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.

Feeling Fat, Fatigued, and Depressed; Think Low Thyroid

Posted on November 26, 2012 by mcminnclinic

Many experts now agree that millions of Americans are falling through the cracks when it comes to the diagnosis and management of low-thyroid conditions (hypothyroidism). Unfortunately, the lack of proper attention to this issue often results in the patient living a life of fatigue, low mood, struggles with obesity, and many other problems.

Although the thyroid gland is small, it has powerful effects on the body. Thyroid hormone regulates the metabolic rate of every single cell. If thyroid function is underactive (hypothyroid) a person can have a multitude of symptoms, sometimes subtle and sometimes profound. These symptoms may include, but are not limited to: fatigue, weight gain, cold extremities, low libido, dry skin, aches and pains, fibromyalgia, constipation, hair loss, brittle nails, poor memory, low stamina, headaches, puffy face, and low body temperature. Perhaps the most common and important of the symptom being varying degrees of fatigue.

Diagnosis of low thyroid conditions, like most medical conditions, starts with listening to and examining the patient. Symptoms, as mentioned above, family history, and physical signs often point to the diagnosis of hypothyroidism. If thyroid disease is suspected, a thorough lab evaluation should also be performed to assist in the diagnosis. However, the goal is to treat the whole patient, and not just to treat the labs.

If hypothyroid disease is confirmed, then proper treatment may include thyroid medications. There are several medications on the market, which may be quite helpful in relieving low thyroid symptoms. These include Synthroid, Armour thyroid, Cytomel, compounded thyroid, and others. One patient may respond well to a particular medicine, while another patient may find that a different medication works best to alleviate his or her thyroid related symptoms. Although Synthroid is often the drug of choice for many physicians, I have found Armour thyroid to be particularly effective in many of my low-thyroid patients. For others, Cytomel may be the key to alleviating their symptoms.

In summary, thyroid dysfunction is a condition that may have a profoundly negative impact on many patients. Yet according to various experts, millions of Americans suffer from inadequate diagnosis and treatment of hypothyroidism. Proper evaluation and treatment of these patients may help tremendously in improving their symptoms, and their quality of life.

Listening……….The Most Powerful Tool in Medicine

Posted on July 11, 2011 by mcminnclinic

A wise and experienced medical school professor once said “listen to the patient, they will tell you what is wrong with them.” As profound as his words were, it took me many years to really “get it.” We in the medical profession tend to drink from the cool-aid of high-tech tests, gadgets, and procedures. They’re hot. They’re sexy, and most importantly they pay big bucks. Listening is old school, passé’ and it’s not codable, billable, or re-imbursable. Unfortunately, the system does not respect the art of listening. It does not adequately pay for a listening physician, and in fact it punishes them. I’ve known bright, kind, caring, compassionate physicians, dearly loved by their patients, who were fired from their jobs basically for being good listeners. They took too much time with patients. They weren’t productive enough. They didn’t churn patients as fast as their colleagues, so they didn’t bring in as much revenue for the practice, and as a result they were let go. Both they and their patients paid the price for a system that devalues listening. Unfortunately this penalty for listening falls disproportionately on female providers, but that’s a story for another day.

Ninety-nine percent of doctors I have known in my twenty something years in health care have been hard working, conscientious, kind, caring, compassionate, smart, well trained, and well-meaning providers who have gone to work every day with the goal of helping and healing their patients. I have the ultimate respect for their talents, and dedication to their noble cause. However, in this day and age of industrial, big business medicine, driven by government, insurance companies, and drug companies, the average primary care physician has about seven to ten minutes per patient. What is a physician to do when a patient comes into the office and gets out their internet printout and a list of symptoms that includes weakness, fatigue, brain fog, abdominal pain, hot flashes, night sweats, low libido, and insomnia? Most likely they’ll get a few perfunctory laboratory tests and the then the doctor will get out the prescription pad. In this case it’ll probably be an antidepressant a sleeping pill, and maybe a pain pill. It’s the well-worn symptom-pill, symptom- pill revolving door, which inevitably leads to more pills to treat the side effects of the first pills.

Stop the madness! The system is broken. It’s a set-up for failure for the physician and the patient. The physician does not have the necessary time to listen to the patient. Therefore they will rarely get to and treat the root cause of the problem. They’ll only put Band-Aids on the symptoms with more pills, which is a prescription for side effects and often a lifetime of unnecessary suffering.

