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Nurse Bridgid

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Wednesday, November 30, 2011

Does exercise change your brain?

I have been touting healthy lifestyles, diets, and exercise as the golden key to weight loss for eons, and I think that everyone knows that some pills, gum, or flakes that you shake on your food aren't really going to solve all of your weight issues forever.  Relying on fad diets (i.e. only eating cabbage soup, drinking water and cayenne pepper) will for sure make you lose weight.  Honestly, who wants to eat cabbage soup all the time and smell like cabbage??  That diet would be over before it started with me...gross! But, you are clearly allowing yourself to be nutritionally deprived, and while it might work for a while, no matter how strong your willpower is, you are going to want real life food again, and depriving yourself of everything will make your cravings that much stronger.  So you may drop the pounds that you want to, but they will pop back on as soon as you start eating normally again.

What does this mean?
An interesting study performed by Harvard is going to be published next week, and looks at the true effects of diet and exercise on the body and how they affect weight loss.  What they found was that dieting (i.e. decreasing your calorie intake) will help you lose weight, as is to be expected, but you most likely will still feel hungry and have cravings. So, despite trying tone really good at eating a lower number of calories, your brain/body will tell you that you still feel hungry and are not satiated.  Bummer.  The good news?  Exercise can change all that!! It is known as inhibitory  control (the ability to prevent overeating and having "self control" with various urges).  When you get even a moderate amount of exercise daily (walking, lunges, weight lifting, running, dancing, etc.) the way that your brain sends out signals is actually altered!  It sends signals that you have reached satiety (feel full) before you normally would (without exercise).  Without exercise, your inhibitory control is low, usually weakened by high amounts of stress and inadequate movements by the body (very stationary), so and overstimulated brain leaves you weakened against temptations to eat foods you shouldn't or to overeat.  When you exercise your body, it actually acts as a stress relief, thus your brain functions better, and allows it to work more efficiently i.e. to send signals that you are fuller faster, that you should eat healthier food, and stick to the calories you allot yourself.  Basically, by exercising, you are giving yourself more willpower.

Thats kind of cool right?  I have always felt that when you workout and do something healthy for your body, it helps you make healthier choices....just because it feels like the right thing to do, but your brain is actually making that decision for you, because you did something good and de-stressed it.  Your bodies crave some form of exercise, and you will be better off for engaging.  So pick up a form of exercise: dodgeball, ping pong, walking, yoga, whatever tickles your fancy and gets your rear in gear will help you to make healthy choices and maintain a healthy lifestyle!!

Yours in Good Health
B

Tuesday, November 29, 2011

Half Fungus, Half Insect: The new miracle drug??

Yarchagumba is causing havoc all over the Tibetan plateaus and Himalayan mountains, fighting, deaths, and all for this type of fungus found on a specific type of caterpillar. I was a little shocked to hear about all of this, seeing that I had never heard of it before, but it is used frequently in Traditional Chinese Medicine (TCM).  Two years ago it was made legal for export by the Nepalese Government, and now everyone is going bonkers for yarchagumba, the market is exploding, and people are starting to fight over "hunting" for it to make money.  But, is it really worth the insanity?

What is it??
Yarchagumba is also known as a vegetable caterpillar. It is merely a fungus, Cordyceps Sinensis, that grows on the larvae of Thitarode caterpillars.  The fungus acts like a parasite and it grows on the outside of the larvae, while they are burrowed underground during the winter months, as they travel up to the surface, they are killed by the fungus, and it sprouts spores from the head and they grow up on the ground. The spores of this fantastical fungus usually pop up during the summer months, and apparently now people are going bonkers for the stuff!




Why do people want it?
According to TCM, yarchgumba is useful for numerous ailments that may come upon you: headaches, nausea, and stomachaches, and it has been used since the 7th Century Tang Dynasty. It also is supposed to give you tons of energy and can have the same effects on men as Viagra, when soaked in an alcohol base dfor a few weeks, and a couple sips will have you raring to be in the sack   It has also been said to "cure" cancer because it is the ultimate yin and yang medicine as they call it both animal and vegetable in one.

Does it work?
Many of the Tibetan people claim that the fungus is a miracle drug and it cures all of their woes.  Interestingly, the fungus isolates have been shown in lab mice to protect the liver and bone marrow during radiation, but all of the rest of the supposed cures have not been studied in Western medicine.  But, I will keep you informed as I think this fungus will be studied more and more to find  as many treatments as we can!

