The Vibrant Life Podcast

Dr. Clark explains why we need to understand menopause as a public health issue. http://drbrittain.com/

Dr. Clark discusses matters of intimacy during a live lecture and answers questions. http://drbrittain.com/

Dr. Clark explains the O-Shot and O-Wave procedures and interviews a patient who regained sexual function and bladder control. http://drbrittain.com/

Dr. Clark Brittain is back with another successful patient story (in her own words) and discusses procedures including the O-Shot and CO2 laser therapy to restore (or improve) sexual function and bring the intimacy back in your marriage. http://drbrittain.com/

Dr. Clark is back to discuss treatment of the Lichen Sclerosus condition using PRP injections. http://drbrittain.com/

Dr. Clark Brittain shares the advice you need about PRP (platelet rich plasma) and the Priapus Shot, which improves sexual wellness in men.

Hello, this is Dr. Clark Brittain of Bloomington, Indiana. I'm a board-certified gynecologist, and I have a very interesting patient interview to share with you today. A little background information first. I was a board-certified family doctor in a little town on the prairie for 10 years, joined the military to do an OB residency, and I've been a practicing OB/GYN doctor, board certified since 1998. I have for about the last 10 years focused on the care of the mature woman, and for the last year and a half or two years have refined that to additional care for intimate wellness. I have found over the years that as we age, there are things that just don't work as well as they used to that we really want to be able to maintain. We want to be able to think. We want to be able to be physically active, and many of wish to maintain sexual intimacy. Well, the patient that I am going to have you listen in on recently received an O-shot. She received an O-shot in September, and I interviewed her in February. The O-Shot is a very interesting procedure where we take your own blood, spin it down, separate the plasma and the red blood cells, activate the plasma, and then insert it back into your own body. Now, think about this, and I want to credit Dr. Charles Runels of Fairhope, Alabama for inventing this procedure. If you get a cut and let's say it bleeds a little bit and it coagulates, a scab forms, and then that tissue disruption gets healed and it bridges across. Well, that happens because of the regenerative properties of the plasma cells that are circulating in your blood, and it allows those tissues to heal. Well, you can take those same plasma cells, concentrate them, activate them with some calcium chloride, and then inject them into critical tissues. This has been done in Orthopedics a lot and other areas, but no one had thought to use this in gynecological procedures until Dr. Runels came along to show how this could be used gynecologically. Well, what we know from the female anatomy is that with aging anatomy, a lot of women will find that they have diminished sensation for sexual pleasure. They find that they have problems with bladder leakage, dryness, and the O-shot infuses these regenerative cells back into the body. After getting the tissues completely numbed up, we use a really skinny needle and numb up the tissues as mentioned, and we infuse the enhanced platelet-rich plasma into the clitoris and underneath the urethra between the urethra and the wall of the vagina, and we find that this helps a lot of things. I'm going to let this patient in this interview tell you kind of what has happened with her, and then we'll have a little bit to talk about after the interview. Thank you very much. I hope you enjoy it. Dr. Clark: Good morning. How are you doing? Patient: I'm great. How are you? Dr. Clark: So how did this, thank you, how did this process work for you? You had an O-Shot in September, right? Patient: Yes. Dr. Clark: What was that like? Patient: It was a very easy experience. I did some research and I was enticed by the fact that it was not a drug or something different that I was putting into my body. Dr. Clark: Sure. Patient: I thought it was great. The research that had been done and the reviews, everybody seemed pleased. Anytime you can use something of your own to make it better, I think is a great thing. Dr. Clark: Wonderful. So can you tell us kind of what you were experiencing that led you to want to get this done? Patient: I've always had a difficulty reaching a climax. And then also after having my daughter, I had incontinence, a