Turek On Men's Health » evolution

Why I Love Medicine-Redux

Paul Turek, MD — Mon, 23 Apr 2012 15:00:12 +0000

One great book–but patients also make a great read.

I was recently asked why I love medicine by a health care blog. They published what they could, but there is really more than my response to them revealed. I’d like to set the record straight.

We all grow up reading in school. A book is a pile of paper with words on it. But when viewed carefully and thoughtfully, it can stir the imagination, take you to faraway places and let you drift into the minds of others. In the words of Thomas Mann in Joseph in Egypt, books allow you to experience a barefoot walk “on the greenest of mosses.”

Patients are the Best Books

I first fell in love with medicine when I realized that patients, in a way, are like books. The look of their skin, the movement of their eyes, the tilt of their head, their posture and walk, they way they talk, how they shake your hand and what they tell you is all a part of their story. It is there for the reading.

In the field of men’s health, in which I specialize, I have come to realize that men are books that may be particularly difficult to open and read. Often the books are shut tight. They may even be locked. Maybe it’s cultural, maybe it’s the species, but this makes them hard to read. And, as a consequence, they barely or never get read (i.e. cared for).

My love for medicine grew further when I realized that the key to taking great care of men is figuring how to open the book. It’s there in all of its glory: you just need to figure out how to open it.

Secret #1

Here is a secret: You must be patient and you must listen. Men need to know that they can trust you, not only as a doctor, but also as a human being. Men need to know that you are on their side and honestly 12-minute office visits simply don’t cut it. By listening and observing, instead of dominating the conversation, you can take in the small signs that are otherwise missed, including the doorway conversations that can change everything.

Secret #2

But there’s another secret. Most women do not understand why a have a balsa wood surfboard hanging on the wall of my office. Guys get it. Having a real and palpable personality as a doctor helps patients trust you. And if they trust you, they start to relax. And if they relax, the book opens up, in all of its wonder and richness.

The stories of many famous lives have made great reading. But the stories of everyday lives make equally great books. The mystery, passion, sadness, joy, desires, struggles, hopes and dreams found in the best written books are far more illuminated and intense, magnified and distilled, in everyday life. As the artist Cezanne once said: “…there is a magnificent richness of color that animates nature.”

Why is Awake the New Sleep?

Paul Turek, MD — Mon, 28 Nov 2011 16:00:01 +0000

Sleeping Beauty definitely gets enough sleep (Source: Disney)

It was no surprise to me to read a recent study that showed that when Stanford men’s basketball players got more than 10 hours of sleep nightly, their on-court performance improved dramatically. They ran faster sprints, took more accurate shots and were less fatigued. Another example of more sleep translating into improved awake performance.

Facts About Sleep Deprivation

According to a recent national survey and the American Academy of Sleep Medicine, here are the current facts about sleep:

Adults should get 7-9 hours of sleep nightly.
Short sleep is defined as less than 6 hours of sleep.
Almost half (48%) of Americans say that they are not great sleepers.
More than 35% of Americans get less than 7 hours of sleep.
On average, “good” sleepers get 1-hour more sleep every night than poor sleepers.
13% say that they never get a good night’s sleep.
1 in 20 Americans have fallen asleep at the wheel while driving in the past month.
1 in 5 Americans have sex less often or have lost interest in sex because they are too sleepy.
In general, we sleep one hour less every night with each passing generation.

Sleep as Oxygen

During sleep, body temperature falls, muscles relax, the heart beats more slowly, blood pressure and pulse rate fall, and breathing slows. Clearly, sleep is more than simply rest and relaxation. It is a time of growth, recuperation and repair. Losing sleep may not physically kill you like being oxygen-deprived, but short sleep patterns are linked to depression, obesity, heart disease, loss of sex drive, attention disorders and a higher likelihood of developing a work-related disability. One Swedish study even showed that sleep deprived people look tired and less healthy and therefore less attractive to others.

Not only that, it’s not that easy to bounce back after losing sleep. The impairments caused by sleep-deprivation remain even after sleeping in for a day. Full recovery after sleep deprivation may take several nights of extended sleep.

So why does our society applaud those who stay up working all night rather than sleeping? Sleep deprivation is no badge of honor; it’s a threat to your health. Maybe this is why the Guinness Book of World Records refuses to recognize any record claims for lack of slumber. In my view, sleep ranks up there with nutrition and exercise as important pillars for a healthy, long and fulfilling life.