There are many herbs that are mainstays of TCM that have not been "proven" to work by Western means, and end up being very beneficial over time.  I will keep my eyes and ears open for more information regarding this hot fungus that seems to have people going crazy to find, to treat their ailments....I have feeling there will be more benefits to come!

Yours in Good Health
B


Sunday, November 27, 2011

Canker sores: The scoop on these painful lesions

I get a lot of questions from people related to canker sores: What exactly are they? How do I get them? Why? How do I get rid of them? So I thought that I would dedicate some time to these painful lesions that can be pretty irritating and really cramp your style for up to two weeks! They aren't contagious, but they can make eating certain foods, and even talking, very difficult.

What are they?
They are small lesions on the soft tissue in your mouth (gums, cheeks, etc.) and they are usually round or oval with a yellow or white base to them and red around the outside. They tend to tingle or burn for about a day, before you can actually see them,and they usually grow from 1/2in (or 12mm) and can get slightly bigger.  Minor canker sores will heal within two weeks and won't leave any scarring, while larger ones (or major canker sores) can take a maximum of 6 weeks to heal, and may leave scars in your mouth.



Why do I get them?
The bummer is that we don't really know what causes canker sores, but they can be caused by:
A minor injury to the soft tissue (biting your cheek, after dental work)
Acidic foods
Food allergies
Celiac Disease (or gluten allergy)
Behcet's disease- a rare disease that causes inflammation throughout your body, including your mouth
Steven's Johnson's disease- also very rare but it can cause sores inside and out on your body
Stress
Decreased immune system (due to chronic disease or otherwise)

What can I do to make them go away or feel better?
Multivitamins: Can give you vitamin B (which may be missing from your diet), zinc, etc
Topical oral medications: Benzocaine (orobase) can numb the area so you don't feel the sores, there are many over the counter (OTC) options at your local pharmacy/chemist.
Mouthwashes: Your HCP can write you for a a medicated mouthwash with tetracycline in it which can help to heal the sores faster
Oral medications: You can take Tagamet, which is OTC, and a medication created to treat heartburn, can help to shorten healing times of canker sores for some people.

Alternative Treatments:
Mouthwash: either 1 teaspoon of baking soda in 1/2cup of warm water OR equal parts liquid Benadryl and Maalox- then swish and spit to make the symptoms go away.
Cover the sore: with either baking soda or Maalox in the sore twice daily.
Also, try to avoid spicy or acidic foods, be careful when brushing teeth around that area, change your toothbrush when the sores heal, and you can drink cold items or suck on ice to help ease the discomfort from the sore.

So, while it stinks we aren't 100% sure what causes them exactly, we know what you can avoid, to try to prevent them, and some pretty simple at home and OTC treatments.  Before taking any medications, I would talk to your HCP, and if you have canker sores that just won't heal, you really should go see your HCP to see if there is a better treatment.

Yours in Good Health
B

Thursday, November 10, 2011

It all starts at home!

In the US, more than 50% of the adults and 35% of children are either overweight or obese, and there have been numerous studies show that childhood obesity puts you at higher risk for adult obesity.  Also, it has been found that parents that are obese have children with a higher percentage of obesity, which goes to show that the risk for obesity starts at home, but there are some things we can do to change the behavior. Recently there was an interesting study regarding patients who are clinically obese that undergo gastric bypass surgery and the effects on the whole family.

What is the study?
A study was performed looking at 35 patients and their families in 2007 to 2009 that have undergone gastric bypass surgery, and all of the nutritional and psychological counseling that goes along with it. The patients that had the surgery were the main food purchasers for the family and did a majority of the cooking.  All of the family came in for pre and post-operative meetings, so they could all be interviewed and weighed, along with the person who had the gastric bypass. The patients post-operative had an average of 8 pounds in the first year while their family members had around 8cm loss in waist circumference, and then continued to lose weight based on healthy lifestyle choices. What they found was amazing: at one year, the families had significantly less amounts of uncontrolled and emotional eating (which is quite a feat), increased physical activities (both together and independently), and they were more likely to pick healthy food choices when choosing food to eat.  Pretty incredible, right?  Clearly the family members all learn from this experience, of how to live and be healthier, which is the overall goal.

