Long-Awaited Medical Study Questions the Power of Prayer

Long-Awaited Medical Study Questions the Power of Prayer

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By BENEDICT CAREY
Published: March 31, 2006

Prayers offered by strangers had no effect on the recovery of people who were undergoing heart surgery, a large and long-awaited study has found.

And patients who knew they were being prayed for had a higher rate of post-operative complications like abnormal heart rhythms, perhaps because of the expectations the prayers created, the researchers suggested.

Because it is the most scientifically rigorous investigation of whether prayer can heal illness, the study, begun almost a decade ago and involving more than 1,800 patients, has for years been the subject of speculation.

The question has been a contentious one among researchers. Proponents have argued that prayer is perhaps the most deeply human response to disease, and that it may relieve suffering by some mechanism that is not yet understood. Skeptics have contended that studying prayer is a waste of money and that it presupposes supernatural intervention, putting it by definition beyond the reach of science.

At least 10 studies of the effects of prayer have been carried out in the last six years, with mixed results. The new study was intended to overcome flaws in the earlier investigations. The report was scheduled to appear in The American Heart Journal next week, but the journal's publisher released it online yesterday.

In a hurriedly convened news conference, the study's authors, led by Dr. Herbert Benson, a cardiologist and director of the Mind/Body Medical Institute near Boston, said that the findings were not the last word on the effects of so-called intercessory prayer. But the results, they said, raised questions about how and whether patients should be told that prayers were being offered for them.

"One conclusion from this is that the role of awareness of prayer should be studied further," said Dr. Charles Bethea, a cardiologist at Integris Baptist Medical Center in Oklahoma City and a co-author of the study.

Other experts said the study underscored the question of whether prayer was an appropriate subject for scientific study.

"The problem with studying religion scientifically is that you do violence to the phenomenon by reducing it to basic elements that can be quantified, and that makes for bad science and bad religion," said Dr. Richard Sloan, a professor of behavioral medicine at Columbia and author of a forthcoming book, "Blind Faith: The Unholy Alliance of Religion and Medicine."

The study cost $2.4 million, and most of the money came from the John Templeton Foundation, which supports research into spirituality. The government has spent more than $2.3 million on prayer research since 2000.

Dean Marek, a chaplain at the Mayo Clinic in Rochester, Minn., and a co-author of the report, said the study said nothing about the power of personal prayer or about prayers for family members and friends.

Working in a large medical center like Mayo, Mr. Marek said, "You hear tons of stories about the power of prayer, and I don't doubt them."

In the study, the researchers monitored 1,802 patients at six hospitals who received coronary bypass surgery, in which doctors reroute circulation around a clogged vein or artery.

The patients were broken into three groups. Two were prayed for; the third was not. Half the patients who received the prayers were told that they were being prayed for; half were told that they might or might not receive prayers.

The researchers asked the members of three congregations — St. Paul's Monastery in St. Paul; the Community of Teresian Carmelites in Worcester, Mass.; and Silent Unity, a Missouri prayer ministry near Kansas City — to deliver the prayers, using the patients' first names and the first initials of their last names.

The congregations were told that they could pray in their own ways, but they were instructed to include the phrase, "for a successful surgery with a quick, healthy recovery and no complications."

Analyzing complications in the 30 days after the operations, the researchers found no differences between those patients who were prayed for and those who were not.

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Visionary health care

IndyStar.com Business
March 23, 2006

Fresh fruit for workers; savings for local provider

By Daniel Lee
daniel.lee@indystar.com

Imagine you're at work and hungry for a midmorning snack.

When you venture to the office vending machines, instead of doughnuts and chips, you find bagels and fresh fruit. And, oh yeah, that same afternoon your employer will host a screening to test your body fat and cholesterol and conduct other health-factor checks.
And if you need a doctor, you can log onto a Web site and check out quality rankings for physicians in your area. In fact, if you choose one of the top docs, you might not have a co-pay.
This is all part of a vision behind a new health-benefits plan meant to transform Indianapolis-based Gateway Medical Resource Alliance from a small insurance player offering niche coverage into a mainline health-benefits provider. Gateway's plan also is the latest version of a new generation of health-insurance products popping up to address employers' growing concern over the rising cost of health care.

Gateway, a physician-owned business with seven employees and $6 million in revenue last year, envisions its plan set to begin this year as a way to improve the quality of care and cut costs for employers and their workers.

Gateway Chief Executive Officer Terrance Kopp said the plan -- called the Quality-Driven Healthcare Partnership -- eventually could become an alternative to traditional health insurance programs offered by providers including WellPoint's Anthem Blue Cross and Blue Shield or M-Plan.

"It's comprehensive, so it covers all medical specialties and any care a patient would need," said Kopp, adding that he hopes to have about 10,000 people in Central Indiana enrolled in the plan by the end of the year.

Gateway is working with the Indiana Employers Quality Health Alliance, a group representing employers with a total of 70,000 workers, including the state of Indiana, the city of Indianapolis and General Motors. Employers want to improve the quality of care and control their health costs, said Dr. Ned Lamkin, president of the alliance.

Gateway's goal is to create coverage for everything from employee screenings and fitness programs to treatments for serious diseases such as diabetes and cancer. Kopp said the new plan could save an estimated 10 percent to 15 percent on total premiums paid by employers and their workers. The average premium for family coverage last year was $10,880, according to the Kaiser Family Foundation.