Are Fathers Better Citizens?

Paul Turek, MD — Mon, 21 Nov 2011 16:00:01 +0000

What wouldn't you give to help one of these? (Source: Leonardo Da Vinci, 1468)

As a surfer, I remember charging pretty big walls of cold, wintery Northern California water with the goal of getting a fast, albeit short, adrenaline-stoked ride. Years ago on Thanksgiving, I was pummeled by a big swell to the point that I wondered whether I would make it out of the water alive. But once I married and had kids, the risk element of waves larger than a single story high became less attractive to me. It wasn’t worth it. Too much at stake. Does fatherhood also reduce other types of risky behavior?

Fatherhood is Transforming

It apparently does. It is well known that fatherhood can be “transformative” or “tempering” for men. But what shape that transformation takes has not been studied very much, despite the fact that unattached men are considered by some to be a source of society’s ““suffering” or “instability.” Loose cannons so to speak.

Fatherhood and High Risk Behavior

A newly published study has tackled this issue. It addressed the changing patterns of crime and substance abuse in new fathers, as these behaviors can threaten both health and society. Specifically, the study asked whether men are less likely to drink, use tobacco or commit crimes after they become fathers. In other words, do tough guys straighten out after having kids?

The authors followed over 200 men ages 12 to 31 who demonstrated high rates of juvenile delinquency in a metropolitan area. They were assessed annually for self-reported acts of crime and court records were reviewed for arrests. Self-reported rates of beer, wine, hard liquor, tobacco and marijuana use were documented, as were co-habitation, marital status and age at first fatherhood. And remarkably, this study was conducted over 19 years!

It has been previous shown that marriage itself and getting older can reduce men’s negative behavior, but this study clearly demonstrated a real association between fatherhood by itself and reduced crime and substance abuse patterns. And, the effects were large and long lasting. Of note, these changes were greater amongst the older men in the group (late 20’s and 30s) and were distinct from those changes expected as men age. Lastly, unlike marriage, cohabitation alone was not shown to reduce risky behavior in young men.

A Golden Opportunity to Help Men Help Themselves

Why is this important? One reason is because it suggests that first fatherhood may present a real opportunity to improve the health and behavior of young men. God knows that there are not many opportunities to do this with those who consider themselves otherwise immortal. New fathers might be more willing to hear messages and make life style changes when they are holding what might be their noblest work in their arms. And these changes in behavior could affect the health of the individual, his children and his family. After all, and I am not sure who said this, “A baby will make love stronger, days shorter, nights longer, bankroll smaller, home happier, clothes shabbier, the past forgotten, and the future worth living for.”

Fertility from Sterility

Paul Turek, MD — Mon, 07 Nov 2011 16:00:55 +0000

What's inside of a coffee mug depends on how you look at it.

Do you think it is possible to have your own children with absolutely no sperm in the ejaculate?
Why yes. It happens on a daily basis in my practice.
Honestly, the word “sterility” has really lost much of its meaning nowadays with advances in reproductive technology.

The Affairs of Sperm

Azoospermia is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts outside the testis in the setting of normal sperm production in the testicle (i.e. vasectomy) or as a result of poorly functioning testicles and normal, open ducts beyond it. We routinely grab sperm from behind vasectomy sites to use with assisted reproduction to conceive. Finding sperm in men with poor sperm production, termed nonobstructive azoospermia, is a more complex matter.

One way to think about sperm production in men with poorly functioning testicles is to compare it to a mug with coffee in it. Say the mug is filled with ¼ cup of coffee. If you hold shake the mug, you may not see any coffee spill over the side. In this case, you might assume that the mug has no coffee inside. But, if you peer into the mug directly, you will see that there is actually coffee in the mug. Similarly, the testicle makes more sperm (coffee) than is found in the ejaculate (spilling over cup). There exists a threshold of sperm production, over which sperm shows up in the ejaculate and below which it will not. So, now you know the secret of making fathers out of “sterile” men with poorly functioning testicles.

Sperm from a Rock

Of course, it’s not quite that simple. There is one more layer of complexity here. Poorly functioning testicles may not make sperm evenly throughout their substance. In many cases, there are “pockets” or “islands” of sperm within a sea of otherwise empty tissue. Clinically, this makes sperm retrieval more difficult and has pushed this technology to a high art.