What does this mean to me?
I think it's pretty interesting that we all know that making healthier lifestyle choices and filling our homes with healthy foods is one way to make healthier choices for our families, but this study shows that the person who makes food choices for the whole family, can have huge impacts on the health of the overall family.  Not to add stress to those that do all of the cooking and shopping for their family (on top of everything else you do), but try to make healthier choices for food, it will take some getting used to, and I am sure that there may be some hemming and hawing by various family members, but as their waists shrink and they feel better, your family will thank you for the healthy choices!

I am NOT suggesting that everyone who is overweight go out and get surgery, but maybe a few family nutrition sessions might encourage everyone to be healthier and understand more about the fuel (food) we are putting in our bodies. If your family doesn't want to go, then YOU can go, there are always health and wellness classes at local gyms, hospitals and clinics, YMCA's, maybe your local place of worship may have free classes, so take charge and go to learn.  Clearly what you buy and what you cook has huge effects on the rest of your family, so be proactive to make yourself and your whole family healthier.

Go and take charge for a healthier you, and a healthier family!

Yours in Good Health
B


Wednesday, November 9, 2011

Can Zinc make my cold go away faster???

I know that it is the season for colds, especially in New England where we have had some strange weather patterns where it has been unseasonably warm, then cold, and flipping back and forth.  People are getting sick with colds, and being this close to the holiday season, we want to kick those colds and feel better fast!  Who has time to be sick?  Not me!  But do the zinc cold medications, such as Zicam, that supposedly "cure" colds, really make you feel better sooner?

Do Zinc Cold Treatments Work?
The main ingredient in Zinc Cold Treatments (i.e. Zicam) is Zinc Gluconate, and is just the same zinc that you would take as part of a vitamin or dietary supplement.  For years there have been conflicting studies whether zinc does help colds or not, and many people feel very strongly that it was all placebo effect why some people felt better with zinc and some didn't.  There have been a couple of recent analyses of numerous different studies, and they show that zinc might actually be beneficial in the treatment of cold symptoms, when taken within the first 24 hours of noticing symptoms of a cold. How zinc actually works on the body to shorten cold times is truly unknown, but currently being studied.  Many HCP's are hesitant to suggest that people take zinc supplementation within the first 24 hours of cold symptoms only because the exact dosage needed is unknown, and there are some bad side effects that can occur with too much zinc.  But, studies have shown that the supplementation can shorten cold time.  Pretty exciting, right?



Are There Any Negative Effects?
And, just like many OTC (over-the-counter) treatments it is not FDA approved, and the nasally inhaled treatments are actually not at all supported by the FDA, and are banned in many placed due to side effects.  In high doses, people report anosmia (loss of smell) which can cause altered tasting ability, from zinc supplementation (either taken orally in high doses or intranasally), and many times the sense of smell does not return, it can be permanent.  Although more likely with intranasal zinc, oral supplementation and lozenges can cause the same results.  In numerous studies, due to the filmy feeling that zinc lozenges can leave in your mouth, many study participants reported feeling nausea.  One other thing to point out is that zinc can alter the absorption of antibiotics and other medications in the stomach, so you just need to be aware if you take daily medications, so you should always ask your HCP before starting any supplementation!

So What Should I Do To Treat a Cold?
-Get lots of rest
-Drink fluids (water, coconut water, ginger ale, really whatever you can put in!)
-Try eating/drinking soups and hot teas (and other beverages), the steam can help with a stuffy nose
-Salt water gargles can help with a sore throat
-Saline drops should be used in dry eyes  and saline nasal sprays should be used for dry nasal passages
-Try some spicy foods to remedy a stuffy nose (but be ready with tissues!!!)
-You can take zinc supplements (such as lozenges) but be careful not to overdo it, less is more!  But please make sure to check with your HCP for any interactions with other medications you might be taking

I hope that you don't get afflicted with the common cold, but if you do, try zinc lozenges, try these tips, but most most of all get some rest!!  So many people stress themselves out around the holiday season with shopping, traveling, having company, etc. make sure if you feel like you are getting sick, take some time for yourself to help your body heal!

Yours in Good Health
B

Ugly but Yummy!

