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IMPOTENCE ------- information
BMI (Body Mass Index Calculator)
Info on VIAGRAthat I edited from the PDR (physician desk reference)
Viagra for women????
does it work?? An early study is out
READ the short article
How much caffeine is in soft drinks?
(you
might
be surprised!)
plus some other info........
Survey Finds 80% Of Women
Don't Know Signs Of Most Common Vaginal Infection
Do you have
a question or would like to see an article about something in particular???
EMAIL
me at ASK THE DOCTOR.
Other Medical related sites:
Hand
Transplant
(click on the pix to go see the FULL size pix)
On January 25 a medical team in
Louisville, Kentucky performed the
first hand transplant in the United States, a complex and experimental
surgery that lasted over 14 hours. Here you'll find information about
the patient, the doctors, and the participating organizations, images
and video from the operation, medical background and news updates.
The
recipient's recovery continues on schedule.
Body Fat Estimator If you DARE!
The
Iron of It All -- Find Your Daily Iron Requirement
How much
do you REALLY need...
Target
Heart Rate Calculator
You ought to KNOW this BEFORE you get out there and KILL yourself!
(from the journal of family practice, jan99)
IMPOTENCE: The inability to "get hard"
Worry is
the first time you can't do it a second time; panic is the
second time
you can't do it the first time.
Although
many sexual topics are now "out of the closet," impotence is
still a
subject that arouses fear and anxiety in many men and women.
This emotional
reaction is further strengthened by the lack of
knowledge
on the part of patients, their partners, and health care
professionals.
Most people were never taught about the erection
process
in school, let alone given accurate information from other
sources.
Much of the knowledge about penile anatomy and
physiology
has only become available in the last five years.
Sometimes impotence is all in the head
Ignorance,
fear, a lack of information, embarrassment, and anxiety
provide
a fertile breeding ground for sexual problems. While some
problems
related to the ability of the penis to become hard and ready
for sex
are tied to physical problems, some cases of impotence are
linked to
psychological issues.
Even when
impotence is tied to physical problems, there can be
psychological
underpinnings that must be addressed with successful
treatment
of the physical causes. For example, many couples have
serious
emotional reactions to the loss of erectile ability and to what
they believe
it represents, and have adjusted their relationships to
explain
and compensate for their emotional problems. When
treatment
of the impotence is successful, there still are the underlying
relationship
problems that need attention.
Our goal
at the Male Health Center is to restore a healthy physical
and emotional
outlook to the patient and his partner and therefore
improve
their ultimate satisfaction with successful treatment of
impotence.
In order to achieve this goal, it is important to:
Educate: explain in detail the mechanism of erections and the many
causes of problems; dispel any myths that may exist concerning
erections.
Try to get the partner involved in the process. Such participation
enhances communication and can identify sources of stress and anxiety
for everyone.
Perform accurate diagnosis of the physical and emotional aspects of the
erection problem.
Educate partners on alternatives for treatment and the expected outcome
and risks of each treatment.
Help the couple define a plan for rebuilding their sexual and emotional
relationship based on their own particular physical and emotional
circumstances.
Continue to support couples with counseling in adjusting to their new
situations and reevaluate them in case of future difficulties.
Prevention: address factors that can either now or in the future
complicate or cause erectile problems such as smoking or high
cholesterol.
What causes an erection?
During an
erection blood fills two chambers in the penis and is
trapped
there. The erection begins when the arteries open up as the
smooth muscles
of the vessel walls relax.
The veins
which drain the blood then close down and prevent blood
from leaking
out. A man must have an adequate blood pressure to
carry blood
into the penis, and can have no leaks in the veins of his
penis that
will allow the blood to escape.
The nerves
are the control mechanism which coordinate the increase
in pressure
in the penis as well as the closing down of the veins. A
man needs
sufficient levels of testosterone in order to have the
desire,
feel aroused, and to get an erection.
Any physical
or emotional factor that affects a man's arteries, veins,
nerves,
or hormones can impact his erections. A man must allow
himself
to relax in order for the blood vessels of the penis to also
relax so
that he can get and maintain an erection.
A discussion
of the problem followed by a physical examination is the
first step
toward diagnosing the cause of the problem.
How does
a physician detect what might be going
wrong?
The starting points of a workup include the following steps:
Assessing nerve function is done by pinprick
Assessing reflexes and toe position.
Blood flow is measured by assessing pulse and penile blood pressure.
Hormone status is assessed by evaluating testicle size and inspection of
the prostate through a prostate exam.
Preliminary screening includes blood tests to audit male hormone level,
thyroid function, presence of diabetes and a man's cholesterol level.