To find sperm, fertility specialists use several sophisticated approaches in men with nonobstructive azoospermia. The traditional testis biopsy works about 30% of the time to find sperm and, as a consequence, is no longer the de rigueur technique for this problem. Fine needle aspiration “mapping”, which I invented about 15 years ago, is easily twice as good as a biopsy in finding sperm and much less invasive. Lastly, “microdissection” of the testis another alternative and involves an all-out surgical assault on the testicle to find sperm making it the most invasive approach. The elegance and complication rates for these approaches vary widely, but their intent is the same: to find enough sperm to allow biological fatherhood. Importantly, when expertly performed, these techniques will find sperm in the majority of cases. For the remainder, there is hope as even newer “no touch” scanning technologies are on the horizon…

Fitting Into Your Genes

Paul Turek, MD — Mon, 19 Sep 2011 15:00:31 +0000

Change is the engine of evolution, and the source of infertility

“Why Me? I take great care of myself.”

I often hear this common question from men with low or no sperm counts who are unable to conceive. In fact, they usually are taking great care of themselves. The fact is, many cases of male infertility are actually genetic and have more to do with the cards that they were dealt.

“But my brothers, sisters and cousins all have kids…!”

Here where is gets a little complicated, as not all genetic traits are handed down the same way. There’s autosomal recessive and dominant, sex-linked, sex-limited, Mendelian and non-Mendelian, and even polygenetic and epigenetic. The thinking implied by this comment is Mendelian, which one of only a few ways to pass genetic traits along. The way infertility occurs is not necessary like that of heart disease or high blood pressure.

Genes and You

What is that saying? “Clothes make the man.” A more modern (and accurate) way of saying this is that “Genes make the man.” And with male infertility, it is becoming quite clear that genes matter a whole lot.

For 50 years, as men were evaluated for infertility, clinicians would simply use the term “unexplained” or “idiopathic” to describe much of what they saw. As the Y chromosome was found to have important genes for “maleness”, interest turned toward this chromosomal location to explain infertility as well. Then, in the mid-1990s, a colleague of mine discovered an area on the Y chromosome that could explain why a chunk of men had low or no sperm counts. Now, it is clear that the Y chromosome is central to normal male fertility.

It is thought that between 500 and 1000 genes are involved with sperm production. This is a reasonably big lot of the estimated 25,000 genes that exist in the human genome. However, currently, fewer than 50 genes have been definitively linked to male infertility. Some of these are on the Y chromosome, but many are not, making the story even more complex than originally thought.

My Answer to “Why Me?”

My long answer to the question “Why me?” revolves around the concepts that 1) there are two different genetic evolutions in the body, and 2) that your genes may be new to you and may not be handed down like clothes. It goes something like this:

Eggs and sperm (also called “gametes”) are responsible for the vast bulk of human evolution. They have a very long term view of where our species is going.
As a consequence, genes in our gametes constantly mutate and change, as change is the engine of evolution. Genetic change in our gametes is expected, nay necessary, for our proper evolution. They mutate rapidly and frequently.
On the contrary, genes in the rest of the body exist to support the work of the gametes, for the good of the species. So, the rate genetic mutations in this system is much lower. As the rocket (body) for the payload (gametes) the body must run fast, hard and true.
Given this setup, with evolutionary pressure high in gametes, new mutations occur far more commonly there than in the rest of the body.
Another way of looking at this is that if every mutation that occurred in our gametes was made manifest in our bodies, we would look entirely different from one generation to the next. Luckily, this isn’t the case, because the quality control “filter” is so good.
But it does explain why there is a lot more genetic change affecting infertility than one might expect.

Maybe it’s true that clothes make the man, but with male fertility it is also true that the clothes were newly purchased and not hand-me-downs.

Dawning of the Deed

Paul Turek, MD — Sat, 08 Jan 2011 23:55:26 +0000

The official photograph of the world's oldest embryo

Here’s a good question: “How old is sex?” You know, the old birds and the bees-type hooking up. Recently, some fossil finds have given us great clues as to the age of intercourse, the conception of copulation, the dawning of the dirty deed.

You might have trouble even imagining your parents or grandparents having sex, but intercourse is at least 375 million years old. That’s quite a tradition to carry on and we should do it proudly.

