Archive for January, 2008

Making Lust Last

Wednesday, January 30th, 2008

By Keith Ablow, M.D.

Good Housekeeping Magazine Logo
Rekindling Passion For The Husband You Still Love

People sometimes tell me they know a couple married 20 years whose sex life
is still as good as it ever was. Here’s what I tell them in return: “There
are only three . One: This couple is lying. Two: They are telling
the truth, because they didn’t have good sex to begin with. Or three: Sex is
all they really have together. They never connected .”

I’ve drawn that conclusion by listening to the many dozens of husbands and
wives I’ve counseled, almost all of whom have admitted that after 10 or 20
years of marriage, passion became elusive.

Sharing lives is different from sharing dinners and long walks and weekends
away. When you were dating the man you ultimately married, you were both acting
much of the time (consciously or not), putting your best feet forward in order
to be attractive to each other.

When you were sick or had a bad headache, you probably pretended it was no
big deal. So did he. Now when your stomach is upset, you feel free to tell him
you’re about to throw up.

When you had an argument with a close friend or your sister, you might have
told him, “It really wasn’t the best day, but it’s getting better now that
we’re together.” He might have smiled, taken your hand, and said, “Tell
me what happened. I want to know.” Now when he asks how your day was, you
might just say, “Fine,” and leave it at that. And he might be happy to
leave it at that too.

Nobody would write that kind of dialogue into a romantic movieunless it was
a sad or serious one. But that’s how married people generally talk because no
one can always act adoring or keep up an air of mystery while sharing the same
space with his or her spouse, year after year. Here are the truths about sex,
as I’ve learned from years of counseling, for most married couples:

Love is constant; passion needs recharging

No surprise: Everything in the universe eventually demagnetizes when left in
proximity to something of the opposite charge. Magnets do, and men and women do
too. Some people fall out of lust in seven days, never mind seven yearsor 17.
Basic animal attraction is a force of nature that seems designed to make us
matenot mate for life. Relaxing in our marriages and freeing ourselves from
the pressure of trying to impress our partners has a outcome: Our
partners are not impressed. The magnetic spell we once cast on them begins to
lift.

Cozy is comfortable, but not sexy

To the extent that men and women become real to each other, they cease to be
princes and princesses, gods and goddesses who inspire romantic fantasies or
amorous worship. Since couples lucky enough to be emotionally genuine with each
other share so many real moments, they need to pay special attention to
creating magical onesbecause great sex requires magic. I’d never suggest that
a couple trade their warm, safe home life for better sex. Why keep your
distance just so you can make love with abandon? I believe you can have a close
marriage and recapture a good sex lifebut only once you admit that reigniting
romance takes creativity and a commitment of time and energy.

Intimacy doesn’t equal sex

When a man and a woman reveal themselves to each other, it makes each person
feel more vulnerable. And, particularly for men, it’s hard to have amazing sex
while feeling emotionally exposed. Our earliest experiences with being close
come from our with parents. And those relationships aren’t (in
any normal scenario) linked with sexual passion. That’s why some husbands and
wives are open about what pleases them sexually only when they have affairs.
They feel as if they have to be free of “family” to be free with their
amorous impulses.

How do yo think, is it true about ?

Why Women Lose Interest in Sex

Tuesday, January 29th, 2008

Living with libido loco? For a growing number of women,
declining hormones, job stress, relationship issues, menopause, and other
problems are taking their toll in the bedroom.

Loss of sexual desire, known in medical terms as hypoactive
sexual desire disorder (HSDD), is the most common form of sexual dysfunction
among women of all ages. A recent study showed that nearly one-third of women
aged 18 to 59 suffer from a lost interest in sex, and it’s not all in their
heads.

Unlike men’s main sexual complaint, erectile dysfunction,
women’s biggest sexual problem is caused by a combination of both mental and
physical factors, which aren’t likely to be cured by merely popping a pill.

“Women’s sexuality tends to be multifaceted and fairly
complicated,” says sex psychologist Sheryl Kingsberg, PhD. “Although we
would love to simplify it so we could have the one-two or even a one-punch
treatment, it doesn’t tend to work that way.”

But the introduction of anti-impotence treatments in the last
few years has spurred more research into the causes of sexual dysfunction among
both men and women, and effective therapies are available to help put the lust
back into women’s lives.

What Is Low Sexual Desire?

Contrary to popular belief, experts say frequency of sexual
intercourse has nothing to do with sexual desire or satisfaction.

“One of first things I do in speaking to women who come in
with sexual concerns is let them know that there is no normal frequency or set
of behaviors and things change with time,” says Jan Shifren, MD, an
assistant professor at Harvard Medical School. “If it’s working for them
and/or their partner, there is no problem.”

But when a woman experiences a significant decrease in interest
in sex that is having an effect on her life and is causing distress, then it’s
considered a problem of low sexual desire or HSDD.

Kingsberg says that sexual desire is more than just an issue of
low libido or sex drive. She says sexual drive is the biological component of
desire, which is reflected as spontaneous sexual interest including sexual
thoughts, erotic fantasies, and daydreams.