little bit if I sneezed or coughed or laugh too hard. So that was concerning too, so those were my reasons. Dr. Clark: Right. I think we did the O-Shot maybe in September, was that? Patient: Mm-hmm (affirmative). Yes. Dr. Clark: Was there any negative effect from it that you noticed? Patient: No, not at all. The first day I was a little swollen, tender but the next day I was fine. I went back to work when I left here, after having the procedure. Dr. Clark: Cool. Patient: It was very simple. Dr. Clark: Okay. Fast forward to today, on a scale of one to 10, let's say pick a number that you were feeling if where 10 is the maximum that you'd want to feel and one is the least you'd want to feel. What were you in September? Patient: Probably a three. Dr. Clark: And now? Patient: An eight. Dr. Clark: Wow. Cool beans. Patient: Yeah. Dr. Clark: So what do you notice now? Patient: More sensitivity. I feel like I have more control I guess you could say. Dr. Clark: Of your bladder? Patient: Yes. Dr. Clark: Wonderful. Patient: Yeah. My biggest thing is sensitivity and control. Dr. Clark: Yeah. So now what about sexual satisfaction? Patient: Yes, definitely better. Faster, happens faster. Dr. Clark: Is it too fast? Patient: No, no. Dr. Clark: I had a patient the other day, said, "Doctor, this worked great but it's happening too fast now." Patient: Oh, yeah, no, not too fast. No, it definitely is a benefit. Yeah Dr. Clark: Yeah. Good. So now, we talked about this a little bit while we're waiting for Erica to come in. There's a process where all these healing agents that are in the plasma that you received back into your body work over a little bit of time that tends to build up, build up, build up for about three to four months to get to your peak effect. This can last a long time. You may need to do this again in a year or two. It's variable but among the things that are real important to maintain good hormone balance, so I'm not sure how much we talked about that, but we'll come back to that a little bit. And then we have patients that want to get two or three injections of PRP with the O-Shot over a shorter period of time just to get things built up a little bit more. But it sounds like you've got a pretty good effect. Patient: Mm-hmm (affirmative). Yes. Dr. Clark: Yeah. Good. So you're satisfied? Patient: Yes. Dr. Clark: Congratulations. Patient: Thank you. Dr. Clark: Well, thank you for letting us interview you. Patient: Yeah. Well, now that you've heard from a real life patient, I'd like to discuss the O-Shot, this patient and you're potential opportunity to participate in the wonders of the O-Shot experience that might change your life. This patient is a middle aged woman who's become menopausal. She had a couple of kids with vaginal delivery, and she noticed that over time she was losing control of her bladder, in part because of the aging process and in part because of the tensional forces that happened with a vaginal delivery. She was beginning to lose some sensation with stimulation of the clitoris during sexual experience. Now, this happens to a lot of women over the aging process, and some more than others. Some of it's in part related to hormonal decline, and some of it just part of the aging process. The PRP injection that she experienced is a remarkable utilization of a process has been in use in medicine for a long time. PRP stands for platelet rich plasma. We take blood and put it in a special FDA approved vacuum cleaner, spin it down in a special FDA approved centrifuge, and separate the serum from the red blood cells, activate that plasma or serum with some calcium chloride, and then it put it back in the body. This has been used in orthopedics for a long time to help improve injured tendons and ligaments, and about eight years ago, a remarkable physician from Alabama named Charles Runels discovered that this could actually be used in the female genital system as well as the male genital system to improve bladder control and sexual satisfaction. Dr. Runels was a real pioneer and still is a real pioneer, and he has used this in hundreds of patients and has trained hundreds of physicians and practitioners to utilize this procedure as well. I think that it's to his great credit that he has not selfishly kept this procedure to himself. I have taken both his online training courses and his hands on training courses in order to be able to provide this procedure for my patients, and many patients have benefited from this. In particular, this