See, before sex there was “spawning,” characterized by an utter lack of intimacy. Despite this, it is still pretty popular today, occurring in well over 90% of fish. Basically, female fish lay eggs into the water and the males then deposit sperm into the water to fertilize them. The embryos that develop are on their own and out in the open. With intercourse came fertilization of eggs within the female body, removing risk to embryos associated with all of those nasty creatures found in pond water.

Until recently, it was believed that sharks (yes sharks) were the first species to have sex and give birth to live offspring. Funny, it’s hard to imagine sharks as particularly romantic, but as they say, you can’t always judge critters by how big their teeth are. I just met a walrus with 2-foot tusks who is the nicest guy you ever met.

What changed all this was a small fish fossil that was found in a piece of limestone on a cattle ranch in Western Australia. About the size of a mackerel, this female fossil contained an embryo within it, along with a petrified umbilical cord. Proof positive: Internal fertilization in backboned animal before sharks, 375 million years ago.

So, if you think the sexual revolution happened in the 70’s or is happening today, you’re wrong. The real revolution in sex occurred during the Devonian period, way before you were a twinkle in anyone’s eye.

No related posts.

Know Your Wooly Mammoths

Paul Turek, MD — Sun, 26 Sep 2010 00:24:42 +0000

How many of these are chasing you?

Whenever I mention to the media that “stress” is bad for male fertility and men’s health in general, they show images of snarling, bumper-to-bumper traffic with heat shimmering off of the asphalt. Sure, that works for stress. But that is not the half of it.

Being stuck in traffic is a form of acute stress, similar to being told that your check bounced, you missed your deadline, or you’re late for that important business meeting for which you planned so hard. Going back 100,000 years, this is same stress associated with being chased by a rogue wooly mammoth. Either way, modern or ancient, the human body responds the same way: by stimulating adrenaline and activating the sympathetic (“fight or flight”) nervous system. Blood is directed to where it is needed most—the heart and muscles–and not to the penis. And the result is loss of sex drive, erections, and lower testosterone levels. Not a great state of affairs for general or sexual health. This response also explains why so many men who are fine with recreational sex hit the skids performance-wise during “scheduled sex” needed for baby making.

More worrisome than the effect of acute stress on health is that of long term or chronic stress. Although more subtle than acute stress, it is far more pervasive in our lives. Do you travel 50,000 air miles or more annually across time zones? Do you change shifts at work? Travel stress and changing work hours (circadian stress) are forms of chronic stress. Do you worry about your finances (financial stress) or workout too much (physical stress)? Is there someone seriously ill in the family or is your love life tanking (emotional stress)? Remember, your body is a very primitive organism and responds the same way to all forms of stress, with the “fight or flight” reaction, ready to run from the wooly mammoth.

So what are the consequences of chronic stress? Well, for both sexes, sex is the first casualty. Intimacy is a close second. Stress hormones lower testosterone production and, as a consequence, sex drive falls. Testosterone is also an important vitamin for mood, muscle mass, male fertility, kidney and bone function and these can also suffer. And must I mention one of the best-studied areas of stress: that of Type A personalities having the shortest “shelf life” on this earth? Is this you? Take the test and find out.

Even more novel is the latest news that humans (like animals) have “clock genes” that control daily, sleep-wake or circadian rhythms. And when these rhythms are upset, as with stress, cancer development is promoted.

My advice: Assess how many wooly mammoths are chasing you, even the small ones. Then, begin a regimen of stress reduction using regular exercise, acupuncture, yoga or massage to get that body of yours tired and relaxed. In the words of Lily Tomlin “For fast-acting relief, try slowing down.”

Medicine Light

Paul Turek, MD — Sun, 08 Aug 2010 18:23:14 +0000

Spoon bending power to heal.

Can prayer heal? Does touch matter in medicine? Long considered a nonrational part of Western medicine, these “lighter side” topics are now receiving close attention and study.

I am reminded about distant healing on the anniversary of the death of a medical school classmate and friend Dr. Elisabeth Targ. As a psychiatrist, daughter of a parapsychologist and niece of chess champion Bobby Fischer, she was not only bright, but also a bit paranormal herself. As a child, she played hide-and-seek with friends and would attempt to use clairvoyance to find them. She was also expected to call out her Christmas presents before opening them. As a trained scientist, she performed some of the best studies showing the effect of prayer or “distant healing” on extending the survival of AIDS and breast cancer patients.

