Health and Shopping Blog

What is the blood of newspapers? Of course you know the answer. It is “headlines”. Ever since the story which headline said, that men are bite their dogs, we’ve had every kind of animal story. So let’s travel to Nevada. Richie Simmons’ cat was sick. She had visited with the local veterinarian to get drugs. One day, Richie cut her finger but thought nothing of it as she tended to the cat. A few days later, she was flat on her back with a high fever. The cat and the killer squirrels would have been more accurate. But we don’t do sensationalism for its own sake here. One thing - it was highly contagious between humans and animals. How did the cat come to be infected? It’s going to remain a mystery. Now this is the ultimate cat story because the headline misses out the vital reference to squirrels. Yes, it was a double attack. The cat and the killer squirrels would have been more accurate. But we don’t do sensationalism for its own sake here. We kept it simple. Did the cat travel back in time or just visit with some squirrel cousins in California? Who knows. I had died before we could ask. The good news evencheap Doxycycline was an almost instant cure. Just goes to show. Once you know which bacteria are making you sick, you get the right antibiotic and get better fast.

There is help now for those who wish to get their health and life back in order. Ambien is a prescription sleep medication that is prescribed for those who suffer from poor sleep quality, are irritable, or who may have trouble staying asleep once they’ve awaken. Ambien can be prescribed once you’ve spoken to your doctor about the symptoms that you have been feeling. While Ambien is safe, it is a prescribed medication, so care should be taken when you decide to administer yourself the pills. You should always be aware that this sleep medication works quickly and is stronger than over the counter sleep aides. Once you are prescribed Ambien, it is important that you do not operate any form of heavy machinery until your body adjusts to the sleep medication, as you may feel extremely drowsy or dizzy as soon as you take it.

The symptoms of insomnia and sleep disorder can run the variety or be as simple as not sleeping enough. There are many ways to find out if you suffer from a sleep disorder or if you have insomnia. Insomnia is a disorder that influence most people who are in their declining years but can affect anyone. Environmental issues, stress, poor diet, and so many other factors can all create underlying stress in your sleep pattern, making it very difficult to fall asleep, stay asleep, or have the much needed deep sleep for a solid night of rest.

There are some cases in which individuals who have experienced sleepwalking or eating while still in “sleep mode” have forgotten all about the experience. For you to be a successful candidate to take this sleep aide, you should be able to give your health care provider the exact account of how you sleep. In rare and extreme cases, some individuals who suffer from sleeping disorders are asked to participate in sleep studies so that they can clearly show medical experts what they go through when they sleep. Ambien is proven to be a successful sleep aide so that folks like you who suffer from detrimental sleeping affects can find recovery and help. Like eating and breathing, proper sleep is something that must not be overlooked. When you take Ambien, be sure that you have at least 8 hours of time to let your body sleep and fully refresh itself. Find your answers to Ambien questions right here.

My Spanish teacher told everyone in class that we should never use “nice”. Nice is a lazy word. What she meant was that, with so many adjectives to choose from, we should not just routinely pick nice. It’s just issued final guidelines for the use of Acomplia. This is a great drug, but patients have to co-operate. Well, that was then. Now “nice” is on every Brit weight watcher’s lips. This is the UK’s gatekeeper for drugs. With so many to choose from, NICE picks the drugs that represent the best value for money - the drugs the state will fund through their National Health Service. They have to change their diets and exercise. If they do, their weight comes down. It’s one of those, “God helps those who help themselves” drugs. So NICE will only fund the drugs if the individual patient loses 5% of their body weight in the first six months. Treatment has to stop if a patient returns to his or her original weight while still taking Acomplia. And treatment is not to continue for more than two years unless the patient has shown real commitment to getting the weight down and keeping it down.