I know that I randomly give you guys tips on yummy, healthy, and totally random fruits and vegetables.  Well, I wanted to give you the scoop on one of my favorite vegetables, but I always forget about it for some reason when people ask me about super veg: celeriac.  I was first introduced to this delicious treat when I lived in Edinburgh, Scotland.  I paid a farm a few GPB a week, and every Thursday morning I had a fresh sack of random veg on my doorstep!  The cool thing was that most of the time, I didn't know what the vegetables were, so the woman from the farm, who knew I was American, would leave a little note with the veg telling me what they were and how to cook them.  It was awesome, and how I got hooked on community supported agriculture (CSA)....and celeriac!

What is Celeriac?
It is a root vegetable, that is from the celery family, mosre specifically derived from wild celery, and it is probably one of the ugliest vegetables you'll find. Sometimes it is called celery knot, celery root, or turnip rooted celery, but it should just be called awesome!  It has a root that grows to usually 3.5 inches in length and has green stalks that grow from the base root, and the root is usually bumpy and dirty.  It has a rough outside, but once you remove the outside of the root, the flesh inside is softer than a potato and bright white.



Why is it good for you?
Celeriac is full of dietary fiber, which we all know fills you up, and in a 1/2 cup serving, only has about 30 calories!  This is a great vegetable to add to meals in lieu of potatoes or other root vegetables because it has this great lightly celery-ish kind of taste which adds a nice flavor, and it has the consistency of a potato.  They are full of Vitamin C, Phosphorous, and Potassium too. The cool thing is that, with lower calories, and tons of vitamins and minerals, mashed celeriac is more of a hit than mashed potatoes at many of my dinner parties. People always ask what's my secret....and the secret is that they aren't mashed potatoes, that's why they taste so different, and so good!  Plus you can eat them raw, as veggie sticks, or cook it and use as a base for soups.  Really, they are super versatile in cooking, just like potatoes, with the plus being that you can eat them raw and they taste good too.

What more could you want? A delicious, new, and interesting flavor, easy to cook with, and a dieters dream (with the low calories and high fiber content)!  Give it a try, if you find it in your local grocery store, buy it, give it a go, and let me know what you think!

Yours in Good Health
B


Tuesday, November 8, 2011

Oscillococcinum and the common cold

I've been asked a lot lately abou the use of oscillococcinum with common colds, and I have done a lot of research into it.  I cannot stand those colds that you feel creeping on slowly throughout the day, you try to brush it off, and not pay too much attention to it.  You drink fluids, get a good nights sleep, yet the very next day you wake up and feel like the living dead. Your head is stuffy, can't concentrate, perhaps a sore throat, and a possible fever...as it goes on, it may move into your chest, leaving a hacking cough that makes people stare at you, as if you are streamlining your virus directly at them with every cough. Yup, I have been there, as recently as two weeks ago.  It is my nightmare.  Especially with day light savings now in effect, I tend to feel more tired anyway, so never mind a long drawn out cold to make you feel that much worse.  I am all about anything that will stave that off!!

What is Oscillococcinum?
Oscillococcinum, also known as Oscillo, is an over the counter supplement, that is supposed to relieve cold and flu symptoms. It is widely used in the EU, France specifically, where it has been used for years as a homeopathic treatment. It is a dilution of cells from duck liver and heart, that contain the oscillococcus bacteria.  In the 1920's a French scientist thought that he had found, in the blood of people sick with the flu, this bacteria, and thought that if it was diluted, then given to people with the active disease, it would then end the flu early.  In homeopathic medicine, there is a theory that "like treats like", in that a small diluted amount of the same bacteria administered, should offset the active bacteria. So, this scientist, found a way to dilute the bacteria from duck livers and hearts, and....oscillococcinum was made!



What's the deal?
Oscillo then became one of the most highly sought after supplements in the EU and in the 1990's it hit the media in the US and now consumers purchase approximately $15million in Oscillo a year. So, tons of people are using this supplement whenever they get sick or feel like they are getting sick.  So, does it work?  In a word, no.  Every form of oscillococcinum on the market has been tested and they found that the dilution of the product is so minimal, that there is nothing other than sucrose and lactose, sugars which are used as fillers, present.  Basically, people are paying a premium for sugar pills.  There have been numerous studies that have shown the effects are no different from a placebo pill (interestingly, they are normally sugar pills).   Most likely, by the time people start taking the Oscillo, their virus has already started it's course, and the pills don't shorten the diration or how bad the cold is, but it truly can become mind over matter for people.  And with colds, so many people feel like taking a supplement is being proactive to get rid of it sooner, but really the virus needs to run its course. There is actually a very large class action suit against Borion, the maker of Oscillo, for the company making false statements about the effects of the "medication" (i.e. that it can cure colds and flu within 48 hours) and for having no actual medicinal ingredients.

