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By Steven Lavender
https://theptpractice.nyc

By now many of you would have heard the word Kegel.  Arnold Kegel was an American gynecologist who developed exercises to strengthen “relaxed genitals” in females.  The exercises have been well studied and are now taught to both men and women as the first line of defense against incontinence both urinary and fecal.  In more recent times the role and importance of the pelvic floor in the pursuit of “core stability” has also been well established. Core stability, as you may know, is the concept that efficiency of movement and prevention of injury comes from an internal bracing of the pelvis and trunk and all movement especially movement that involves force or repetition, revolves around this internally braced and stable base.  The stable base and the moving parts need control through a range of strength and endurance. As it turns out, proper activation of the pelvic floor muscles will also engage the deep essential muscles strongly related to core stability.  So done correctly you get a lot of bang for your buck if you learn how to do this well.

One of the things that drive me crazy is at the mere mention of the word Kegel, a patient will immediately stop breathing, suck in their gut as forcefully as possible, possibly contract the pelvic floor or not, and hold this ‘till they turn blue.  The energy cost is too great and no one could possibly sustain this level of muscle activation or oxygen deprivation for long.  You need to be able to use these muscles all day, not for two minutes and forget them. The ability to perform ten perfect examples of a Kegel exercise while lying down in isolation will not help you unless you integrate that ability and use the knowledge and control of those muscles while living your life and doing the things you want to do.

If you remember nothing else from this article remember this.  Activation of the pelvic floor and core stability muscles is like turning on a light with a dimmer switch, not a toggle switch.  It is not an on or off proposition. Rather is a graded body bracing that is able to increase and decrease as required to perform a certain function safely and efficiently.   For example, the amount of gentle pelvic floor and core muscle activation required to stand up from sitting without peeing your pants is not the same as the amount needed while carrying home two heavy shopping bags from the market and that is not the same as the amount required to kayak upstream.  Most of us can function well on just a normal amount of control of endurance and strength. If you wanted to perform at an Olympic level you would have to train especially for that event.

Instead of thinking about the word Kegel think of the concept of pelvic floor control.  It gives the impression of a more dynamic remedy rather than a static one. 

The post Kegel Smegal appeared first on malecare.org.

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Celebrate 20 years of Malecare Prostate Cancer Support Groups., at a special two hour discussion with three of NYC”s top cancer doctors. Your questions will be welcome!

Dr. Kelly Cassano, Senior Associate Dean for Clinical Affairs, Chief of Ambulatory Care at Mount Sinai Downtown

William K. Oh, MD, Medical Oncologist and

Robert Stewart, MD, Radiation Oncologist

Moderated by:

Darryl Mitteldorf, LCSW, Executive Director, Malecare

Wednesday September 26th 2018,

5:30-7:30pm

Mount Sinai Downtown Union Square

Manhattan

10 Union Square East 2nd Floor Auditorium

Food will be served

No cost, no tickets, no reservations…just show up! Spouses, partners and friends are welcome.

The post Malecare – 20 Year Celebration in NYC appeared first on malecare.org.

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Radiation therapy might hurt men by inadvertently damaging their rectum. Men considering radiation therapy would be wise to ask their radiation oncologist about SpaceOar, a hydrogel product. SpaceOAR stands for Spacing Organs at Risk. Think of SpaceOar as a rectal spacer.  Hydrogel is a water-like substance that’s injected between the rectum and prostate in order to reduce the radiation dose to the rectum. Published studies have investigated it’s use with various kinds of radiation- IMRT, 3D-CRT, SBRT, protons, low dose rate brachytherapy, high dose rate brachytherapy, salvage radiation after primary prostatectomy, and salvage brachytherapy after primary radiation.  Those studies say hydrogel is usually safe and adds about 12mm of space between the rectum and prostate. 

Very few men will feel the hydrogel – it is fully absorbed by your body within a year and then pissed out.

SpaceOar may have a very useful role in men with bowel inflammation, a history of rectal issues (hemorrhoids, for example), or anatomic abnormalities.  SpaceOar may not be useful for men with late stage or advanced prostate cancer where the risk of rectal toxicity is trumped by the life extending potential of hitting the outside of the rectum with radiation.   For more information, please feel encouraged to read through  https://www.spaceoar.com/

The post SpaceOar Hydrogel to Protect Your Rectum During Radiation Therapy appeared first on malecare.org.

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What view or place or sounds makes you feel most relaxed? Can you make a one to three minute video of that? For me, it’s standing in the ocean, water lapping my ankles, listening to distant waves breaking. For my father, it was watching horses at riding academy in The Bronx, NY.

