Twelve Four – Continuous Reboot
Life is a continuous reboot. Improvements are best made when small.
Signs of an Enlarged Prostate (Benign Prostatic Hyperplasia – BPH)
- Urinary Symptoms:
- Frequent urination, especially at night (nocturia)
- Difficulty starting urination
- Weak or interrupted urine stream
- Inability to empty the bladder
- Dribbling at the end of urination
- Pain or Discomfort:
- Painful urination or ejaculation in some cases
- Infections or Complications:
- Increased risk of urinary tract infections (UTIs)
Natural Methods to Potentially Manage or Reduce Prostate Size
While natural remedies won’t replace medical treatments, they may support prostate health:
- Dietary Changes:
- Include: Tomatoes (rich in lycopene), cruciferous vegetables (broccoli, cauliflower), fatty fish (omega-3 fatty acids), and nuts.
- Avoid: Caffeine, alcohol, and spicy foods that may irritate the bladder.
- Supplements:
- Saw Palmetto: Popular herb for BPH symptom management.
- Beta-Sitosterol: Found in plant sterols, may improve urinary flow.
- Pygeum: Extract from African plum bark, supports urinary health.
- Exercise:
- Regular physical activity, particularly pelvic floor exercises, can improve bladder control.
- Hydration Habits:
- Avoid drinking large amounts of fluids at one time, especially in the evening.
Effectiveness of a Second TURP Surgery
A second TURP surgery may be an option if symptoms have returned or persisted. Factors to consider:
- Effectiveness: It can provide relief, but outcomes vary. A thorough evaluation by a urologist is necessary to determine if residual or regrowth of prostate tissue is causing symptoms.
- Risks: Repeat surgeries carry slightly higher risks of complications, such as scarring or incontinence.
- Alternatives: Minimally invasive treatments like laser therapy, Rezūm (water vapor therapy), or UroLift may also be worth discussing with your doctor.
Consulting your urologist is essential to evaluate your current prostate condition, symptoms, and the best course of action. Let me know if you’d like help preparing for that discussion!
Here are some questions to ask your urologist to ensure you get the most comprehensive understanding of your situation and potential treatments:
Understanding Your Current Condition
- What is causing my current symptoms?
- Has the size of my prostate changed since my last evaluation?
- Are my symptoms related to a recurrence of BPH, or could they be due to something else (e.g., bladder issues, scar tissue)?
- Do I need additional diagnostic tests, such as imaging or urodynamic studies, to evaluate my condition further?
Treatment Options
- What are my treatment options at this stage?
- Would a second TURP surgery likely improve my symptoms? What are the risks and benefits?
- Should I consider other less invasive treatments (e.g., laser therapy, Rezūm, UroLift)?
- Can medication help manage my symptoms, or have we exhausted pharmaceutical options?
Long-Term Management
- What lifestyle changes can I make to help manage my condition?
- Are there natural supplements or dietary adjustments that could help without interfering with my current health conditions or medications?
- How often should I follow up with you to monitor my prostate health?
Surgical and Procedural Considerations
- If I undergo a second TURP, what is the expected recovery time?
- Are there specific risks for someone in my age and health condition?
- How likely is it that I will need additional procedures in the future?
- Can you explain the difference in outcomes between TURP and newer procedures like laser ablation or water vapor therapy?
Managing Symptoms and Quality of Life
- What can I do to improve urinary control and reduce frequency or urgency?
- How can I prevent UTIs or other complications?
- What should I do if I experience sudden urinary retention?
Additional Concerns
- How does my medical history (e.g., TURP surgery, diabetes, or stroke) impact your recommendations?
- Are there warning signs that my condition worsens or requires urgent attention?
Bring a notepad to jot down the answers or have a trusted person with you to help remember the discussion. These questions can guide the conversation and help you and your urologist develop a treatment plan tailored to your needs.
Improving urinary control and reducing frequency or urgency involves a combination of lifestyle adjustments, exercises, and, in some cases, medical interventions. Here’s what you can try:
1. Pelvic Floor Exercises (Kegels)
Strengthening the pelvic floor muscles can improve bladder control:
- How to Perform:
- Identify the right muscles by stopping your urine mid-flow (do not make this a regular habit, as it can disrupt urination).
- Tighten the muscles, hold for 3-5 seconds, then relax for the same amount of time.
- Repeat 10-15 times per session, three times a day.
- Consistency: You may notice improvements in a few weeks.
2. Timed Voiding
- Schedule Bathroom Breaks:
- Go to the bathroom at regular intervals, such as every 2-3 hours, even if you don’t feel the urge.
