Sex and the ageing process

copy from http://www.mydr.com.au/seniors-health/sex-and-the-ageing-process

Most older people want and are able to enjoy an active, satisfying sex life. However, over time, you may notice a slowing of sexual response. This is part of the normal ageing process.

What changes do women experience?

Women may notice changes in the shape and flexibility of the vagina. These changes may not cause a serious loss in the ability to enjoy sex. After menopause, many women will have a decrease in vaginal lubrication that can affect sexual pleasure. Simple lubricants (such as KY Jelly or Replens) can help.

What changes do men experience?

Men often notice more distinct changes. It may take longer to get an erection or the erection may not be as firm as in earlier years. The feeling that an ejaculation is about to happen may be shorter. The loss of erection after orgasm may be more rapid or it may take longer before an erection is again possible. Some men may find they need more stimulation to become aroused.

Older men and impotence

As men get older, impotence — the loss of ability to achieve and maintain an erection hard enough for sexual intercourse (also called erectile dysfunction) — seems to increase, especially in men with heart disease, high blood pressure and diabetic complications. For many men, impotence can be managed and perhaps even reversed.

Effects of illness or disability

Although illness or disability can affect sexuality, even the most serious conditions shouldn't stop you from having a satisfying sex life.

• Heart disease. Many people who have had a heart attack are afraid that having sex will cause another attack. The risk of this is very low. Follow your doctor's advice. Most people can start having sex again 12 to 16 weeks after an attack.
• Diabetic complications. Most men with diabetic complications do not have problems, but it is one of the few conditions that can cause impotence. In most cases medical treatment can help.
• Stroke. Sexual function is rarely damaged by a stroke and it is unlikely that sexual exertion will cause another stroke.
• Arthritis. Joint pain due to arthritis can limit sexual activity. Surgery and some medicines may relieve this pain.
• Surgery. Most people worry about having any kind of surgery, especially when the sex organs are involved. The good news is that most people do return to the kind of sex life they enjoyed before having surgery.
• Hysterectomy. This is the surgical removal of the womb. A hysterectomy should not affect sexual functioning. If a hysterectomy seems to take away your ability to enjoy sex, seek advice.
• Mastectomy. This is the surgical removal of all or part of a woman's breast. Although her body is as capable of sexual response as ever, a woman may lose her sexual desire or her sense of being desired. Sometimes it is useful to talk with other women who have had a mastectomy.
• Prostatectomy. This is the surgical removal of all or part of the prostate. This procedure can cause impotence in some cases. If a radical prostatectomy (removal of the entire gland) is needed, surgical techniques can save the nerves going to the penis and an erection may still be possible.

Other issues

• Alcohol. Too much alcohol can reduce potency in men and delay orgasm in women.
• Medicines. Antidepressants, tranquillisers and certain high blood pressure medicines can cause impotence. Some medicines can make it difficult for men to ejaculate. Some medicines reduce a woman's sexual desire. Check with your doctor. They can often prescribe a medicine without this side effect.

Emotional concerns

Sexuality is often a delicate balance of emotional and physical issues. How we feel may affect what we are able to do. For example, worrying about impotence can create enough stress to cause it.
As a woman ages, she may become more anxious about her appearance. This emphasis on youthful physical beauty can interfere with a woman's ability to enjoy sex.
Older couples may have the same problems that affect people of any age. They may also have the added concerns of age, retirement and other lifestyle changes, and illness. These problems can cause sexual difficulties. Talk openly with your doctor about this. The important thing is for both members of a couple to find what makes them both happy.

Last Reviewed: 14 April 2010

Your Doctor. Dr Michael Jones, Medical Editor.
©Copyright: myDr, MIMS Australia, 2000-2013. All rights reserved.

References

1. 1. Mayo Clinic. Sexual health and aging: keep the passion alive [website]. Sep 2009. http://www.mayoclinic.com/health/sexual-health/HA00035/METHOD=print (accessed August 2010).
   
   2. National Institute on Aging. Age Page. Sexuality in later life [website]. Updated April 2010. http://www.nia.nih.gov/HealthInformation/Publications/sexuality.htm (accessed August 2010).