Kingsberg, who is an associate professor of reproductive
biology at the Case Western Reserve School of Medicine says, “It’s about
your body signaling that it wants to be sexual. Whether or not there is any
intention to act on it, we all have a certain level of drive.”

That sexual drive declines naturally with age based on
physiological factors. But sexual desire also encompasses interpersonal and
psychological factors that create a willingness to be sexual.

“Above and beyond horniness, it is the sense of intimacy in
the relationship,” says Kingsberg. “If you are mad at your spouse, you
could be horny but you’re not going want to be sexual with that particular
person.”

Therefore, all of these aspects of sexual desire must be
examined in order to determine the root of the problem.

Common causes for a loss of sexual desire and drive in women
include:

  • Interpersonal relationship issues. Partner performance problems,
    lack of emotional satisfaction with the relationship, the birth of a child, and
    becoming a caregiver for a loved one can decrease sexual desire.
  • influences. Job stress, peer pressure, and media
    images of sexuality can negatively influence sexual desire.
  • Low testosterone. Testosterone affects sexual drive in both men and
    women. Testosterone levels peak in women’s mid-20s and then steadily decline
    until menopause, when they drop dramatically.
  • Medical problems: Mental illnesses such as depression, or medical
    conditions, such as , fibroids, and thyroid disorders, impact a
    woman’s sexual drive both mentally and physically.
  • Medications: Certain antidepressants (including the new generation
    of SSRIs), blood pressure lowering drugs, and oral can lower
    sexual drive in many ways, such as decreasing available testosterone levels or
    affecting blood flow.
  • Age. Blood levels of androgens fall continuously in women as they
    age.

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Reducing Medication Costs - Topic Overview

Monday, January 28th, 2008
diabetes,
high blood pressure, and low back pain, require fewer
medications if you can increase your activity level, lose weight, and improve
your diet. For some people who have type 2 diabetes, simple measures such as
eating a balanced diet that spreads
carbohydrate throughout the day and exercising
regularly can help keep your blood sugar level within a safe range without
insulin or other medications. Likewise, following a
particular eating plan and lowering your salt intake has been proven to lower
blood pressure.1

How can I save money on prescriptions?

Generic medications are less expensive
copies of brand-name medications. Ask your doctor if you can take a
generic equivalent for the brand-name medication that
you take now. Generic equivalents are made according to the same strict U.S.
Food and Drug Administration (FDA) standards as brand-name drugs and therefore
have the same quality, strength, purity, and stability as their more expensive
counterparts.

Unfortunately, generic equivalents are not available for every
brand-name medication. If there is not an equivalent, ask your doctor if there
is a similar medication in the same class that may be less expensive or that
has a generic equivalent. For example, Flomax, which is used to treat an
enlarged prostate, is a relatively expensive medication that does not have a
generic equivalent. However, another medication that also is used for enlarged
prostate, Hytrin, does have a less expensive generic equivalent.

Always shop around for the best deal on
medications. The retail cost of medications can vary widely from pharmacy to
pharmacy. While finding a good deal is important, it’s also important that your
pharmacist (or pharmacists) knows your medical history, including all the
drugs-both prescription and nonprescription, as well as dietary supplements and
herbs-you take, even if they are not dispensed at that particular pharmacy.
That way he or she can provide valuable advice about any potential for drug
interactions, side effects, or other problems.

Also, compare costs of buying medications online. Some large
drugstore chains have Web sites that offer savings. See a complete list of Web
sites on the National Association of Boards of Pharmacy (NABP) site at
http://www.nabp.net/vipps/consumer/search.asp. Look for Web sites that display
the NABP VIPPS (Verified Internet Pharmacy Practice Sites) seal, which means
they have met state and federal requirements.

The U.S. Medicare Web site, http://www.medicare.gov, has a useful
tool for comparing prices of hundreds of prescription drugs and generic
equivalents at pharmacies near you and also available by mail order. You can
access this information by answering “Yes” to the question “Do you have
Medicare?” and entering your Zip code. The Web site requires that you answer
several screens of questions and have some familiarity with computers. People
who have difficulty can call 1-800-MEDICARE (1-800-633-4227) to receive lists
of prices for the drugs they use.

Pill splitting is another strategy that
can help you save money without losing drug or safety. Some
tablets are available at double the dose and at the same or almost the same
cost as lower doses. By splitting the larger dose, you can essentially get two
doses for the price of one. However, many medications are not suitable for pill
splitting, including timed-release pills and capsules. The chart below lists 10
commonly prescribed medications that researchers have determined can be split
safely and effectively with significant cost savings.2

Medications that can be split to save
money

Medication Most commonly
prescribed for:
Savings
Clonazepam (Klonopin) Panic disorder, epilepsy 41%
Doxazosin (Cardura) Hypertension 46%
Citalopram (Celexa) Depression 46%
Atorvastatin (Lipitor) High cholesterol 33%
Paroxetine (Paxil) Depression 46%
Pravastatin (Pravachol) High cholesterol 23%
Sildenafil (Viagra) Erectile dysfunction 50%
Lisinopril (Zestril) Heart failure, high blood
pressure
38%
Sertraline (Zoloft) Depression 46%
Olanzapine (Zyprexa) Schizophrenia, bipolar disorder 31%

Ask your doctor or pharmacist if any of your prescription
medications are sold at higher dosages and if it’s possible to split them. Talk
to your pharmacist about how to split pills with an inexpensive, easy-to-use
pill
splitter.

