Testosterone Replacement: The Basics

Testosterone replacement is becoming more popular these days. It can be very beneficial if levels are low, but it is important to educate yourself on the risks/benefits before considering therapy.

Testosterone, a hormone produced by the testicles, is responsible for male sexual characteristics as well as maintaining bone density, muscle mass, sense of well-being and sexual fuction.

Levels start to decline naturally after age 30.There are also disease processes which can cause this decline, alcoholism, stress, certain medications and other factors.

If low T is confirmed with lab testing, and replacement is being considered, it is important to be monitored closely by your prescribing doctor to lower your risk of adverse events. Lab tests will be performed every 3 months to monitor testosterone levels, red blood cell count and prostate specific antigen (PSA) will be checked every 6 months.

Movember-November a Month to Shed Light on Prostate Cancer

‘Movember’ is Men’s Health Month

November has recently become known as ‘Movember’- a time when men are encouraged  to grow their facial hair for a social awareness campaign known as men’s health month. It opens the conversation to talk about things pertaining to men’s health like prostate and testicular cancer.



  •  Most common cancer found in American men (other than skin cancer)
  • Second leading cause of cancer deaths in men  (behind lung cancer)
  •  1 in 6 men will be diagnosed with prostates cancer during his lifetime
  •  1 in 36 men will die of this disease

While prostate cancer is a serious disease, but most men do not die from it. In fact, more than 2.5 million men in the United States who have had prostate cancer at some point are still alive today.


  •  AGE: Risk of prostate cancer goes up as men get older. Screening for prostate cancer should start around age 45 to 50.
  •  RACE: African-American men are more likely to get prostate cancer and die from it than in men of other races.
  •  NATIONALITY: Prostate cancer is most common in North America, northwestern Europe, Australia, and the Caribbean
  •  FAMILY HISTORY: Men with close family members (father or brother) who have had prostate cancer are more likely to get it themselves, especially if their relatives were young when they got the disease.
  •  GENES: Scientists have found some inherited genes that seem to raise prostate cancer risk, but they account for only a small fraction of cases.
  •  DIET: Men who eat a lot of red meat or high-fat dairy products have a greater chance of getting prostate cancer
  •  OBESITY: Some studies have found that very overweight men may be at greater risk for having more advanced prostate cancer and of dying from it.

EARLY DETECTION HELPS SAVE LIFES.  It starts with a physical exam which includes prostate screening.  A doctor will perform a rectal exam and obtain blood work to include a PSA (prostate specific antigen) if recommended. It is not a perfect test for diagnosing prostate cancer, but it is one more tool that doctors can use.

If there are concerns after the history, physical, and lab work, then a prostate ultrasound test is the next step. This is usually done thru a urologist. He can also obtain biopsies of the prostate at that time if he sees any areas of concern.

Treatment of prostate cancer has come a long way in the last several years, and as with all cancers, the sooner it is found, the more treatment options are available to a person.


Benefits of the Flu Vaccine

Benefits of the Flu Vaccine

Every year, we hear something similar to the reasons listed below for not getting an annual flu vaccine. And, every year, we see some of those same patients back in the clinic in December or January and they are positive for influenza. Now there are always the few who manage to make it through the gauntlet unscathed, but it’s a numbers game, so play the odds and get vaccinated. Here are some of the reasons people opt not to get the vaccine followed by the facts:

1. I’m healthy. Influenza can strike even the healthiest person and cause severe illness. In 2010, the CDC’s advisory commitee on immunization recommended that everyone 6 months of age and older get vaccinated with the flu vaccine.

2. I’ve gotten the flu shot before and it gave me the flu. It is simply not possible to get the flu from an inactivated flu shot. In fact, it is not even possible to get the flu from a live vaccine. The nasal spray contains weakened live viruses. The weakened viruses only cause infection in the cooler temperatures found in the nose. The viruses cannot infect the lungs or other areas in the body where warmer temperatures exist.

3. I never get the flu. The flu season is predictably unpredictable. While last year might have been a mild season, think back to 2009 H1N1 pandemic, or just 2 years ago, when the flu season hit early and hard.

4. So what if I get the flu?  Even if it does not bother you to have the fever, sore throat, cough and body aches for up to 14 days with the potential for complications such as pneumonia, consider this: We vaccinate not only to protect ourselves, but to protect those around us. The elderly, the very young and those with compromised immune systems benefit when others are vaccinated.