patient had improved of sensation and bladder control from a three out of ten to an eight out of ten. She's just absolutely thrilled. We did her O-Shot in September, and interviewed her at the beginning of February. This is a pretty common interval of maximum improvement that happens with the infusion of these PRP injections. The PRP a serum contains a number of cells and healing agents that are existing in all of us. Imagine if you would, you suffer a small laceration. That laceration bleeds, the bleeding stops scab, if you will, forms and the scabs sloughs off and those wounded edges heal back together. That's because they're all of these regenerative cells and platelets live in, in your natural circulation, so the platelets and these agents seek to let your blood coagulate in an appropriate manner, a scab to form, and then these tissues to heal. What the the PRP seeks to do is to concentrate these same healing agents in a small package of fluid, which is your plasma, and then we reintroduce that into your body. Those same processes are in play depending on where they're put in your body. In orthopedic cases, that might go in your knee, or it might go in your hip. In the female reproductive system, this might include the clitoris or the space between the wall of the and the urethra for bladder control and sexual sensation. It's also used for inflammatory processes such as interstitial cystitis and the overactive bladder. In this particular patient, she started to notice relief right away, and this achieved its maximum benefit over the course of several months. This may last forever. It may need a boost after many more months or a year or two. It depends in part as to her natural aging processes or physical activity, her hormonal status, but it's not uncommon, particularly in women after having a child birth naturally and the aging process, that the tissues become distorted a little bit because of strain intention in the vaginal canal with a vaginal delivery, and a decline in hormone production over time that diminishes the effect of the hormones on tissues and allows them to age faster than they would if hormone levels were maintained and these regenerative cells were maintained. You can find out more about this process if you would like by looking at our website, www.doctorbritain.com. You can visit our web page, Vibrant Life, on Facebook. You can call our office at 812-331-9160, and we'd love to hear from you. You might want to make an appointment or just call and get more information. Again, it's doctorbrittain.com. Vibrant Life on Facebook, and 812-331-9160 for our office number. We'd love to hear from you. Thank you for listening.

Dr. Brittain: Good afternoon. This is Dr. Brittain. I want to share with you a personal story here about a patient that I saw in my office today. This is a woman who comes in who is interested in hormone replacement therapy. As you might know, women tend to lose their hormone production as they go through menopause around the age of 50, or sooner if they are surgical and have had their uterus removed. There could be some gradual or rather abrupt changes that occur because of the decline in hormone production. In menopause, women lose about 90% of their estrogen production. Estrogen helps with hot flashes, night sweats, concentration, memory, mood, vaginal lubrication, skin texture, joint lubrication. Women also lose a large percentage of their testosterone production, which happens mostly in the ovaries. Testosterone helps with strength, endurance, muscle mass, mental clarity, sexual desire. Progesterone levels decline dramatically during menopause. Progesterone helps with mood and has a calming effect and really works along with estrogen to help women sleep a lot better. This is really important because I don't know if you're aware of this, you can live 30 days without food, about seven days without water, but only five days without sleep, so in some respects sleep is more important than food and water, and we tend to neglect this as a health issue. I'm going to now present our patient, Mrs. Johnson, that's not her real name, and this is a real interview prior to examination in my office. Dr. Brittain: Hi there, Mrs. Johnson. How you doing? Mrs. Johnson: Just fine, thank you. Dr. Brittain: Well, welcome to our practice. I'm Dr. Brittain. Erica here is going to take some notes for us. How can I help you today? Mrs. Johnson: Well, I came in looking for some answers for hormone replacement I