Buying prescriptions in bulk can also
save you money. Ask your doctor to write a prescription for several months’
supply of medications that you take consistently. Mail-order services can often
save you money on large orders.

Are prescription medications always necessary?

There may be an over-the-counter alternative for your
prescription medication. For example, nonprescription Aleve is a fraction of
the cost of the prescription equivalent Naprosyn. (Generic versions of
over-the-counter medications can save you even more money.) Often
nonprescription equivalents of prescription medications come in lower
strengths, so get instructions from your doctor on how to take them.

In the case of antibiotics, recent research has found that
antibiotics are not always necessary. For example, up to 80% of ear infections
get better without antibiotics.3 Your doctor might
recommend that you take a wait-and-see approach before buying expensive
antibiotics. Likewise, randomized trials show that 69% of people who had
sinus infection recovered without any antibiotics.4

Can I save money by purchasing prescription medications from Canada? Is it safe?

The answer to the first question is “Yes.” You can buy most
prescription medications, either over the Internet, by mail order, or in
person, for less money from Canadian pharmacies than from their U.S.
counterparts. Whether it is legal to do so remains .

The FDA warns that the safety of drugs bought from other
countries cannot be ensured. However, many doctors acknowledge that Canada also
demands safety and efficacy for medications, and they would rather their
patients buy medications from Canada than have to skip doses because they can’t
afford their medications. U.S. citizens have been buying medications in Canada
for years, although officially federal law prohibits the practice. Currently,
the U.S. Customs Service allows Americans to bring a 90-day supply of
prescription drugs across the Canadian borders for personal use.5

Talk to your doctor if you decide to import your medications, and
be sure to buy only from licensed Canadian pharmacies and wholesalers.

How can my doctor help?

To enlist your doctor’s help, tell him or her that your
prescription medication bill is a financial burden. Ask for drugs that are less
expensive but just as effective. Often, several medications can be used to
treat the same condition, and your doctor may be able to prescribe the one that
is the most economical. For example, researchers have found that older, less
expensive antibiotics such as amoxicillin work better than newer antibiotics
for children who need treatment for middle ear inflammation.6

Often, drug companies give doctors medication samples free of
charge. You might ask your doctor if he or she has medication samples,
especially when you are trying out a new medication to see whether it will
work.

How can my insurance plan help save me money?

Take time to find out about how your medical insurance or
managed health care plan covers medication costs. Some insurance companies
cover only generic medications if they are available. With some insurance
plans, you may have to pay more for medications that are not on the plan’s list
of preferred medications. Some insurers cover medications that are bought only
at participating pharmacies. Your insurance company also may not pay for
certain medications such as weight-loss and hair-growth drugs. Ask the customer
service representative whether your medications are covered, whether you need
to buy at participating pharmacies, and about your copayment. Many insurance
companies also list this information on their Web sites.

If you have a choice between plans, check what your copayment for
prescription drugs will be, the maximum amount the plan will pay in a year, and
other particulars. Choose the plan that best suits your needs. When buying
medications, find out which payment option will be the least expensive. Some
factors to consider include whether there is a generic version of a preferred
medication, and whether an over-the-counter equivalent is cheaper than your
copayment. Remember, having the right information can save you time and
money.

What about the Medicare drug program?

Beginning in January 2006, a new Medicare drug program-the
Medicare Part D prescription drug benefit-will begin. For the most current
information about what the Medicare Part D Act means for you, go to
http://www.medicare.gov or call 1-800-MEDICARE. Your doctor, pharmacist, or
social worker may also be able to help you understand
your Medicare benefits.

What other resources are available?

See whether the pharmaceutical company that makes your
medication has a patient assistance program. Many pharmaceutical companies
offer free or discounted drugs for people who cannot afford them. These
companies often require that your doctor contact them first about your case. In
any case, your doctor will need to be involved, and the application process can
be complex. You may need to provide to verify your income. The
nonprofit organization RxAssist provides doctors and other health care
providers with the information they need to access these programs. You can find
out more at http://www.rxassist.org. This Web site
also lists state programs for seniors and disabled and low-income people.

If you have a rare disease, you may be eligible for the National
Organization for Rare Disorders (NORD) medication assistance program. This
program helps people with rare diseases whose income is too high to qualify for
Medicaid but too low to pay for their prescribed medications. For more
information, visit http://www.rarediseases.org/programs/medication.