Male menopause

copy from: http://www.mydr.com.au/seniors-health/male-menopause

As they age, many men worry about what they might expect and whether there is such a thing as the male menopause.
Strictly speaking, and when compared with the changes that happen at the time of the female menopause, there is no such thing as a male menopause.
In women, the menopause is a sign of rapid reduction in female hormone production, which can produce a variety of symptoms, both physical and psychological. As men age, the production of male hormones also declines, but the decline in testosterone is generally regarded as being very gradual — usually less than one per cent a year after the age of about 30.
However, many men in their 40s and 50s do report symptoms such as:

• reduced physical strength;
• a degree of muscle loss;
• mood swings and irritability;
• loss of libido;
• erectile dysfunction;
• changes in sleep patterns;
• reduced energy;
• depressed mood; and
• lack of motivation.

These problems may be the result of ageing or gradually reducing testosterone levels. They may also be caused by other problems, such as an underlying medical problem, medication side effect, lack of exercise or excessive alcohol use.
Having a check-up with your doctor is a good idea if you are experiencing any of these problems. Your doctor can determine the most likely cause and whether treatment is required. In many cases, lifestyle adjustments — such as a healthy diet and regular physical activity — may help.
Men with these problems also need support from family and friends. They may need help to accept a new stage in their lives and to be reminded of what they have achieved, rather than what they haven’t.

Testosterone deficiency

Many older men will have testosterone levels similar to those of men in their 30s. Only about one in 200 men under 60 and one in 10 men over 60 have abnormally low testosterone levels.
Fatigue, muscle weakness, low mood and loss of sex drive can indicate low testosterone, but these symptoms can be also caused by other conditions. Your doctor can check your testosterone level if you have these symptoms.
Even if your testosterone level is mildly reduced, the cause may be another condition such as depression or obesity. If so, treating the underlying condition may return testosterone levels to normal.
Testosterone therapy does help men with severe testosterone deficiency, but the evidence isn’t clear regarding whether it helps other men. Bear in mind that testosterone therapy does have potential risks, including enlargement of the prostate, growth of prostate cancer or breast cancer that is already present, breathing problems during sleep and acne.

Last Reviewed: 20 February 2013

myDr, 2013
©Copyright: myDr, MIMS Australia, 2000-2013. All rights reserved.

References

1. 1. Androgen replacement therapy (revised June 2009. Amended October 2009). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Apr 2013).
   
   2. MayoClinic.com. Male menopause: myth or reality? (updated 23 Jul 2011). http://www.mayoclinic.com/health/male-menopause/MC00058 (accessed Apr 2013).
   
   3. Andrology Australia. Testosterone deficiency (June 2010). https://www.andrologyaustralia.org/wp-content/uploads/Factsheet_TestosteroneDeficiency_20101.pdf (accessed Apr 2013).

"求缺斋"的悟

近日读《曾国藩家书》，字字珠玑，如饮醇酒。业能有专，方有所成。既立志为医，必终生以行医为念，悬壶济世。

书中多劝慰曾家兄弟学习须以“有恒”为学中之贵，终必有所得。

凡事不可强求完美，过度追求，则是“吝”。曾府宅中书房称为“求缺斋”，守得一缺，也顾得大全，凡事有得有失，不可事事周全，家中所有预备都有一缺。故自家学习处也 效仿曾前辈，挂“求缺斋”，时刻警醒。

24 Hours Body Energy Schedule

 