A stress audit involves a questionnaire to be completed at home.
A man may
also apply a simple snap gauge that can reveal if the
penis is
becoming erect during the night. The normal male has about
two or three
erections a night. The snap gauge is a painless tool that
unsnaps
when the penis becomes erect, revealing that an erection
occurred
when the man was asleep. This can tell the physician that
the man's
equipment is working, and that there may be another
cause that
is interrupting the natural erection process.
There may
be more specific testing required based on the results of
the physical
exam and screening tests.
Is impotence just a symptom of old age?
According
to Masters and Johnson, at least 25 to 30 percent of
people in
their 60's have intercourse at least weekly...and that's not
weakly.
There are
normal changes in a man's sexual function as he gets
older, but
these are not impotence and do not mean he is going to
lose his
erectile ability (in other words, you don't wear out your
penis.)
These changes come on slowly and include:
Taking a longer time to reach an erection.
The erection being slightly less firm than when he was younger.
An increased ease in delaying orgasm and ejaculation (a positive change
for many couples).
A loss of force in ejaculation.
A decrease in volume of the fluid ejaculated.
The erection being lost more readily after orgasm.
An increase in the amount of time it takes from orgasm to the time that
a
man is able to get another erection.
Most men
and women are able to adjust to these changes and still
have a perfectly
satisfactory sexual relationships. Although a man of
60 may not
be able to run a mile as fast as when he was 18, he
should be
able to cover the distance and may even enjoy the scenery
more. The
same goes for his wife, especially since she may
appreciate
the increased ease with which he can delay ejaculation.
A few additional important facts are:
Most men experience erection problems at some point in their lives due
to
job, alcohol, stress or mental problems.
Past sexual practices, including masturbation, do NOT cause impotence.
An occasional problem does not mean a man will develop a chronic
condition.
Physical factors can directly affect a man's ability to get and maintain
an
erection.
The mind is very powerful and a man with or without any physical problem
can sabotage his erections just by worrying about his ability to perform.
The important
point to remember is that sexual intimacy need not end
when you
become a senior citizen. And, finally, if you or your partner
have an
intimacy problem in this day and time, you need not suffer
any longer
as successful treatment is readily available.
What a man thinks when he is unable to "get hard?"
Many men
view impotence as a real challenge to their self-esteem.
Furthermore,
many men believe a number of myths surrounding
potency
problems. Some men may fear they themselves have
caused their
erection problem by past actions such as infidelity or
masturbation.
A man may
have feelings of guilt because he no longer fulfills what he
views as
his role as a man. It is also common for a man to fear that
impotence
is the first sign of his physical decline toward old age and
death. Most
men, even when they admit there is a problem, are
reluctant
to ask for help.
How some men think about sex:
Men shouldn't express certain feelings.
Sex is a performance.
A man must orchestrate sex.
A man always wants and is always ready to have sex.
All physical contact must lead to sex.
Sex equals intercourse.
Sex requires an erection.
Good sex is increasing excitement terminated only by orgasm.
Sex should be natural and spontaneous.
In this enlightened
age, the preceding myths no longer have any
influence
us.
How does stress relate to impotence?
Stress is
defined as any mental or physical demand that is placed on
a person.
Stress comes from "good" things as well as events labeled
as "bad."
Adrenaline is an erection buster. Adrenaline is fine when
we're cheering
for our favorite team or in the middle of a heated
argument...certainly
not when we'd want to get an erection.
A person's
reaction to stressful events is physiological. Stress can
cause a
man's heart rate to increase, and it can elevate blood
pressure,
increase muscle tension, and speed breathing. This
phenomenon
is called the "fight or flight" response.
What some
people don't know is that stress can pile on and cause a
cumulative
effect. Constant arousal due to stress, can affect sleep,
energy level,
and concentration, as well as sexual desire and
functioning.
Most patients
and their partners are not surprised that stress can
cause an
ulcer or a rise in blood pressure. They are often surprised,
however,
that these factors can have an effect on erections. A man's
normal response
to stress, such as being afraid or angry, is for the
nervous
system to move blood away from "nonessential" activities
and into
muscles so that he can either fight or get away from the
situation.
Ironically,
fear of not being able to achieve an erection can actually
cause an
impotence problem. That's because if a man thinks that he
is not going
to get a erection, his body may respond to this belief by
shunting
blood away from his penis, thus making his erection go
away.
How can a man relax and let things happen naturally?
It is a widely
accepted fact that for a man to have sexual desire, to
be able
to be aroused to erection and orgasm, he must feel relaxed.
Our emotions
about a given situation are determined by what we
think about
that situation. This is called the ABC's of thinking and
feeling:
A The situation.