Most veterans know that the Veterans Administration offers
prescription drug coverage for retired veterans. But many people don’t know
that the same service is available for their families and survivors. Call the
VA Health Benefits Service Center toll-free at 1-877-222-VETS (8387), or go to
http://www1.va.gov/health_benefits/.

Some organizations offer special discounts on prescription drugs
for their members. For example, members of AARP save 17% on brand drugs and at
least 50% on generic drugs. Also, many pharmacies offer some form of a discount
plan for seniors.

, and more another.

Multiple Sclerosis (MS) - Medications

Sunday, January 27th, 2008
multiple sclerosis (MS) may be used:

  • During a
    relapse, to make the attack shorter and less
    severe.
  • Over a long period of time, to alter the natural course of
    the disease (disease-modifying therapy).
  • To control specific
    symptoms as they occur.

Controlling a relapse

Medications can shorten a sudden relapse and help you recover
more quickly. Temporary treatment with medications called
corticosteroids is the most common treatment used to
control a relapse. These medications have not been shown
to affect the long-term course of the disease or to prevent disability.

Altering the course of MS using disease-modifying treatment

Strong evidence suggests that MS is caused by the
immune system causing
inflammation and attacking the myelin-the coating
surrounding the nerve and nerve fibers. Medications that change the activity of
the immune system can reduce the number and severity of attacks that damage the
protective myelin.

Currently, interferon beta (Avonex and Rebif, and Betaseron),
glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) are the only
medications that have been approved for this purpose. For people with
relapsing-remitting MS, these medications can reduce
the number and severity of relapses and can result in fewer brain lesions. They
may also delay disability in some people. Betaseron and Novantrone may delay
disease progression in some people with
secondary progressive MS.

Currently, there is no effective disease-modifying treatment for
primary progressive MS.

Relieving symptoms

Treating specific symptoms can be effective, even if it does not
stop the progression of the disease. Symptoms that can often be controlled or
relieved with medication include:

  • Fatigue. Medications to reduce fatigue
    or help you sleep better may include amantadine (Symmetrel), modafinil
    (Provigil), or fluoxetine (Prozac).
  • Muscle stiffness
    (spasticity) and tremors. Medications that may reduce muscles spasms or
    stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene
    (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam
    (Klonopin). Sometimes a combination of these medications works best to reduce
    your muscle symptoms.
  • Urinary problems and constipation.
    Medications used to reduce frequent urination may include propantheline
    (Pro-Banthine), oxybutynin (Ditropan), or tolterodine (Detrol). Medications
    sometimes used to relieve constipation include bulk agents such as psyllium
    (Metamucil) or daily use of laxatives.
  • Pain and
    abnormal sensations. Depending on the severity of the pain, both
    prescription and nonprescription medications may be tried. Prescription
    medications commonly used to reduce pain associated with MS include baclofen
    (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).
    medications may include acetaminophen, ibuprofen, or naproxen
    sodium.
  • Depression. Antidepressant medications may be used to
    reduce depression that often occurs as a result of having MS.
    often tried include tricyclic antidepressants-such as amitriptyline (Elavil),
    desipramine (Norpramin), or imipramine (Tofranil)-or selective serotonin
    reuptake inhibitors (SSRIs)-such as fluoxetine (Prozac) or sertraline (Zoloft)
    among others.
  • Sexual difficulties. Medications used
    to relieve sexual difficulties that can be associated with MS include
    sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also
    be given to improve
    erectile dysfunction.

MS can affect many parts of the nervous system and produce a wide
range of symptoms. The choice of medications depends on your symptoms.
Medication may be used only some of the time or regularly, depending on how
severe or constant a particular symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See the
Home Treatment section of this topic.

Medication Choices

Symptom management

Medications used to treat symptoms of an attack of multiple
sclerosis (MS) and help you recover more quickly from a relapse include:

  • Corticosteroids (such as
    methylprednisolone).
  • ACTH (adrenocorticotropic
    hormone).
  • Intravenous immunoglobulin (IVIG) or
    plasma exchange (neither is used frequently).

Relapsing-remitting MS

Medications used specifically for relapsing-remitting MS to
reduce the number and severity of relapses and possibly delay disability
include:

  • Interferon beta (Avonex, Rebif, and
    Betaseron).
  • Glatiramer acetate
    (Copaxone).
  • Mitoxantrone (Novantrone) for relapsing-remitting MS
    that is rapidly getting worse.

Secondary-progressive MS

Medications used to treat and possibly delay the progression of
secondary progressive MS that is also relapsing include:

  • Interferon beta-1b (such as
    Betaseron).
  • Mitoxantrone (Novantrone).

MS

No medicines have been clearly proven to help, and none have
been approved for primary-progressive MS. Some of the newer and experimental
medications, such as
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) are being tested for
primary-progressive MS.

Medications being studied

A variety of
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) have been tried as
therapy for MS. While none have been clearly proven beneficial and none have
been approved for treatment of MS, these medications may be used when standard
therapy fails.

Several medicines are currently being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to participate in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at http://www.nationalmssociety.org.

