Hi all-
Lots of influenza questions streaming in with all the media reports about the H1N1 vaccine. Here's a specific question, and I'll answer everyone else's questions as well:
"As an HIV positive man how concerned should I be about H1N1, recognizing it's symptoms, and are there
vaccinations available?"
Dr. Vy Chu responds:
All of our HIV positive patients should be concerned about H1N1 - and the "regular" seasonal flu as well. All types of influenza can cause greatly increased severity of symptoms in HIV positive patients, relative to HIV negative patients, despite a good CD4 count and an undetectable viral load.
It's for that reason that we recommend that our HIV patients receive two different flu shots this season - one for H1N1 influenza (previously known as "Swine flu"), and one for regular seasonal flu.
For our HIV negative patients, it's always a good idea to get vaccinated for seasonal flu every year. This year, there's good reason to want to get the Swine flu vaccine as well, since it seems to be targeting the "young and healthy" unusually well. Typically, influenza viruses hit the very young and the very old really hard, and spare the 18-35 age group. Not so with Swine flu. It's hitting this age group particularly hard worldwide.
For either vaccine, recommendations on who should get one really boils down to a matter of supply. When the country has plenty of vaccine, everyone should get the vaccination. The purpose of this is to prevent our frail and vulnerable patients from catching the flu from young healthy people by giving the vaccine to everyone.
For Swine Flu, because we are expecting to have enough vaccine for everyone who wants one, we are recommending that EVERYONE receive this vaccine.
Wednesday, September 16, 2009
Tuesday, September 8, 2009
A question of size...
Hi Readers -
Here's an interesting question that has been asked of this blog in a variety of ways. We're not urologists, but I will take a stab at answering this one:
"Serious question: What do I need to do in order to increase the amount of semen I ejaculate? The amount I ejaculate now is ridiculously small.... just a drop, if anything.... "
DR VY CHU RESPONDS:
Let me start by discussing what is considered "normal" for semen. The average load volume is somewhere between 2mL and 5mL. Two mLs probably doesn't seem like a lot, but it's at the low end of normal. Five mLs, for what it's worth, probably doesn't seem like a lot either when you compare it to what you may see in porn. Before you even attempt to want to compare yourself to those guys, just remember, those porn stars are chosen for a reason, including load size. Same applies to the stuff you see on sites like xtube. Those clips are posted for a reason. Someone was proud of what they did and wanted to show off a bit.
Having said that, there are ways you can increase the amount that you ejaculate. We know that the longer you wait between cumming, the larger the volume tends to be. Also, the longer you spend on stimulation, the foreplay, we know that both the volume of ejaculate and the force will be increased. You may have already noticed this already.
It probably helps to be well-hydrated as well.
Beyond that, there is nothing else - no herb, no supplement, no bottles of bills as seen on TV or purchased online that will reliably and consistently increase your load volume.
So, bottom line: don't think too much about it, enjoy the journey to orgasm by prolonging it, and you'll likely be happy with the result.
Vy
Here's an interesting question that has been asked of this blog in a variety of ways. We're not urologists, but I will take a stab at answering this one:
"Serious question: What do I need to do in order to increase the amount of semen I ejaculate? The amount I ejaculate now is ridiculously small.... just a drop, if anything.... "
DR VY CHU RESPONDS:
Let me start by discussing what is considered "normal" for semen. The average load volume is somewhere between 2mL and 5mL. Two mLs probably doesn't seem like a lot, but it's at the low end of normal. Five mLs, for what it's worth, probably doesn't seem like a lot either when you compare it to what you may see in porn. Before you even attempt to want to compare yourself to those guys, just remember, those porn stars are chosen for a reason, including load size. Same applies to the stuff you see on sites like xtube. Those clips are posted for a reason. Someone was proud of what they did and wanted to show off a bit.
Having said that, there are ways you can increase the amount that you ejaculate. We know that the longer you wait between cumming, the larger the volume tends to be. Also, the longer you spend on stimulation, the foreplay, we know that both the volume of ejaculate and the force will be increased. You may have already noticed this already.
It probably helps to be well-hydrated as well.
Beyond that, there is nothing else - no herb, no supplement, no bottles of bills as seen on TV or purchased online that will reliably and consistently increase your load volume.
So, bottom line: don't think too much about it, enjoy the journey to orgasm by prolonging it, and you'll likely be happy with the result.
Vy
Why doesn't my doctor examine me more thoroughly than at other times?
Hi all-
There have been a few questions on the variability of physical exams during routine visits, i.e., why does my doctor examine me for thirty seconds during one visit and for ten minutes at another? Here's one I've chosen at random. I'll do my best to address the other questions in my answer. I apologize in advance for the length of my response...
"The question about how thorough a physical should be prompts me to ask a similar question: I see my current doctor about every 3-4 months and he NEVER examines me in any way. We just discuss my latest blood test results and whether to change my HIV meds or not.
This is at one of the large Seattle hospitals, so I know they're pretty tight on their time. But when we're done discussing the test results and I want to talk about something physical that might be bothering me, we're always out of time and he says "Oh, that's normal..." to whatever I'm trying to discuss.
Generally I'm doing fine after 22 years of HIV+. My viral load has never been undetectable, but stable in the 2000 range for many, many years.
Should I be expecting more from my doctor than just a complete hands-off approach? I've been seeing him for about 3 years. He's only seen me with my shirt off once."
DR. VY CHU RESPONDS:
I think you're right to expect more of an examination during your visit. The care of those living with HIV has improved dramatically with new versions or classes of medications that are far more tolerable than those used ten or even five years ago. However, good care still requires vigilance.
