Archive for July, 2015

When most people get hurt, their body creates a blood clot at the site of the injury to stop the bleeding. In order for the blood to properly clot, the body must produce enough cells called platelets, and proteins known as clotting factors. However, for people with a bleeding disorder, they either have too few platelets or clotting factors, or those cells don’t work properly, so when they bleed, a clot is not formed or forms too slowly, thus causing excessive bleeding, even death. This is a serious concern not only for injuries but also for people who need surgery or for women during childbirth.

There can be several causes…

von Willebrand disease

von Willebrand disease is the most common bleeding disorder, affecting up to 1% of the U.S. population; it occurs equally in men and women. People with von Willebrand disease typically inherited it from their parents. It is caused by a missing or defective clotting protein called von Willebrand factor. Acquired von Willebrand disease can occur in adults as a result of an autoimmune disease, such as lupus, or from heart disease and some types of cancer. It can also occur after taking some medications.

People with von Willebrand disease commonly have nosebleeds, bruise easily, and bleed excessively during and after surgery. Female patients often experience heavy menstrual periods that last longer than average, and excessive bleeding after childbirth.


People with hemophilia do not bleed any faster than other people, but they bleed for longer because their blood lacks enough clotting factor. While it is one of the more common of the genetic bleeding disorders, it is still very rare: only about 1 in 10,000 people are born with it, and most are males. About one-third of people who have hemophilia do not carry the gene but rather develop it through a mutation of their own genes; this is called sporadic hemophilia.

A person can, in rare cases, develop hemophilia later in life; this is called acquired hemophilia. Most cases of acquired hemophilia are seen in middle-aged or elderly people, or women who have recently given birth or are in there final stages of pregnancy, but this condition typically improves with proper treatment.


Certain medications can also cause a patient to bleed more easily. “Blood thinners,” as they are often called, are sometimes prescribed to patients who have suffered a heart attack or stroke, or for people who are at a high risk for these conditions. Anticoagulants, such as heparin or warfarin (also called Coumadin), cause a chemical reaction in the body which lengthens the time it takes to form a blood clot, whereas antiplatelet drugs, such as aspirin, prevent platelets from clumping together to form a clot. The effects of both of these types of drugs are desirable if you want to prevent a dangerous clot from forming in the heart or brain, but can cause major bleeding issues if the patient is injured or requires surgery.

Partial Thromboplastin Time & Prothrombin Time tests

There are simple tests that can help your doctor determine if you have a genetic or acquired bleeding disorder. If you are having surgery or are pregnant, your doctor may want to conduct these tests to see if there is a risk of complications from excessive bleeding during or after surgery or childbirth, either because you have a bleeding disorder or are taking a blood-thinning medication.

The Partial Thromboplastin Time (PTT) test measures how well your blood clots; it is also referred to as the Activated Partial Thromboplastin Time (aPTT) test. This test uses a sample of your blood to examine whether you have enough of the blood-clotting factors VIII, IX, XI, and XII.

The Prothrombin Time (PT) test is a similar test that finds clotting problems for factors I, II, V, VII, and X.

If you need a PTT or PT tests, order your own lab tests on line at a discount: or


Male hypogonadism is a condition in which the testes are not producing enough testosterone. You have seen the commercials during sports broadcasts: “Do you suffer from ‘low-T’?” If you are male, maybe you have even wondered if your testosterone levels are “normal.” Well, with age and chronic illness, testosterone levels often do decline. Add to the puzzle that male hypogonadism symptoms are similar to those of many common chronic conditions in older men, and it can be difficult to diagnose the root cause of a man’s low testosterone level.

Testosterone replacement therapy for hypogonadism in older men is a hotly debated topic among physicians, especially since there is little research on potential long-term risks. So in an older man with low testosterone, a definitive diagnosis of hypogonadism must first be established. Here are some of the things your doctor will ask you and consider in their differential:

  • Are you experiencing symptoms of hypogonadism such as sexual dysfunction, low energy, depression, or irritability? If you are not experiencing hypogonadal symptoms, testosterone replacement is not the appropriate course of treatment.
  • Many physicians will want to confirm lab results showing a low testosterone level with a second set of labwork taken in the morning after fasting.
  • It is common for testosterone levels to dip during acute illnesses and then return to the normal range in the weeks or months after recovery. If you were recently very ill, some healthcare providers will want to repeat testosterone level tests in three months to see if your levels are still low.
  • There are several common conditions that alter sex hormone-binding globulin (SHBG) in older men. Doctors will often want to obtain a SHBG measurement and use those results to determine free testosterone levels. If your free testosterone is in the normal range, it definitively indicates that you donot have hypogonadism, thus testosterone therapy would not be warranted.
  • Erectile dysfunction (ED) without other sexual symptoms is not indicative of hypogonadism. If your only symptom is ED, your doctor may prescribe a PDE5 inhibitor (such as Viagra or Cialis) but probably will not test your testosterone level.