1:00 the body will enter a stage of light sleep, easy to wake up. The mind is clearly, so it is hard to fall asleep if you are still awake.
2:00 majority of your organs will be in the slowest day work status, but the liver detoxification for human body is still in hard work for rowing blood gas.
3:00 body will enter the stage of deep sleep, all muscles relax completely. This is Yinshi area of ​​the lung Qi very strong: anti-coughing class group and western medicine is very effective now. The negative effect is also small.
4:00  "the darkness before dawn".  Elder person is easy to pass away, and also the most prone to accidents. Blood pressure in the lowest level in a day, diabetes patients are easy to hypoglycaemia, cardiovascular and cerebrovascular patients are easy to myocardial infarction.
5:00 yang gradually sublimated full mental state.
6:00 blood pressure begins to increase gradually accelerated heartbeat. Hypertensive patients eat antihypertensive drugs.
7:00 the body's immune system is strongest. After breakfast, nutrition will be absorbed by the body.
8:00 various physiological hormone secretion strong, body begins to enter the work state.
9:00 suitable for injections, surgery, and physical examination. Blood will active cerebral cortex excitability, pain reduction.
10:00 is highest efficiency.
10:00-11:00 belong to the body's first prime-time. Heart full play to its energetic without fatigue.
12:00 intense work one morning and needed a rest.
12:00-13:00 is the best mid-sleeping time. Should not fatigue combat, if person can lying down to rest for half an hour or one hour.
14:00 unresponsive. Tend to have a sense of drowsiness, reduced ability of the human stress.
15:00 lunch nutrition absorption gradually being transported to the body, the ability to work is resumed.
15:00-17:00 second prime-time body. It is suitable to meetings, public relations, receiving important guests.
16:00 blood sugar began to increase the false fire apparent at this time. Yang and yin deficiency patients’ face is red.
17:00 the efficiency of afternoon time to achieve the highest value, suitable physical exercise.
18:00 body decreased sensitivity, reduce pain along again.
19:00 most likely to quarrel. At this point the evening peak to human blood pressure fluctuations and the mood of the people is the most unstable.
20:00 body enters the third stage of a golden. Memory is strongest, exceptionally rapid response of the brain.
20:00-21:00 suitable for homework, reading, creative, exercise.
21:00 most likely to quarrel. Human blood pressure fluctuations and the mood of the people is the most unstable.
22:00 Good grooming. Respiratory rate, body temperature decreased. Best to go to bed after ten thirty foot bath can fall asleep quickly.
23:00 yang is weak, the body function decline, began to enter deep sleep, day fatigue began to ease.
24:00 blood in the lowest value of the day, in addition to the rest, should not carry out any activities.

Introduction of diabetes

Diabetes is a metabolic disorder that is characterized by high blood glucose and either insufficient or ineffective insulin. 5.9% of the population in the United States has diabetes, and diabetes is the seventh leading cause of death in our country. Diabetes is a chronic disease without a cure, however, with proper management and treatment, diabetics can live a normal, healthy lives.

Insulin

Insulin is a hormone secreted by specialized cells in the pancreas in response to (among other things), increased blood glucose concentration. The primary role of insulin is to control the transport of glucose from the bloodstream into the cells. After consuming a meal, insulin enhances the uptake of the energy nutrients (amino acids, glucose, and fatty acids). Insulin helps maintain blood glucose within normal limits and stimulates protein synthesis, glucose synthesis in the liver and muscle, and fat synthesis.

Without insulin, or when insulin is ineffective, glucose regulation falters and the metabolism of energy-yielding nutrients changes. In diabetes, there is too much glucose in the blood. When glucose builds in the blood instead of going into the cells, it can cause two problems:

• Your cells may become starved for energy
• Over time, high glucose blood levels may harm your kidneys, heart, eyes or nerves

There are two main types of diabetes, Type I and Type II, described below.

Type I Diabetes
(a.k.a. Juvenile Onset Diabetes, Insulin-Dependant Diabetes)

Insulin-dependant is caused by damage to the pancreas. The pancreas contains beta cells, which make insulin. With Type I diabetes, the deficiency of insulin is due to a decline in the number of beta cells the pancreas contains. It appears that certain genes make Type I diabetics more susceptible, but a triggering factor (usually a viral infection) sets it off. In most people with Type I diabetes, the immune system makes a mistake, attacking the beta cells and causing them to die. Without the beta cells, you cannot produce insulin. Glucose then builds up in the blood and causes diabetes.