In her study of how prayer can heal, Dr. Targ used scientific methods to determine whether “intention” from others 1500 miles away could help treat medical ills. In small studies of AIDS patients before current treatments were developed, she showed that they could live longer and spend less time in the hospital with distant healing. Her papers are in no way definitive and are highly criticized, but to date remain the best and most scientific attempts the world has seen in the last 150 years to define the potential of faith to heal.

What made Elisabeth Targ a unique force in her field is that she refused to speculate about how or why distant healing works. She had a simple goal: to define the existence (or not) of the effect. Her boyfriend, Mark Comings, however is more daring in this regard. A theoretical physicist, he suggested that if we actually live in an eight-dimensional universe instead of the accepted three dimensions, then we might be more interconnected than we currently understand, and this could explain how a healer in Santa Fe could influence a patient in San Francisco. Sadly, Elisabeth died at age 41 years of a brain tumor. Ironically, it was the same kind of tumor that she was studying with distant healing treatment.

What about the role of touch in medicine? Clearly, patients who visit doctors for terrifyingly short visits feel that the visit is incomplete without a physical exam. The doctor’s visit is just not the same as that with your accountant, lawyer or financial advisor. The laying on of hands is a special part of the medical relationship and has been for millennia. In fact, there is good science to show that the physical exam is not as good at disease detection as a good patient history. What needs more study is what makes touch so special, almost medicinal, in the doctor’s office. Can it cure disease? I wish that my friend Dr. Targ were around for this one. She might be able to help us decide whether, in the words of Diane Ackerman: “touch seems to be as essential as sunlight.” My view as a men’s health specialist is that if it has the potential to heal, then use it, regardless of whether we understand why or how it works.

Synthetic Cells: The Latest Vinyl?

Paul Turek, MD — Mon, 24 May 2010 05:16:26 +0000

Synthetic cells: true science or fashion vinyl?

Believe it or not, science has now claimed to have made “synthetic life.” Life created from non-living substances. J Craig Venter and colleagues, after a decade of work, produced a man-made version of the entire DNA content (genome) of a bacteria (adding in a couple of harmless “watermarks” to track it) and inserted it into the shell of another bacteria after removing its DNA. And, lo and behold, the artificial genome starting making proteins and the man-made bacteria began to replicate.

You may remember Craig Venter as the man in corporate biotech a decade back who challenged the U.S. government in a race to completely encode the entire human genome. The Human Genome Project was completed in 2003 and jointly announced. This is a beautiful thing but Venter wanted to “own” and patent the human genome and charge others for using it as a resource whereas the U.S. government insisted that it be made publicly available, which it is.

Is this really synthetic life? No. Essentially, Venter performed the equivalent of gutting a computer and then entirely reprogramming it. Is this an important scientific achievement? Absolutely, a tour de force, since technology has been limiting this work for years. Recently, however, there has been a 100-fold increase in the length of genetic material that can be manufactured from raw chemicals in the lab. Without a doubt, science has been dreaming about this kind of work for three decades and recombinant DNA technology is an early product of this movement.

So, an entirely “artificial cell” was not produced by Venter, as the control station was man-made, but the rest of the cell was not. My only hope is that this is not just another “pleather” (plastic and leather) product in our lives. As Lily Tomlin said: “[even] vinyl leopard skin is becoming an endangered synthetic.” On the contrary, this work may have advance science sufficiently to begin the manufacture of designer cells, good or bad, that can clean up oil spills, dynamite and waste water, dispose of nuclear waste and deliver antibiotics, chemotherapy, testosterone or Viagra to hard to reach but important areas of the body.

Does Male Infertility Begin in the Womb?

Paul Turek, MD — Mon, 03 May 2010 04:59:19 +0000

This Da Vinci fetus is way past the critical window of exposure.

A relatively alarming study was published a couple of years ago that suggested that a pregnant woman’s behavior can determine the fertility of her unborn son. Sperm quality from 387 men was compared to beef consumption their mothers reported while pregnant with them. They found that the sons of “high beef consumers” (>7 beef meals/week) had sperm counts that were 24% lower than in men whose mothers ate less beef. Interestingly, sperm counts in the sons were not related to mother’s consumption of other meat or to the son’s consumption of meat. In essence, the author’s thought that estrogens in beef consumed by women may alter the testis development of their unborn sons and may adversely affect the son’s fertility. Similarly impressive decreases in semen quality have been described in the sons of women who smoked during pregnancy.