Sorry to be the bearer of bad news, but the only thing to help with colds are plenty of fluids, lots of rest, and time. I'll keep my eyes peeled for anything that will kick colds faster, but for now, the old fashioned way is best.  But, if you do happen to use Oscillo and it works for you, then I have some magic beans for you too!

Yours in Good Health
B

Friday, November 4, 2011

Are vitamin supplements actually killing you?

I am not a huge believer in vitamin supplements, and all of you who have read my blog since the beginning know why; as long as you eat a healthy diet full of fresh veg and fruits, all while getting in lots of proteins, you shouldn't need to take in extra vitamins. That being said, I know a lot of people who are super "healthy" take vitamin supplements to boost their healthiness and but some new research has shown, that despite living a healthy lifestyle, certain supplements can actually be harmful to you.  The long-term use of multivitamins and supplements and effects have never been studied before.



What's the scoop?
There was a rather large study out of Finland, recently published in the Archives of Internal Medicine, that concluded the use of multivitamins, B6, iron, zinc, magnesium, and copper. They looked at close to 39,000 women ages 55 to 69, and the data was collected from 1986 with data points related to vitamin use collected in 1986, 1997, and 2004. They found that 40% of the participants in the study died as of 2008 and multivitamins/supplements, alone, were related to a 2.4% increase in mortality. Vitamin B6, Magnesium, zinc, and iron had a 3-6% higher risk and copper supplementation had an 18% higher rate of mortality!  Calcium supplements, though, had a decreased risk of mortality. They also found that certain antioxidant supplements, along with beta-carotene, Vitamin A, and Vitamin E may also have negative long-term effects.

What does this mean?
Well, it isn't conclusive saying that all vitamins are bad BUT it does add weight to my personal mantra, that eating a healthy diet, and living a healthy lifestyle far surpasses taking vitamin supplementation.  Vitamins and minerals are best absorbed by your body through foods, so why not just eat those healthy foods and lay off taking a pill and eating crap? I know so many of us that do live healthy lifestyles want to be as healthy as possible, but taking vitamins might actually prove detrimental, so stick to the healthy foods, getting exercise, and keeping your stress levels low.  So, try to improve your diets, try to plan your meals, and until further notice, unless medically necessary stop taking extra supplements.....except for calcium!  If you are worried or concerned about not taking vitamins, talk to your HCP about what is best for YOU.

Yours in Good Health
B

Thursday, November 3, 2011

Be a PART of some research

I would love if any of you, who would like to be a part of some ongoing research regarding medications and side effects, which is designed at looking at how, as HCP's we currently inform patients about medications and their side effects/management, to help improve communications in the future.  The company is focused on improving patient adherence, education, and health literacy through simplifying patient materials and publishing articles concerned with healthcare issues.

It is totally anonymous, and your chance to help some current researchers.  I have NOTHING to do with this survey/research, and I receive no funding in any form. Furthermore, Healthcare Consumers Inc has no conflicts of interest and also does not make money from this survey.

 I just was asked if some of my readers would want to participate, so I am throwing it out there for all of you to participate, if you so choose!

the link for the survey is: https://www.surveymonkey.com/s.aspx?sm=hqU67RGAmQ9cGrDSTD7rHQVkTYUOgDqgyG%2b7qu%2fIHSQ%3d

Yours in Good Health
B

How often should I get a Mammogram?

It seems to be a topic that is coming up a lot in the news, and people keep asking me about when they should get mammograms, if they should get mammograms, and if there are better tests. It really is a highly discussed topic, for numerous reasons, but for years the National Cancer Institute recommendation is for women over the age of 40 to get mammograms every 1 to 2 years, and women with a strong family history you may need to start at a younger age, have them more frequently, and also have genetic testing performed.