Gateway's plan uses chart reviews by peer physicians to rank doctors. The top-ranked doctors then would receive higher reimbursements. Patients also may pay no co-pay, or a reduced co-pay, for using top-rated doctors.

Founded in 1995 by three cardiac physician practices, Gateway has offered specialized coverage for flat fees for diseases such as heart disease and cancer. Gateway has expanded to offer services including corporate wellness programs.

Now, in its effort to expand into primary care, Gateway has signed on American Health Network, a large physician practice, for its new plan.

Dr. Ben Park, president and CEO of American Health Network, said Gateway has been successful in lowering costs for its specialized coverage. "So now the objective is to show that that can work on a more broad scale," he said.

As an example, Kopp said, under the new program diabetics may face no payments for doctor visits to help them manage their blood sugar.

"What we're saying to the employers is it's a lot cheaper to pay 100 percent of the costs for that office visit and drugs and avoid the emergency room visit when the diabetic shows up not taking their medication," he said. "What you're doing is creating incentives for the patient to really manage their disease."

But Gateway faces potential hurdles.

Clarian President and CEO Daniel Evans praised Lamkin as a visionary leader in reforming health care but had some reservations about the approach.

"This particular plan is complex and will have to evolve like all pay-for-performance plans to something that is more easily understood by the provider and the patient," he said. "I commend them on a good start, but I expect it to be different in two to three years than what it is today."
Evans added that quality ratings of physicians must be based on objective criteria and worried about having physicians rendering opinions on other physicians' work.

And other benefits companies are developing systems for rating physician performance.
Anthem, for example, is working with the Indiana Health Information Exchange to roll out an experimental program in Central Indiana that pays bonuses to primary-care physicians who meet certain medical standards in treating patients.

Anthem declined to comment on Gateway's plan.

Gateway's approach is raising curiosity among employers.

"We're just interested in seeing how this is rolled out," said Jerry Malooley, director of health policy and plan design and development for Indiana's Personnel Department. "We're very interested in a concept of a very-high-performing, high-quality network of providers."
The state's 32,000 insured employees now may choose among five plans, all either offered or administered by M-Plan or Anthem. Keith Beesley, a lawyer with the personnel department, said the state has made no decisions about the new plan but added that Gateway, like any insurer, may bid for a state contract to offer benefits.


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Report: Health Insurance Companies to Use IT to Influence Doctors, Patients

By M.L. Baker, Ziff Davis Internet
March 21, 2006

A new report released by First Consulting Group predicts that health insurers are using health IT to expand their influence over doctors and patients.

Increasingly, health plans will use the Internet to reach out to patients directly with tips for staying healthy and keeping costs down.

Additionally, health plans help health care providers acquire technology and use information collected by that technology to steer patients toward particular doctors.

The FCG report "Health Plan Predictions" finds that data collected as part of programs to pay physicians for better care will be used to "aggressively steer members [for example, patients] to high-quality, low-cost providers."

As evidence, the report describes Aetna's Aexcel network, which consists of analytic software and a database system "to evaluate providers' relative costs compared to other doctors providing similar services."

Under the program, which covers about 300,000 patients in 10 states, doctors in specialties including cardiology, obstetrics, and orthopedics, are Aexcel-designated.

Different employer plans can provide an array of financial incentives to encourage patients to use these doctors.

Other health plans, including Blue Shield of California, Cigna, Premera and Massachusetts-based Tufts Health Plan, also offer so-called "tiered systems", says the report, though it does not describe how technology is used to select health care providers.

As employers force more health costs on to patients, online tools to tell patients the cost of services provided are also becoming more abundant, says the report. Similarly, health plans and consumer groups are pushing to put information online about the quality and performance of doctors and hospitals.

However, the American Medical Association has said that such disclosures could be harmful and misleading because measuring quality is not clear cut and can be influenced by factors outside a physician's control.

In addition to encouraging patients to use the Internet, health plans will also encourage health care providers to use information technology.

In particular, community physicians can expect health plans to invest more in electronic prescribing programs.

For example, Highmark plans to spend $26.5 million to cover as much as three-quarters of physicians' costs for hardware, software, and connectivity.

Several e-prescribing plans give physicians financial incentives to exchange a paper prescription pad for one electronically connected to pharmacies.

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Depression

What is it?
There are a few pointers. First, doctors don't consider depression to be 'clinical' - meaning an illness in need of treatment - unless symptoms have lasted for more than two weeks.

This kind of depression is caused by changed brain and body chemistry, which doesn't happen overnight. In fact, depression often comes on so slowly that many men have difficulty noticing the change.

What happens?
Although depression is technically a mental illness, many of the symptoms of depression are actually physical. Depressed people find it difficult to get to sleep, or to feel rested when they wake. Waking through the night, or waking far too early in the morning, is quite a strong sign of depression.

Depressed people have little energy, and they often find it difficult to motivate themselves to do anything. Appetite and interest in food diminishes, and many people lose weight. Aches and pains and a general physical malaise are also very common.

Thinking is affected too. For example, it can be difficult to concentrate, so that it's impossible to follow a TV programme all the way through. Everything seems an effort.

Even short newspaper articles are a struggle, and few depressed people can manage to read novels, even if this is something they used to enjoy. Memory also suffers, so that it's hard (for example) to remember phone numbers, and easy to forget important things at work.