Sounds almost biblical, doesn’t it? I bring this up because of a point that I made in last week’s blog. In “The Curse of Women’s Urine,” I mentioned how xenoestrogens or environmental estrogens have been shown in animals to act at a very precise point in the developing male fetus and result in intersex conditions at birth or infertility as adults. Well, as the study of mothers’ beef intake reveals, the same issues may also exist in humans. As Aristotle once said: “At his best, man is the noblest of all animals; separated from law and justice he is the worst.”

Time for a quick lesson in biology. When do testicles develop in humans? Believe it or not, when male fetus in just 4 weeks old, the location where the future testis will be is organized (the urogenital ridge). Two weeks later, the primitive germ cells (sperm precursor cells) migrate to the urogenital ridge and set up what is to later become the testis. About 1-2 weeks after that, “sex cords” develop in the primitive testis, setting up the architecture of the mature organ. So, by 8-12 weeks of pregnancy, the human testis is virtually a complete organ, holding within it all of the potential it will ever have.

So the “critical window” of exposure for the human testis, that period in which even a potentially small exposure could wreak significant developmental and long lasting havoc, is about the time when women actually just realize that they are pregnant. The time of morning sickness and painful breasts.

So, does male infertility begin in the womb? Still not clear, really, as all studies have flaws. For example, in the study of beef eating pregnant women, the cohort of son’s whose sperm counts were so thoroughly examined were ALL fertile. That’s right, their wives were all pregnant. Oscar Wilde couldn’t have said it better when he said: “The pure and simple truth is rarely pure and never simple.”

The Curse of Women’s Urine

Paul Turek, MD — Sun, 25 Apr 2010 22:21:26 +0000

Estrogens and the manly man.

There must be something in the air… or water. The Bolivian President Evo Morales recently asserted publicly that hormones found in mass-produced foods are “feminizing” men. Speaking about chicken in Bolivia, which he believes are “loaded with feminine hormones,” he suggested that when men eat chicken “they are diverted from their nature as men.” So, is this how metrosexuals came to be?

But wait, the Vatican commented on this issue a year earlier, although they blamed female hormones from birth control pills for the increased estrogens in ground water. Pedro Castellvi, writing in the Vatican newspaper L’Osservatore Romano in 2009, stated: “we have sufficient data to affirm that one of the reasons for the not insignificant rise in male infertility in the west, is the environmental contamination caused by the pill.” Actually, it’s not the birth control pill itself but the urine from women taking the pill.

In fact, to date, the urine of women taking birth control pills has been blamed for worsening sperm counts in men, the growth of female sex organs in male fish, breast growth in young men and the early onset of puberty in young girls. What next?

Can I add a little balance to this discussion? First of all, exactly what is happening to men in Bolivia such that the President is not happy with them? Are they more civilized and less disruptive? Second, male infertility is not necessarily increasing in the western world; it may even be true that men have lower sperm counts now than a generation ago not because they are less fertile but because women are more fertile. Third, estrogens are found everywhere in the environment including in many plants (phytoestrogens) such as soy and legumes, and are not produced exclusively from the urine of women. Fourth, the intersex conditions that have been reported in many animal species tend to be caused by a very specific exposure at a very specific time point during fetal development and have been linked to pesticides, bisphenol A, dioxins and other environmental contaminants (xenoestrogens). Fifth, did we somehow forget about the worldwide obesity epidemic in humans and the fact that fat converts male hormones to female hormones? Lastly, there is little evidence that substantially increasing a man’s estrogen levels as an adult will dramatically alter anything, except maybe waist size and color preferences. Where the truth lies in all of this is currently unknown, but it is hard for me as a urologist to see how women’s urine could be blamed for so much.

Genome: Repair Thyself

Paul Turek, MD — Mon, 22 Mar 2010 05:02:15 +0000

How damaged is your genetic sheet metal?