What view chills you? Please point your smartphone camera and make a short 1-3 (or longer, if you wish) video. Please upload your relaxing short video’s to Youtube, with menatpeace-Malecare as part of your title or video description. Then, share your video link here (if you wish). The idea is to create a library of prostate cancer patient created video’s that everyone could use to have a moment of relaxation and to create awareness of Malecare and our prostate cancer support network. If you want to further support our work, please place a link in your description to Malecare’s donation page, https://malecare.org/donate I hope that you find this project fun and relaxing.

The post Relaxation Video Challenge – Malecare appeared first on malecare.org.

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Treating prostate cancer with antidepressants

Imagine treating Prostate Cancer with an anti-depressant medication.

A new USC School of Pharmacy study suggests that the monoamine oxidase-A enzyme (MAO-A) pathway could be used for treating prostate cancer. The drugs under consideration are the new, third generation of reversible, selective MAO-A inhibitors such as moclobemide, toloxatone and brofaromine, also known as RIMAs (reversible inhibitors of MAO-A).

The MAO-A gene is relevant for depression and other mental illnesses, as well as autism and aggression.

The current study showed an increased MAO-A expression in prostate cancer.

So, reducing MAO-A expression reduces prostate cancer development by decreasing cell proliferation and cancer stem cells.  

Because MAO-A inhibitors are successfully being used to treat other diseases linked to this enzyme, such as depression, the right inhibitors also hold the potential and in treating prostate cancer and reducing prostate cancer growth.

“The results of this study are significant as they suggest that the MAO-A pathway is an important target in prostate cancer,” said study co-author Mitchell Gross of the Keck School of Medicine of USC. “This is especially exciting because MAO inhibitors are already FDA-approved and available to treat depression.”

The results are being tested now in human clinical trials as prostate cancer  patients receive treatment with MAO inhibitors (phenelzine sulfate). The preliminary data are promising.

The post Treating prostate cancer with antidepressants appeared first on malecare.org.

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 What’s the chance that somebody who was exposed to radiation now has a subsequent cancer later on in their life? The chance of that is a statistical one, meaning there’s no large study out there where people are followed for hundreds of months.

Researchers have looked at young women who had breast cancer in the 1960s and had these large fields of radiation that were delivered back then – these are called mantel fields – and then they looked at them later on and said, “What was the chance of them developing breast cancer?” And there are large data bases where you can start measuring these.

In general the chance of a radiation induced secondary cancer is extraordinary low. And it usually takes 20 years, 15 years, maybe 10 years at the earliest to even see. For men with prostate cancer men, the rate of a radiation induced malignancy is very small.

Colorectal cancer is the number three cause of cancer in men. Bladder cancer is number four. Just because you have one cancer doesn’t mean you can’t have a subsequent cancer.

Good prostate cancer imaging often finds other malignancies. Oncologists see incidental secondary cancers all the time.

Radiation delivered to hundreds of millions of people will cause cancer in a very low number of people. So, with that said, when you have a child you try not to expose them to radiation. When you have any human being, you don’t expose them to even a drop of radiation if they don’t need it. Once someone has a diagnosis of cancer you’re trying to cure them of their disease, prevent metastatic disease, let them live the rest of their lives. For that individual, not exposing them to the necessary tests to accurately know where their tumor is much worse than the microscopic chance that you may induce a secondary malignancy 20 years later.

So really the issue at play, and we see really smart people who ask very thoughtful questions like this, is what’s dangerous to an individual versus what is dangerous to a population? Exposing a population, hundreds of millions of people, to radiation needlessly will cause cancer in a very small number of people. For people who already have that diagnosis to better assess what the cancer status is you have to expose them, but the exposure they’re getting is such a trivial thing it’s not something that doctors want to avoid.

The post Does Radiation Therapy Cause a Second Cancer? appeared first on malecare.org.

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Radiation is high energy x-rays. When you are depositing energy into a target with the latest technology, you’re able to kill off a tumor and you’re able to preferentially address a given region and to spare the adjacent tissues around that region. There are different types of radiation, but therapeutic radiation is high dose energy that gets delivered to ablate and kill off tumors.

The mechanism is that it’s damaging the DNA of a cancer cell. So when cancer cells try to divide, they die off after having radiation. Radiation works by killing off the cancer cells through damaging their DNA.

When cancer cells try to divide, which is all that cancer cells do, they essentially die off.

A common thought around cancer cells is that cancer cells divide and continue to divide because the DNA within them is different.

We have cancer cells throughout our lifetime and our body has a pre-programed way of killing off abnormal cells. The cancer cell is the cell that got away. The body did not realize it was abnormal and that particular cell continued to divide and continued to divide. So the normal process of the body saying, “This cell’s not behaving the way it should,” fell through the cracks.

The damage that the radiation performs on the cancer cell DNA is called double stranded DNA breaks. That’s a fancy way of saying the damage renders the cancer cell unable to continue to divide, and when it tries to, it dies off. Essentially, during radiation therapy, the cancer cells are dying off and the normal tissue is healing itself in between each of the treatments.