If your doctor confirms through a physical exam and bloodwork that you do have hypogonadism, they may suggest testosterone replacement, but it is important to consider the unknown cardiovascular risks of testosterone therapy, especially for older patients. And even if diagnosed with hypogonadism, some patients are not appropriate candidates for testosterone replacement including people with:

  • Prostate cancer or certain other prostate-related conditions
  • Breast cancer (a disease which can occur in males)
  • Polycythemia, an abnormally high concentration of hemoglobin in the blood
  • Untreated obstructive sleep apnea
  • Severe lower urinary symptoms
  • Congestive heart failure that has not been controlled

If your doctor does prescribe testosterone therapy, several options are available:

  • Topical gel–Used daily to produce consistent testosterone levels. It is important that women and children not be exposed to topical testosterone gels.
  • Transdermal patch–Provides steady testosterone levels. Skin irritation at the patch site can be a problem for some patients.
  • Intramuscular testosterone–The most cost-effective treatment option, an injection is given every two weeks. Some patients who have trouble with fluctuating testosterone levels between injections will need weekly injections of a lower dose.

All men using testosterone replacement therapy should be closely monitored by their healthcare provider, and testosterone levels should be retested regularly. For those using a gel or patch, testosterone should be measured 3 to 12 hours after application. For men using intramuscular testosterone, levels should be checked midway between injections.

After 4 to 6 months of prescription drug therapy, your doctor should check to see whether your low testosterone symptoms have improved. If they have not, it can be assumed that testosterone replacement is not working for you, and you should discontinue use.

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Magnesium – Key Element for Good Health

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Why magnesium is a key element of good health

Magnesium. Maybe you remember it from the periodic table in 10th grade chemistry class. What you may not realize is that our bodies use this shiny gray rock-like element in many ways. In fact, it is integral in over 300 biochemical reactions, from muscle contractions to neurotransmission, blood pressure and heart rhythm to immune response.

So how can you be sure that you are getting enough of this vital nutrient?

For adults, the recommended dietary allowance (RDA) of magnesium from food varies by age and gender:

Age Male Female
19–30 years 400 mg 310 mg
31–51+ 420 mg 320 mg

Note: amounts differ for pregnant or lactating women.

Most people eat proper amounts of magnesium in foods such as spinach, whole grains, beans, nuts, and potatoes. But according to the National Institutes of Health, many older Americans–especially men over age 70–are not consuming the proper amount of magnesium. Yet despite these dietary shortfalls, magnesium deficiency is still quite rare, even among seniors.

Dr. Bruce Bistrian, chief of clinical nutrition at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School, explains, “The kidney has an extraordinary ability to reduce magnesium loss in urine, and thus achieve magnesium balance on a wide variety of intakes.”

Examples of magnesium-rich foods

1 ounce of dry-roasted almonds, 80 milligrams

1/2 cup frozen spinach (cooked), 78 milligrams

1/2 cup bran flakes, 64 milligrams

1 medium baked potato with skin, 48 milligrams

1/2 cup canned kidney beans, 35 milligrams

Are magnesium supplements necessary?

For optimal health, it is preferable to get your necessary magnesium from food. High-fiber foods like nuts, dark-green leafy vegetables, unrefined grains, and beans are all good options.

For those who have issues with magnesium absorption from food– such as people with diabetes, Crohn’s disease or celiac disease, some kidney conditions, alcoholism, and people on certain medications– magnesium supplements can be beneficial.

But be wary of the claims of some magnesium supplement manufacturers that their product can increase energy, regulate sleep cycles, and reduce body aches. According to Dr. Bistrian, “There’s no evidence, to my knowledge, that it [magnesium] would be effective for those symptoms.”

And ingesting excessive amounts of magnesium from supplements can have an adverse effect on your health including diarrhea, nausea, and abdominal cramping, even cardiac arrest.

Think you could have low magnesium?

As noted, magnesium deficiency is rare, but if you have a condition that predisposes you to poor magnesium absorption, or you are concerned about your levels, ask your doctor for a blood test.

Learn about our magnesium blood tests:

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Learn more about the importance of magnesium in your diet and how it impacts health >>