believe. Dr. Brittain: Okay. Well, what are your questions? Mrs. Johnson: The questions are you know, as you get older, the sex drive's not there and seeing what solutions is out there. Dr. Brittain: Okay. Well, what have you done so far? Mrs. Johnson: Not really anything. Dr. Brittain: Uh-huh. So suffered in silence? Mrs. Johnson: Yes, yes. Talked with my regular family physician and she referred me. Dr. Brittain: Have you mentioned this along the way that you're having some problems, have you mentioned to any other doctors? Mrs. Johnson: Basically I had talked to her about it for a few years. She just suggested maybe extra time and put forth a little bit more effort maybe. Dr. Brittain: Yeah, you know, that's a pretty common thing that a lot of doctors do and it's not because they don't want to take care of you but they're not maybe tuned in to what our bodies need and the proper interpretation of the literature. And it's unfortunate because there's a lot of things that we can do. As you know at menopause all this crazy stuff happens. You have hot flashes, night sweats, problems with concentration, memory, mood, vaginal lubrication, strength, endurance, muscle mass, mental clarity, sexual disorder. All those things suffer for want of hormones that are pretty easy to replace actually. It has to be done properly and under some supervision but there's some pretty cool things that we can do medically. But I'd like to educate you for just a moment if you don't mind, about what we know and maybe some things that you might think are going on or that you've been told that just aren't so. Let's start with the Women's Health Initiative which was begun in 1997 and in 2002 there was this report, "Oh, my God, estrogen is killing women. It's causing breast cancer. Quit taking it." I don't know if you remember that or not? Mrs. Johnson: Yeah. Dr. Brittain: Okay. Well, what actually happened was that these researchers studied placebo and Premarin and Prempro three different groups of women, large groups, 9,000 women in each group, and they wanted to look at different outcomes. Placebo is a sugar pill. Premarin is the old fashioned conjugated estrogen and then Prempro is the conjugated with a synthetic progesterone. After five years of this study they noticed that the Prempro patients had a little more breast cancer so ethically they said we need to stop that part of the study. But at the same time, the women who took only the estrogen had less breast cancer than the women who were taking nothing. Well, let's continue that part of the study. But the public media got a hold of this and all they could see was, "Well, there was estrogen in this pill. It must be bad. Everybody should quit taking it." Millions of women quit taking it. Thousands of doctors quit prescribing it without reading what the study actually said and meant. I read the study and I realized that this was a gold mine of information but the press was interpreting it incorrectly. The average person and the average doctor didn't read the study. So these doctors went ahead and continued studying these women who were taking just Premarin compared to the women who were taking the placebo for another eight years. At the end of 13 years of study, the women taking Premarin had more than 20% reduction in breast cancer incidence than the women who took nothing. So in that part of the study, women taking Premarin actually had less breast cancer than the women who took nothing. Mrs. Johnson: I have been advised by doctors that that would be my highest risk. If I would go on hormone replacement that it was a high risk of developing cancer. Dr. Brittain: It's a misinterpretation of that study that is still prevalent today that is scaring women away from taking hormone replacement therapy. What do you suppose is the number one cause of death in menopause? Mrs. Johnson: I don't know. Dr. Brittain: Heart disease. Mrs. Johnson: Heart disease. Okay. Dr. Brittain: So heart disease kills more women in menopause than the next 16 causes of death combined. There is a pretty great study out of Denmark published just about 10 years ago, where they have this healthcare system where everybody is in an electric medical record catchment, if you will. So, they can follow everybody. They looked at all the women who were between the ages of 50 and 59 and followed them for seven years and looked at what they took or didn't take and who got heart attacks, 698,000 women. And guess what? The women using estrogen properly cut their