Other, subtler, changes in thinking can be harder to spot. For example, people find that minor setbacks - things they would usually shrug off - seem devastating. Problems in one area generalise, so that they seem to affect every aspect of life.

Severe symptoms
In severe depression, people can feel that they're useless; that their lives are a waste of time; or that they must have been guilty of something terrible. A few people hear voices that aren't really there (hallucinations).

It's very common to feel you can't face the day, to wish you didn't have to wake up in the morning, or even to feel like ending it all. Suicidal thoughts like this are a frightening symptom. Fortunately, most people don't act on them.

Treatment
But there is some good news in all this despondency. Paradoxically, the worse depressive symptoms are, the more likely the sufferer is to get better with treatment. GPs are able to prescribe antidepressants, which aren't addictive, aren't usually sedating, and which begin to work in two to four weeks.

Psychological treatments such as counselling or cognitive behavioural therapy can be very effective, not only in healing depression, but also in preventing the illness from coming back. These 'talking treatments' work well alongside medicine.

Coping with suicidal thoughts
Thinking about suicide is one of the common symptoms of depression. These thoughts are 'the illness speaking': they aren't logical or sensible, and not how you'd usually think.

Thoughts of harming yourself can be hard to get rid of if you're on your own. Try to be with people (even if you're feeling rotten and not saying very much).

Confiding in someone about suicidal thoughts doesn't make it more likely that you'll act on them. If possible, try to let someone know how you feel. "I'm going through a rough patch" can be enough - you don't necessarily need to say more.

Try to distract yourself if the thoughts become too much: go for a walk, listen to music, or watch TV.

Make sure you avoid alcohol or drugs - although they can ease some of the tension, they also make it much more likely that you'll act impulsively, or will not be aware of what you're doing.

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Stress

The most common perception of stress is the 'fight or flight' scenario, and the story goes something like this. A caveman is confronted by an angry mastodon: he either needs to club it to death or run for his life. A quick surge in the 'stress-hormone' adrenaline allows him to act by strengthening his heartbeat, widening his airways and redirecting blood to his muscles.

But there are two problems with this Neanderthal model. First, the riskiest animals our predecessors had to confront were rabbits and deer, not elephants and tigers. In fact, our hairy forefathers spent most of their time collecting berries and roots with their children, aunties and pals. Just like us, the caveman never stood alone in front of wild animals - unless there had been some kind of terrible mistake.

The second error is to try to relate stress solely to adrenaline. Although the physical effects of frights and acute (short-term) stress are caused by adrenaline, this hormone doesn't enter the brain. Longer-term stress relates to a range of other hormones and brain neurotransmitters.

Important brain chemicals affected by stress

* serotonin - involved in regulation of sleep, appetite and mood
* dopamine - part of the brain's 'reward system'
* noradrenaline - involved in regulating energy and drive
* GABA - has a general sedative effect
* glutamate - tends to activate nerve cells
* CRF - increases steroid levels

Steroid levels rise during long-term stress, and it seems likely that it's the body's own natural steroids - not adrenaline - that cause most stress-related health problems. Long-term, increased steroid levels have been linked to impaired immunity and illnesses such as heart disease, cancer and depression.

These chemicals would have affected the caveman just as they do us. Our macho image of 'fight or flight' stress is wrong, because being stressed isn't about a beating heart or a dry mouth. The signs are much more subtle - and they can't be tackled with a club and a spear.

Tips to identify stress symptoms

* constant fatigue and irregular sleep patterns
* poor concentration and short-term memory
* introspection increases and is accompanied by neglect of the family and personal appearance
* constant repetition of the same actions
* increased irritability

But even if you don't recognise the stress-symptoms listed here, don't presume you're fit and well. Everyone's reaction is idiosyncratic, and it can be astonishingly difficult to recognise at the time.

Fortunately, your own pattern of stressed-out behaviours will tend to recur each time you get frazzled. If stress makes you bite your fingernails to the quick (like Samuel Johnson), or gorge on junk food (like Bill Clinton) or drink more than you should (like most of us), it's likely that you'll start doing the same thing again next time.

There are medical treatments that help stress-related conditions such as depression and anxiety, but nothing that's really effective for stress itself. This is quite appropriate - stress isn't an illness, it's an important part of life. Learning to cope with - and even enjoy - stress is the best way. Cavemen, lay down your clubs.

This article was last medically reviewed by Dr Rob Hicks in May 2005.

First published in October 1997.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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Exercise

Why exercise?
Exercise makes your body stronger, fitter and more flexible. It protects your heart and bones, keeps your weight at an ideal level, helps to reduce stress and makes you feel good too. And it reduces the risk of a range of illnesses including diabetes, heart disease and stroke.

Simple steps
A few small changes to your everyday life can make a big difference:

* Get up to change the TV channel instead of using the remote.
* Use the stairs instead of the lift or escalator.
* Get off the bus one stop earlier.
* Walk to buy a paper rather than driving.

Ways to stay fit
It doesn't matter what you do or where you do it - activity on a regular basis is what's important.

Experts recommend that every man gets active for at least 20 to 30 minutes on at least five days of the week. You'll know if you're doing enough because you'll feel yourself breathing a little bit harder and faster, and your pulse will be faster than usual.

It doesn't have to be the gym, either. Walking, cycling, swimming and running, are all simple, accessible and convenient ways to get a daily dose of exercise.