It’s not possible for the cancer cell to heal itself with the doses we’re giving.

Radiation’s been around for well over 100 years, and it’s not a binary thing where you turn on a switch and there’s radiation. You’re able to really modulate the doses and determine what doses to give, and to which areas you’re delivering it, with such accuracy you’re able to give the appropriate dose for the appropriate cancer.

Not every cancer requires the same dose, and not every normal tissue repairs the same way. Radiation oncologists have to memorize what doses every single structure in the body can tolerate, what percentage of whatever structure can tolerate with each dose, and that goes part into the training of being a radiation oncologist.

The tolerance of the rectum is different than the tolerance of the bladder. The tolerance of nerves is different than the tolerance of brain tissue.

Each of the organs and systems that we have in our body have a different ability to repair itself when it’s faced with high energy ionizing radiation. When you go outside get a sunburn, you don’t stay with that burn forever. Your body heals itself. When you have a cut, your body heals itself. If the cut is too big you need to have stitches. It’s the same sort of analogy that you would give with radiation toxicity or radiation healing. There’s a certain dose at which your body will be able to heal, and that’s really the skill of the radiation oncologist to paint the dosage just so to allow your healthy cells to heal while the cancer cells gets destroyed.

The post How Does Radiation Therapy Cure Prostate Cancer? appeared first on malecare.org.

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Is Cyberknife Better For Prostate Cancer - YouTube

Precision Radiation Treatment . Cyberknife has improved prostate cancer treatment as dynamically as robotic surgery . But, Cyberknife is not for everyone. See if it’s right for you. Seth Blacksburg, MD and Darryl Mitteldorf, LCSW, explain.

1. How does radiation therapy actually work? 00:44

2. Does radiation therapy cause second cancers? 06:28

3. Should I worry about CAT scans? 15:00

4. What’s the difference between Radiation Oncologist, Radiologist and other Oncologists?15:53

5. What’s new and great in radiation therapy? 17:22

6. What is Cyberknife? 18:23

7. How does Cyberknife work? 27:00

8. Are there special considerations for African American, who die from prostate cancer at a rate 2.4 higher than that for Caucasian men? 32:21

9. How much radiation will Cyberknife give me, compared to other types of radiation treatments? 34:25

10. How many times do I have to be treated by Cyberknife? 39:50

11. How do you know that Cyberknife killed all my cancer? 42:32

12. Will Cyberknife treatment change the length of my penis? 47:21

13. How does radiation therapy cause erectile dysfunction? 48:00

14. Should I sperm bank before radiation therapy? 50:30

15. Will I be incontinent after radiation therapy? 51:24

16. How long does each Cyberknife session take? 52:40

17. What can I do if Cyberknife doesn’t kill all of my prostate cancer? 54:40

18. Can Cyberknife reduce pain from a distant bone metastasis? 57:14

PLEASE CLICK ON SUBSCRIBE, and PLEASE GIVE THIS VIDEO A “THUMBS UP’

The post Is Cyberknife a good prostate cancer treatment? appeared first on malecare.org.

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Taking care of a loved one can be a rewarding but stressful experience. You may feel that you are the best equipped to handle the situation, or financial concerns may have prodded you unwittingly into the caregiver role. No matter how prepared you may be for the job, caregiver stress can plague anyone. This stress materializes slowly as a type of burnout, where a caregiver disappears into a role that takes them away from their own life.

Stress not only affects the caregiver but the person requiring care as well. Good intentions turn into a bad situation for all, as burnout takes out two victims at once. Awareness of the risk of burnout is key to addressing and managing the difficult process of caregiving.

What Causes Caregiver Burnout?

The causes of caregiver burnout can range from over-committing oneself to a task they are ill-prepared to removing oneself from social situations that once provided joy in life.

The risks of caregiver stress include:

  • Financial need. Families who have assets and abundant income often choose to have professionals provide care precisely because they wish to avoid stress.

  • Living with someone who needs care. If a partner or parent needs care, there is a higher likelihood that a loved one will want to take on the role of a caregiver. Although the desire to save the person needing care is laudable and understandable, family members lack objectivity when it comes to making care decisions.

  • Lack of choice. Stress follows those who have no choice but to step into the caregiver role. These people develop regret and despair as diseases and conditions progress.

Signs of Burnout

Caregiver stress develops slowly. This slow burn makes it much less likely to identify. A caregiver’s life changes, becoming increasingly dread-filled and negative. Sleep becomes irregular. Exercise is avoided, as well as engagement in social situations. A caregiver may begin to neglect healthy meals, opting instead to just eat something small after feeding their loved one. In addition to skipping proper meals, a caregiver may neglect their own medical care. They may spend a lot of time at doctor’s offices, but rarely for their own care.