B. The thought or label about the situation.
C. The emotional outcome that results from how one labels the situation.
For example,
if the situation (A) is that a man is going to have sex,
the thought
(B) is that he is worried about being able to function, then
the resulting
feeling (C) is that he is anxious.
As a man
moves from pleasure and relaxation to performance and
anxiety,
the chances of problems increase. In other words, the
concerns
or fears of being able to perform are sufficient to produce
anxiety
and result in a lack of ability to attain or maintain an erection.
All men have
a psychological reaction to an erection problem even if
its cause
is primarily physical.
What do women think when a man can't get hard?
When a man
has an erectile problem, the couple has a sexual
problem.
The women
in the relationships frequently have questions, doubts,
resentments,
insecurities, and a need for information, understanding,
and reassurance.
Too often the man alone is seen as the patient and
his partner
is - at best - barely acknowledged, and - at worst- merely
tolerated
or even discouraged.
It is not
enough if the partner's participation is limited only to hearing
the patient's
interpretations of the doctor's replies. Filtering
information
and questions through the patient to the woman can lead
to misunderstanding
and unhappiness. The woman's own concerns
and questions
must be addressed. Unlike many areas of medicine
where only
the patient is treated, with erection problems both
members
of the couple need to be considered.
Sometimes
a woman, raised on the myths of men as highly sexual
and always
ready, sees her partner's erection as an emotional lie
detector.
A woman may view an erection as proof that a man loves
or desires
her. Therefore, she believes the absence of an erection
means he
doesn't care, or doesn't find her attractive.
A potency
problem can spiral into a major communication breakdown
in a short
period of time. A typical scenario goes like this: a man
experiences
erection difficulties, feeling ashamed, embarrassed, and
"less of
a man," he withdraws from his partner. With the lack of
ability
to perform, it's not uncommon for men to have a marked drop
in their
desire or libido. Afterall, why put yourself in a position where
you may
not be able to perform? Over time, he may go so far as to
refuse to
kiss her, hug her, even to hold hands with her, saying, as
did one
man, " I didn't want to start anything I couldn't finish." He may
start arguments
to avoid sexual encounters. Because he doesn't
understand
that he has a health problem, not a character defect, he
may refuse
to discuss the issue with anyone including his partner, his
doctor,
a friend. Meanwhile, the partner is feeling rejected, neglected
, and full
of self-doubt. She may question her own attractiveness.
She may
wonder if her husband still cares for her. She may even
think he
is having an affair. She may withdraw. She is often afraid to
bring up
the subject that is so obviously painful for her husband. The
result:
each partner is isolated and miserable. Unfortunately, the
Male Health
Center has seen relationships end over this situation.
A number
of women whose partners have potency difficulties feel
inadequate.
It's not uncommon for a woman to blame herself. A
woman may
be fairly open about her self-blame or she may keep her
feelings
quite hidden. A woman may also feel hurt and angry because
her partner
has withdrawn from her physically and emotionally. The
relief felt
by an insecure partner who understands she is not to blame
can be enormous
and can enable her to more fully participate and
support
her partner's diagnosis and treatment.
Medical conditions that may affect sexual intimacy
There are
a number of medical conditions that are associated with
impotence.
Probably the most common is the use of certain
medications
that have side effects that can affect a man's potency.
Examples
are drugs used to treat high blood pressure, sedatives,
tranquilizers,
and pain pills. Fortunately, the side effect of impotence
is reversible
when the dosage is altered, or a different medication is
prescribed
by the physician.
Medical illnesses
that are often associated with impotence are
diabetes,
heart conditions and kidney and liver diseases. There are
various
surgical procedures that are often associated with
impotence.
The most common are cancer surgery of the colon,
rectum,
bladder, and prostate gland.
Most problems
of intimacy in the elderly can successfully be treated.
If a woman
is suffering from the problem of estrogen deficiency, then
she should
consult with her gynecologist who might prescribe some
form of
estrogen replacement therapy. If a man suffers from
impotence,
he should contact a urologist who has sophisticated
diagnostic
techniques to identify the cause of the problem and
recommend
appropriate treatment.
TREATMENT OPTIONS FOR IMPOTENCE
Oral Medications
Yohimbine
is a useful first-line treatment for erection problems. It
appears
to help about a quarter of the men who try it, and side
effects
are usually minimal. Currently, medications are being tried in
clinical
studies, including a medicine called Sidenafil, which in Europe
has shown
excellent preliminary results, especially in men who have
primarily
a psychological cause.
Topical Medications
On the horizon
are new methods of applying medicine to produce
erections.