risk of heart attack in half compared to the women who took nothing. But the women who took Prempro, like the Women's Health Initiative, they had a higher risk of heart attack than the women who took nothing. The women who took just estrogen had a markedly reduced risk. So after years of studying and looking at this, the American College of Obstetricians/Gynecologists has said that in menopause women should take hormone replacement therapy unless there is some specific contraindication and that women who do, reduce their risk of death from preventable disease by as much as 50% compared to women who take nothing. So that's breast, heart, colon, less dementia, less osteoporosis. Oh, and you'll feel better. Mrs. Johnson: Alright. That's great. Everybody's looking for that magic pill. Dr. Brittain: Yeah, no kidding. Well, and if you think about it, you spent what, 40 years of your life making a lot of hormones? How did things work? Mrs. Johnson: Pretty good. Dr. Brittain: Yeah. So you had a life. Did you make babies? Mrs. Johnson: Unfortunately no. Dr. Brittain: Did you try? Mrs. Johnson: I tried. Dr. Brittain: Did that feel good? Mrs. Johnson: Many years of fertility drugs though, yeah. Dr. Brittain: But that felt good, right? Having the sexuality and expressing it with intercourse and all that. When you become menopausal around the age of 50, that hormone support disappears. What we know about this is if you can put those hormones back into you in a way that it makes your body think you're still making them, that's healthy and you can do it forever and you'll feel good. Mrs. Johnson: Okay. Dr. Brittain: Are you ready for that? Mrs. Johnson: I am ready for that. I definitely am. Dr. Brittain: Let me ask you a couple more questions. What seems to be bothering you? What prompted this visit? Mrs. Johnson: I think the low sex drive which in turn causes marital issues. Dr. Brittain: Yeah. I hear that a lot. Mrs. Johnson: Yeah, yeah. You don't want to be traded in for a 20-year-old so ... Dr. Brittain: Or a couple of them. Mrs. Johnson: A couple of them, yeah. Dr. Brittain: Are you having intercourse? Mrs. Johnson: Yes. Dr. Brittain: Is it painful? Mrs. Johnson: At times, yes. Dr. Brittain: Are you getting satisfied? Mrs. Johnson: No, I mean my sex drive has been pretty low for a while. Dr. Brittain: So you feel like just a passive recipient or just a ...? Mrs. Johnson: Yes. Dr. Brittain: So you're not getting anything out of it? Mrs. Johnson: Exactly. Dr. Brittain: But you did in the past? Mrs. Johnson: Oh, definitely, yes. Dr. Brittain: So you're not even able to have an orgasm now? Mrs. Johnson: Not with normal intercourse. Dr. Brittain: Yeah, yeah. But you wouldn't initiate that kind of thing now? Mrs. Johnson: Well, I still do, yeah. Dr. Brittain: Do you have to use a lubricant? Mrs. Johnson: Yes. Dr. Brittain: Do you get infections? Mrs. Johnson: No, no, haven't had any issues with that. Dr. Brittain: Good. Do you have any bladder irritation? Mrs. Johnson: No. Dr. Brittain: Do you get hot flashes, night sweats? Mrs. Johnson: I don't. I went through menopause probably at about 43. Probably because of a lot of years of fertility pills. Dr. Brittain: Oh, yeah, yeah, yeah. Mrs. Johnson: Actually I've been one of the fortunate ones about ... Didn't really have many side effects from menopause. Dr. Brittain: Okay. So not a lot of the hot flashes or night sweats you said, okay. Do you get irritable? Mrs. Johnson: I don't think so. Dr. Brittain: How's your sleep? Mrs. Johnson: Good. Dr. Brittain: Have you had a bone density scan? Mrs. Johnson: Yes. Dr. Brittain: How long ago was it? Mrs. Johnson: Actually I just had one about a month ago. Dr. Brittain: What did it show? Mrs. Johnson: Not good but I've had some issues for about ... I guess my last one was probably six years ago and it showed not osteoporosis but ... Dr. Brittain: The osteopenia. Mrs. Johnson: Yes, yes. Dr. Brittain: Where did you have that done? Mrs. Johnson: IU Health. Dr. Brittain: Okay. Well, we can actually reverse that trend and improve your bone density with proper hormone replacement therapy. Has anyone ever looked at your female hormone levels? Mrs. Johnson: Yeah. Dr. Brittain: Okay. That's a pretty important thing to follow and, of course, your symptoms and your physical exam. So we put all that together. We look at what's going on with you with the various symptoms, vaginal dryness or whatever it might be, or low libido. And then we look at your blood work and we look at a