Pick something that you enjoy. If it's going to feel like a chore then you're not going to do it.

Three types of exercise

1. Aerobic (also known as cardiovascular). Used to build up cardiovascular fitness and endurance, and to improve the absorption of oxygen by the lungs and its delivery around the body by the heart and circulation. Running, rowing and cycling are examples of good aerobic exercises.
2. Anaerobic. Used to build up strength. Exercises are performed against resistance, for instance weightlifting.
3. Stretching. Vital for developing the flexibility that protects muscles from injury.

Safe routine

* Always warm up by doing five to ten minutes of light aerobic exercise such as running on the spot.
* Stretch once the muscles are warmed up for about five minutes.
* Perform your chosen exercise.
* Cool down by doing light aerobic exercise again for five to ten minutes and performing a few stretches.
* Drink water to replace any lost during your workout.

This article was last medically reviewed by Dr Rob Hicks in May 2005. First published in October 1997.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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Too busy for sex

Sex in the early days
When you meet someone and fall in love, your whole life revolves around getting to know them better, particularly their body. After a while, however, you realise love won't pay the bills and you settle down to 'normal' life.

This is generally when sex becomes something you do at night in bed - preferably before you fall asleep. But, after a hard day's graft, sometimes there just isn't enough energy left.

Quality not quantity
At this stage, quality becomes more important than quantity. When you're having sex as often as you like, it doesn't really matter if you have the odd unsatisfactory encounter. But if you're only managing it once a week - if you're lucky - you need make the most of it. Which means making sure you're not hanging on to any unrealistic expectations.

Sex and spontaneity
It's a myth that sex is better when it's spontaneous. That holiday you've been looking forward to for the past six months - would it have been more enjoyable without any planning? Not necessarily. In fact, on the contrary, it might have been a disaster. Although a surprise sex session can be fantastic, planning builds anticipation. And anticipation builds arousal.

If you have kids or you work long hours, you'll probably need to schedule in time for sex. This means you can make sure you feel your sexiest by planning what to wear and taking a relaxing bath or shower. You can also spend days teasing each other with what you've got planned for when the time comes.

Taking turns
Another myth is that sex should be entirely mutual at all times. Apparently, you should caress one another at exactly the same moment, fuelling passion in perfect synch. But that's a bit like patting your head and rubbing your stomach. Yes, it's possible, but it means you can't concentrate properly on either activity. How can you focus your attention fully on giving pleasure at the same time as luxuriating in the sensation of being touched? It's not possible. Someone will miss out.

So take it in turns. Enjoy the look on your partner's face as you build them into a frenzy of sexual excitement. Then relax and enjoy when it's your turn. Mutual sex is great for a quick one. But if you have to plan the time together, use it to the full.

Start talking
Some people believe good sex should be instinctive. If you really love your partner, they say, and if you're really in tune with them, you'll know exactly how they like to be touched. Your bodies will writhe in mutual passion without a word being uttered.

For some reason, sex is the one arena where we expect our partners to read our minds. Rather than simply saying a word or two about what we like or don't, we go to extraordinary lengths to give encouragement by groaning and moaning at exactly the right moment. The opportunity for miscommunication with this method is huge.

Rather than gambling with your sexual satisfaction, start talking. You'll find it builds far more intimacy than a silent romantic failure. And it's not just in the midst of an ecstactic encounter that it's good to talk. Next time you realise you haven't had sex for weeks, get your diaries out and make a date. And as the date gets nearer, talk about what you're going to do to each other and how you're going to make sure it's a night (or day) to remember. For more ideas see Make a date

Tips for talking

* Whoever is doing the touching should do most of the talking
* Next time you're caressing your partner, ask for feedback. Would they like it harder or softer? Longer or shorter strokes? Up a bit or down a bit?
* For more ideas, see Bedroom talk

Reasons to make time for sex
Still not convinced it's worth pencilling in a bedroom session? Research shows that regular sex can make you feel and look healthier. When you make love, your body releases substances in the brain that reduce stress and anxiety. It also produces chemicals that create stronger feelings of affection between couples; stimulates growth hormones that reduce fatty tissue and increase lean muscle; and burns off more than 100 calories per hour.

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Becoming a Father

A transformed role
Roles are changing for dads - 30 or 40 years ago it may have been taken for granted that the father was the breadwinner and head of the family. These days there's far less rigid expectations of a dad's responsibilities - couples often work together, both in and outside the home, and share responsibilites for day-to-day parenting issues. But even in the more traditional roles, the introduction of paternity leave and flexible work entitlements has provided greater opportunities for working dads to enjoy family time.

Balancing work and family
Employment has also changed and many parents now work longer hours with less job security, whether or not they’re the main breadwinner. Britons frequently spend more than 40 hours a week at work, exceeding the European average for working hours.

Young children won’t understand the stresses of your working day

The need to manage work pressures and the desire to participate fully in family life can be a difficult juggling act. Young children won’t understand the stresses of your working day. They’ll be eager to see you as soon as you get home and will need your time and attention, whatever you’re day's been like.

The evening routine
Set aside time each night to help with everyday tasks such as homework or getting ready for school the next day. Don’t forget playtime, but do slot it into the routine.

You and your kids may enjoy rough and tumble play, but try to keep it for the start of the evening. Hyping your kids up close to bedtime will not get them in the mood for sleep. Calm activities and bathtime can provide the closeness you and your children need as well as helping prepare them for bedtime.