Imaging parking your car at home after work and all the nicks and scratches are removed while you sleep, before heading to work the next day. All shiny and new, polished even, while you sleep. Believe it or not, this is normally what happens to your genes and chromosomes on a minute-to-minute basis. DNA mismatch repair is a constant and vigilant process, occurring in all cells of the body. Why the biologic vigilance? Well, It keeps us whole, healthy and cancer free.

About 11 years ago, we published a paper showing for the first time that infertile men can’t repair the errors normally encountered in their DNA as well as normal men. This was startling news in part because it implied that infertile men may be more likely to develop other problems later in life, including cancer. Why cancer? Because the development of cancer has been associated with the inability to normally repair the frequent daily errors that occur to one’s DNA as the body’s cells divide and renew.

Today, however, we know much more. We know that testis cancer is 3-fold more likely to occur in previously infertile men than in fertile men as they age. And our latest research has shown that prostate cancer, thought to be a disease exclusive to older men, occurs more seriously and more commonly in previously infertile men.

So what does this mean? Is male infertility the first sign of a larger problem in our species? It is the ultimate medical problem of a species trying to reproduce? Well, honestly it isn’t entirely clear. However, to me it indicates that male infertility should certainly be considered an insurable and real medical condition that should be taken as seriously as a heart attack. Even more worrisome is the issue of whether the use of sperm from severely infertile men is putting their offspring at even higher risk of medical issues than that experienced by their fathers.

So do not ignore the infertility issue when it strikes and get that male partner evaluated by a specialist. Teach him to perform testicular self-examination, a simple maneuver performed once monthly in the shower that has far more potential to extend his life than even exercising or weight control. Educate him about prostate cancer so that he does not ignore the powerful screening tools available to find it early. The age of innocence is over. The warning signs are now clear; get men the care that they deserve.

Your DNA Barcode

Paul Turek, MD — Mon, 22 Feb 2010 02:03:04 +0000

Can we be DNA barcoded like a soup can in a grocery store?

How many of you would take a blood test to learn exactly how long you will live? How about whether or not you will become demented? Since the Human Genome Project ended, the genes and mutations associated with a vast array of diseases are being discovered daily and it is pretty easy to just put them on “chip” and make them available to the public.

Don’t get me wrong; gene testing already has already improved our lives. Such tests can clarify a diagnosis and better direct care, while others allow families to avoid having children with life-threatening or disabling conditions. They can be used to prevent disease before it happens, as with monitoring and removal of colon growths among those who have a gene for familial polyposis, and can diagnose common iron-storage diseases early enough to treat them and prevent them from becoming fatal. They can also help to positively identify murderers two decades after the crime.

One real problem is that many commercialized gene tests are targeted to healthy people who might be at high risk because of a strong family medical history for a disorder. Unfortunately, because of how complex we are as biological organisms, the tests give only a “probability” for developing the disorder. That means that some people who carry a mutation may never develop the disease. Another limitation is the possibility of laboratory errors. What this means is that the tests are not perfect and could be wrong.

And what happens to your job prospects and health (or life) insurance rates when it is learned through genetic testing that you might develop a significant disease? Well…nothing. Because of the federal GINA Law (Genetic Information Nondiscrimination Act) passed in May 2008, insurance companies and employers cannot discriminate on the basis of information derived from genetic tests. So, genetics has now been added to the list of characteristics first embodied by the Civil Rights Act of 1964, that states that U.S. employers cannot discriminate according to race, color, national origin, sex, or religion. And this is good.

So, go ahead and take the “23 and Me” “DeCode” or “Navigenics” genomic screens if you so desire. Get to know your DNA barcode. Maybe you will get an idea of what may be around the corner for you. And maybe, just maybe, you will take better care of yourself knowing more about your genes. Just understand that many in the medical community feel that uncertainties surrounding test results, the current lack of available treatment options, the tests’ potential for provoking anxiety and social stigmatization could outweigh the benefits of testing. You know the saying: “Too much information…”

No related posts.

Music to Our Ears

Paul Turek, MD — Sun, 08 Nov 2009 18:08:05 +0000

Miles and Microsurgery: it doesn't get any better.

For as long we have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting and consoling their spirits, inducing calm and tranquility, or the trance of dance. I have listened to the sounds of classical jazz during microsurgery operations throughout my professional career as a surgeon. Coltrane, Miles, Evans, Djavan, Caetano Veloso and all the greats sweetly waft in the operating suite and overcome the din of devices within the room. Does music in the operating room lead to less wasted and more fluid surgical motion, and therefore faster procedures and better patient outcomes? Who knows. But as the background makes the painting, the music may make the maestro.