Creams rubbed on the skin of the penis and pellets
inserted
in the tip of the urethra are under trial and some show
promise.
Injection Therapy
This is a
very effective treatment for many men, and improvement in
the drugs
have reduced side effects. Look for prostaglandin E-1 or a
combination
of several medications based on prostaglandin.
Vacuum Devices
Devices that
produce erection by suction continue to be safe,
effective,
and economical.
Penile implants
Penile implants
have been successfully used since 1960 to treat over
100,000
impotent men. Surgery, however, to insert a penile implant
should only
be performed in rare situations. When a man can't or
won't succeed
with other treatments, an implant is the last resort. Of
all the
approaches, this one caries the most irrevocable
consequences.
Once you've had an implant, that's it -- the normal
spongy tissue
has been damaged and destroyed, and your chances
of ever
functioning normally again are gone.
Just because
an implant is the last resort doesn't mean it's not a
good one.
A modern implant, when properly installed in the right
patient,
can work wonders. It restores a man's ability to enjoy a full
relationship
with his partner, making his life whole again.
Just as there
are different types of makes and models of cars, there
are also
various styles of implants available. But the three-piece (two
cylinders,
reservoir and pump) models tend to produce the happiest
patients.
Besides an expensive surgical procedure, significant side
effects
are possible. These include mechanical failure (reportedly five
percent),
infection (devastating, but only two percent), erosion,
migration,
intractable pain, and autoinflation. While some question the
possibility
of reactions similar to breast implants, since the fluid is
saline,
there is no adverse reaction with the leakage. Furthermore,
the body
appearrs to form a capsule around the components, almost
in a self-protective
manner.
How much caffeine is in soft drinks?
SOFT DRINK (12-oz. serving)
CAFFEINE CONTENT (mg)
Jolt
72.0
Sugar-Free Mr. Pibb
58.8
Mountain Dew
54.0
Mello Yello
52.8
TAB
46.8
Coca-Cola
45.6
Diet Coke
45.6
Shasta Cola
44.4
Shasta Cherry Cola
44.4
Shasta Diet Cola
44.4
Shasta Diet Cherry Cola
44.4
Mr. PIBB
40.8
Dr. Pepper
39.6
Big Red
38.4
Sugar-Free Dr. Pepper
39.6
Pepsi-Cola
38.4
Aspen
36.0
Diet Pepsi
36.0
Pepsi Light
36.0
RC Cola
36.0
Diet Rite
36.0
Kick
31.2
Canada Dry Jamaica Cola
30.0
Canada Dry Diet Cola
1.2
Sugar-free Mr. Pibb............. WHEW!
[Data obtained from the National Soft Drink Association]
A little 'info' on EAR INFECTIONS in kids..
Study Shows Middle Ear Inflammation Decreases
Progressively With Age
CHAPEL
HILL, NC -- Jan. 8, 1999 -- An ear condition common among infants
and toddlers known
as otitis mediawith effusion decreases steadily as children
approach
their school years, according to a new University of North Carolina at
Chapel
Hill study.
The study,
conducted at UNC-CH's Frank Porter Graham Child Development
Center,
is good news for parents worried about early ear problems, which
mostly
disappear by kindergarten.
Every two
to four weeks from infancy through age five, researchers tested 86
black children
attending nine child-care centres in North Carolina's Triangle area
to learn
whether they had otitis media with effusion and how long it lasted. The
most commonly
reported diagnosis for children under age two, the condition
involves
inflammation, fluid build-up in the middle ear and, sometimes,
infections.
"Between ages six months and
12 months, we found some of these children
had fluid in their ears
as much as three-quarters of the time," said Dr. Susan
Zeisel,
study co-ordinator and adjunct associate professor of nursing. "By age
two, they
had it 30 percent of the time and by age three, they had it as little as
10 percent."
A report on the findings appears in this month’s issue of Pediatrics.
"Only eight
of 60 children who had experienced more than four consecutive
months
of otitis media with effusion in both ears before age two continued to
show persistent
effusion after age two," Zeisel said. "These findings are good
news in that they
confirm what many doctors believed -- that most children will
outgrow
otitis media even if we do nothing."
Children
with fluid in their middle ears may or may not feel pain, Zeisel said.
Some experience
temporary hearing loss while others do not. A small
percentage
require tubes surgically placed in their ears for drainage.
Interest
in otitis media with effusion is high because it appears to be increasing,
possibly
because of the growing number of children in child-care, she said.
Some
researchers believe the condition can slow children's speech and
language development
and impede academic success, while others say no one
has documented
lasting effects.
"The bottom
line is that we just don't know the answer to this very important
question,"
Zeisel said. "A lot of researchers are working on it."