Active participation
You may feel a little daunted about getting involved in some of your child’s activities outside the home, such as playgroup or the parent-teacher association. There are still more women than men taking part, but this is gradually changing. Do take the plunge and get involved - whether you're a trailblazer setting up your own group or joining other parents your child will benefit by your participation.

Did you know...

* Almost two-thirds of fathers are concerned about the emotional wellbeing and behaviour of their children but most don't get in touch with services to obtain the support they need. A major worry for fathers is the desire to improve family life and communication. (Parentline Plus Report 2004)
* When dads spend time talking with their sons about worries, school work and social lives, their boys grow up with greater confidence and motivation.
* Boys and girls whose fathers are involved in their education when they are age seven have higher educational attainment by age 20. (The Impact of Parental Involvement on Children’s Education, Department for Education and Skills 2003)

Good behaviour
In the past, the stereotype of mum warning, “Wait till your father gets home” showed who was supposed to be responsible for discipline in a family. This way of managing children has given way to a more positive approach to parenting in which the adult present, whether mum or dad, uses warmth, encouragement and praise to get the good behaviour they want and applies any consequences for unwanted behaviour straight away.

Teaching by example
For your children, you’re the most important male role model. They will be watching and copying you to learn how to behave. When they see you behaving in a sensitive and respectful way, they'll copy and understand this is how others should be treated.

Good communication with your partner is needed to ensure each of you supports the other with a consistent approach to your children. Put aside time to discuss what you both consider is wanted and unwanted behaviour, set the ground rules you expect the whole family to follow and agree some rewards and reasonable consequences.

Setting standards for all of you will work best. For example, if your family is trying to develop good eating habits by having meals at the table, problems arise if one adult still has their meal in front of the TV.

Fathers living away
If a relationship breaks up and you end up living apart from your children, maintaining contact can be challenging and at times distressing for both you and them. The majority of children want to continue to see their father and report losing contact as the worst aspect of their parents’ separation.

It's not unusual...
Twenty per cent of all dependent children live apart from their fathers (National Statistics 2003).

To make time with your children successful for all of you, both you and their other parent will need to cooperate and communicate clearly about visits. Make concrete arrangements about when and where you’ll see your children and then stick to these plans. If you're going to be early or late let the other parent know what's happening.

You don’t need to plan expensive trips or gifts. Your children will benefit most from time with you doing everyday activities such as going to the park, doing schoolwork together, visiting the pool or playing at your home. Boredom can be a problem when children are away from their everyday environment. Ask if they can bring one or two favourite toys with them or keep some games for them to make sure they have a variety of things to do.

When picking up or dropping children off, stick to calm discussions about contact. Keep more emotional subjects or disagreements for private conversations between you and you former partner.

Whether you live with your children or not, your warm, supportive relationship promotes your child’s development.

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Snoring

Causes
It's thought to affect four out of ten men and up to three out of ten women. And millions of partners and neighbours suffer sleep-disturbed nights as a result.

The noise of snoring is caused by parts of the nose and throat - in particular, the soft palate - vibrating as you breathe in and out. At night, the muscles that help keep your airways open relax and become floppy. This causes the airways to narrow and vibrate more, making snoring more likely.

There are also a number of factors that can make snoring worse:

* Alcohol or sleeping tablets - these relax the muscles even further.
* Being overweight - this puts pressure on the airways.
* Colds, allergies, nasal polyps, a damaged or crooked nose - can block the nose, causing you to breathe through your mouth.
* Smoking - smokers are twice as likely as non-smokers to snore because their airways get inflamed and blocked.
* Sleeping on your back.

The problems snoring brings
Prods, kicks, and punches from your partner, the threat of divorce and complaints from the neighbors are all common.

You may also be suffering with obstructive sleep apnoea (OSA). In this condition, the relaxed throat muscles block the airway briefly hundreds of times each night stopping you breathing and depriving your body of oxygen. In the short-term this causes tiredness during the day, irritability and restlessness, and puts you at risk of accidents when driving for example. In the long-term it can cause high blood pressure, heart attacks and strokes. Treatment involves wearing a dental splint and using a continuous positive airways pressure (CPAP) machine while you sleep to keep the airways properly ventilated.

To help yourself:

* Avoid drinking alcohol late at night.
* Maintain your ideal weight.
* Raise the head of the bed.
* Sleep on your side. To prevent you rolling on to your back, sew a ball in the back of your pyjama top or wedge a pillow under your back.
* Keep your nasal passages clear by using a humidifier, inhaling steam or rubbing a few drops of eucalyptus or olbas oil on your pillowcase. Antihistamine tablets and/or anti-inflammatory nasal sprays may help. Always check with the pharmacist that they're suitable for you, especially if you're taking other medicines.

Other 'cures' you may want to try include nasal strips, as made popular by footballer Robbie Fowler, devices that re-position the jaw, homeopathic nasal drops and sprays. Try a few to see what works for you.

Surgery
As a last resort, surgery can be used to remove nasal polyps, straighten crooked noses and cut out floppy soft palate tissue to stop it vibrating. Laser surgery stiffens the palate to reduce vibration. Somnoplasty uses radio frequency energy to shrink the floppy soft palate tissue rather than cutting it out.

This article was last medically reviewed by Dr Rob Hicks in December 2005.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.


