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Health Checkup: December 2008


You'll get equally fit running on a treadmill or outdoors. In fact, many distance-running athletes use the treadmill to save their legs from the pounding of roadwork. But there is a slight difference in energy expenditure (calories burned) between the two. Outdoor running burns slightly more calories than treadmill running at the same speed due to lack of air resistance on the treadmill. Researchers studying this phenomenon found that setting the treadmill at 1 percent elevation equals things out. Set the treadmill at 1 percent so that treadmill walking or running mimics outdoor exercise.



Running is still one of the most popular -- and easiest -- ways to stay fit or get back in shape after time away from exercise. No fancy equipment is needed; no expensive health club bill comes calling every month. All you need is desire and two feet.

From blisters to sprained ankles, from muscle cramps to heel spurs, there are numerous injuries that can sideline runners. A few simple steps can keep you running pain free:

• Wear proper footwear and replace shoes regularly
• Stretch and warm up properly
• Cross train
• Avoid overexerting yourself
• Drink 10-15 ounces of water for every 20-30 minutes of running


Although some old fitness fictions such as "no pain, no gain" are fading fast, plenty of popular exercise misconceptions still exist. Here are some of the most common myths as well as the not-so-common facts based on current exercise research.

1. You will burn more fat if you exercise longer at a lower intensity.
The most important focus in exercise and weight control is not the percentage of exercise energy coming from fat but the total energy cost, or how many calories are burned during the activity. The faster you walk, step or run, for example, the more calories you use per minute. However, high-intensity exercise is difficult to sustain if you are just beginning or returning to exercise, so you may not exercise very long at this level. It is safer, and more practical, to start out at a lower intensity and work your way up gradually.
2. If you are not going to workout hard and often, exercise is a waste of time.
This kind of thinking keeps a lot of people from maintaining or even starting an exercise program. Research continues to show that any exercise is better than none. For example, regular walking or gardening for as little as an hour a week has been shown to reduce the risk of heart disease.

3. Yoga is a completely gentle and sage exercise.
Yoga is an excellent form of exercise, but some styles are quite rigorous and demanding both physically and mentally. As with any form of exercise, qualified, careful instruction is necessary for a safe, effective workout.
4. If you exercise long and hard enough, you will always get the results you want.
In reality, genetics plays an important role in how people respond to exercise. Studies have shown a wide variation in how different exercisers respond to the same training program.

5. Exercise is one sure way to lose all the weight you desire.
As with all responses to exercise, weight gain or loss is impacted by many factors, including dietary intake and genetics. All individuals will not lose the same amount of weight on the same exercise program. It is possible to be active and overweight. However, although exercise alone cannot guarantee your ideal weight, regular physical activity is one of the most important factors for successful weight management.

6. If you want to lose weight, stay away from strength training because you will bulk up. Most exercise experts believe that cardiovascular exercise and strength training are both valuable for maintaining a healthy weight. Strength training helps maintain muscle mass and decrease body fat percentage.

7. Water fitness programs are primarily for older people or exercisers with injuries.
Recent research has shown that water fitness programs can be highly challenging and effective for both improving fitness and losing weight. Even top athletes integrate water fitness workouts into their training programs.

8. The health and fitness benefits of mind-body exercise like tai chi and yoga are questionable.
In fact, research showing the benefits of these exercises continues to grow. Tai chi, for example, has been shown to help treat low-back pain and fibromyalgia. Improved flexibility, balance, coordination, posture, strength and stress management are just some of the potential results of mind-body exercise such as yoga.

9. Overweight people are unlikely to benefit much from exercise.
Studies show that obese people who participate in regular exercise programs have a lower risk of all-cause mortality than sedentary individuals, regardless of weight. Both men and women of all sizes and fitness levels can improve their health with modest increases in activity.

10. Home workouts are fine, but going to a gym is the best way to get fit.
Research has shown that some people find it easier to stick to a home-based fitness program. In spite of all the hype on trendy exercise programs and facilities, the "best" program for you is the one you will participate in consistently.


• If 10 percent of the American public started a walking program, $5.6 billion in heart disease costs could be saved.

• On average, smoking will shorten your life by 10 years, but obesity will shorten it by 13 years.

• The average American child eats 15-30 percent more calories than are needed for healthy growth.



The American Academy of Orthopaedic Surgeons offers information on everything from common sports injuries to choosing the right orthopaedic surgeon.

One of Chesapeake Urology’s Newest and Brightest Docs Answers Your Questions about Bladder Cancer

Adam R. Metwalli, M.D., of Chesapeake Urology Associates, answers common questions about the risk factors, symptoms and treatments for bladder cancer.

Q: My father had bladder cancer. Does this put me at risk?
Family history can be a risk factor for bladder cancer. Other more common risk factors include being a Caucasian male aged 60+, smoking, exposure to industrial chemicals, chronic bladder inflammation or foley catheter use, chemo or radiation for other cancers, and obesity.