A recent study suggests that listening to music in surgery may also benefit patients. Maybe this is why oral surgeons and dentists offer earphones and video glasses to their patients. Anything is better than listening to the whine of the drill during a root canal. The effect of music on cortical, limbic or higher brain centers has previously been studied in patients undergoing brain surgery. These centers control feeling, thoughts and memory. In this recent research, a neurosurgeon studied the effect of different kinds of music on deeper portions of the brain, located in the thalamus. This region is responsible for sensation, motor function, consciousness, sleep and alertness. This study of music and Parkinson’s patients is quite different from what Oliver Sacks describes in his book Musicophilia, in which music therapy is used to increase the mobility and responsiveness of Parkinson’s patients.

According to this new study in awake patients undergoing surgery for Parkinson disease, music slowed the neuronal firings deep within the brain. As a consequence, patients became physically more relaxed, calm and even slept during their surgery. And pure melodic music appeared to be the most soothing to most patients.

So music in the operating room may make more sense than we think. In addition to helping the surgeon with his surgery, it may reduce patient anxiety. This in turn, could shorten operative times, reduce the need for anesthetic medication, and lead to quicker patient recovery and shorter hospital stays. In a word, more music, less pills.

No Sex? Get Some Sleep!

A Short History of the Y Chromosome

Paul Turek, MD — Wed, 23 Sep 2009 00:59:50 +0000

The Y chromosome: diminutive but cool.

Among the many chromosomes in a man’s body, the smallest one with the largest personality has to be the Y chromosome. With it, you are a male; without it, you are a female, with few exceptions. More than any other chromosome, it really defines who you are.

The Y chromosome controls other traits as well: hairy ears, tooth enamel, and stature to name a few. But for the longest time, the Y chromosome was also considered home to a lot of “junk DNA” that we thought had no purpose. We now know that much of this DNA has a purpose and that the Y is the home of many important male fertility genes.

Before its association with male fertility, the Y chromosome was widely considered a genetic black hole, a chromosome that evolved as a broken remnant of the X chromosome. We knew that the “maleness” gene was on the Y and a few other genes. However, since the Y chromosome has been fully undressed as a result of the human genome project, we now know that it is very unique, even special, and that it evolves in its own special way to keep men men.

The Y chromosome, and its neighbor the X chromosome, evolved into “sex” chromosomes hundreds of millions of years ago. This is important because many species do not have a chromosome for each sex like we do. Some species become male or female based simply on the environment in which they find themselves. Imagine that! A boy in the Artic but a girl in the Caribbean. At first, the original sex chromosomes probably evolved as a pair of two X chromosomes. Then, 150 million years ago, the Y chromosome made its break from the X chromosome. Basically, it stopped associating with it and this led to our current X-Y system of sex determination. I guess this is when men really became men.

As it works now, the single Y chromosome has no partner with which to swap genes when sperm are made (at a normal rate of 1200 sperm/heartbeat!) This “swap meet” of genes that occurs when new sperm are formed is an important repair process for the 22 other chromosomes and is absolutely critical for our evolution as a species. In fact, this is the source of our evolution. So, now that the Y chromosome has become isolated and less of a team player, is it doomed to extinction? More importantly, are men are doomed to extinction?

So how does the Y chromosome survive and repair itself, living alone in isolation while the world is changing around it? Well, we now know that it manages very well on its own, thank you. And this has probably been true for about 5 million years. Although it no longer swaps genes with the X chromosome, from which it came, the human Y chromosome is able to swap genes with itself to discard bad genes. It’s called gene conversion and no other chromosome does it. Just the Y. How uniquely male.

Basically, essential Y chromosome genes are arranged in a series of eight “palindromes,” or mirror image sequences, each of which folds like a hairpin in which its two arms come together. Then the “DNA checkers” compare the two arms for any differences and convert a mutation back to the correct sequence, thus saving the Y’s genes from mutational decay. So, the older “junk DNA” thought to exist on the Y chromosome is now known to represent DNA that it critical for its survival. One man’s junk is another man’s treasure. And so it goes, the Y lives on, and men do too.