The power of listening is that it can be such a compelling tool in finding and treating what is at the root cause of the patient’s problems. The power of the prescription pad is that it’s the accepted tool of modern western medicine. Unfortunately, after a lifetime of conditioning, it also meets many patient’s expectations (especially with direct to consumer advertising by the drug companies). Practice managers also love it because it helps meet the ten minute deadline to get the patient out and shore up the financial bottom line.

Just yesterday I had a patient in my office who was in tears because she had been suffering for ten years with profound fatigue. She had been to many physicians. She did not feel as though her doctors had ever taken her seriously. The tests were all “within normal limits”, so it must be all in her head. After ten years of searching for an answer to her symptoms she never felt “listened to.”

In fairness to doctors, the issue of non-listening goes well beyond the medical sphere. As parents, friends, brothers, sisters, husbands, wives, politicians, teachers, and world leaders, we would all benefit from being better listeners. It seems to me to be one of the most important skills that a human being can learn. We teach reading, writing, and arithmetic to our kids but we hardly ever teach them about the art of listening.
Such a class should be a part of the curriculum at every stage of ones education. Especially in medical school, there should be an emphasis on the art of listening. It is so fundamental to what we do as healers. It is diagnostic as well as therapeutic. One might say the classes are not needed. “Listening is easy. Anyone can do it” they might claim. But then again, if good listening is so easy why is it such a rarity for a patient to find a medical provider who is a good listener?

In summary, the most powerful tool in medicine is neither a scalpel, a drug, nor an MRI scanner. It is an engaged, caring, compassionate provide, patiently and earnestly listening to the wants, needs, joys, and suffering of the patient in front of him or her, who has honored the healer by entrusting them with their heart, their soul, their mind, and their body. Let’ all strive to be better listeners.

Healthy Sexuality

Posted on February 20, 2011 by mcminnclinic

Healthy Sexuality by James E. McMinn M.D.

Healthy intimate relationships are good for mind, body, and spirit. Many studies have shown that people who are blessed with long term loving relationships are generally happier, healthier, and live longer. However, most of us find that it is not always easy to wake up on the sunny side of the bed every morning in our personal lives. Of all of the issues that couple struggle over, money and sex are probably the two most common causes of relationship discord. They can both bring us great joy, or if they are not going well, they can bring us serious misery, frustration, and stress. We’ll leave the discussion of money for another place and time. Today we’ll focus on intimate relationships.

There are many reasons to devote attention and energy to the intimate part of our relationships. Sexual intimacy is a basic biological need. It’s good for you, and your relationship in many ways. It decreases stress, boosts self-esteem, and nurtures relationships. It can relieve pain, improve sleep, and act as a natural anti-depressant. It may also boost the immune system, improve blood flow, lower blood pressure, and improves cardiac health. Finally, it brings you closer together as a couple, plus it’s fun and it feels good.

Despite all of these great positive effects of a satisfying sexually intimate relationship, lost libido and other sexual maladies are some of the most common complaints I hear in my practice. Those who can identify with these issues are in good company. About one third of American women are not interested in sex. 113 million Americans are living with the TINS syndrome ( Two Income- No Sex). The number one factor in quenching sexual desire is fatigue, followed by stress, poor communication, stale relationships, anxiety, medical problems, and lack of sleep. Other issues have to do with emotions, values, upbringing, self-image, health, and ultimately life balance. The tone of the relationship on a day to day basis also plays a significant role in the bedroom. A dishonoring relationship in our actions, words, and tone is bound to foster resentment and to chill the passion down below. I frequently hear a similar refrain: “he yells at me all day, and then wants to have sex at night. It just doesn’t work that way for me”.

Besides low interest, the other common areas of frequent concern for women are problems with arousal, orgasm, and painful sex. These are all multifactorial issues with physical, psychological, and social components. Not infrequently, there are also hormonal imbalances, which may also be major contributors to these problems. Certainly, testosterone is king for both men and women when it comes to libido, however adequate estrogen is also important for a woman’s sex drive. Similarly, if a woman has a hypothyroid condition, or adrenal fatigue, sex is going to be low on her priority list. Neurotransmitter dysfunction may also contribute to diminished sexuality. Frequently, but not in all cases, proper testing and balancing of these hormones with bio-identical supplementation may result in a significant improvement in these problems.

