor digestion, and stomach upset.

Food Allergies and Sensitivities: The gut has the daunting challenge sifting through every single molecule we eat and of deciding what to let in, and what keep out. That’s one reason that we call the gut “the second brain.” To meet this challenge, approximately 70% of our immune system lies in the gut.

For millions of years our ancestors ate a “natural” diet of berries, fruits, vegetables, roots, and leaves. They killed critters and ate fish for lean protein. Now let’s fast forward to the modern American grocery store. Most of the food we might find in the center isles may rightfully be considered by our bodies to be like a foreign body, and thus generate an immune response. This untoward immune response may express itself in all sorts of clinical symptoms. Our food has changed drastically in a relatively short period of time, but our immune system is genetically the same as our hunter-gatherer ancestors.

Poor Digestion: Next time you find yourself at the drug store, take a moment to walk down the isles and look at the over-the- counter medications. You’ll find that by far, the number one item is the digestive and gastrointestinal aids. Year after year, Nexium and its acid blocking cousins are at the top of the charts in terms of prescriptions sold. These powerful acid blockers, as well as the seemingly benign antacids like Tums, interfere with our natural digestive ability. As such, we may not get the nutrients form our food that we need to maintain healthy cells.

Bacterial Imbalance (Dysbiosis): The human body exists in an amazing state of synergistic balance with our gut flora. Perhaps an oversimplification, but this mainly consists of “good bacteria,” “bad bacteria,” and yeast. We cannot survive without our “good bacteria.” Unfortunately, we frequently kill off the good bacteria with the antibiotics that we take. Also, with the sugar ladened diets we frequently find our guts in a miserable state of yeast overgrowth. This can result in bowel wall inflammation, and eventually “leaky gut syndrome.” A cascade of inflammatory and immune reactions then take place which can affect the far reaches of the body, including brain, bones, skin, auto-immune disease, etc.

Similarly, parasites may add another twist to the complex milieu of bacterial flora.

A simple plan for gut health recovery involves the 4R program: Remove, Repair, Restore, and Replace. This program is available in the integrative medical literature, and I have had great success by adopting it in my practice.

Step One: Remove the stressors on the gut such as the drugs, alcohol, sugar, caffeine, tobacco, and other poor food choices that we find in the modern American diet. A gut detoxification program may be helpful in this regard.

Step Two: Repair the damage with optimal nutrition, stress reduction, etc. Targeted nutritionals may help such as aloe vera juice, quercitin, licorice root, garlic, tumeric, digestive enzymes, and fish oils.

Step Three: Restore a healthy bacterial balance with high quality probiotics. Cutting out unnecessary antibiotics, treating yeast, and reducing the sugar in the diet may also help.

Step Four: Replace the deficient elements such as digestive enzymes, which can have a major impact on digestion and utilization of nutrients.

In summary, continue to ignore and abuse the gut and you will reap the unhealthy consequences. Give the gut the respect it’s due, and you will enjoy the many benefits in the years to come. Start today with the 4R program; remove, repair, restore, and replace gut health program in order to achieve optimal overall wellness.

Your Weakest Link

Posted on July 4, 2011 by mcminnclinic

Your Weakest Link by James E. McMinn, M.D.

We’ve all heard the adage before: a chain is only as strong as your weakest link. So what’s your weakest link? At the end of the day, what’s going to get you? And just as importantly, what can you do to improve your odds?

Cardiovascular disease: Heart disease is by far the number one cause of death in America. Almost one million Americans die of cardiovascular disease each year. This amounts to about 40%, or 1 out of 2.7 deaths in our country. Your first important decision in avoiding this, the weakest of all links, is to pick your parents well. There is definitely a genetic component for cardiovascular disease. However, much of the risk for cardiovascular disease is also attributable to lifestyle choices, and most of these risk factors are well within your control. Smoking is perhaps the biggest single risk factor. If you smoke, you automatically increase your risk of dying from heart disease by approximately 3 fold. If you smoke, the single most important thing that you can do for your health is to put away the pack. It’s not easy, but the benefits are enormous. Obesity and being overweight are the next major risk factors. In fact, obesity has overtaken smoking as the number one overall cause of preventable death in America. I believe that a few extra pounds is often the beginning the slippery slope of disease leading to a premature death. Many of the other risk factors for cardiac disease are often directly linked to the weight issue, such as hypertension, diabetes, high cholesterol and triglycerides. Obesity is also very pro-inflammatory, and inflammation is evermore being appreciated as a major contributor to many disease processes, including heart disease, as well as Alzheimer’s and cancer.

Cancer: Although cardiovascular disease is by far the most common cause of death, cancer is the most feared. Although we declared a “war on cancer” many years ago, this terrible disease has gone unabated. Two out of every five people in America will develop cancer, and one in five will die from it. Approximately one in every eight women will develop breast cancer in her lifetime. Even worse almost all men will get prostate cancer if they live long enough. To my way of thinking, the key is prevention. Certainly, diagnostic tests are becoming more and more advanced, but they can’t prevent cancer, they can only find it, and by that time you’ve already got the disease.