What To Think About

Long-term treatment with interferon beta and glatiramer acetate
can improve the quality of life for some people who have relapsing-remitting MS
by making relapses less frequent and less severe. Some evidence suggests that
these medications may also reduce or delay future disability caused by this
form of the disease.

The National Multiple Sclerosis Society recommends that treatment
with interferon beta or glatiramer acetate be started as soon as it is clear
that you have MS. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

Despite the recommendation, however, some people find it
difficult to decide whether to begin disease-modifying therapy, especially when
their symptoms have been fairly mild. Some may not want to bear the risks and
flu-like side effects of interferon therapy when they are not sure they need
it. Some may want to see whether their disease worsens before starting therapy.
A small percentage of people diagnosed with MS may never have more than a few
mild episodes and may never develop any disability, but the disease is
unpredictable. For more information, see:

Should I have disease-modifying therapy for
MS?

If you decide not to try disease-modifying therapy at this time,
work with your doctor to monitor your health through regular checkups and
periodic MRI scans to evaluate whether the disease is progressing. If new
lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

Treating symptoms and relapses

The need and desire for medication vary. If your symptoms are
mild, you may choose to manage them without any medication. If you have
specific symptoms that are causing problems, certain medications may help you
keep them under control. Or you may want to use medication only during a
relapse.

You may also want to consider:

  • The possible side effects of using steroids
    or other medications to treat symptoms or control a relapse. Some people have
    only minor side effects, but others may have side effects that concern them
    more than their MS symptoms.
  • The costs of treating symptoms and
    controlling relapses. In some cases, using medication to control symptoms and
    relapses may reduce the need for hospital stays.
  • Other personal
    issues that you face at work or at home.

Also keep in mind that it can be hard to tell whether
medication is helping. Multiple sclerosis is a disease with spontaneous
remissions, which means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment does not mean
that a treatment is working.

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Type 1 Diabetes: Living With Complications - Home Treatment

Saturday, January 26th, 2008


type 1 diabetes are:

  • Keep your blood sugar as close to normal as
    possible. The American Diabetes Association recommends a
    hemoglobin A1c
    (HbA1c) level of less than 7%. Some people may be
    able to achieve a normal level of less than 6%.2 The
    lower the A1c, the lower the chance of s.
    The A1c level is a measure of your blood sugar over the
    past 2 or 3 months.
  • Eat a diet that spreads
    carbohydrate throughout the day.
  • Get
    regular exercise.
  • Take your prescribed insulin either by injection
    or through an
    insulin pump.
  • Do not smoke.

For more information, see the Home Treatment section of the topic
Type
1 Diabetes: Living With the Disease.

Other measures to care for and protect yourself depend on which
complication you have.

Heart and large blood vessel disease

Even if you don’t have heart and blood vessel problems, you are
at risk for them.

  • Don’t smoke. Smoking increases your risk of a
    heart attack or
    stroke, and makes many health problems
    worse.
  • Take your blood pressure medicine, if
    prescribed.
  • Take aspirin daily, if advised by your health
    .
  • Drink alcohol in moderation. This means no more than
    1 drink a day for women and no more than 2 drinks a day for men. Discuss with
    your health professional whether you should drink alcohol.

Eye disease (diabetic retinopathy)

Call your eye specialist if you notice any changes in your
vision. Vision changes may mean worsening of diabetic retinopathy. Early
detection and treatment can help prevent vision loss.

If you have severe vision loss from diabetic retinopathy,
vision aids can help. Your local or state organization
for the visually impaired can help you find these aids.

For more information, see the topic
Diabetic .

Kidney disease (diabetic nephropathy)

  • Take your
    blood pressure medications, if prescribed. Your blood
    pressure should be less than 130/80 mm Hg. Ask your health professional if you
    need to monitor your blood pressure at home.
  • Get no more than 10%
    of your daily calories from protein foods if you have small amounts of protein
    in your urine (microalbuminuria).2
  • Limit
    salt in your diet because it makes your body retain fluid and can increase your
    blood pressure.

For more information, see the topic
Diabetic Nephropathy.

Foot problems

Daily care of your feet is very important. Because
diabetic neuropathy and diabetic damage to the blood
vessels in your legs can lead to severe infections and deformities of your
feet, seek treatment for any foot problem, no matter how minor it seems. Even a
small foot injury can lead to serious .

For more information, see

Foot care for people with
diabetes

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral
neuropathy
):

  • Turn your water heater down, and use a bath
    thermometer or have someone test your bath water to make sure it is not too
    hot.
  • Don’t go barefoot. Always wear shoes, even in the
    house.
  • Don’t use an electric blanket.
  • Arrange your
    furniture so that the walkways through your house are free of clutter.

If it affects your body’s internal functioning (autonomic neuropathy):

  • Eat smaller, more frequent meals that contain
    less fat and fiber, if you have
    gastroparesis or other digestive
    problems.
  • Drink more fluids each day, if you have urinary problems
    or profuse sweating. This will prevent urinary tract infections and
    dehydration.
  • Try a device for erection
    problems or a lubricating cream for vaginal dryness, if you have sexual
    problems. Talk to your health professional about medication for erection
    problems (Cialis, Levitra, Viagra). For more information, see the topic
    Erection Problems.
  • Check your blood sugar
    level frequently during the day and during the night occasionally, if you have
    unawareness.