Q: What symptoms should I look for that signal bladder cancer?
Early-stage bladder cancer often has no symptoms. Your first warning signs may be hematuria (blood in the urine often detectable only under a microscope), painful urination, frequent urination, slow or intermittent urine stream, pelvic pain or the urge to urinate without results.

Q: How is bladder cancer typically treated?
Treatment depends on factors such as your health, age, stage of cancer and the type, grade and stage of the tumor. Initial evaluation involves surgically removing tumors to assess the stage and grade.  Most patients can then be treated with either immunotherapy or chemotherapy in their bladder that has been shown to lower the recurrence rate. If the tumor(s) are more advanced, typically more aggressive treatment is recommended and some patients with receive radiation, chemo or immunotherapy in addition to or lieu of surgery.

Q: Why should I choose Chesapeake Urology?
We have specialists who have tremendous experience and training in treating bladder cancer, and our surgeons are also leaders in the use of robotics to improve the precision and outcome of certain procedures. CUA urologists performed the very first robotic bladder cystectomy in the state of Maryland. A robotic cystectomy is performed less invasively, through small incisions, and results in fewer complications, less blood less, faster recovery and for many patients, the ability to urinate without a special appliance.

Dr. Metwalli joined Chesapeake Urology following a fellowships with the National Cancer Institute and M.D. Anderson Cancer Center in urologic oncology. He is trained in robotic surgery and specializes in treating a range of urologic cancers, including prostate, bladder, urethra and cancer of the penis. Dr. Metwalli is now accepting new patients at Chesapeake Urology’s Columbia, Maryland office.  410-715-2090.

As the largest urology practice group in Maryland, Chesapeake Urology combines the expertise of 46 top physicians in 16 offices and 14 ambulatory surgical centers throughout the state. CUA offers expertise in treating prostate cancer, testicular cancer, erectile dysfunction, infertility, vasectomy, vasectomy reversal and more. For details, call 1-866-955-0002 or visit

Do I Have A Kidney Stone?

Dr. David M. Fenig, M.D. from Chesapeake Urology answers your questions about kidney stones.

Q: I’m in a lot of pain and think I might have a kidney stone. What are the symptoms?
Yes, kidney stones can be very painful! If you have sudden, intense pain in your back or side near your kidney that radiates towards your stomach, groin or genitals, you may have a kidney stone and should see a doctor. Other symptoms can include nausea, vomiting, fever, blood in your urine, or frequent urination.

Q: How did I get a kidney stone?
Kidney stones form when your urine becomes too concentrated. Crystals separate from the urine and build up inside the kidneys. Stones can be as tiny as a grain of sand or as large as a golf ball.

Q: How do you diagnose kidney stones?
   An X-ray, CT scan or ultrasound can tell us where the stone is and how big it is. This helps me decide whether the stone needs treatment or not. Smaller stones may pass out of the body on their own.

Q: How do you treat kidney stones?
  Many small kidney stones can be treated conservatively with pain medication and a medicine to aid in the passage of the stone. If the stone needs to be treated, I might use a special machine that passes sound waves through the body that break up the stone into smaller, more easily passable pieces. Sometimes a  small camera, called a ureteroscope, is passed into the urinary tract, where the stone can be grasped or broken into smaller pieces with a laser. Or, for large and complicated stones, a scope can be placed directly into the kidney from the back to break up and remove the stones.

Q: Is there anything that puts me at higher risk of getting a kidney stone?
Approximately 10-15% of people in the U.S. will develop a kidney stone.  If you have a family history of kidney stones, you have a higher risk of getting one. Certain metabolic diseases can also put you at risk. If you don't drink enough water or you eat a lot of meat or foods that have a lot of salt, you might develop kidney stones.

Q: How can I prevent kidney stones?
If you’ve had a kidney stone before, you’re unfortunately at greater risk of developing another one. However, there are some things you can do to decrease your risk.  I tell my patients to stay hydrated and drink water with freshly squeezed lemon, reduce their salt and/or protein intake, stay away from caffeine and foods high in oxalate, and have a normal calcium intake. I sometimes prescribe special medications for my patients and recommend a special diet.

David M. Fenig, M.D., received his undergraduate degree from the University of Pennsylvania and graduated from the University of Pennsylvania School of Medicine. Dr. Fenig specializes in vasectomy, vasectomy reversal, varicocele repairs, male sexual dysfunction, hypogonadism, impotence, Peyronie’s Disease, male infertility, sperm retrieval for IVF, as well as general urology needs.

For more information about Dr. Fenig and the services available at Chesapeake Urology Associates, call 1-866-955-0002 or visit our website at

Chesapeake Urology Associates is the premier urology practice in Maryland, treating prostate cancer, testicular cancer, erectile dysfunction and incontinence, plus performing vasectomies, reverse vasectomies and more. If you have a concern, schedule a screening today by calling 1-866-955-0002.

Issue 132: December 2008