physical exam and that usually matches up. Then we come up with a plan if you're interested. Mrs. Johnson: Um-hmm. (Affirmative) Dr. Brittain: And then we do some surveillance. Mrs. Johnson: Okay. Dr. Brittain: So what I tell my patients is that I'm glad to follow you. I love to do this work and to me it's not even work. To me it's emotional enrichment. But we're going to be metaphorically joined at the hip because you want to get a good result. You want to feel better and I'd like you to also and so that is going to involve, at least initially for a little while, a periodic exam, a reassessment of what's going on with your symptoms and some labs. Mrs. Johnson: Okay. Dr. Brittain: I may have to do this two or three times to get the proper balance of what works for you, that makes you feel better. Does that sound like sort of a plan? Mrs. Johnson: Sounds like a very good plan. Dr. Brittain: What kinds of questions does that bring up for you so far? Mrs. Johnson: Basically I guess just your guidance, what you recommend. Like I said, the doctors that I dealt with before was reluctant to put me on anything because I do have breast cancer in my family and they didn't want to do anything that might initiate on the cancer side of things. Dr. Brittain: Right, right. Mrs. Johnson: So I just came to you to see if there's better answers out there than what I've been given. Dr. Brittain: Well, I think there are and I have a lot of patients who think the same way. Once they get going it's like, "Oh, man, I'm never going back to the way it was before." Well, I'm going to start an exam here in just a minute and I'm going to turn off the recorder. If you have some questions at the end we'll sure take care of that too. Mrs. Johnson: Okay. Dr. Brittain: Thank you very much. Mrs. Johnson: Thank you. We just concluded our interview, examination, and an exit interview on Mrs. Johnson here. And, we came up with a plan to begin some vaginal Estrogen, some oral Progesterone. And both of these are bioidentical. And keep in mind that women are not deficient in Conjugated Estrogen like Premarin. They're deficient in biologically identical Estrogen. And, there's no reason in the world to consider using other than bioidentical hormone therapy. Even though some of the medical societies and so forth say, "Well, there's really no qualitative difference." Well, there is, and my wife is a family doctor. She and I attended the International Menopause Society's World Congress Meeting in Vancouver, Washington a few months ago and smart doctors from Africa, Asia, Europe, North and South America, Australia get together every couple years. And people who attend these meetings are experts in treating the menopausal woman. And to a doctor, they advocated the use of Estrogen, Estrogen, Estrogen and don't quit. And, they also say it matters what you take, what form of Estrogen you take, and how you take it. And, the North American Menopause Society went a step further and issued a paper last fall. And put physicians on notice to remember that menopause is forever. If you have a 65-year-old woman, just because she's 65 doesn't mean she has to quit taking hormones. She can take them forever. Doctors in the past have frequently told their patients at about that age that, "Oh, you need to quit taking it." And that's not based on any evidence whatsoever. And one of the things that I pride myself on in my practice is to practice evidence-based medicine, and stuff that makes sense. So, we started Mrs. Johnson on some vaginal Estrogen, which is bioidentical Estradiol and some oral Progesterone at bedtime. And, got a series of labs which are pending. And then we'll do a follow-up examination after a couple months of doing just that simple intervention. And reassess how she's feeling biologically and emotionally, and with her vaginal lubrication and so forth. And then we'll get some follow-up labs at that time, and probably do a little bit more vigorous therapy. So this is kinda how I approach the menopausal woman. In this particular case there's variations of this, but this is a pretty basic look at the care of the menopausal woman. Now, if you have questions, I'd invite you to visit my website www.drbrittain.com Facepage that we have is Vibrant Life. That is the trade name of my private practice that I use for my hormone patients. And, you can call our office at 812-331-9160. Once again, that's www.drbrittain.com Vibrant Life on Facebook, and 812-331-9160. Hope to see you soon. Thank you.