If it affects one nerve (focal
neuropathy
):

  • Wear a joint splint, if your health
    professional advises.
  • Take breaks during activities that require
    repetitive movements.
  • Make sure your work area has appropriate
    support for the affected joint.

For more information, see the topic
Diabetic Neuropathy.

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Male Sexual Problems

Friday, January 25th, 2008

A sexual problem, or sexual dysfunction, refers to a problem during any
phase of the sexual response cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm and resolution.

While research suggests that sexual dysfunction is common (43% of women and
31% of men report some degree of difficulty), it is a topic that many people
are hesitant to discuss. Fortunately, most cases of sexual dysfunction are
treatable, so it is important to share your concerns with your partner and
doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
problem.

  • Physical causes: Many physical and/or medical conditions can cause problems
    with sexual function. These conditions include diabetes, heart and vascular
    (blood vessel) disease, neurological disorders, hormonal imbalances, chronic
    diseases such as kidney or liver failure, and alcoholism and drug abuse. In
    addition, the side effects of certain medications, including some
    antidepressant drugs, can affect sexual desire and function.
  • Psychological causes: These include stress and anxiety,
    concern about sexual , marital or relationship problems, depression,
    feelings of guilt and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are disorders, erectile
dysfunction and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

  • Premature ejaculation: This refers to ejaculation that occurs before or
    soon after penetration.
  • Inhibited or retarded ejaculation: This is when ejaculation is slow to
    occur.
  • Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is
    forced back into the bladder rather than through the urethra and out the end of
    the penis.

In some cases, premature and inhibited ejaculation are caused by
psychological factors, including a strict religious background that causes the
person to view sex as sinful, a lack of attraction for a partner and past
traumatic events. Premature ejaculation, the most common form of sexual
dysfunction in men, often is due to nervousness over how well he will perform
during sex. Certain drugs, including some anti-depressants, may affect
ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from
diabetic neuropathy (nerve damage). This is due to problems with the nerves in
the bladder and the bladder neck that allow the ejaculate to flow backward. In
other men, retrograde ejaculation occurs after operations on the bladder neck
or prostate, or after certain abdominal operations. In addition, certain
medications, particularly those used to treat mood disorders, may cause
problems with ejaculation.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to
attain and/or maintain an erection suitable for intercourse. Causes of erectile
dysfunction include diseases affecting blood flow, such as atherosclerosis
(hardening of the arteries); nerve disorders; psychological factors, such as
stress, depression, and performance anxiety (nervousness over his ability to
sexually perform); and injury to the penis. Chronic illness, certain
medications, and a condition called Peyronie’s disease (scar tissue in the
penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or
interest in sexual activity. Reduced libido can result from physical or
psychological factors. It has been associated with low levels of the hormone
testosterone. It also may be caused by psychological problems, such as anxiety
and depression; medical illnesses, such as diabetes and high blood pressure;
certain medications, including some anti-depressants; and relationship
difficulties.

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Blood Pressure Medications and ED

Thursday, January 24th, 2008


To treat erectile dysfunction (ED), you have to lower your blood pressure
first. Some people are able to do that through lifestyle changes alone. Others
need help from prescribed blood pressure medication.

A problem for many men, however, is that some types of blood pressure
medicines can actually cause erectile dysfunction. That may make it
difficult to stay on your medication, especially if your high blood pressure
never caused any symptoms before. An estimated 70% of men who have side effects
from blood pressure medicine stop taking it.

Many drugs used to treat high blood pressure have been linked to erectile
dysfunction. But some are much less likely than others to cause problems.
Certain of the blood pressures drugs may even improve erectile
dysfunction for some men.

It’s known that diuretics (or water pills, like hydrochlorothiazide) and
(like Atenolol) can cause erection problems. These are also the
first drugs that a doctor is likely to prescribe if you are not able to lower
your blood pressure through diet and exercise.

If you’re taking a diuretic, you should stay on your medicine until your
blood pressure is under control. If your erection problem persists, or your
blood pressure goes back up, then your doctor might switch you to a drug that’s
less likely to cause erectile dysfunction. Or, a of
might work better to control your blood pressure and reduce the risk of
erectile dysfunction.

If you take a beta blocker you may also want to ask your doctor if it might
cause erectile dysfunction. You might be better off on a medication less likely
to cause a problem.

Erection-Friendly High Blood Pressure Drugs

Some families of high blood pressure drugs rarely cause erectile dysfunction
as a side effect:

  • ACE inhibitors
  • Alpha-blockers
  • Calcium channel blockers
  • ARBs

ACE (angiotensin converting enzyme) inhibitors — such as Lotensin, Capoten,
Zestril, Prinivil, etc. — widen blood vessels and increase blood flow.
Erectile dysfunction is rarely a side effect, occurring in less than 1% of
patients. There are several different medications in the category. This seems
to be true of all of them.