While the
new study contained no major surprises, it is important for several
reasons,
Henderson said. The examinations closely documented what
happened
to the children's middle ears over an extended period and now offer
scientists
an accurate natural history of the condition.
Most previous
comparable work relied on less precise doctors' records and
parents'
memories, which are even less accurate. Forty-six of the 86 subjects
were girls.
Throughout the study, subjects received whatever treatment their
doctors
felt appropriate at the time.
Treatment of Depression May Help Reduce
Mortality In Older Women
CHICAGO, IL -- Oct. 28, 1998 -- Elderly women with six or more
depressive symptoms had a substantially increased risk of mortality,
compared with women who reported five or fewer symptoms of
depression, according to an article in the current issue of the Archives
of Internal Medicine.
The researchers completed a follow-up study of 7,518 white women
age 67 or older to study the relationship between depressive symptoms
and mortality. During the seven-year follow-up, the researchers
reported a seven percent mortality rate in women with no depressive
symptoms, a 17 percent mortality rate for those with three to five
symptoms of depression and a 24 percent mortality rate in those with
six or more symptoms of depression.
Depressive symptoms were a significant risk factor for cardiovascular
and noncancer, noncardiovascular mortality, but not for cancer
mortality.
"Depression is a common and readily treatable condition among older
adults, but few receive appropriate treatment," they write. "Depressive
symptoms are associated with increased cardiovascular and
noncancer, noncardiovascular mortality in older women. Although the
effect of treatment for depressive symptoms on mortality remains to be
determined, these findings suggest that treatment for depression may
not only enhance quality of life but also reduce mortality among women
with depressive symptoms."
Survey
Finds 80% Of Women Don't Know
Signs Of Most Common Vaginal Infection
NEW YORK, NY -- June 23, 1998 -- Eighty-percent of women don't
recognize the signs of bacterial vaginosis (BV), the most common and
potentially serious vaginal infection and 70 percent self-treat vaginal
infections with over-the-counter (OTC) medications before calling a
health professional, according to a new survey released today by the
American Social Health Association and the 3M National Vaginitis
Association.
In a survey of 301 women who had experienced at least one vaginal
infection in the past three years, 80 percent could not describe the
symptoms of bacterial vaginosis, although it affects as many as 25
percent of women in ob-gyn clinics in the United States and is more
common than yeast infection. Moreover, unlike yeast infections, clinical
evidence associates BV with health problems such as pelvic
inflammatory disease -- which has been linked to infertility -- cervicitis,
pregnancy complications and post-operative infection.
Recent studies show that many women with bacterial vaginosis
incorrectly self-diagnose their symptoms, mistaking them for a yeast
infection. Consequently, inappropriate self-medication with
over-the-counter antifungal products is common. These treatments
have no utility against BV, which can only be treated with prescription
medication.
The most commonly prescribed treatment for BV is metronidazole,
administered intravaginally or orally. Clindamycin is another treatment.
"Because of the potential for confusing symptoms of BV with yeast, we
urge women to see their health care provider for proper diagnosis and
treatment," said Linda Alexander, Ph.D., FAAN, president and CEO of
the American Social Health Association.
Yeast infection presents with a white curd-like, odorless discharge
and itching. The most common symptoms of BV, however, include a
foul or fishy vaginal odor and an excessive white or gray vaginal
discharge with a milk-like consistency. These symptoms are variable
and may not be present at all times. The presence of bacterial
vaginosis can only be confirmed through an examination by a health
care professional.
"Because health care providers may not test for bacterial vaginosis
during routine examinations, it is essential that women understand the
signs and symptoms and take the initiative in communicating any
unusual symptoms to their providers, so that proper tests can be
administered and appropriate treatment provided," said Dr. David
Soper, director of the division of benign gynecology, Medical University
of South Carolina and advisor to the 3M National Vaginitis Association.
Only one-half (152) of the survey respondents reported that their health
care providers screened for vaginal infections during routine
examinations. In addition, approximately one-third of total survey
respondents said that during routine examinations their health care
providers did not inquire about unusual vaginal discharge (35 percent)
or odor (40 percent), two typical signs of infection.
Bacterial vaginosis is caused by a disruption in the bacterial flora of
the
vagina. Women with the disease have mixed, predominantly anaerobic
bacteria, including 100 to 1,000 times more bacteria than in a healthy
vagina, which is usually dominated by lactobacilli that protect against
infection.
The survey was designed to evaluate women's knowledge of common
vaginal infections as well as their behavior and experience regarding
diagnosis and treatment of these infections.
PDR® entry for: (edited for
my
page...)