Cope by Knowing Yourself

Since this type of stress develops slowly, periodic self-assessment is the first step to avoiding burnout. Online caregiver checklists provide a handy way to check on oneself. Questions include how many minutes in the past week were set aside for exercise and caregiver self-care. Other areas covered include social, emotional, and spiritual health. It is also crucial to self-assess your level of caregiver awareness, which is your understanding of your relative’s disease and its prognosis. Understanding your role and limitations as a caregiver require a grounded understanding of reality. Caregivers can get lost in their daily routine and miss the forest for the trees.

Coping Through Self-Care

One of the best ways to avoid the feelings of despair and depression that can accompany caregiving is by focusing on your health and well-being. Some experts even suggest that caregiver well-being is more important than that of the person needing care. Anyone who has paid attention to an airplane safety presentation before a flight will know that you are supposed to grab your air mask first before trying to help others.  

Similarly, being selfish helps your loved ones. You are a more effective caregiver when you are physically, emotionally, and mentally well. Make your health a priority. Visit your doctor, exercise every day, eat a balanced diet, and spend time having fun with friends away from the person who needs care. Step away from the caregiver role when you can. Reach out for help from professionals for both your care and for your loved one’s care.

By all means, avoid self-medicating to solve your stress. Alcohol and drugs are common escape mechanisms for caregiver stress, but these temporary sources of relief end up harming you and your relative in the long run.

Caregiver stress is unfortunately common, but it’s easily managed through understanding of the caregiver role and the importance of well-being to the person needing care.

Guest Blog Author

Harry Cline is creator of NewCaregiver.org and author of the upcoming book, The A-Z Home Care Handbook: Health Management How-Tos for Senior Caregivers. As a retired nursing home administrator, father of three, and caregiver to his ninety-year-old uncle, Harry knows how challenging and rewarding caregiving can be. He also understands that caregiving is often overwhelming for those just starting out.

The post Caregivers Should Remember Their Own Needs appeared first on malecare.org.

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Being told that you have prostate cancer may be one of the most stressful events that occur in your lifetime. After a cancer diagnosis, you may be overwhelmed, worried about what happens next, or thinking about its impact on your life. The many emotions that follow a prostate cancer diagnosis make a major impression on your psychological state, affecting both your mental and physical health.

Research shows that there is a significant connection between emotional healing and physical well-being. Though a prostate cancer diagnosis can be difficult to cope with, there are multiple things you can do to begin your emotional healing process.
 

  1. Join a Malecare Support Group

After a prostate cancer diagnosis, the feeling of “no one understands what I’m going through” is completely normal. Even when surrounded by caring friends and family, feeling isolated is one of the most common effects of a diagnosis. It’s important to share your feelings with others, especially those that can relate to your emotions. Joining a support group can be a powerful tool in coping with your diagnosis. Cancer support groups can be found locally or online and provide free support to help manage your life from treatment to recovery.   
 

  1. Do Your Research

The initial shock of a cancer diagnosis can really get your mind wandering. What’s most important is to do your research and get informed on the facts. Take steps to learn more about your cancer diagnosis, but make sure to do so at a pace that is most comfortable to you. For some, immediate information might be just what they need to cope, but for others, less information may be more beneficial at first. Learn as much about your cancer as possible and ask your cancer care team or other professionals exactly what your diagnosis means.

  1. Start a Fundraiser

Cancer is now a cultural commonality– 40% of Americans will be diagnosed with cancer in their lifetime, and 54% have a family member who was diagnosed. Organizing a fundraiser for Malecare can be an important step to remind yourself that you are not alone in this journey, and can bring light to a motivating community.  Holding a fundraiser can allow you to take your mind off your own worries, and help you become a player in the bigger picture. Registering your event online through a platform for nonprofits, like this one, will allow you to share your fundraising event with the entirety of this community, no matter their location. Feeling support in a new way can inspire you to take action and emphasize that you can make a difference in the face of cancer.
 

  1. Take Time to Yourself

Just as it is important to find comfort in others, it is equally as important to reflect individually. Make sure to schedule time with yourself to process all that is going on, and to consider your current thoughts and emotions. Taking time each week to journal is a great way to jot down your feelings throughout your journey, and watch your insights evolve every step of the way. A mere fifteen to thirty minutes may be all you need to heal emotionally. Taking time to do something you enjoy each day, whether it be reading, biking, cooking, or listening to music can be a significant reminder to focus on things you can control, instead of what you can’t.

There is a lot you can learn from Malecare and the resources we offer. Be sure to check out our site for information on support groups, research, and taking action.

The post 4 Things to Do After a Prostate Cancer Diagnosis appeared first on malecare.org.

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