There is always someone thinking something interesting somewhere in the world. Take just one story from California as an example. It raises the difficult question of how you should dispose of “pills” you no longer need or which have expired. Many offer a service to dispose of old and unwanted medications for you. Do you ever wonder what happens after casual disposal? Your local waste management authority comes round to collect the refuse which is then dumped. This pile then rots down as rain washes through it so, sooner or later, dissolved drugs end up in the watertable and potentially get recycled into your drinking water. The medications flushed go more directly into the water supply. Perhaps you have no interest in the people downstream of you. I wonder what the people upstream think of you. But, back to Ambien. Ambien is, of course, a nonbenzodiazepine hypnotic. In fact, Ambien works in exactly the same way as a conventional benzodiazepine and is probably just as addictive. For this reason, Ambien is listed by the DEA. You will be pleased and delighted to know that the US Government has your interests at heart. It always wants to protect you and the environment, here “always” is non an exaggeration. If there is no-one else immediately available to handle the disposal, the controlled substances should be collected by a law enforcement officer. So, if your local pharmacy has not registered with the DEA, their only way of disposing of your unwanted drugs is to call the cops. Anyone can walk in and leave their unwanted medications, including Ambien but excluding all illegal substances and walk out - no questions asked. And is this a welcome service? Over the first fifteen months of the program, local citizens have deposited 1,800 pounds of medications, not all Ambien, of course. So there is clearly a demand for this kind of service. It is pure self-interest, of course. Who wants to get high from drinking tap water? And do we really want all those bacteria out there to get used to all those antibiotics in the water? If you don’t know the answers to these and other questions of social conscience or self-interest, take an Ambien and sleep on it.

As you know Erectile dysfunction can have destructive effects on your relationship with your partner, and the diagnosis and treatment of the problem will not only have a positive effect on you as a couple, but it will also help to bridge between you and your physician as tests prove whether those first symptoms of ED really are an early warning of vascular problems. That’s either your heart itself, or the blood vessels taking the blood round your body, or the pressure of the system. To continue the bad news, avoiding any trip to consult your physician and simply buying Viagra online, or Cialis or Levitra is potentially dangerous. You may be leaving a serious heart condition as a time bomb in your system.

How do we know this?

In the Massachusetts Male Aging Study (MMAS), just over half the thirteen hundred men aged between forty and seventy years experienced one or more periods of ED - about 10% had a complete loss of function. It established a clear link between diabetes, cardiovascular disease and ED. About nine years later, a second team of researchers polled the same group of respondents2. The prevalence rate of ED was found to increase with age and was most common among those with below average levels of education diagnosed with high blood pressure, heart disease and diabetes. This confirmed a general trend of data that about 80% of cases of ED have an organic origin, and arteriosclerosis is probably the most common. This is where the walls of the arteries thicken, and fatty substances, cholesterol, dead cells, calcium and fibrin (a clotting material in the blood) slowly accumulate and limit the flow of blood.

Continuing the flow of good news: as part of the ageing process, the layer of cells lining the interior surface of all blood vessels, called the endothelial layer, decreases the production of nitric oxide. This makes erectile dysfunction more likely when blood flow is reduced through the penis. More generally, endothelium helps to control blood pressure, blood circulation and the clotting process, so poor sexual performance is a critical first symptom of what may become heart disease if not treated. This is even more of a threat to long-term smokers because nicotine both directly affects the vascular endothelium and restricts the smooth-muscle contraction in the cavernosal body producing ED.

In a study completed in 2002(1), 980 patients who reported ED were diagnosed as follows:

• 18% of patients had undiagnosed high blood pressure;
• 16% had diabetes;
• 15% had a benign growth in the prostate;
• 5% had heart disease resulting from a reduced flow of blood,
• 4% had prostate cancer, and
• 1% had depression.

Just so we are absolutely clear, the main link between ED and cardiovascular disease is the vascular endothelium. If you have less nitric oxide, ED can be the first major symptom of what will become a more general endothelial cell dysfunction leading to cardiovascular disease or diabetes (1).

So, if that is all the bad news, the good news is that there are many ways to treat ED - successfully in most cases. Because of the choices of treatment, we can usually find combinations of treatment that are compatible (and, yes, this may be a choice between Viagra, Cialis and Levitra, or one of the other slightly more invasive medications or devices). In the past, some of the medications to reduce high blood pressure and to lower the level of lipids in your blood were incompabile with the treatments for ED. If we physicians are involved early enough, we can also help you to stop smoking and reduce your weight, both of which will give you many more years of active life.