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Difficulty Ejaculating

What is retarded ejaculation?
Difficulty in ejaculating is known by doctors as retarded ejaculation. Although men who suffer from this problem may be fully sexually aroused during sex and enjoying the stimulation, orgasm seems to take for ever and may not happen at all.

Retarded ejaculation (RE) can be a very distressing condition. Sufferers can feel embarrassed, isolated, confused and very frustrated.

Partners often blame themselves and feel inadequate, which puts even more pressure on the sufferer to perform and compounds the problem further.

Some men may have suffered from the condition all their life, in all sexual situations. Some will have no problem when masturbating alone, but tense up completely with a partner. Others may only have the problem during intercourse.

Retrograde ejaculation
Some men suffer from retrograde ejaculation, which is very different from retarded ejaculation. If you experience the sensation of orgasm but don't ejaculate, you're probably suffering from this. Instead of the semen being expelled, it's forced backwards into the bladder. Sufferers will sometimes notice that their urine is cloudy after orgasm. This condition is often a result of spinal injury, diabetes, neurological diseases or prostate surgery. It's important to seek treatment, as retrograde ejaculation can cause infertility if left untreated.

Physical causes
If you suffer from retarded ejaculation when you're masturbating as well as with a partner, then the cause may be physical. Check with your GP if you think any of these may apply to you:

* diabetes
* nerve damage
* prostate disease
* alcohol abuse
* prescription drugs such as betablockers or antidepressants

Change your habits
If you've always masturbated in exactly the same way, with exactly the same stroke and exactly the same pressure, your body may not know how to respond to anything different. Intercourse or a new partner is going to feel different. Try expanding your masturbatory repertoire. Gradually you should notice your body's increased sensitivity to a variety of touch.

Psychological blocks
The most common causes of RE are psychological. For some reason or another, your mind is blocking out the physical sensations and stopping ejaculation. Your body is telling you that you're ready - you have an erection to prove it - but your head may be trying to tell you something else. Possible psychological reasons include:

* You're a perfectionist. Sex is a performance and you must make it perfect for your partner. Sex has become all work and no play.
* You're scared to lose control. This may be a character trait in many areas of your life, not just sexually.
* You're worried that you're not a good lover. You can't enjoy your physical sensations if you're worrying about your sexual prowess and ability to please your partner.
* Deep down, you believe sex is wrong. Shame or guilt about sexuality due to negative childhood messages or a sexual trauma will prevent your enjoyment.
* You're distracted. Concerns about work or other tasks mean your mind's not on the job.
* You're spectating. Concentrate on the physical sensations of love making - slip-off into your favourite fantasy. This will free you from feeling too conscious of reaching a climax.
* You're unhappy. If you're feeling angry or insecure with your partner, you may struggle to feel relaxed enough to enjoy yourself. Try to sort out relationship tensions before you get to the bedroom.

Self-help tips and exercises
For ways to put these tips into action, see the section on practical exercises.

* Make sure you're feeling relaxed. Try breathing exercises or buy a relaxation tape.
* Enjoy being sensual first, taking time to focus on pleasurable sensations.
* Escape into your favourite fantasy to block out any negative thoughts or distractions.
* Try different positions to maximise stimulation.
* Strengthen your pelvic floor muscles.

More help
If some of these points have rung a bell for you, you may find that simply talking it through with your partner will help. Or you may both decide to try the support and guidance of a psychosexual therapist.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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Prostate Cancer

The prostate is a male sex gland which produces a thick fluid that forms part of the semen. It is about the size of a walnut and is located below the bladder and in front of the rectum.

Mens Health Issues prostate cancer treatment Causes
The causes of prostate cancer are not fully understood yet, but it appears to be associated with a high fat, high meat, low-vegetable diet.

Men with a strong family history of prostate cancer are at greater risk of developing the disease.

Ethnic origin also seems to play a role. Afro-Caribbean or African-American men are more likely to develop the disease than Asian men, for example.

Prevention approaches
A healthy, low-fat diet seems to help prevent this condition. Eat at least five portions of fruit and vegetables a day, including plenty of tomatoes, and reduce your consumption of red and processed meat.

Drink alcohol in moderation, no more than three to four units a day. One unit is half a pint of ordinary strength beer or lager OR a glass of wine OR a pub measure of spirit.

Symptoms
In its early stages, prostate cancer often doesn't cause symptoms, but when they do occur, they may include any of the following problems:

* difficulty or delay in urinating
* stopping and starting urinating
* a weak stream of urine
* urinating more often than usual
* pain while urinating
* blood in the urine
* pain or stiffness in the lower back, pelvis and hips

Diagnosis and treatment
If diagnosed early, treatment can be quite successful, therefore it's important to be aware of the symptoms and go to your GP as early as possible.

Your GP will examine you and arrange for any blood tests (a prostate specific antigen or PSA test), x-rays and rectal examinations that may be necessary. If you're referred to a specialist then they may arrange for you to have a biopsy of the prostate and this should indicate whether the tumour is aggressive or not. These results will influence the types of treatment available to you.

Treatment depends on a number of factors, primarily whether the cancer is contained within the prostate (localised) or has spread around the body (advanced). Localised disease, where the cancer is small and contained is generally managed by observation ('watchful waiting'), surgery (radical prostatectomy where the prostate is removed) or radiotherapy.