VIAGRA™
Tablets
(PFIZER INC)
(sildenafil citrate)
VIAGRA™, an oral therapy for erectile dysfunction.
Mechanism of Action
The physiologic mechanism of erection of the penis involves release
of nitric oxide (NO) in the corpus cavernosum (the expandable tissue
in the underside of the penis)during sexual
stimulation. NO then activates the enzyme guanylate cyclase, which
results in increased levels of cyclic guanosine monophosphate
(cGMP), producing smooth muscle relaxation in the corpus
cavernosum and allowing inflow of blood. Sildenafil has no direct
relaxant effect on isolated human corpus cavernosum, but enhances
the effect of nitric oxide (NO) by inhibiting phosphodiesterase type
5
(PDE5), which is responsible for degradation of cGMP in the corpus
cavernosum. When sexual stimulation causes local release of NO,
inhibition of PDE5 by sildenafil causes increased levels of cGMP in
the corpus cavernosum, resulting in smooth muscle relaxation and
inflow of blood to the corpus cavernosum. Sildenafil at recommended
doses has no effect in the absence of sexual stimulation.
Pharmacokinetics and Metabolism
It is eliminated
predominantly by hepatic metabolism (mainly cytochrome P450 3A4)
and is converted to an active metabolite with properties similar to
the
parent, sildenafil. Both sildenafil and the metabolite have terminal
half
lives of about 4 hours.
Absorption and Distribution: VIAGRA is rapidly absorbed.
Maximum observed plasma concentrations are reached within 30 to
120 minutes (median 60 minutes) of oral dosing in the fasted state.
When VIAGRA is taken with a high fat meal, the rate of absorption is
reduced.
After either oral or intravenous administration, sildenafil is excreted
as
metabolites predominantly in the feces.
Based upon measurements of sildenafil in semen of healthy
volunteers 90 minutes after dosing, less than 0.001% of the
administered dose may appear in the semen of patients.
Pharmacodynamics
Most studies assessed the efficacy of VIAGRA
approximately 60 minutes post dose. The erectile response, as
assessed by penile plethysmography (this is
a 'little' blood pressure cuff for the penis), generally increased
with
increasing sildenafil dose and plasma concentration. The time course
of effect was examined in one study, showing an effect for up to 4
hours but the response was diminished compared to 2 hours.
During 3 to 6 months of double-blind treatment or longer-term (1
year), open-label studies, few patients withdrew from active
treatment for any reason, including lack of effectiveness. At the end
of the long-term study, 88% of patients reported that VIAGRA
improved their erections.
VIAGRA improved these aspects of sexual function:
frequency, firmness and maintenance of erections; frequency of
orgasm; frequency and level of desire; frequency, satisfaction and
enjoyment of intercourse; and overall relationship satisfaction.
There were highly statistically significant improvements on the two
principal IIEF questions (frequency of successful penetration during
sexual activity and maintenance of erections after penetration) on
VIAGRA compared to placebo. On a global improvement question,
57% of VIAGRA patients reported improved erections versus 10% on
placebo. Diary data indicated that on VIAGRA, 48% of intercourse
attempts were successful versus 12% on placebo.
Across all trials, VIAGRA improved the erections of 43% of radical
prostatectomy patients compared to 15% on placebo.
A review of population subgroups demonstrated efficacy regardless
of baseline severity, etiology, race and age. VIAGRA was effective
in
a broad range of ED patients, including those with a history of
coronary artery disease, hypertension, other cardiac disease,
peripheral vascular disease, diabetes mellitus, depression, coronary
artery bypass graft (CABG), radical prostatectomy, trans-urethral
resection of the prostate (TURP) and spinal cord injury, and in
patients taking anti-depressants/anti-psychotics and
anti-hypertensives/diuretics.
INDICATION AND USAGE
VIAGRA is indicated for the treatment of erectile dysfunction. The
studies that established benefit demonstrated improvements in
success rates for sexual intercourse compared with placebo.
VIAGRA was shown to potentiate the
hypotensive effects of nitrates, and its administration to patients
who
are concurrently using organic nitrates in any form is therefore
contraindicated.
Drug Interactions
Effects of Other Drugs on VIAGRA
In vivo studies: Cimetidine (800 mg),TAGAMET
caused a 56% increase in plasma sildenafil concentrations when
co-administered with VIAGRA (50 mg) to healthy volunteers.
When a single 100 mg dose of VIAGRA was administered with
erythromycin, there was a 182% increase in sildenafil
systemic
exposure (AUC).
PRECAUTIONS
There is a degree of cardiac risk associated with sexual activity;
therefore, physicians may wish to consider the cardiovascular status
of their patients prior to initiating any treatment for erectile
dysfunction.