For More information on facts/myths about the flu vaccine, go to: http://www.cdc.gov/flu/about/qa/misconceptions.htm

Vaccines Required for 7th Graders in Texas Public Schools

Vaccines Required for 7th Graders in Texas Public Schools

According to the Texas Department of Health- Immunization Department, students entering 7th grade are required to have a current booster for the following vaccines:

  • Varicella (Chicken Pox)- a second dose is required if not yet received
  • Meningitis – all students entering 7th grade
  • Tdap  (tetanus booster containing whooping cough vaccine) 1 dose of Tdap is required if at least 5 years have passed since the last dose of tetanus-containing vaccine


For more information on vaccine requirements for K-12 in Texas public schools, click here: http://www.immunizationinfo.org/vaccines/state-requirements/texas . Please contact your child’s school or Texas Department of Health for list of exemptions.clin2_Jan2012Adolescent

Prevention and Treatment of Rattlesnake Bites

Prevention and Treatment of Rattlesnake Bitesrattlesnake

by Dr. J. Brad Lichtenhan

Snakes are a reality in the Austin area.   There are four types of poisonous snakes in Central Texas. The Western Diamondback rattlesnake, broad banded copperhead, Western cottonmouth water moccasin, and the Texas coral snake.

The first three snakes listed above are in the pit viper family, named because they each have a facial pit located near the eye on nostil and each side of the head.  These pits detect heat given off by warm blooded animals. Pit vipers generally have large, triangular shaped heads set off from a thinner neck, have pupils shaped like a cat’s (elliptical pupils), and large front teeth, fangs, that are essentially hypodermic needles that fold backwards in the mouth when the mouth is closed.

Rattlesnakes are, unfortunately, a very common snake in this area. They generally do not climb trees or bushes, preferring the ground. They blend in well with rocks and dirt, and hide very well in any type of cover.  Therefore, keep your grass mowed, shrubs trimmed, and frequently inspect your yard/garage/house/patio/pool area make sure that all items that could provide cover to a snake are picked up off the ground. This “tidiness” goes a long way to cutting down on the number of rattlesnakes you are likely to encounter.

Copperheads prefer rocky, woody hillsides near some water. They blend in perfectly with dry leaves, rarely climb, but usually hide under rocks and boards. Again, if you live in a rocky, woody area near water, the above recommendations with help with keeping copperheads out of your yard.

The cottonmouth water moccasin is essentially a water snake. However, they can and do travel overland to find mates or to move to a different pond/creek/swamp, and when they do, they will seek cover under boards, tin, trash, etc.  Keep this stuff picked up off the ground if you do not wish to attract snakes.

Coral snakes are common but rarely seen, as they spend the majority of their life below ground. They are brightly colored banded snakes confused with snakes in the tricolor king snake family. They do not have pits, triangular heads, or elliptical pupils, and their enlarged front teeth are smaller and do not fold back in the mouth.

Coral snakes are most likely to be found after a rain. Once again, they like to hide under cover, but they may also be found in loose dirt and leaves. Unless it is picked up and handled, bites by coral snakes rarely occur

Snakes are around, but they do not have any desire to seek out and bite humans. They will flee if given a chance. So common sense will keep you from being bitten by a poisonous snake 99% of the time.  Do not play with snakes; young men like to say “Watch this” after drinking a few beers, and this activity causes about one half of all ER visits for snake bite.

The other half of ER visits occur when some one accidently comes into contact with a snake. For instance, walking in the dark, reaching in or under possible snake hiding places, stepping into thick grass/shrubs/cover that could hide a snake are frequent scenerios for these accidental snake bites. But will a little forethought, all of these accidental bites can be prevented.  Teach your children not to reach under boards or into dark areas when they are chasing a ball, and don’t let them wade into high grass or cover with out carefully looking first. And don’t walk around at night without watching where you are stepping if you live in a neighborhood known to have some venomous snakes.

It is also a good idea to learn to identify venomous snakes in your area, and be knowledgeable enough to let the harmless snakes alone. Harmless snakes are beneficial to a neighborhood. They eat rodents, insects and other snakes. They occupy areas that could otherwise be homes to poisonous snakes, ie, if a person kills all the ratsnakes and kingsnakes found on their property, they just made more room for other snakes, (possibly some that are venomous) to move in and take over the hiding places.

The treatment of a snake bite is very simple. Remove rings and watches and bracelets on the bitten extremity, so if there is swelling, which there will be with a pit viper bite, these items will not cause problems. If possible, splint the affected extremity, to limit muscle motion, which increases the spread of venom.  Do not cut the bite site. Do not ice it. Do not wrap an ace wrap around it. Just go to the hospital.

Most ER’s now know how to treat a poisonous snake bite. But there are a few things you should know. If they do not act like they know what they are doing, ask them to call the poison control center. They will have a specialist available 24 hours a day that they can put into contact with the ER staff. The first treatment of acute snake bite is NEVER surgery. On rare occasions, surgery could be required a few days into snake bite treatment.