As it turns out, one of the most common sexual stressors of women is a frustration shared by their partners, i.e. problems such as early ejaculation, erectile dysfunction. Erectile dysfunction (ED) should be taken seriously. Although it may be due to benign causes such as performance anxiety, it may also be the canary in the coal mine signaling significant vascular problems elsewhere, such as the heart or brain. Low interest, or lack of sexual desire is also a problem for many men. The good news is that these problems are treatable in the vast majority of cases. There are many different techniques, and options for therapy. In most cases, where there is a will to improve the problem, there is a way.

In the end, it’s really more an issue of priorities than it is about sex organs. It’s about caring for each other more than caring for the leaky faucet, the ball game, or the TV show. The amount of enjoyment you get out of a sexual relationship depends on the amount of attention you put into it. It’s your birthright to have a healthy, satisfying, and fulfilling sexual relationship. There’s no reason to think that you have to give up this part of our life as we grow older. However, it doesn’t always come easy, and we definitely must deal proactively with intimacy problems. If we don’t address these issues, they are not going to go away on their own, and they’re probably going to get worse, leading ultimately to more dysfunction, frustration, and stress. Once a week becomes once a month, which insidiously becomes once a year. Before you know it, you’re just glorified roommates. If you don’t resolve to act, then you’re resolving not to act.

Finally, let me leave you with some practical tips. First, it’s all about balance. We need to attend to the pillars of health in order to live our overall life and our sexual life to the fullest. That means getting the proper nutrition, hydration, sleep, stress reduction, and exercise. Attention to these principles will bring our body, mind, and spirit into a state of balance. Only in this state can we realize our full potential in our lives and in our intimate relationships.

More specifically, make physical intimacy a priority in your life. Put it on the schedule if you need to. Commit to an agreed upon desired frequency of interactions and stick to it. Get away, or get a baby sitter. Learn to practice intimacy mindfulness. Learn to let go, and be in the moment, not worrying about the kids or the job. The amount of enjoyment you get out of a relationship depends on thought, energy, and creativity you put into it. Finally, if you’re having problems, get some professional help. See a counselor, or get your hormones checked, and oh yes, don’t forget to do your Kegels.

The sexiest organ of all is not the genitals or the breasts, it’s the brains. It all starts up top. Use this sexy organ to commit to a lifetime of intimacy. Then make it happen.

Low Thyroid

Posted on November 30, 2010 by mcminnclinic

Low thyroid (hypothyroid) is a common and potentially devastating problem in America. It affects approximately 10 million women in America, and according to the Thyroid Foundation of America, more than half of the patients with low thyroid in are undiagnosed. Of those who are diagnosed, many are not receiving optimal treatment.

Thyroid hormone affects every single cell in the body, and it is the master controller for overall metabolism. The most common symptoms of low thyroid that I see in my office are fatigue (low energy) and the inability to lose weight. Other common symptoms include constipation, fibromyalgia, depression, brain fog, anxiety, dry skin, hair loss, low body temperature, low stamina, cold intolerance, cold hands and feet, low libido, generalized aches and pains, swelling, edema, puffiness, and brittle nails. Actual diseases that may be associated with low thyroid include hardening of the arteries, generalized inflammation, cardiovascular disease, abnormal lipid (cholesterol) levels, abnormal menstrual periods, infertility, poor pregnancy outcomes, low mood, depression, fibromyalgia, chronic fatigue syndrome, and obesity.

The standard screening test most doctors use is called a Thyroid Stimulating Hormone test (TSH). TSH may certainly be helpful in diagnosing a low thyroid condition. However, if a patient presents with symptoms consistent with low thyroid, such as fatigue, I feel that a more thorough evaluation is often warranted. Often upon further evaluation, and especially with clinical correlation, the patient may be found to be hypothyroid even with a normal TSH. I frequently find that in such cases when the thyroid function is optimized, the patient’s symptoms improve dramatically.

The most common treatment for low thyroid is Synthroid. However, I have found that many patients respond better to a more natural and well rounded thyroid preparation such as Armour thyroid.

If you’re feeling fatigued, gaining weight, or having other low thyroid symptoms, call McMinn Clinic at 205-868-1313 for a thorough thyroid work evaluation.