Type I diabetes exhibits the following warning signs:

• Losing weight without trying
• An increased need to urinate
• Increased hunger
• Increased thirst
• Trouble seeing
• Feeling tired and/or
• Going into a coma

For Type I diabetics, treatment usually consists of a healthy diet, exercise, and insulin shots to replace the insulin that your body no longer produces. Most insulin-dependent diabetics test their blood at least four times per day to monitor their blood’s glucose level. This is necessary to keep their blood glucose within certain limits. If blood glucose is not monitored, and if insulin levels are not kept in check, three things may happen:

1. Ketoacidosis – occurs when your blood glucose levels are highly elevated, by either eating too much or taking too little insulin, by stress or illness. In this case, there is too little insulin in the blood. Your body then begins breaking down fat for energy, producing chemicals called ketones. Ketones can make you throw up, have difficulty breathing, cause excessive thirst, cause dry, itchy skin, or even cause coma.

2. Hypoglycemia – occurs when blood glucose levels become too low. It can be cause by taking too much insulin, eating too little, skipping meals, eating at the wrong time, exercising too intensely or for too long, or by drinking alcohol on an empty stomach. If your blood glucose is too low you may feel hungry, confused, tired, shaky or nervous.

3. Complications – elevated glucose levels in the blood over time can hurt your organs. Diabetes can damage kidneys, eyes and nerves, and makes heart and blood vessel disease more likely. Diabetics can defend themselves from complications by keeping their glucose levels under control.

Type II Diabetes
(a.k.a. Adult Onset Diabetes, Non-Insulin-Dependent Diabetes)

Type II diabetes is the most common form of diabetes, with about 90% of diabetes falling into the Type II category. With Type II diabetes, glucose builds up in the blood – not because not enough insulin is present, but probably because cells lose their insulin receptors and become less sensitive to insulin. Type II diabetes usually (though not always) occurs in individuals who are over 40 years of age who are overweight.

Type II diabetes produces mild symptoms, and can be controlled with a healthy diet, exercise and weight loss. Type II diabetics should also monitor their glucose levels to be sure they are maintaining healthy levels. In some cases, weight loss, diet and exercise are not enough to control the glucose levels. In those cases, your physician may control your diabetes by prescribing diabetes pills or insulin shots.

Type II diabetes can cause three types of problems:

1. High Blood Sugar – high glucose levels in the blood are most likely when you’re sick or under a lot of stress. High blood sugar can cause you to have a headache, blurry vision, excessive thirst and an increased need to urinate, and cause dry, itchy skin. Though less of a problem with Type II diabetes, ketones can build up in the blood when Type II diabetics have symptoms of high blood sugar, or when they are sick.
2. Low Blood Sugar – When blood sugar falls to low you may feel tired, shaky, nervous, hungry or confused. It may be caused by taking too much diabetes medicine, eating too little or skipping meals, exercising too intensely or for too long, or from drinking alcohol without eating.
3. Complications – Elevated blood glucose over many years can hurt organs, including the eyes, kidneys, and eyes. It can also make heart and blood vessel disease more likely. The best defense against complications is a careful monitoring of blood glucose, a healthy diet and exercise.

Risks for Diabetes

• Individuals with parents or siblings with diabetes
• People over the age of 45
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides
• Certain racial and ethnic groups (African Americans, Latinos, Asians and Native Americans)
• Women who had gestational diabetes or who had a baby weighing 9 pounds or more at birth.

Warning Signs of Diabetes

Type I: Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability

*Type II: Any of the Type I symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands or feet Recurring skin, gum or bladder infections *individuals with Type II diabetes often have no symptoms

 

Understanding Fat and Cholesterol

Blood Lipid Parameters:

The National Cholesterol Education program recommends that everyone over the age of 20 be tested for cholesterol at least once every 5 years.

The National Cholesterol Education Program
Blood Lipid	Desirable	Borderline	High
Total Cholesterol	< 200 mg/dL	200-239 mg/dL	>= 240 mg/dL
Low-Density Lipoproteins (LDL)	< 130 mg/dL	130-159 mg/dL	>= 160 mg/dL
High-Density Lipoproteins (HDL)	> 35 mg/dL (values >60 mg/dL are considered a negative risk factor)
Triglycerides	< 200 mg/dL

Lipids (Fats) Explained:

Fats, or lipids, can be divided into three general categories: Triglycerides, Phospholipids and Sterols.