The treatment of pit viper snake bites in Texas is with antivenom, and it is given when there is a poisonous snake bite that is causing significant symptoms, ie, pain, swelling, bruising, and maybe bleeding, nausea, vomiting.  It is made from the antibodies produced in sheep that have been exposed to snake venom, then the antibodies are purified and dried, and sent to the ERs across the US. Horse serum is no longer used.  This medicine should never be used outside of an ER due to risk of severe allergy.

In summary, snakes are definitely present in and around neighborhoods in Central Texas, but with some simple things done around the house and neighborhood, and staying alert and smart when in their area and near their hiding places, snake bite can be avoided.

Dr. Brad Lichtenhan is a Board Certified Family Practice physician and co-owner of VIK Medical- Urgent Care and Family Practice in River Place, Lakeway and Westlake. He has served as an expert witness for snakebite cases in court and has published several articles on snake bites in recent Medical Journals.


Fact: HPV Vaccines Protect Against Several Known Cancers

Fact: HPV Vaccines Protect Against Several Known Cancers

If you realized that you could protect your child from certain cancers with a vaccine, would you do it?

There are two  FDA approved vaccines, Gardasil® and Cervarix®, that protect against  cervical cancer.  An infection of HPV (Human Papilloma Virus)—types 16 and 18— cause approximately 70 percent of all cases of cervical cancer. Although the first HPV vaccine was FDA approved in 2006, the general public still lacks sufficient information on the indications and importance of receiving this vaccine.

HPV types 16 and/or 18 also cause some vaginal, vulvarpenileand oropharyngeal (throat) cancers. (throat cancers are not an indication for either vaccine) At least 17 other types of HPV are responsible for the remaining 30 percent of cervical cancer cases.

In addition, one of the vaccines- Gardasil, protects against infection by two additional HPV types, 6 and 11, which are responsible for about 90 percent of all cases of genital warts in males and females and 10 percent of cervical cancers in females. The HPV vaccine is a series of 3 vaccines given over 6 months and is recommended by the Centers for Disease Control and Prevention (CDC)  for all girls and boys ages 11 or 12 years old. The vaccine is also recommended in young women and men ages 13 through 26 years old who have not already received the vaccine or have not completed all booster shots.

The first dose may be given at the same time as the booster vaccines that 7th graders are required to receive if students in the Texas public school system (Meningitis Vaccine, Chicken Pox Vaccine and Tdap- or ‘tetanus booster’)

Who recommends the HPV Vaccine?

(Click the LInks below to read what they have to say about the HPV vaccine)

Centers for Disease Control (CDC)

Advisory Committee on Immunization Practices (ACIP)

American Academy of Pediatrics  (AAP)

American Academy of Family Physicians (AAFP)

American Cancer Society


For more information on the HPV vaccine, contact your doctor.

Sources: National Cancer Institute, CDC, American Cancer Society


Take Control of Asthma

May is Asthma Awareness Month- Take Control of Asthma

Asthma is a chronic disease that inflames and narrows the airways causing wheezing, coughing and tightness in the chest. The airways become inflamed (this may be due to allergies, illness, exercise or unknown reasons) and swollen causing a constriction or tightening. This means that less air is able to move through. The cells in the airways make more mucus than usual causing even less air to be able to flow through.

There are several different medications used to manage asthma. Many are inhalers which fall into several different categories

  • Long Acting and Short Acting Bronchodilators- These medications open up the airways by relaxing the muscles around the airways or bronchials.
  • Corticosteroids or steroids- These medications reduce the swelling and inflammation around the airways. They may also help decrease mucus production
  • Combination bronchodilator/corticosteroid- These inhalers combine both types of medication for increased effectiveness

If you are using a short-acting or ‘rescue inhaler’ only (often called ProAir, Ventolin or Albuterol) and find that you need it several times a day, there is a good chance that your asthma is NOT under control. Talk with your doctor about a more effective way to manage your asthma.

People with asthma should get a pneumonia vaccine as well as an annual flu vaccine as both of these illnesses may cause complications if there is underlying asthma.

Symptoms  of asthma can be controlled by following recommended guidlines which will allow a person to stay active, sleep through the night and avoid complications. The key is to control asthma before it controls your life.

Welcome Bryan Just, DC, FNP-C

Dr Just 4x5

Dr. Bryan Just joined the VIK Medical team in March of this year. He received his undergraduate sports medicine training in Kinesiology from Texas A&M University in College Station, Texas.  Shortly after, he relocated back to Houston for advanced education at Texas Chiropractic College, where he was  awarded a Doctorate in Chiropractic. During his time in private practice, he continued medical studies to attain a license of a Family Nurse Practitioner.   Dr. Just is a member of the American Heart Association, American Chiropractic Association and Texas Chiropractic Association.