- Gradually increase the time between bathroom visits to train your bladder to hold more.
3. Dietary Adjustments
- Avoid Bladder Irritants:
- Caffeine, alcohol, spicy foods, acidic fruits (like oranges or tomatoes), artificial sweeteners, and carbonated beverages can exacerbate urgency.
- Stay Hydrated:
- Drink plenty of water but avoid large amounts all at once. Spread your fluid intake throughout the day and limit it in the evening to reduce nighttime urination.
4. Bladder Training
Teach your bladder to hold urine longer:
- Delay urination slightly when you feel the urge, starting with a few minutes and gradually increasing.
- Pair this with deep breathing or distraction techniques to manage the sensation of urgency.
5. Maintain a Healthy Weight
Excess weight can put pressure on the bladder, worsening symptoms. Losing even a small amount of weight can relieve this pressure.
6. Manage Underlying Conditions
Conditions like diabetes, constipation, or UTIs can worsen urinary frequency or urgency:
- Work with your healthcare provider to manage these effectively.
7. Double Voiding
After finishing urination, wait a moment, and then try to urinate again. This can help empty the bladder more fully.
8. Medications (Consult a Doctor)
If lifestyle changes aren’t enough, your doctor may prescribe:
- Alpha-blockers: To relax the bladder neck muscles and prostate.
- Anticholinergics: To reduce bladder spasms.
- Beta-3 agonists: To help the bladder hold more urine.
9. Physical Activity
Regular exercise, especially walking or swimming, can improve circulation and reduce pelvic pressure.
10. Reduce Nighttime Disruption
- Avoid drinking fluids 2-3 hours before bedtime.
- Elevate your legs during the day if you have swelling, reducing fluid accumulation that may contribute to nocturia.
When to Seek Medical Advice
If symptoms persist or worsen despite these strategies, consult your doctor. They can assess whether medications, devices, or procedures offer additional relief.
=====
Banks with Notable CRE Exposure:
Smaller and regional banks often have higher concentrations of CRE loans relative to their total loan portfolios. For instance, Bank OZK has 68.6% of its total loans in commercial property, making it one of the most exposed institutions.
According to data from Florida Atlantic University, 67 banks have CRE exposure exceeding 300% of their total equity, a threshold considered excessive and indicative of higher risk.
Truist Bank’s CRE Exposure:
Truist Bank has a moderate level of CRE exposure. Morningstar notes that while Truist’s CRE exposure is moderate, its office space exposure is low.
Additionally, Florida Atlantic University’s data indicates that Truist’s CRE exposure is 87% of its total equity, which is below the 300% threshold considered excessive.
Therefore, Truist Bank is not among the institutions with the highest levels of CRE exposure.
Conclusion:
While listing 282 banks with high CRE exposure here is impractical, data suggests that smaller and regional banks often have higher concentrations. Truist Bank, however, maintains a moderate CRE exposure and is not considered excessive risk in this area.
Recent Developments in Commercial Real Estate and Banking
Big US banks withstand Fed’s commercial real estate shock scenario
Moody’s Reviewing Six Regional Banks for Possible Downgrades
S&P issues negative outlook on five U.S. regional banks due to risky office space exposure
Sources
=====
Several email marketing services offer free plans that allow you to create contact lists and send newsletters. Here are some notable options:
MailerLite
Free Plan: Up to 1,000 subscribers and 12,000 emails per month. Features include a drag-and-drop editor, email automation, landing pages, and pop-up forms.
Brevo (formerly Sendinblue)
Free Plan: Unlimited subscribers with a sending limit of 300 emails per day. Offers SMS marketing, transactional emails, and basic reporting.
Mailchimp
Free Plan: Up to 500 contacts and 1,000 emails per month. Includes a marketing CRM, landing pages, and basic templates.
Sender
Free Plan: Up to 2,500 subscribers and 15,000 emails per month. Features include automation, segmentation, and analytics.
Omnisend
Free Plan: Up to 250 contacts and 500 emails per month. Designed for e-commerce, offering automation workflows and SMS capabilities.
Benchmark Email
Free Plan: Up to 500 subscribers and 3,500 emails per month. Provides a drag-and-drop editor, responsive templates, and basic automation.
HubSpot
Free Plan: Up to 2,000 emails per month with unlimited subscribers. Includes CRM integration, forms, and reporting dashboards.
When selecting a service, consider factors such as the size of your contact list, the volume of emails you plan to send, and the specific features you require. Many of these platforms offer scalable options, allowing you to upgrade as your needs grow.
Life is a continuous reboot. Improvements are best made when small.