Hello. This is Dr. Clark Brittain. I'm a gynecologist in Bloomington, Indiana, and I'd like the share with you what I think is some important information that I think will make a change in your life. I grew up on a farm in the Midwest near Winterset, Iowa, home of the book The Bridges of Madison County, written by James Waller, and the site for the movie of the same name starring Robert Redford and Meryl Streep. It was a town full of wonderful people, who ... very loving and giving and kind. But it dawned on me, as I was growing up, that these are really not very healthy people. And we were showered with love and attention and comfort food, and I do mean comfort food. All of my relatives were fat. Most of my friends' parents were fat. Many of them smoked cigarettes and really didn't very good care of them. By the time I was 16 years old, most of my family members had passed by the time they were in their mid sixties, and the only one really left was a grandfather who was about 86 when he finally died. And he'd stayed pretty healthy up until the end, and walked every day and took pretty good care of himself. He never smoked cigarettes, never really drank alcohol and had a pretty modest life. So I started looking around at the common thread among people that I knew who managed to stay healthy for a long time and have a long, healthy life, and seemed to have a pretty good attitude, and seemed to be active into their older years. And they all had some common things that they did. Many of them had some kind of a faith community, they had a sensible diet, they had a group of friends, and they did some form of exercise. And I started medical school when I was in my mid-twenties, and took it upon myself to start with a pretty good exercise program, even though I'd been in the army during Vietnam, and I worked construction and worked farm work. I was strong and healthy and all that. But I started running and doing additional exercise, and, in fact, ever since 1975 I've run or walked two to six miles at lunchtime every day. And I'm a firm believer that that's helped make me healthier and more alert, and have a more vibrant life. In fact, that's the name of my spa practice, where I focus on intimate wellness and care of the menopausal and the andropausal man, Vibrant Life in Bloomington, Indiana. And you can reach us on our website at www.drbrittain.com, or call our office at 812-331-9160, or visit our Facebook page at Vibrant Life. I'd be happy to interact with you. But I'd like to tell you a little bit more about why I'm so passionate about this, and what it means for me, and I think will mean for you, and some of the consequences of the things that we do and the things that we don't do. So by maintaining some physical activity, you can interact with your children. You can interact and be active with your grandchildren. You can go hiking and swimming and biking and play tennis and golf and square dance and do the fun things that require a little bit of physical activity that many people, as they get into their sixties and seventies, are just not able to do, and this I kind of sad. But the people who do stay active find that they have sharper minds, they have better sex lives, they have less heart disease, they have fewer cancers, they have fewer strokes, they have stronger bones, and they have less depression, and along with all of these physical activity things, a sensible diet, and, above all else, maintaining a good hormone balance. As we age, our bodies inevitably lose some of the hormone production that made us really vital and alive when were in our peak reproductive years. Women poop out around the age of fifty, and many men do so at an even earlier age, and it's amazing how many people we see whose hormones have bottomed out, and they're just feeling awful. Well, in my practice, in about the last 10 years, I have focused almost exclusively on the care of the aging woman and the aging man, and how to help them maintain a vital life and a vibrant life, and maintain the physical capabilities that they're so wanting and able to do. The government in England looked at the civil servants and published an article in the mid-seventies when I was in medical school that really peaked my interest. They wanted to find out who in their civil servant society was having heart attacks and who wasn't. So they looked at activity patterns of their servants, and they found that people who did even modest activity had fewer heart attacks. And this modest activity included ballroom dancing, bicycling, swimming, running, walking up and down steps and modest activities like that. And so that, along with the family history that I had, really got me going on a healthy exercise program. I did long distance running, I have done resistance training and so forth. And to this day, one of the things that I try to do on a daily basis, is I get up early, I do some yoga, I do some stretching, I do a little bit of a physical therapy routine, I spend and hour sweating on the elliptical trainer, and then I am at my office by 7:00 AM every day, and I'm 70 years old. And I can go all day long seeing patients, taking care of complicated things, complicated patients, and feel energized by the people that I interact with, and they get energy from me. And I really think that by setting an example, I can encourage them to obtain and maintain a physical fitness and a hormone balance that will keep them vital and alive for a really long time. Now, they may not live a lot longer, but they will have a healthier life. And what I like to say, is that people don't want to just kind of ... live and die, they want to live, live, live, live, live, live, die. And nobody wants to linger, and you want to stay as physically fit and active as long as you can. And by staying physically active now and in the future, and maintaining hormone balance, you can make that happen. So once again, please visit my website, www.drbrittain.com. Visit our Facebook page at Vibrant Life. Give our office a call at 812-331-9160. I'd love to talk to you some more. Thank you very much. This is Clark Brittain signing off.