1. M. Kirby; G. Jackson; J. Betteridge et al. Is erectile dysfunction a marker for cardiovascular disease? International Journal Clinical Practice 2002; 55(9):614-8.

2. C.B. Johannes; A.B. Araujo; H.A. Feldman et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. Journal of Urology 2000; 163(2):460-3.

I was a few years back, the Massachusetts Male Aging Study (MMAS) of men aged between forty and seventy years found that 28% of men with diabetes had ED - about three times the incidence in the general population. Averaging out the later surveys over the age range, ED develops between ten and fifteen years earlier in men with diabetes. Above the age of 50 years, between 50-60% of men with diabetes will have difficulties with an erection. If you’re aged above 70, you almost definetly have got some problems with erections.

The cause of ED in diabetic men usually has both organic and psychological elements. Even if the first cause is not psychological, the onset of organic ED almost inevitably produces serious performance anxiety and, if not treated, depression. The combination inevitably affects the libido and this reinforces the disability.

Vascular disease with decreased flow of blood into the penis through arterial narrowing, hardening and closure, high blood pressure, peripheral nerve damage, hormonal problems, say, because of decreased gonadal function, and obesity are all more common in diabetic men and each one may be the cause of your ED. An increasing body of research indicates that half of all ED cases in diabetic men over 50 years are caused by arteriosclerotic disease resulting in a thickening, hardening and loss of elasticity in the arterial walls.

So that leaves us with the question of how we treat both the ED and the diabetes.

• Good control over the level of blood sugar can prevent the nerve and blood vessel damage that leads to ED.
• Many of the medications used to treat high blood pressure and depression may cause ED. Sometimes, a simple change can restore function.
• Performance anxiety and depression can cause ED. To keep your stress levels under control, you should review your current tasks, and set more reasonable goals and deadlines.
• Regular physical exercise can keep your arteries clear and boost your stamina. If you lack motivation, do not stay solitary. Join a club or gym.
• If you sleep well, you are less likely to suffer from ED.
• Smoking and other uses of tobacco, (a) constrict and may block your blood vessels; and (b) can also reduce nitric oxide levels, both of which which may limit the flow of blood into your penis.
• Drinking too much alcohol can damage your blood vessels and make ED more likely.

I suppose I’m coming to Diabetes slightly later than I should. Erectile Dysfunction is quite a common early symptom of Type 2 Diabetes, cardiovascular disease or both. If you check through the literature, you’ll find that about 12% of patients who are later confirmed as diabetic first appear in the consulting rooms complaining of ED. Putting the cart before the horse, the evidence is that treating ED in cardiovascular patients who are also diabetic significantly reduces the mortality rate. So some good can come out of treating ED, usually with Viagra, Cialis or Levitra although, given that these drugs may not always be allowed as treatment, it is better to prevent the onset of the Diabetes if at all possible, say, by reducing excess weight.
As your physician, I can also consider Viagra, Cialis or Levitra, but these drugs are not safe if you are taking nitrates to treat heart disease or alpha blockers to treat high blood pressure or prostate enlargement This takes us into new territory for these articles. The vacuum constriction device works no matter what the cause of the ED. If you find the idea of using this piece of equipment off-putting, there is the possibility of intracavernosal injections to the penis to help stimulate an erection. Surgery and penile prostheses implantation are highly successful, but there are greater risks of infection when operating on diabetic men.

Thus, there are well-established systems for treating both diabetes and ED. There is no need to suffer in silence. Your sex life can be restored in most cases, albeit that sometimes, you cannot rely on a simple pill to solve the problems.
I’ll keep wearing the physician’s hat for a little longer. There are a number of possible causes of erectile dysfunction (ED) to work our way through, giving us a fair chance to review all the most common.