Signs of an Enlarged Prostate (Benign Prostatic Hyperplasia – BPH)
- Urinary Symptoms:
- Frequent urination, especially at night (nocturia)
- Difficulty starting urination
- Weak or interrupted urine stream
- Inability to empty the bladder
- Dribbling at the end of urination
- Pain or Discomfort:
- Painful urination or ejaculation in some cases
- Infections or Complications:
- Increased risk of urinary tract infections (UTIs)
Natural Methods to Potentially Manage or Reduce Prostate Size
While natural remedies won’t replace medical treatments, they may support prostate health:
- Dietary Changes:
- Include: Tomatoes (rich in lycopene), cruciferous vegetables (broccoli, cauliflower), fatty fish (omega-3 fatty acids), and nuts.
- Avoid: Caffeine, alcohol, and spicy foods that may irritate the bladder.
- Supplements:
- Saw Palmetto: Popular herb for BPH symptom management.
- Beta-Sitosterol: Found in plant sterols, may improve urinary flow.
- Pygeum: Extract from African plum bark, supports urinary health.
- Exercise:
- Regular physical activity, particularly pelvic floor exercises, can improve bladder control.
- Hydration Habits:
- Avoid drinking large amounts of fluids at one time, especially in the evening.
Effectiveness of a Second TURP Surgery
A second TURP surgery may be an option if symptoms have returned or persisted. Factors to consider:
- Effectiveness: It can provide relief, but outcomes vary. A thorough evaluation by a urologist is necessary to determine if residual or regrowth of prostate tissue is causing symptoms.
- Risks: Repeat surgeries carry slightly higher risks of complications, such as scarring or incontinence.
- Alternatives: Minimally invasive treatments like laser therapy, Rezūm (water vapor therapy), or UroLift may also be worth discussing with your doctor.
Consulting your urologist is essential to evaluate your current prostate condition, symptoms, and the best course of action. Let me know if you’d like help preparing for that discussion!
Here are some questions to ask your urologist to ensure you get the most comprehensive understanding of your situation and potential treatments:
Understanding Your Current Condition
- What is causing my current symptoms?
- Has the size of my prostate changed since my last evaluation?
- Are my symptoms related to a recurrence of BPH, or could they be due to something else (e.g., bladder issues, scar tissue)?
- Do I need additional diagnostic tests, such as imaging or urodynamic studies, to evaluate my condition further?
Treatment Options
- What are my treatment options at this stage?
- Would a second TURP surgery likely improve my symptoms? What are the risks and benefits?
- Should I consider other less invasive treatments (e.g., laser therapy, Rezūm, UroLift)?
- Can medication help manage my symptoms, or have we exhausted pharmaceutical options?
Long-Term Management
- What lifestyle changes can I make to help manage my condition?
- Are there natural supplements or dietary adjustments that could help without interfering with my current health conditions or medications?
- How often should I follow up with you to monitor my prostate health?
Surgical and Procedural Considerations
- If I undergo a second TURP, what is the expected recovery time?
- Are there specific risks for someone in my age and health condition?
- How likely is it that I will need additional procedures in the future?
- Can you explain the difference in outcomes between TURP and newer procedures like laser ablation or water vapor therapy?
Managing Symptoms and Quality of Life
- What can I do to improve urinary control and reduce frequency or urgency?
- How can I prevent UTIs or other complications?
- What should I do if I experience sudden urinary retention?
Additional Concerns
- How does my medical history (e.g., TURP surgery, diabetes, or stroke) impact your recommendations?
- Are there warning signs that my condition worsens or requires urgent attention?
Bring a notepad to jot down the answers or have a trusted person with you to help remember the discussion. These questions can guide the conversation and help you and your urologist develop a treatment plan tailored to your needs.
Improving urinary control and reducing frequency or urgency involves a combination of lifestyle adjustments, exercises, and, in some cases, medical interventions. Here’s what you can try:
1. Pelvic Floor Exercises (Kegels)
Strengthening the pelvic floor muscles can improve bladder control:
- How to Perform:
- Identify the right muscles by stopping your urine mid-flow (do not make this a regular habit, as it can disrupt urination).
- Tighten the muscles, hold for 3-5 seconds, then relax for the same amount of time.
- Repeat 10-15 times per session, three times a day.
- Consistency: You may notice improvements in a few weeks.
2. Timed Voiding
- Schedule Bathroom Breaks:
- Go to the bathroom at regular intervals, such as every 2-3 hours, even if you don’t feel the urge.
- Gradually increase the time between bathroom visits to train your bladder to hold more.
