terça-feira, 1 de novembro de 2011

APRIL 7, 2011 THE BIG E.D. or NOT SO BIG




"Time is a flowing river. Happy are those who allow themselves to be carried, unresisting with the current. They float through easy days. They live, unquestioning, in the moment."
-Christopher Morley


This certainly doesn't sound like a description of salmon swimming upstream. But in a way it does. I felt like a salmon and I wasted time in my active days. Today I do not waste time. I live each day to the fullest. I sometimes think if I am not busy I am wasting time. I have to slow the process down. I feel I should be doing something at every minute- whether knitting, stitching, reading, writing or meditating. How ridiculous is that! Life moves to the unseen drummer so it doesn't matter if I go fast or slow. I am happy just being in the moment. When meditating I am taken to that river and I float, feeling the cool water on my back and the sun beating on my chest. It feels serene. This meditative feeling allows me to get through my days. It allows me to educate patients and also learn from patients. I lead a grateful life. Do you lead a grateful life ?


Impotence. What a scary word. The newest terminology is Erectile Dysfunction (ED). It does sound somewhat classy. Not many men want to admit to this. I must admit that since Viagra, Levitra and viagra cialis online pharmacy pharmacy have been on television more, it has opened the bedroom door for discussion. So I thought why not here. It is estimated that 20-35 million men suffer with Erectile Dysfunction. It is defined as the inability to achieve or maintain an erection. The two categories of ED are physiological and psychological. Which do you think has the highest percentage- psychological or physiological? Physiological has 80-90% while psychological is only 10-20%. Easy to tell the difference. If a man has an erection during sleep or in the morning upon awakening, it is NOT physiological.

The most common causes of a physiological condition are:
1. Heart disease
2. Hypertension (high blood pressure)
3. Diabetes
4. Atherosclerosis
5. Thyroid disease
6. Kidney disease
7. Peyronie's disease - curvature of the penis due to atherosclerosis of the penile arterial vessels
8. Neurodegenerative diseases
9. History of prostate cancer
10.Lack of testosterone

What is always forgotten as a cause are the types of medications the individual is on and the recreational drug use. Prescription medications include those for high blood pressure (especially beta blockers) and anti-depressants such as Zoloft, Celexa, Paxil. The most common recreational drugs that may cause ED are alcohol, marijuana and cocaine.

For psychological impotence, there can be many factors. These include grief, depression, sexual abuse, guilt and chronic stress. By far the most common cause is being in an unhappy, unfulfilled relationship. I can do some therapy with the patient if he feels comfortable. I am a great listener. I think years of sobriety and the advice of taking the cotton out of my ears and putting it into my mouth helped a lot.

First came Viagra, followed by Levitra, then 36 hour Cialis and NOW the daily 5 mg Cialis so you are ready at all times. As Virginia Slims used to say, "You've came a long way, baby!" All these medications work by releasing nitric oxide, a vasodilator that allows blood to rush to the penile vessels. If the man is taking nitroglycerin he should not even attempt to take any of those 3 drugs.

There are herbal alternatives:
1. An old medication for high blood pressure called Yohimbe can be used for ED If you use the tincture(1:5) 15 drops twice a day, or 5-6 mg tablets three times a day.

2. Yin Yang Huo (Epimedium spp) - This is used in traditional Chinese medicine (TCM). You men have heard of this . It is sold in the USA as Horny Goat Weed. Dose: Tincure (1:5) 1.5-2.5 ml twice a day. I advise as a tea: 1 tsp of the herb, seep for 20 minutes and drink 4 oz twice a day

3. Xian Mao Root (Curculigo orchiodes )- I find this TCM herb to be the most effective. It is difficult to get, although it can be obtained in Chinatown, NYC. Tincture (1:5) 1/2 to 1 ml twice a day.

Other herbs used are Fresh Oat, Ashwaganda, Damiana, Ginkgo, Asian Ginseng, and Morinda Root. I use a formula from Herbal Vitality called Male Libido. Check out www.longevitynutritionals.com for a bottle. If you want a supplement that releases nitric oxide use L-arginine. It must be taken in high doses- somewhere between 6 - 9 grams per day. I would use the powder because it only comes in 500 mg to 1000 mg tablets. I have seen men use up to 15 grams. Since it releases nitric oxide, be careful with your blood pressure. No one wants to be erect as they pass out!

Until tomorrow...