There are also medications known as calcium channel blockers, such as
Diltiazem, Verapamil, or Amlodipine. As a group, they rarely cause erectile
dysfunction. But erection problems may be less common with some individual
drugs within that group than with others. Your doctor can tell you which.

In general, alpha-blockers do not often cause erection problems either. In
one study published in the journal Hypertension in 1997, a small
number of men actually had a 100% improvement in their erectile dysfunction
after two years on the alpha-blocker Cardura.

Drugs known as ARBs (angiotensin II receptor blockers, like Losarten) are
not only unlikely to cause erection problems, but they may actually
improve sexual function in men with high blood pressure.

A 2001 study published in the American Journal of the Medical
Sciences
looked at the drug Cozaar, an ARB. At first, just 7% of men and
women in the study said they felt sexually satisfied overall. After 12 weeks of
Cozaar, about 58% said they were sexually satisfied. The percentage of men who
reported having erectile dysfunction dropped from 75% to 12%.

Another study compared the drug Diovan, an ARB, with Coreg, a .
The study, published in the American Journal of Hypertension in 2001,
compared the effect of the two drugs on blood pressure and frequency of sexual
intercourse.

The drugs controlled blood pressure equally well. But people who took the
ARB reported having sex more often during the 16 weeks of treatment. They said
they had sex about eight times a month before, and 10 times a month after.
People taking the beta-blocker had sex much less often: eight times a month
before, and four times a month after.

Steps to Take If Your Medicine Causes Erection Problems

Tell your doctor if you think your blood pressure medicine may be causing
problems with your erections.

If it is your medication, and not just your high blood pressure,
switching to another may solve the problem. Never stop taking your
medicine without your doctor’s OK.

But high blood pressure itself still could be to blame for your erectile
dysfunction. In that case, ask about trying an erectile dysfunction drug like
Viagra, Cialis, or Levitra.

You should only take these drugs once your blood pressure is under control.
They are not safe for men with untreated high blood pressure. They are also not
safe for men taking alpha-blockers, or men taking nitrate drugs for heart
disease.

Erection Problems (Erectile Dysfunction) - Exams and Tests

Wednesday, January 23rd, 2008
erection problem.

As part of the initial evaluation, your health professional
may:

  • Review your risk factors for an erection
    problem. For more , see the What Increases Your Risk section of this
    topic.
  • Ask
    questions about your sexual function.
  • Do a
    complete physical of the abdomen, penis, prostate, rectum, and
    testicles.
  • Do laboratory tests for:
    • Testosterone.
      A low testosterone level may reduce sexual desire, leading to an erection
      problem.
    • Prolactin. A
      high level of prolactin () may indicate a small tumor in the
      brain, which can affect other hormone levels in the body. When hormone levels
      are affected, an erection problem may result.
    • Thyroid hormone. Either a high or low level of thyroid
      hormone may cause problems with sexual desire or erections.
    • Blood glucose. Elevated blood sugar (glucose) levels
      may indicate the presence of
      diabetes, which can contribute to
      erection problems.

At this point, oral medications such as
Viagra, Levitra, or Cialis are often recommended
unless an easily treated cause (such as a medication side effect or
testosterone deficiency) has been identified. If oral medications do not work
or your doctor feels more testing is necessary, he or she may recommend:

  • Specific tests for erection problems, such as a
    nocturnal penile tumescence testing (rigidity test) and an intracavernosal
    injection test. These both help determine whether physical or psychological
    factors are causing your erection problem.
  • A psychological
    evaluation, if a psychological issue is suspected.

An
ultrasound may be done if your doctor suspects you
have a circulation problem (peripheral arterial disease). Even if
the blood vessels cannot be repaired, it may be helpful to know if you have
this condition because it may indicate you have a risk for other blood vessel
(vascular) problems. In very rare instances, you may have angiography-an X-ray
test of blood flow through an artery. Its usefulness is limited because
treatment to repair the blood vessels that supply blood to the penis is
appropriate for very few men.

, and more another.

Sexual Dysfunction in Women

Tuesday, January 22nd, 2008

A sexual problem, or sexual dysfunction, refers to a problem
during any phase of the
sexual response cycle that prevents the individual or couple from
satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43%
of women and 31% of men report some degree of difficulty), it is a topic that
many people are hesitant to discuss. Fortunately, most cases of sexual
dysfunction are treatable, so it is important to share your concerns with your
partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
problem.

