tramadol articles

For once, I’m going to put on my physician’s hat and give you the view from the other side.

Well, my first step was to review the medical records to see if there were any immediate clues. If there are existing diseases or one of the medications currently on prescription has an ED side effect, we have solved the case before we start. I should let you in on a small medical secret. About a quarter of all the cases that we see are drug-related. Usually, we simply change the medication and the ED goes away. Alternatively, we have to counsel lifestyle changes because the excessive alcohol consumption or recreational drug of choice is not doing the patient any favors.

So my patient has walked through the door and, in the same breath as blurting out that he’s suffering erectile dysfunction (ED), he’s also into the knee-jerk questions about where to buy Viagra, should he risk buying Viagra online, and so on. I know Pfizer Inc. did a wonderful thing when they invented Viagra, but that medication so dominates the public consciousness that many men seem have never even heard about Cialis and Levitra, let alone all the other treatments that are available and may be necessary. Still even though my patients are predictable, they are at least coming through the door to get treatment. Ten years ago that did not happen. The world is a better place thanks to Pfizer Inc. The next most obvious possibility is Diabetes. I may also do a blood sugar test just to be thorough. Blood pressure tests out in the normal range, so that’s another good sign.

The questions are designed to establish whether we’re dealing with problems of desire (which could be psychological or physical), whether it’s purely ED or there are also problems with achieving orgasm, and to check up on those lifestyle choices which could be the real problem.

The physical examination tries to cover as many possibilities as possible in as short a time as possible. Most men find an examination deeply embarrassing so keeping it short is a “good thing”. I’m looking for anything that might suggest a systemic problem. So, I’m obviously going to start with the penis. Some of my questions have probed whether the penis has changed shape in any way or perhaps the erection is painful. A physical examination could find evidence of lumps or the answers to the questions may reveal that the penis now bends or curves when erect, all of which could suggest Peyronie’s disease. Similarly, if the penis is not sensitive when I touch it, this may indicate possible problems in the peripheral nervous system.

Following the same idea and taking a quick overview of the body also allows me to look for any changes to the usual distribution of body hair or any enlargement to the pectorals (a polite way of suggesting that my patient may be developing small breasts). If the testicles feel slightly smaller than I would expect, this can suggest a low testosterone level. Any such abnormality can indicate problems with the hormone balance or the endocrine system. I’m also testing the pulses in both the wrists and ankles. If there are any circulatory problems, I’m likely to find a decrease pulse at the extremities.

So these are all the quick and easy explanations. In most cases, there is little to suggest the need to go on to further tests and I can then get into a discussion of the medication options. This is when the patient finally begins to look more comfortable again. We have finally come back to his original questions, except that I’m also telling him about Cialis and Levitra. Viagra may have the name, but Cialis in particular does have some interesting characteristics.

On July, the Federation of European Pharmacological Societies Congress discussed the medicinal role of cannabis. It is routinely used for controlling nausea among patients on chemotherapy and for encouraging appetite among AIDS patients. Science is now developing medications that focus on the parts of the body affected by disease and not the central nervous system. So, for example, when the body is injured cannabinoids are naturally released in the affected area and reduce pain. Unfortunately, the effect is very short-lived. Thus, research is now aiming to produce more medications that maintain cannabinoid levels in the affected areas for pain relief and for the control of anxiety and depression. The converse treatments are also working well for dealing with nicotine addiction and obesity. The main problem with cannabis is in its addictive nature. So, medications like acomplia that block the cannabinoid receptors help to reduce addictive behavior and reduce appetite. Acomplia is now a front line treatment for obesity in Europe, second in effectiveness only to the use of gastric bands or surgical bypasses (which reduce weight by an average of 30%). By coincidence, the French health authority Afssaps also released new statistics confirming the safety profile of acomplia in relation to depression. People with no history of depression show no adverse symptoms. Others only show an increase in depression at the beginning of a course of treatment. This can easily be monitored and compensated for.

The July conference heard news that one constituent of cannabis, THVC, may offer a better way to reduce appetite than acomplia and, more importantly, may be effective to treat neurodegenerative disorders like Huntington’s disease, Parkinson’s and Alzheimer’s. Why is more not heard about these advances? Possibly because of the prejudice that cannabis is a drug that should be banned. It is a shame society cannot see beyond a name to the good results science can produce.

I think I’m coming to Diabetes slightly later than I should. ED is a common early symptom of Type 2 Diabetes and cardiovascular disease. 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.

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. Above 70 years, it is almost certain that diabetic men will have some difficulty with erectile function.

The cause of ED in diabetic men usually has organic 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.

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.

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.
• Smoking constrict and may block your blood vessels; and can also reduce nitric oxide levels, both of which which may limit the flow of blood into your penis.
• 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.

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.

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.

All contemprorary medical books have become much more informative recently. A simple statement reflecting the vast amount of knowledge that has been accumulated through research over the last one hundred years. Yet, when you look at these books, you are confronted by mountains of facts about increasingly minute processes within the body. 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.

Nowadays ED is studied in details, depicted with wonderfull pictures and described in very interesting articles. 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. A heterosexual couple may engage in sexual intercourse. A homosexual couple may offer mutual manual satisfaction, oral or anal intercourse. Multiple partners may engage in group sex. Many different social taboos would potentially be breached in any more detailed explanation. The common denominators are that the party or parties are expressing their sexuality in the ways that give them the most pleasure. The greater the pleasure we try to obtain the greater disappointment we gain in the end when we don’t obtain the result we want.

Will medical treatment be asked for and a success?

In part, this will be determined by the nature of the relationship. Where the relationship is socially disapproved, the man may well not seek treatment at all because of fear.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.

Unfortunately, many pairs don’t get any treatment from the underlying causes of the ED. 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.

This is two completely different cultural imperatives in conflict. Men are sure that one thing they must have everyday is erection. Any publicly acknowledged failure means shame. 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. In theory, doctors are bound by duties of confidentiality, but the fear of exposure means that many men and their partners do not get treatment when the research shows that couples who are in love and share a strong commitment to their relationship are the ones who would most benefit from that treatment.