• Triglycerides - (fats and oils) This is the main form of fat in the diet. Triglycerides provide us with energy, insulates, cushions and protects internal organs and helps our bodies use carbohydrates and proteins more efficiently. Triglycerides can be further divided into the following categories:
• Saturated fats - Usually solid at room temperature, saturated fats contain the maximum number of hydrogen atoms (saturated with hydrogen). Saturated fats are considered the most detrimental to health.
• Monounsaturated fats - Liquid at room temperature, monounsaturated fats include olive and canola oils. This type of fat tends to lower "bad" LDL cholesterol while leaving the "good" HDL cholesterol unchanged.
• Polyunsaturated fats - Liquid at room temperature, polyunsaturated fats include corn oil, safflower oil and sunflower oil. This type of fat tends to lower both "bad" LDL and "good" HDL cholesterol.
• Hydrogenated fats - This fat results from a process where hydrogen atoms are added back to polyunsaturated or monounsaturated fats to protect against rancidity . This procedure effectively causes hydrogenated fats to become saturated fats. Thus, if a food lists partially hydrogenated oils among its first three ingredients, it usually contains alot of trans-fatty acids and saturated fats.
• Trans-fatty acids - In nature, most unsaturated fats are cis-fatty acids. During hydrogenation, the molecular structure changes from cis- to trans-fatty acids. Trans-fatty acids increase "bad" LDL cholesterol and lower "good" HDL cholesterol, which may increase heart disease risk.
• Essential fatty acids - Essential fatty acids must be supplied by the diet. The body uses essential fatty acids to maintain the structural parts of cell membranes. They are also used as a component in the production of hormone-like substances (eicosanoids) that help regulate blood pressure, clot formation, and maintain the immune response.
• Linoleic Acid - The Omega-6 family. Common sources for these essential fatty acids are vegetable oils and meats. Most individuals can ensure an adequate intake of Omega-6 fatty acids by including grains, seeds, leafy vegetables, and small amounts of vegetable oils and meats in the diet.
• Linolenic Acid - The Omega-3 family. Linolenic acid is a major component of the communicating membranes of the brain, and is active in the eye's retina. It is essential for growth and development. Fish, in particular, is abundant in both Omega-3 and Omega-6 fatty acids.
• Phospholipids - (eg. lecithin) Phospholipids help transport fat-soluble vitamins, hormones and other substances through cell membranes. Because they can dissolve in both water and fat, they act as an emulsifier, helping to keep fats suspended in body fluids and blood. The liver can produce all the body's phospholipids from scratch, therefore it is not an essential nutrient.
• Sterols - Sterols include cholesterol, vitamin D and sex hormones. The are a component of bile, sex hormones (testosterone), adrenal hormones (cortisol) and are a structural component of cell membranes. 9/10 of the body's cholesterol is stored in cells.
  
  Cholesterol - The liver manufacturers about 800-1500 mg. of cholesterol per day, which contributes much more to total body cholesterol than does diet. The liver can also make cholesterol from carbohydrates, proteins or fat. Only animal foods contain cholesterol. Excess cholesterol harms the body when it forms deposits on artery walls, leading to atherosclerosis and heart disease. Cholesterol can be further divided into HDLs and LDLs:

·         Low-Density Lipoproteins (LDL) - Considered "bad" cholesterol. It is produced in the liver and circulates through the body, transporting fat to the muscles, heart, fat stores and other tissues.

·         High-Density Lipoproteins (HDL) - Considered "good" cholesterol. It is produced by the liver to carry cholesterol and phospholipids from the cells back to the liver for recycling and/or excretion. Because HDLs represent cholesterol removal from arteries and blood to the liver for breakdown and disposal, it is considered "good" cholesterol. Therefore, high levels of HDL cholesterol is considered a negative risk factor for heart disease.