  • Physical causes. Many physical and/or medical conditions can cause
    problems with sexual function. These conditions include diabetes, heart
    disease, neurological diseases, hormonal imbalances, menopause, chronic
    diseases such as kidney disease or liver failure, and alcoholism and drug
    abuse. In addition, the side effects of certain medications, including some
    antidepressant drugs, can affect sexual desire and function.
  • causes. These include work-related stress and anxiety,
    concern about sexual performance, marital or relationship problems, depression,
    feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women
include:

  • Inhibited sexual desire. This involves a lack of sexual desire or
    interest in sex. Many factors can contribute to a lack of desire, including
    hormonal changes, medical conditions and treatments (for example cancer and
    chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular
    sexual routines also may contribute to a lack of enthusiasm for sex, as can
    lifestyle factors, such as careers and the care of children.
  • Inability to become aroused. For women, the inability to become
    physically aroused during sexual activity often involves insufficient vaginal
    lubrication. The inability to become aroused also may be related to anxiety or
    inadequate stimulation. In addition, researchers are investigating how blood
    flow problems affecting the vagina and clitoris may contribute to arousal
    problems.
  • Lack of orgasm (anorgasmia). This is the absence of sexual climax
    (orgasm). It can be caused by sexual inhibition, , lack of
    knowledge and psychological factors such as guilt, anxiety, or a past sexual
    trauma or abuse. Other factors contributing to anorgasmia include insufficient
    stimulation, certain medications, and chronic diseases.
  • Painful intercourse. Pain during intercourse can be caused by a
    number of problems, including
    endometriosis, a pelvic mass, ovarian cysts,
    vaginitis, poor lubrication, the presence of scar tissue from surgery, or a

    sexually transmitted disease. A condition called vaginismus is a painful,
    involuntary spasm of the muscles that surround the vaginal entrance. It may
    occur in women who fear that penetration will be painful and also may stem from
    a sexual phobia or from a previous traumatic or painful experience.

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a physical exam and a
thorough evaluation of symptoms and a physical exam. The doctor may perform a

pelvic examination to evaluate the health of the reproductive organs and a

Pap smear to detect changes in the cells of the cervix (to check for cancer
or a pre-cancerous condition). He or she may order other tests to rule out any
medical problems that may be contributing to the problem.

An evaluation of your attitude regarding sex, as well as other
possible contributing factors (fear, anxiety, past sexual trauma/abuse,
relationship problems, alcohol or drug abuse, etc.) will help the doctor
understand the underlying cause of the problem and make appropriate
recommendations for treatment.

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Rx Drug Abuse: Common and Dangerous

Monday, January 21st, 2008

In the 1970s, parents worried that their longhaired, bell-bottomed teenagers were getting drunk or smoking marijuana. Today, dangers also come in the form of prescription medicines — from opioid pain relievers such as OxyContin to ADHD drugs such as Ritalin.

drug abuse appears to be on the rise in this country. Wilson Compton, MD, director of the division of epidemiology services and prevention research at the National Institute on Drug Abuse (NIDA), says the reasons aren’t clear.

But he suspects that increasing numbers of prescriptions written for certain drugs, such as ADHD medications, afford greater opportunity. “A certain portion of those will be diverted for abuse purposes,” he says.

Compton also says that in the current environment it seems almost normal to pop pills. “All of the for pills may play a role in our willingness to try them.”

Roughly 6.3 million Americans report that they’re currently using prescription drugs for nonmedical reasons, according to the U.S. Department of Health and Human Services.

Prescription drug abuse knows no age. The elderly are vulnerable because they’re more likely to take many medications, often long term. Also, women may be as much as 55% more likely as men to be prescribed drugs that can be abused, such as narcotics and tranquilizers; therefore, their risk is greater, according to the NIDA.

Teens and Prescription Drug Abuse

Abuse is most common among young people, Compton says. “Prescription drug abuse — like most drug abuse — tends to peak in the teens and 20s,” he tells WebMD.

Almost one in five teens — roughly 4.5 million — has tried getting high with prescription drugs (typically with pain relievers such as Vicodin or OxyContin, or stimulants, such as Ritalin and Adderall). That’s according to a recent national study on teen abuse of prescription and over-the-counter drugs by the nonprofit Partnership for a Drug-Free America.

The study also found that teens’ abuse of prescription and over-the-counter medicines is equal to or higher than abuse of drugs such as cocaine and crack, Ecstasy, , and heroin.

Some teens say that prescription medicines are much safer to abuse than illegal drugs. But just because prescription drugs aren’t cooked up in someone’s garage doesn’t mean that they’re safe. According to Compton, the main risk for many drugs is addiction.

“As people try these substances, some of them will find that they really like them,” he says. “They take more of them and they continue to take them, even when they no longer want to. And that’s the hallmark of addiction. It creeps up on people in very subtle and unexpected ways. No one starts out taking a drug, saying, ‘I want to be an addict.’”

Besides addiction, prescription drug abuse can bring on a host of health problems, such as irregular heartbeats, seizures, hostility, and paranoia — even infections with HIV or other agents if someone dissolves and injects pills to get a quick high. Overdoses can be fatal. To combat the potential for abuse, some drug companies have marketed newer, versions that are harder to misuse.

It’s important to remember that most people can reap benefits from prescription drugs without problems. But a minority will run into trouble. “Using these substances outside of a doctor’s prescription is already a red flag and a warning,” Compton says.

Which drugs are commonly abused? Who’s most susceptible? How could they be endangering their health? Here’s the rundown.

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