Advanced disease is where the tumour is large or has spread and is often treated using hormone therapy (reducing the amount of testosterone in the body to slow down or stop the growth of the cancer cells).

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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Testicular Cancer

The testes are a man's sperm production factories. On average about 300 million sperm are produced by the testes every day. They also produce the male sex hormone testosterone that is responsible for a man's physical characteristics.

Testicular cancer is the most common cancer that affects young men between the ages of 19 and 44. Most importantly, detected early enough it's almost always curable - with the majority of men who have treatment making a full recovery. So why are men still dying from it every year?

Causes
It's not known why testicular cancer occurs or why one man is more likely to get it than another. It may be hereditary. If you have a close male relative with testicular cancer then you could be ten times more likely to develop it.

Men who had an undescended or partly descended testicle are five times more likely to develop testicular cancer.

Examine them monthly
After a warm bath or shower look out for:

* testicle swelling
* a pea-sized hard lump on the testicle
* a dull ache
* a sharp pain felt around the testicle or in the scrotum

If something doesn't feel right - get it checked out - don't ignore it.

Prevention approaches
Some research suggests that regular exercise may prevent testicular cancer from developing. Certainly if a boy with an undescended testicle has it corrected before the age of ten then his risk drops back down to the average risk a man has of developing testicular cancer which is about one in 450.

However, since little is known and understood about why testicular cancer develops the emphasis focuses on being more aware and examining the testicles regularly. Then, if cancer does develop it can be detected and treated early on.

Ideally self-examination is done every month. First of all, get used to what your testicles feel like normally by getting to know them. If you're not sure what they're supposed to feel like then ask your doctor to show you.

Self-examination is best done after a bath or shower when the scrotum is relaxed. It's no good examining them when you have an erection because the scrotal sac is too tight preventing you from feeling the testes properly.

Holding your scrotum in the palms of the hands, use your fingers and thumbs to examine the shape, size, consistency and smoothness of the testes. It's not unusual for one testicle to be larger than the other or for one to hang lower than the other.

Why don't men check themselves?
Some say they're embarrassed, some are frightened of finding anything wrong. Others remember sporting days where any testicular contact was associated with excruciating pain and believe quite wrongly that self-examination will be painful.

Some men leave it to their partners to take the responsibility. Often it's a woman who discovers the problem and sends her man to the doctor! Many men say they're not sure how to examine themselves or what to look out for.

If something doesn't feel right then get it checked out by your doctor, don't ignore it.

Bob Champion won the Grand National, and Lance Armstrong won the Tour de France, both after having suffered with the disease - and they didn't let it stop them achieving success after they were diagnosed.

Symptoms

* a painless lump or swelling in either testicle
* enlargement of the testicle
* a feeling of heaviness in the scrotum
* a dull ache in the scrotum or the groin
* pain or discomfort in the testicle or scrotum
* a sudden collection of fluid in the scrotum

If you notice any of these, or if you're worried and just want some reassurance that everything is all right, then ask your doctor to check you. Don't ignore any changes or concerns.

Diagnosis and treatment
To diagnose testicular cancer your GP will examine your testicles and feel for any lumps or swellings. Your GP may need to refer you to the hospital for treatment and will arrange for an ultrasound scan which will show any changes in structure in the testicles.

If you're referred to a specialist, they may arrange for you to have an orchidectomy (removal of the testicle). The testicle is then sent to the laboratory for tissue testing. If the tumour is low grade then a surveillance policy may be adopted. If the tumour is more advanced then chemotherapy or occasionally radiotherapy may be used.

A prosthetic testicle replaces the one removed to ensure that the scrotum appears normal. Having a testicle removed shouldn't affect a man's sex life or his chances of becoming a father.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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Confidence - MensHealthOnly.com

Confidence

1). Confidence at Work:
Where previously you were quite relaxed and focused, you now tense up and question your ability. Your energy is going by the second. This certain person chatters on at you about something, not listening to your responses, while only seeking to talk about their issues and how you can help them. You stammer some feeble responses by way of reply, feeling your strength ebb away until you find an excuse to leave.

Sitting in the toilet cubicle a few minutes later, you reflect on what has just happened. Why does this person have such an impact on you and how can you overcome it so that work ceases to be a place of torture?

What you can do?

One solution is look at things from a military-style perspective - when you want to make a change to an environment or situation you can do it in two ways: infection or explosion. There are several practical things that you can do.

Explosion is radical and immediate - there are usually casualties and fall-out. Infection is about making slow, positive change - influencing others by your positive example. Its effects are more lasting and often more beneficial.

At work we usually wait until we've had enough of a particular situation and explode, leaving a lot of bad feeling and damage. If we can begin to infect our environment in a positive way on a daily basis, the changes will be lasting, less damaging and sustainable.

To start infecting your environment

Move around as though you're confident - and this goes for standing and sitting also. You'll feel confident as a result - it's that simple, but our minds can get in the way. Ignore your mind for a while. We are psycho-physical beings. If we change our physical behaviour we change our mindset; if we change our mindset we can change our behaviour.

Learn to listen. Nod and smile, question and encourage. Try to actually find out if this energy-taking person you find so hard to deal with has something to say - you might be pleasantly surprised. Also, if you give an example of how to do something well, others may be encouraged to follow your example.

When we find ourselves in a work environment that is predominantly and increasingly one of 'positive infection', this will lead to a general mood of confidence. Individual and group performance, and therefore productivity, will all improve.