What is a mammogram?
Well, a mammogram is basically a very low dose x-ray looking at the dense breast tissues for any changes in the tissues, that may not be able to be felt upon either SBE (self breast exam) or when your HCP performs a manual exam.  It is read by a radiologist and it can show slight to small changes in the dense tissues that are best compared over time.  It is usually the first choice in women who have no symptoms of anything, as it is simple, relatively cheap, and noninvasive.  There are risks of false positive results based on the normal aging changes of breast tissues and false negatives, where changes are not seen on the exam.



What's the debate?
With mammograms, it was always touted that along with a thorough physical exam by your HCP, a high-density mammogram was the best way to detect breast cancer, and detect it early.  Because breast tissue is so dense, and depending on the time of the month, breasts can feel lumpy, but it is usually just due to hormonal changes.  Mammograms can pick up calcium deposits in the breast, which are totally normal, but when they layer upon each other, they can look like a growth, which would require more invasive testing.  This is known as a false positive.  Because mammograms are very sensitive to changes but not for specific changes, there are many "false positives" which can require people to have an MRI, biopsy, or an ultrasound (all depends on the size, density, etc) and which follow-up exams is all based upon your presentation, symptoms, and the changes in your mammogram. False positive rates can range from 30% to 77%, with an average of 62% false positive in a 10 year period of screening, which puts women at risk for many unnecessary and invasive procedures. And, that is a high percentage of every woman that will have false positives! Recent research, looking at the National Cancer Institute registry, showed that women who had every other year mammogram had a lower rate of false positives around 41%.  There is still a decent risk of false positives, but it is lower than annual exams. Also, they found that of the false positive results on women with annual mammograms, 9% were recommended to have biopsies based on the findings versus 4% with mammograms every other year.  And, there was no real difference in diagnosis of cancer, women were still diagnosed at the same stages of cancer, whether they had annual mammograms or not.

What should I do?
You should talk to your HCP about your risks of breast cancer and the risk benefit of every other year mammograms to decrease your rate of false positives and invasive procedures. And with every mammogram, you are exposing yourself to a low level of radiation, and depending on your HCPs level of comfort with physical exams yearly, it might be in your best interest to go with mammograms every other year.  So talk to your HCP, get the scoop, and do what is best for you!

Yours in Good Health
B

Wednesday, November 2, 2011

Squirters? Is that real??

I was recently asked one of those questions that I thought I for certain knew the answer to, but after doing some research found out I was quite off base, and totally misinformed.  I was asked, in one of those side conversations that someone asked me at a party when I was alone, about female ejaculation.  They asked if women squirting really meant they were ejaculating, just like a man.  My immediate answer was that no they don't, it is really just pee....but I remembered hearing different theories on this topic, and who knew it has been one of the most highly debated sex topics regarding females? Not me!

What is it?
Literally, it is the gushing, or squirting of fluids from (and around) the urethra before, during, and after orgasm, once there is adequate stimulation of the G-spot. The amounts can vary greatly and some women have about a half a teaspoon (5ml) of fluid while others can have around a pint (500ml) of fluid expelled. In those terms, it sounds pretty gross.  But it is a fact of life for some women and not for others; just because you may "squirt" during orgasm, you are not weird, and just because you don't that doesn't make you weird either.



What's the big debate?
The debate surrounds not that this can actually happen, but what actually comes out; is it something like what men ejaculate or is it just urine that comes out when an orgasm causes pressure on the bladder?  I was always under the impression that it was urine that came out, so I never really understood the obsession that some people have with female orgasm squirting.  Historically, it was understood that women could "ejaculate" just like men in the 16th century.  As science and history evolved, theories changed. The 1970's and 1980's proved tough for the female ejaculation theory and it was then that there were numerous publications stating that it was just urine and there was no such thing as female ejaculation.  So, it became quite a debate, to which many HCPs believed in the urine theory which lead to many women having unnecessary surgery to relieve their urinary incontinence.  So not only did these women have unnecessary surgery, but it didn't even work!

The verdict?
Hundreds of thousands of women have now been studied, and the fluid that is actually released during the orgasm, is almost the exact composition (minus the sperm, or course) as male ejaculation!  It is not know why some women do ejaculate and some don't; but it is most likely the same way that some men have more ejaculate than others, and just the way your body works.

So, whether you are a squirter or not, just have fun and if your partner wants you to squirt and you don't...have a water bottle nearby and give them a nice big squirt to the face ;)

Yours in Good Health
B