If you’re at the age of 40, you’re at risk of some kind of erectile dysfunction (ED). Some 10% of you will have a complete failure of erections - more often, this affects older men. Alongside this news is the equally significant evidence of depressive illnesses. Researchers estimate that about a quarter of men will suffer some degree of anxiety or depression at some point during their lives. When this happens, the symptoms may not appear too serious and you will probably not seek treatment. This is an entirely understandable reaction. But it is always better to get a professional opinion before self-medicating.

If you seek for a treatment, your physician will advise you some. In such cases, the issue of cause and effect can become complicated. The ED may have been caused by the anxiety or depression itself, or there may have been an independent cause. But what began as a small problem can be aggravated as a side effect of the antidepressant medications you are prescribed. It is somewhat ironic that one of the factors depressing you may be your declining sexual performance, but the treatment for that depression can complete deprive you of your desire to have sex. If it gets worse, the selective serotonin reuptake inhibitors (SSRIs) antidepressants not only affect sexual performance, but may also disturb sleep patterns and cause weight gain. Not surprisingly, this prompts many patients to stop taking the medication. Thus, although treatment using one or more antidepressants is usually successful in 90% of all cases, less than one third of patients complete the course of medication, and the incidence of relapse is high.

This creates big problems for the medics trying to balance treatments for both the depressive illnesses and the ED. Because there may be adverse reactions between the different medications, you should not take Viagra, Cialis or Levitra on your own initiative if you are already taking any other medications. Your physician has a number of options:

• First way is to change antidepressant. In a number of clinical double-blind studies, Serzone (Nefazodone) and Wellbutrin (bupropion) were shown to cause fewer problems on sexual function than SSRIs. If you respond well to either of these, you may find that you feel less depressed and your sexual performance improves. Wellbutrin is also less likely to cause weight gain which may aid your choice of medication.
• With some drugs, e.g. Zoloft (sertraline) and Anafranil (clomipramine), it may be possible to change the medication regime. If you have a fairly consistent time when you engage in sexual activity, this should be timed when the drug’s level in your body would be at its lowest, i.e. you would take your daily dose after sexual intercourse.
• Then your physician may authorise you to take one of the specific ED medications such as Viagra, Cialis or Levitra. In a 2003 randomised study of ninety men suffering from antidepressant-induced ED, 54% of those treated with Viagra (sildenafil citrate) as against the placebo showed improvement. Note that only slightly over half the sample showed improvement. There are limits to the effectiveness of Viagra, Cialis and Levitra.
• There are some case reports and small clinical studies that have found some additional medications can modify the effect of the antidepressant. For example, in an off-label test, Amantadine has been shown to relieve the SSRI-induced inability to reach an orgasm in some but not all people.

All this has assumed that the ED was in fact caused by the depression or the medication to treat that depression. If there are alternative explanations for the ED, those should also be thoroughly investigated. It would compound the irony if the true cause of your ED should prove not to be the antidepressants but a condition requiring a different treatment.

There are a lots and lots of very good, qualificated and informative books on health. People get impressed by the depth of knowledge because instead of one sentence approximating how a muscle works, there are now whole chapters devoted to the thin muscle filaments containing multiple proteins. Instead of simple engineering analogies of muscles and cables, human knowledge has become obsessed by the identification of ever more complex chemical and molecular processes. This is my wood-for-the-trees moment.

Erectile dysfunction can now be described in terms of complex chemical interactions and illustrated with wonderful diagrams. There are still all kinds of analogies with hydraulic engineering, but the sophistication of the functional analysis is breathtaking. However, it is not a part of the medical books to observe and describe the entirely human context in which the erection is supposed to operate. A single male may masturbate.

Will medical treatment be asked for and a success? In part, this will be determined by the erectial disfunction. Where the relationship is socially disapproved, the man may well not seek treatment at all because of fear. A physical examination might reveal different types of sexual activity, or a chance remark in the consultation might expose the forbidden practices. This is ironic. If the parties to the relationship have a strong mutual commitment and lovingly support each other, the likelihood is that the co-operation between all involved would produce excellent medical outcomes. Well-established sexual intimacy and commitment preserve the right level of desire and motivate everyone to getting a solution that works well. Were it not for online pharmacies and their willingness to supply medications like cialis without prescription, many partnerships might never be able to get appropriate treatment of any kind.