In short, a confident company is a successful company. And companies are made up of every person that works there - so everybody's confidence is important to the work environment. Our work space is a constant bombardment of influences, both positive and negative from the physical environment, the people in it and our own self-confidence.

Be aware of this and remember that it's your responsibility to develop your confidence at work, otherwise you run the risk of becoming the energy-draining 'life taker' that forces people to flee to the nearest exit when you pass by.

2). Confidence and body imageIn western societies the media is full of pictures of 'ideal bodies'. The 'perfect' male is handsome, tall and muscular and their 'perfect' female equivalent is beautiful, firm and seemingly impossibly thin - often with disproportionately large breasts. These 'perfect' people are seen to have happiness, wealth and partners. The subliminal message is 'be like this and you can have these things too'. This is what creates the pressure in most people - aspiring to these idealised body images. We want these things and we think this is the way to get them. This pressure affects a lot of men and women and, increasingly, boys and girls.

A whole host of studies have shown most men want to be 'beefier' and most women want to be slimmer. An alarming amount of young people think they're too fat, go on diets and skip meals.

You're more than your image

Many people ignore the fact that the idealised body images that surround them are just that - idealised - and actually unattainable for most of us. This means they find themselves on a relentless pursuit of the elusive perfect figure - which just leaves them chronically dissatisfied with their appearance. This can lead to poor self-esteem and a lack of confidence.

It helps to put the whole issue into perspective, remembering you're not alone. The vast majority of people don't have (and won't ever have) these perfect bodies either, but what does that really mean? The truth is that it doesn't actually mean you can't have the positive things we associate with these images. This is a fallacy that started in Hollywood - and it should remain there.

The biggest myth is you can't be considered physically attractive without fitting into this mould. There are many ways to be attractive beyond the stereotype. It's certainly not always the best looking person that gets the girl or guy. Most of us are much more likely to talk and get to know somebody who is friendly and approachable rather than a more physically attractive self-centred person. Our personality and behaviour count for a lot. We need to accept ourselves for who we are and what we're meant to look like. Our aim should be to be the best and healthiest we can - we need to realise that this is the 'perfect' us. Value yourselfRecognise your attributes and make the most of them rather than dwelling on imperfections. By all means eat sensibly and exercise to have a healthy body - but also have a healthy mind. Your attitude towards yourself makes a big difference. Lack of confidence in your appearance can lead you to behave in defensive ways that appear unfriendly and aloof, and this behaviour is likely to put people off rather than your appearance.

Believing in yourself and feeling good about the way you look will help to automatically send off more positive signals about the person you really are. So don't waste any more time trying to be a second class somebody else and get on with being a first class you!

3). Family

Generally we accept the status quo, but these expectations can be hard to handle when they come from our families - especially our parents. Family expectations can be very difficult to ignore and tend to have a big influence on us regardless of whether they're positive or negative.

Positive expectations

Positive expectations may be meant to spur us on, but often they can just lead to a chronic sense of not quite making the mark - or not quite ever being good enough. At worst some people are left with a permanent sense of failure.

Negative expectations

Negative expectations on the other hand may be intended as a form of reverse psychology: "You can't do it" usually triggers the reaction "Oh yes I will". The logic of this supposedly being that you'll be motivated to do something you are told you can't do.

The flaw and danger in this approach is that, despite good intentions, the recipient is left feeling undermined and insecure. Every time something goes wrong in their life it can seem to be a confirmation of all the negative predictions that were made about them. Rather than trying to prove their families wrong, they can sometimes just give up and accept what they have been made to believe is their fate - no job, no partner, no prospects and probably prison.

What can you do?

Whether positive or negative, ultimately the problem with family expectations is that they put you under pressure and you don't feel free to just be yourself. Not being able to relax and be natural will affect your relationship with your family and can lead to resentment and other problems.

If you're not really bothered about the family myths about who you are, and your parents' lingering aspirations for you don't bother you then the best thing to do is nothing. Just accept that your family haven't yet totally figured you out or completely adapted to the adult version of you, and let it go.

But if you feel that you can't just ignore it, then there are a number of things you can do. The first step often is to try to have a greater understanding of just what their expectations are about.

Family expectations often say more about the family member who holds them than the person they're directed at. Maybe the family member wants you to be better than they are, or maybe not like them at all. They could be trying to live through you - wanting you to achieve what they felt they couldn't.

Talk to them about it and let them know how they make you feel. Tell them about the effect it has on your life. Avoid being confrontational, which rarely is successful; be honest and straightforward instead. If you don't talk about it, you can never really be sure they know.

The other important thing is to let them see the real you. Families often don't see the real us, because we don't let them. Don't collude with their expectations and pretend to be a different person at home - be yourself. Wear the clothes you would going out, smoke, drink, laugh loudly - do what you do. You may well feel a bit uncomfortable at first but in the end you'll be more relaxed and enjoy their company far more. Taking your family into your world make this easier to do. Go down to your local or have a dinner party with your friends and them. I can feel some of you gasping at the very suggestion - try it first and then reject it, you never know it might just be OK.

But remember, this is a two-way process; if you want your family to see the real you, then make an effort to see the real them. You no doubt have expectations of them which could also do with a review.

All content within MensHealthOnly.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. MensHealthOnly.com is not responsible or liable for any diagnosis made by a user based on the content of MensHealthOnly.com website.

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