3. Dietary Adjustments
- Avoid Bladder Irritants:
- Caffeine, alcohol, spicy foods, acidic fruits (like oranges or tomatoes), artificial sweeteners, and carbonated beverages can exacerbate urgency.
- Stay Hydrated:
- Drink plenty of water but avoid large amounts all at once. Spread your fluid intake throughout the day and limit it in the evening to reduce nighttime urination.
4. Bladder Training
Teach your bladder to hold urine longer:
- Delay urination slightly when you feel the urge, starting with a few minutes and gradually increasing.
- Pair this with deep breathing or distraction techniques to manage the sensation of urgency.
5. Maintain a Healthy Weight
Excess weight can put pressure on the bladder, worsening symptoms. Losing even a small amount of weight can relieve this pressure.
6. Manage Underlying Conditions
Conditions like diabetes, constipation, or UTIs can worsen urinary frequency or urgency:
- Work with your healthcare provider to manage these effectively.
7. Double Voiding
After finishing urination, wait a moment, and then try to urinate again. This can help empty the bladder more fully.
8. Medications (Consult a Doctor)
If lifestyle changes aren’t enough, your doctor may prescribe:
- Alpha-blockers: To relax the bladder neck muscles and prostate.
- Anticholinergics: To reduce bladder spasms.
- Beta-3 agonists: To help the bladder hold more urine.
9. Physical Activity
Regular exercise, especially walking or swimming, can improve circulation and reduce pelvic pressure.
10. Reduce Nighttime Disruption
- Avoid drinking fluids 2-3 hours before bedtime.
- Elevate your legs during the day if you have swelling, reducing fluid accumulation that may contribute to nocturia.
When to Seek Medical Advice
If symptoms persist or worsen despite these strategies, consult your doctor. They can assess whether medications, devices, or procedures offer additional relief.
=====
Identifying 282 banks with high levels of commercial real estate (CRE) exposure is challenging due to the dynamic nature of financial data and varying definitions of “high exposure.” However, I can provide insights into banks with significant CRE exposure and address Truist Bank’s position.
Banks with Notable CRE Exposure:
Smaller and regional banks often have higher concentrations of CRE loans relative to their total loan portfolios. For instance, Bank OZK has 68.6% of its total loans in commercial property, making it one of the most exposed institutions.
According to data from Florida Atlantic University, 67 banks have CRE exposure exceeding 300% of their total equity, a threshold considered excessive and indicative of higher risk.
Truist Bank’s CRE Exposure:
Truist Bank has a moderate level of CRE exposure. Morningstar notes that while Truist’s CRE exposure is moderate, its office space exposure is low.
Additionally, Florida Atlantic University’s data indicates that Truist’s CRE exposure is 87% of its total equity, which is below the 300% threshold considered excessive.
Therefore, Truist Bank is not among the institutions with the highest levels of CRE exposure.
Conclusion:
While listing 282 banks with high CRE exposure here is impractical, data suggests that smaller and regional banks often have higher concentrations. Truist Bank, however, maintains a moderate CRE exposure and is not considered excessive risk in this area.
Recent Developments in Commercial Real Estate and Banking
Big US banks withstand Fed’s commercial real estate shock scenario
Moody’s Reviewing Six Regional Banks for Possible Downgrades
S&P issues negative outlook on five U.S. regional banks due to risky office space exposure
Sources
=====
Several email marketing services offer free plans that allow you to create contact lists and send newsletters. Here are some notable options:
MailerLite
Free Plan: Up to 1,000 subscribers and 12,000 emails per month. Features include a drag-and-drop editor, email automation, landing pages, and pop-up forms.
Brevo (formerly Sendinblue)
Free Plan: Unlimited subscribers with a sending limit of 300 emails per day. Offers SMS marketing, transactional emails, and basic reporting.
Mailchimp
Free Plan: Up to 500 contacts and 1,000 emails per month. Includes a marketing CRM, landing pages, and basic templates.
Sender
Free Plan: Up to 2,500 subscribers and 15,000 emails per month. Features include automation, segmentation, and analytics.
Omnisend
Free Plan: Up to 250 contacts and 500 emails per month. Designed for e-commerce, offering automation workflows and SMS capabilities.
Benchmark Email
Free Plan: Up to 500 subscribers and 3,500 emails per month. Provides a drag-and-drop editor, responsive templates, and basic automation.
HubSpot
Free Plan: Up to 2,000 emails per month with unlimited subscribers. Includes CRM integration, forms, and reporting dashboards.
When selecting a service, consider factors such as the size of your contact list, the volume of emails you plan to send, and the specific features you require. Many of these platforms offer scalable options, allowing you to upgrade as your needs grow.