Approximate Cholesterol Amounts in Foods:

Food	mg/chol
Grains, vegetables, fruits	0
Whole Milk, 1 cup	30-35
Nonfat Milk, 1 cup	5-10
Cheese, 1 ounce	25-30
Butter, 1 tablespoon	10
Beef, chicken, or pork, 3 ounces	70-85
Liver, 3 ounces	410
Egg yolk	213
Egg white	0
Shrimp, 3 ounces	165
Fish, lobster, clams, 3 ounces	50-60

The table above shows the approximate amounts of cholesterol that can be found in common foods.

Note that current research indicates that food cholesterol does not appear to increase blood cholesterol as dramatically as does saturated fats. So while it is wise to watch your cholesterol intake, be sure to decrease your consumption of saturated fats as well.

How you can improve your Cholesterol Levels

• Reduce or maintain a desirable weight
• Exercise. Aerobic exercise four days per week for 30 minutes or more can increase the level of ("good") HDL cholesterol in your body
• Choose monounsaturated or polyunsaturated fats in small amounts in place of saturated fats
• Avoid saturated fats.
• Eat fish once or twice per week
• Avoid hydrogenated or trans-fatty acids
• Reduce consumption of high-cholesterol foods
• Consume more soluble fiber
• Graze. Eating 5 or more meals per day keeps insulin concentrations low and slows down the liver's synthesis of cholesterol

Note

16.7 Million People Around the Globe Die From Heart Disease Each Year

This year, more than 32 million people across the world will suffer a heart attack or stroke, and about 12.5 million of those incidents are fatal.2 Blood cholesterol levels have a lot to do with a person抯 risk of getting heart disease. In fact, the higher the blood cholesterol level, the greater the risk for developing heart disease.

Regular tracking of cholesterol and triglycerides is important for many reasons.

• Testing your numbers over time helps you make informed decisions.
• Checking your numbers gives you peace of mind. Why wait and worry?
• Tracking your levels lets you know if your heart health regimen is working.

 

Australia's mental health

by Dr Norman Swan

A national health survey has found a significant number of Australians have mental health issues.

24 08 2009

The psychological wellbeing of Australians has become a lot clearer thanks to the second national mental health survey. The Australian Bureau of Statistics doorknocked thousands of households asking questions about common mental health problems.
They found that one in two of us will have anxiety, depression, or a problem with drug and alcohol abuse in our lifetimes. About one in five people surveyed had had a mental disorder in the last 12 months; and one in four of those had had more than one – losing about nine days of useful functioning every month.
Yet surprisingly few people were being treated. Largely because they felt they didn't need any help or, wrongly, they felt there was no help available. This included people who were suicidal.
It was also found that people with physical illnesses were more likely to have anxiety, depression or problems abusing alcohol and other drugs.
Since this survey was done the Government has provided more access to evidence-based psychological treatments so more people are receiving help. But these deep-seated beliefs that nothing that can be done are a problem, as is the stigma which still exists to people identifying themselves as psychologically unwell.
So it's important that doctors, friends and families recognise when someone has a mental illness and offer assistance, but it's also important to recognize that there may be more than one thing going on at the same time, a physical illness with anxiety and depression, or a drug and alcohol problem with illness with anxiety and depression and they all need to be treated so the person can become well again.

For Reference

Title: Australian and New Zealand Journal of Psychiatry
Author: Henderson S et al. State of the nation's mental health 2007.
URL: http://www.informahealthcare.com/loi/anp
2009;43:591-593
Title: Australian and New Zealand Journal of Psychiatry
Author: Johnston AK et al. Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:635-643
Title: Australian and New Zealand Journal of Psychiatry
Author: Whiteford H, Groves A Policy implications of the 2007 Australian National survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:644-651
Title: Australian and New Zealand Journal of Psychiatry
Author: Teesson M et al. Comorbidity in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:606-614
Title: Australian and New Zealand Journal of Psychiatry
Author: Meadows Gn, Burgess PM Perceived need for mental health care: findings from the 2007 Australian Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:624-634
Title: Australian and New Zealand Journal of Psychiatry
Author: Burgess PM et al. Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:615-623
Title: Australian and New Zealand Journal of Psychiatry
Author: Slade T et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings.
URL: http://www.informahealthcare.com/loi/anp
2009;43:594-605