Information for Patients
Physicians should discuss with patients the contraindication of
VIAGRA with concurrent organic nitrates.
There was no effect on sperm motility or morphology after single 100
mg oral doses of VIAGRA in healthy volunteers.
ADVERSE EVENTS - (in the order of frequency)
Headache
- Flushing - Dyspepsia (heart burn) - Nasal Congestion
Urinary Tract Infection - Abnormal Vision -Diarrhea - Dizziness
-Rash
No cases of priapism (p r o l o n g e d, painful erections)were reported.
The following events occurred in < 2% of patients in controlled
clinical
trials; a causal relationship to VIAGRA is uncertain. Reported events
include those with a plausible relation to drug use; omitted are minor
events and reports too imprecise to be meaningful:
Body as a whole: face edema, photosensitivity reaction, shock,
asthenia, pain, chills, accidental fall, abdominal pain, allergic reaction,
chest pain, accidental injury.
Cardiovascular: angina pectoris, AV block, migraine, syncope,
tachycardia, palpitation, hypotension, postural hypotension,
myocardial ischemia, cerebral thrombosis, cardiac arrest, heart
failure, abnormal electrocardiogram, cardiomyopathy.
Digestive: vomiting, glossitis, colitis, dysphagia, gastritis,
gastroenteritis, esophagitis, stomatitis, dry mouth, liver function
tests
abnormal, rectal hemorrhage, gingivitis.
Hemic and Lymphatic: anemia and leukopenia.
Metabolic and Nutritional: thirst, edema, gout, unstable diabetes,
hyperglycemia, peripheral edema, hyperuricemia, hypoglycemic
reaction, hypernatremia.
Musculoskeletal: arthritis, arthrosis, myalgia, tendon rupture,
tenosynovitis, bone pain, myasthenia, synovitis.
Nervous: ataxia, hypertonia, neuralgia, neuropathy, paresthesia,
tremor, vertigo, depression, insomnia, somnolence, abnormal
dreams, reflexes decreased, hypesthesia.
Respiratory: asthma, dyspnea, laryngitis, pharyngitis, sinusitis,
bronchitis, sputum increased, cough increased.
Skin and appendages: urticaria, herpes simplex, pruritus, sweating,
skin ulcer, contact dermatitis, exfoliative dermatitis.
Special senses: mydriasis, conjunctivitis, photophobia, tinnitus,
eye
pain, deafness, ear pain, eye hemorrhage, cataract, dry eyes.
Urogenital: cystitis, nocturia, urinary frequency, breast enlargement,
urinary incontinence, abnormal ejaculation, genital edema and
anorgasmia.
OVERDOSAGE
In studies with healthy volunteers of single doses up to 800 mg,
adverse events were similar to those seen at lower doses but
incidence rates were increased.
In cases of overdose, standard supportive measures should be
adopted as required. Renal dialysis is not expected to accelerate
clearance as sildenafil is highly bound to plasma proteins and it is
not
eliminated in the urine.
DOSAGE AND ADMINISTRATION
For most patients, the recommended dose is 50 mg taken, as
needed, approximately 1 hour before sexual activity. However,
VIAGRA may be taken anywhere from 4 hours to 0.5 hour
before
sexual activity. Based on effectiveness and toleration, the dose may
be increased to a maximum recommended dose of 100 mg or
decreased to 25 mg. The maximum recommended dosing frequency
is once per day.
HOW SUPPLIED
VIAGRA™ (sildenafil citrate) is supplied as blue, film-coated,
rounded-diamond-shaped tablets.
25 mg 50 mg 100 mg
The cost is ~$10./tablet
Hope that was Helpful!
How Is High Blood Pressure Treated?
Salt restriction is the VERY first thing. By eliminating table and cooking
salt and salty
foods, can reduce blood pressure by about 5 points in 50% of patients.
Regular exercise and weight loss can each result in a similar
decrease in blood pressure. If these don't work, medication will be
needed,
to reduce the risk of stroke, heart disease, blindness, and kidney
failure.
There are numerous blood pressure medications of different
classes. Each class acts in a different way to lower the pressure.
It is,
rare to be unable to find an effective drug or drug combination
that will bring a patient's blood pressure into the normal range.
Most doctor use approximately 15 - 20 different high blood pressure medications, and tailor them to each individual, to find the BEST control WITHOUT (or with minimal) side effects.