The number one rule of cancer prevention is “don’t smoke”. Sound familiar? As it turns out, the same preventive measures pertinent to cardiovascular disease, also apply to cancer. It’s all about diet and lifestyle. Studies suggest that if you take people from a country with a low rate of cancer and put them in a country with a high rate of cancer, once they adopt the diet and lifestyle of the new country, their cancer rate goes way up, to equal that of their new home country. In fact a majority of cancers in our country could be prevented with smoking cessation, exercise, diet, and lifestyle changes. Some specific strategies for cancer prevention include the following: stay slim, get regular exercise, avid saturated fats, eat more fiber, avoid excess alcohol, avoid unnecessary radiation, avoid toxins, This is more powerful than any expensive, high tech treatment on earth. Your mother was right, eat your fruits and vegetables!

Diabetes: It is fair and accurate to say that we are currently in the midst of a very frightening epidemic of type 2 diabetes. Between 1980 and 2002 the prevalence of diabetes has doubled. If this trend continues, we may soon start to see shorter lifespan in America starting with the next generation. Unfortunately, these shorter lifespans will be fraught with complications such as: heart disease, hypertension, stroke, impotence, kidney failure, amputations, blindness, and nerve damage. Diabetes has even been linked with cancer.

I know I’m beginning to sound like a broken record, but here we go again. For diabetes prevention, it’s back to basics. You really are what you eat. Diet and exercise are the keys to diabetes prevention. The basic diet principe is called glycemic index. Avoid sugar and anything that acts like sugar, such as white flour. Sugar hides and goes by many names, so learn to read labels. Often “health foods” are really sugar Trojan horses and heart attacks in disguise.

Dementia: So far we’ve had the most common disease, the most feared disease, and the scariest disease. I’ll wrap things up with what I consider the saddest of diseases; dementia. This tragic disease may take many forms including Alzheimer’s disease, vascular dementia, and stroke dementia. Your lifetime risk of dementia now stands at about 10-15 percent. Once again, prevention lies in the foundations of wellness: exercise, diet with plenty of antioxidants. Staying socially involved, and keeping your mind active are also helpful.

The list of weak links goes on to include infectious disease, kidney failure, and liver disease. However, by now it is quite clear that the prevention prescription remains largely the same. Most importantly, it all starts with the conscious decision to live a wellness lifestyle. It sounds simple enough, but in our modern day stressed out society full of junk food and toxins, the wellness path is the exception rather than the norm. In addition, it is not enough to make a decision. One must then set goals and devise an action plan for getting there. In America, we seem to be caught up in a “victim mentality” when it comes to our health. Even the phrase “heart attack” implies that this disease lashes out at innocent victims, like a “shark attack.” When in fact, most of us have been knowingly sewing the seeds of that heart attack for many years. It says on the package of cigarettes in bold letters, yet many of us knowingly keep smoking. We know that most processed food is full of junk, and fast food makes us fat, and causes heart diseases, diabetes, and stroke and yet many of us keep eating it.

My plea is that we wake up out of our victim slumber and realize that we, the patients, have much more control than ever before to make changes for the better. Changes that will shore up our weak link, and allow us to live a life of wellness.

Integrative Medicine….The Next Frontier

Posted on May 3, 2011 by mcminnclinic

The patient, the patient, the patient! It’s all about the patient. As a physician, or for that matter any sort of healer, we must never lose our focus as to our most important mission. It is to use our knowledge, experience, listening skills, examination findings, referral network, and test results to help every patient reach his or her maximal potential in mind, body, and spirit. Mother Theresa had a wonderful saying: “one, by one, by one.” Also, in medicine, we must realize that each patient is unique and different, and what therapy one patient responds to, another may not.

Integrative medicine, also called complimentary medicine, attempts to do just that. It is individualized, patient focused, open minded, evidence based, and outcomes oriented. It has an expanded toolbox of therapies. Too many times in this world we tend to put up walls, which define traditional turf battles. The Hatfields hate the McCoys, The Tutsies battle with the Hutus. Alabama and Auburn fans aren’t always the best of friends on game day. Thereto in medicine, healers sometimes lose focus on what is important. Instead of an open- minded search for the best treatment for the patient, we tend to look at the possibilities through a narrowly focused set of glasses. To a hammer, all the world looks like a nail. Likewise, many healers can’t look past their own discipline, training, and bias to consider other modalities, which may ultimately produce the best result for the patient.

Traditional western medicine is a marvel of scientific endeavor. Were it not for this amazing medical discipline, I and many of my family members would not be alive today. I stand in awe of many of the modern high tech capabilities of today’s doctors. However, I and other integrative medicine practitioners also realize that there are also other modalities, which have been utilized for hundreds or perhaps thousands of years, which should also be considered while devising the patient’s treatment plan. These modalities may include nutritional therapies, detoxification, mind body therapies, massage, spiritual healing, breath work, hormone balancing, neurotransmitter adjustment, and acupuncture.
I have personally had patients who have responded well with Acupuncture, who had previously found no relief at vaunted medical institutions such as Mayo Clinic.

I do believe that integrative medicine is the wave of the future. Little by little, patients finding that the old model of “sick care” is not working for them. They get sick, go to the doctor, and get on pill after pill. They are awakening to a new approach, which is true wellness medicine. They are demanding a change, and the medical community is starting to listen. Ten years ago integrative medicine was not on the radar screen. Now you will find that Harvard, Duke, Mayo Clinic, Stanford, Vanderbilt, and Cleveland Clinic (just to name a few) all have integrative medical clinics. The tide is slowly turning toward a more open minded and inclusive form of medicine, and in the long run doctors and patients will both benefit.