A good visit for HIV care should include a review of any symptoms you may have experienced or concerns you may have developed since your last visit, a review of your labs, your medications, and a quick but thorough physical, which can be surprisingly brief! A quick look in your mouth, a scan of the skin of your limbs, palms, torso, back, a few presses on lymph nodes, a listen to your lungs and your heart, and a press on the belly can be done in a matter of one to two minutes, and doesn't require disrobing (maybe just the lift of the shirt).
All of us HIV providers will get lulled into a sense of security with patients who are so stable such as yourself. Especially those of us who have packed schedules. And absolutely with patients with whom we are very familiar. You've developed a level of trust with us, but we have developed the same trust with you. If you say "I've been completely fine the last three months, healthy as an ox, I've never felt better," you can understand how a harried provider might skip the exam. We won't always have the time or feel it necessary to do an examination (this may vary with experience), but ideally we would perform one.
For those who undergo yearly annual exams who notice a variance in the length and breadth of the physical exam portion, the same applies (however, I would absolutely expect an examination during an annual physical). Whether this takes a few minutes or ten may depend on the practice patterns of the provider, any concurrent complains you may have, and your age. Some of us are indeed more thorough than others, but there is even a variance between all of us who are doing the same things. It's true that we are relying more and more, for better or worse, on blood tests for annual screening. It seems that every few weeks, an editorial will appear in a major journal written by a seasoned physician lamenting the diminishing physical exam. There are many reasons why the physical exam seems to be shrinking: improved reliability of lab tests, less time for patient visits because of increased productivity demands on primary care providers, the list goes on. In the end, my advice to a patient with this concern remains the same.
Be your own advocate. If you feel you would be better served by having a more thorough exam during your visit, know that it's okay to ask. Don't worry that you may embarrass your provider, or cause them to think you are second guessing them. That shouldn't be your concern. A good provider who may feel any of those feelings will have them outweighed by the relief of a clear exam.
I hope that helps.
Vy Chu, MD
Rob Killian MD also responds:
If you are not getting what you expect or need from your doctor please be brave enough to ask for an explanation. Come prepared to your visits. Have your questions written down. Also remember that all physicians have differing styles and personalities but in most cases seek to do what is best for their patients. Most physicians cannot read your minds and none that I know of want to be rigid or arrogant in their care.
There have been a few questions on the variability of physical exams during routine visits, i.e., why does my doctor examine me for thirty seconds during one visit and for ten minutes at another? Here's one I've chosen at random. I'll do my best to address the other questions in my answer. I apologize in advance for the length of my response...
"The question about how thorough a physical should be prompts me to ask a similar question: I see my current doctor about every 3-4 months and he NEVER examines me in any way. We just discuss my latest blood test results and whether to change my HIV meds or not.
This is at one of the large Seattle hospitals, so I know they're pretty tight on their time. But when we're done discussing the test results and I want to talk about something physical that might be bothering me, we're always out of time and he says "Oh, that's normal..." to whatever I'm trying to discuss.
Generally I'm doing fine after 22 years of HIV+. My viral load has never been undetectable, but stable in the 2000 range for many, many years.
Should I be expecting more from my doctor than just a complete hands-off approach? I've been seeing him for about 3 years. He's only seen me with my shirt off once."
DR. VY CHU RESPONDS:
I think you're right to expect more of an examination during your visit. The care of those living with HIV has improved dramatically with new versions or classes of medications that are far more tolerable than those used ten or even five years ago. However, good care still requires vigilance.
A good visit for HIV care should include a review of any symptoms you may have experienced or concerns you may have developed since your last visit, a review of your labs, your medications, and a quick but thorough physical, which can be surprisingly brief! A quick look in your mouth, a scan of the skin of your limbs, palms, torso, back, a few presses on lymph nodes, a listen to your lungs and your heart, and a press on the belly can be done in a matter of one to two minutes, and doesn't require disrobing (maybe just the lift of the shirt).
All of us HIV providers will get lulled into a sense of security with patients who are so stable such as yourself. Especially those of us who have packed schedules. And absolutely with patients with whom we are very familiar. You've developed a level of trust with us, but we have developed the same trust with you. If you say "I've been completely fine the last three months, healthy as an ox, I've never felt better," you can understand how a harried provider might skip the exam. We won't always have the time or feel it necessary to do an examination (this may vary with experience), but ideally we would perform one.
For those who undergo yearly annual exams who notice a variance in the length and breadth of the physical exam portion, the same applies (however, I would absolutely expect an examination during an annual physical). Whether this takes a few minutes or ten may depend on the practice patterns of the provider, any concurrent complains you may have, and your age. Some of us are indeed more thorough than others, but there is even a variance between all of us who are doing the same things. It's true that we are relying more and more, for better or worse, on blood tests for annual screening. It seems that every few weeks, an editorial will appear in a major journal written by a seasoned physician lamenting the diminishing physical exam. There are many reasons why the physical exam seems to be shrinking: improved reliability of lab tests, less time for patient visits because of increased productivity demands on primary care providers, the list goes on. In the end, my advice to a patient with this concern remains the same.
Be your own advocate. If you feel you would be better served by having a more thorough exam during your visit, know that it's okay to ask. Don't worry that you may embarrass your provider, or cause them to think you are second guessing them. That shouldn't be your concern. A good provider who may feel any of those feelings will have them outweighed by the relief of a clear exam.
I hope that helps.
Vy Chu, MD
Rob Killian MD also responds:
If you are not getting what you expect or need from your doctor please be brave enough to ask for an explanation. Come prepared to your visits. Have your questions written down. Also remember that all physicians have differing styles and personalities but in most cases seek to do what is best for their patients. Most physicians cannot read your minds and none that I know of want to be rigid or arrogant in their care.
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