Diuretics, also called "water pills", are commonly used to treat mild
hypertension. Examples of diuretics include hydrochlorothiazide (HYDROCHLORTHIAZIDE),
triamterene, (MAXZIDE), and furosimide (LASIX). Diuretics increase
work by increasing urination and lowering the blood pressure by decreasing
blood volume and by dilating the arteries. Diuretics are frequently combined
with other anti-hypertensive medications to achieve blood pressure control.
Beta blockers decrease the force of heart contraction, thereby reducing
the
pressure that the heart generates in our arteries. These medications
include
atenolol (TENORMIN), propranolol (INDERAL), and others. Common side
effects include depression, fatigue, nightmares, and difficulty obtaining
an erection (impotence).
Calcium Channel Blockers lower blood pressure by decreasing the force
of heart contraction and by relaxing the muscle walls of the arteries.
Examples of calcium channel blockers are verapamil (CALAN), diltiazem
(CARDIZEM), nifedipine (PROCARDIA), and others. Side effects include fatigue,
ankle swelling, flushing, headache, and constipation.
Angiotensin Converting Enzyme, (ACE) inhibitors, are the newest
class of
medication. They prevent the production of a chemical (angiotensin
II),
which is a potent constrictor of blood vessels. As the vessels relax,
blood
pressure decreases. These medications include enalapril (VASOTEC),
captopril (CAPOTEN), and lisinopril (ZESTRIL, PRINIVIL). The
anti-hypertensive effect of ACE inhibitors is increased by the addition
of
diuretics. These medications are especially beneficial to the
kidneys in patients that are diabetic. Side effects are infrequent
with these medications, but at times, they can affect the kidneys and increase
the level of potassium in the blood. These medications require periodic
blood chemistry checks to watch for
these problems. A peculiar side effect of 'some' of the ACE inhibitors,
is a dry cough that disappears when the medication is discontinued.
Additional non drug therapy such as acupuncture, various relaxation
techniques, and bio-feedback, can be effective in certain patients
and are gaining more widespread acceptance.
Treating hypertension significantly reduces the risk of stroke, heart
attack
and kidney failure. The most important approach remains EARLY detection
of this "silent killer," thereby allowing proper treatment BEFORE damage
has occurred.
Obesity
Puts Black Teens At Greater Risk For Diabetes Than White Teens
COLUMBUS,
OH -- Feb. 25, 1999 -- A new study suggests that obese black
teenagers
have a greater risk of developing diabetes as adults than do their
white
counterparts.
Researchers
found significantly higher levels of three indicators for the onset of
type II
diabetes in obese black adolescents, compared to those of obese white
adolescents.
"There
are racial and ethnic differences in glucose metabolism that put obese
black
adolescents at a greater risk for type II diabetes," said Dara Schuster,
assistant
professor of internal medicine at Ohio State. "Our results show a
need for
early aggressive weight management in black teens."
A person
with type II diabetes -- sometimes called adult-onset diabetes --
doesn't
produce enough insulin to metabolise blood sugar, or glucose. This
causes
blood sugar to build up in the blood stream, which can cause problems
like hyperglycemia.
According to the American Diabetes Association, a person
can inherit
a tendency to develop type II diabetes, but it usually takes another
factor,
like obesity, to bring on the disease. About 15 million Americans have
this form
of diabetes.
The study
appears in a recent issue of the American Journal of the Medical
Sciences.
Schuster
and her colleagues separated the non-diabetic teenagers into four
groups
-- seven obese black teens; nine obese white teens; 15 lean black
teens;
and 29 lean white teens. The researchers tested each group on two
separate
days for glucose tolerance, insulin resistance and C-peptide levels --
all indicators
of adult-onset diabetes.
On the
first day, each teenager was given glucose orally. At least seven days
later,
the subjects underwent an intravenous glucose tolerance test. Giving
them glucose
intravenously allowed for a more accurate reading of insulin
resistance
and glucose metabolism, Schuster said.
After each
test, the researchers drew blood samples at timed intervals to test
for glucose
tolerance, insulin metabolism and C-peptide levels. They compared
the results
of each group and found that the obese black adolescents fared far
worse
in glucose tolerance and insulin metabolism compared to the other three
groups,
even the obese white teenagers.
"The glucose,
insulin and C-peptide levels in the lean groups looked exactly the
same after
each test," Schuster said. "While the obese white teens had higher
insulin,
sugar and C-peptide levels, they weren't much different from the lean
groups.
Their levels weren't nearly as abnormal as what we saw in the obese
black
children."
Within
the first five minutes of receiving glucose intravenously, insulin and
C-peptide
levels were at least twice as high in the obese black group than they
were in
the obese white group.
"Obesity
in the black children had a much more detrimental effect on glucose
metabolism
than it did in the white children," Schuster said.
End
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