This is two completely different cultural imperatives in conflict. Men are socially conditioned to believe that they will always be able to have an erection. Any publicly acknowledged failure means shame. Unfortunately, many partnerships do not get treatment for the underlying causes of the dysfunction. Although most will know that the dysfunction can be a symptom of diabetes and cardiovascular diseases, fear of exposure may force the couples or groups to ignore or deny the problem until it is too late for the easy treatment represented by cialis to continue on its own. By then, the chances of an effective treatment for the underlying cause may be remote. Yet they are only allowed to have erections in certain very carefully defined social situations. Step outside those situations and you are into potentially disapproved or even criminal territory.

Before urologists recognized the physical nature of impotence, medications generally fell into three categories - aphrodisiacs, surgery and mechanical treatments.

Aphrodisiacs

Lots and lots of substances have been used to increase sexual performance. Oysters, lobsters, and spices are examples. Spanish Fly, a substance made by grinding the wings of certain beetles, was a favorite of famous Marquis de Sade. In the United States it is illegal because of a tendency to cause seizures or death. Many of these substances actually simply irritate the genital organs. The user interprets this irritation as increased sensitivity, thereby giving the impression of increased performance. Rhinoceros horn has been unsuccesfully used for so long that its name has become synonymous with arousal. Unfortunately, this has led to widespread slaughter of the animals that they face extinction.

Surgery/Transplants

The idea of using animal testes to treat impotence began in the Middle Ages, when a standard treatment for “the male malady” was to place the testicles of a cock under the bed. The Malleus Maleficarum was a guide to witchcraft during that era that asserted witch’s spells caused impotence. This was a major reason witch-hunting became so widespread. Charles Edouard Brown-Sequard injected himself with an extract from the testicles of dogs that he claimed made him smarter and stronger. After ten injections, he reported improved erections, as well as a stronger jet of urine and “power of defecation.” He made no claims about the effect this had on the dogs. His “Elixir of Life” became an instant best-seller. Its 1889 launch rivaled that of Levitra, even without a famous spokesman.

Eugen Steinach in 1920 pioneered surgical treatment of impotence with a revolutionary idea-vasectomy. He believed blocking the vas deferens (the tubes semen passes through) would force maleness factors back into the bloodstream instead of letting them go to waste on the sheets. The erections probably weren’t much better, but with female partners spending less time pregnant opportunity became much more. Freud, the person most responsible for the mistaken impression that impotence was primarily psychological, set back our understanding of the disorder by decades. Taking him out of the gene pool probably did more to help the science of impotence therapy than anything else Steinach did. Many respected universities have subsequently been involved in the transplantation of animal or human testicular tissue. Swiss professor Paul Niehans treated tens of thousands of men with testicular cell injections in the early twentieth century. His procedure sometimes went straight to the root of the problem by injecting a booster shot directly into the patient’s testes.* Patients receiving the treatments included Charlie Chaplin (and you wondered why he walked that way), Aristotle Onassis, and Pope Pius XII. Chaplin was a well-known womanizer, but the Pope’s interest in this treatment remains a mystery. Another researcher in Chicago proudly stated his initial patient checked himself out of the hospital four days after surgery in order to satisfy his newfound potency. He fully understood the rule: “Never waste an erection.” Dr. Leo Stanley removed the testicles of recently executed prisoners at San Quentin in the 1920s. He transplanted them into other, more fortunate (albeit impotent) prisoners, reporting improvement in strength, well-being, and libido among the recipients. When the supply ran low, he substituted goat, ram, boar, and deer testicular tissue.

Mechanical

Hot metal rods inserted into the urethra during medieval times wasn’t able to revive erections. No one wanted a second treatment, and that wasn’t very surprising. Many types of splints have been used, including hollowed-out antlers and horns. Encouraged by finding the penis bone (baculum) in some animals, early surgeons placed rib cartilage into the penis. Although these initial attempts failed, penile prostheses have more recently proven particularly reliable.