Natural Health and Herbal Remedies Blog – information on herbal medicine

There are men who don’t want to ever lose what they presently have. To that end, they are willing to do everything possible—including taking the pill. Their thinking goes like this: why shouldn’t a healthy man use it to make sure he won’t lose his own hard erection? This and other philosophical dilemmas raised by the pill are perplexing because they verge on areas where there are no clearly defined medical answers at this time. The oral erection drugs are so new that no one as yet has had enough experience to be able to say yes or no to their “off-label” use.

Should doctors give patients who are not suffering from ED—but who nonetheless want to maximize their peak performance in every way—access to these new medications? They have already demanded them. One of my patients, a forty-two-year-old man with no erection problems, was insistent. He stated categorically that he wanted to see if he could turn back the clock and regain the rocklike hardness he had when he was twenty. His rationale was direct. “If it’s available,” he said, “why shouldn’t I use it, as long as it won’t hurt me?”

In another significant turn of events, one of my female patients, a very attractive forty-one-year-old divorcee who had heard of the pills, wanted to know if she could get a prescription for them. “If they are all that I’ve heard they are, I want to keep them in the night table, next to the condoms.”

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Another patient who sought to enroll in the study was John, a fifty-eight-year-old maintenance crew supervisor who had recently undergone triple bypass surgery. For the five years prior to the operation, his heart disease had put a brake on his sexual relationship with Harriet, his wife. What was frustrating to both of them was that now that his heart was repaired, he still had ED. Harriet, who accompanied John to my office, put it this way: “We thought that the surgery would put the bad times behind us, that the pressures and stress of his illness would be gone. When we finally felt the time was right, John couldn’t respond, no matter what I tried. We both were disappointed. And, I’ll tell you the truth, I was a little angry, too. I want to be supportive and reassuring, but I’m having a really hard time. We fight a lot. I feel like no matter what medicine has to offer, nothing will help us.”

I wasn’t surprised to hear Harriet’s view. Being the partner of a man with ED is no easy matter. Many couples maintain a truce; either they won’t talk about the problem or they ignore it in the false belief that it doesn’t exist. Sadly, their self-induced silence not only distances them physically, but emotionally as well. Often, the relationship, already on shaky ground, disintegrates completely. And ED can foster doubt in the partner, as well.

As Harriet said, “I thought I knew what the trouble was after the operation. John just didn’t find me attractive anymore. Alter all, we’ve been married for twenty-five years and I’ve had three children. I don’t look like I did when we first got married. I thought that now that he had recovered his health, he wanted a younger, more vibrant woman at his side. On one level I was devastated but ironically, on another, I was kind of relieved. Now I wouldn’t have to feel rejected because we didn’t have to try to have sex. I looked elsewhere for comfort, and buried myself—like so many unhappy people do—in my work.”

John looked stunned as Harriet told her side of the ED story. “I never felt that way,” he said to her. “I thought you’d leave me because I was failing you.”

After consulting John’s cardiologist, I was able to reduce the dosage of some of his heart medications, which I felt were contributing to his erection problems. I also enrolled the couple in the Vasomax study.

While the 40 mg of Vasomax did them both a world of good, it was the foundation on which they could start to rebuild their torn relationship. John, who was so beaten down by years of erectile failure, needed to face the profound psychological damage that both he and Harriet had experienced. Harriet, in turn, could benefit by facing her anger and doubts. I suggested to them that they seek professional help. Happily, they took my advice and began seeing a therapist who specialized in marital issues.

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Chest pain is a frightening symptom that can affect individuals of all ages. In an older person the degree of pain may be less vivid than in a younger person and therefore may go unnoticed. Chest pain is either acute (sudden) or chronic (longstanding). Acute chest pain has many causes, including illnesses affecting the heart, lungs, and the muscles and bones of the chest and spine. The type of pain often tells the physician the underlying cause.

A common cause of acute chest pain is a heart attack (myocardial infarction, coronary thrombosis). Typically, but not necessarily, the pain starts suddenly and is felt behind the breastbone. It is characterized by a pressing or heavy feeling that sometimes travels to the back or to the shoulder and wrist. Occasionally, it is felt in the neck and jaw. You may experience a pain in the lower chest and mistake it for indigestion. I know of many older people who postponed a visit to the physician because they assumed they were suffering from indigestion when, in fact, they had experienced a heart attack.

Often the pain of a heart attack is less typical in the elderly. One woman came to my office complaining of indigestion, a problem she had had for many years. While she was waiting, the nurse noticed that she was burping frequently, and seemed to be uncomfortable. An electrocardiogram showed that she had suffered a myocardial infarction. At no time had she complained of the chest pain that usually accompanies a heart attack.

Other causes for the sudden onset of chest pain are a pneumothorax (collapse of a lung), pulmonary embolism (blood clot in the lung), or an acute lung infection (pneumonia). Usually, symptoms such as shortness of breath, cough, phlegm, or fever indicate a lung problem. Acute chest pain can also result from spontaneous fractures of the spine and ribs. Some older people have a tendency to experience spontaneous fractures of their spine. Sometimes this causes pain in the chest, rather than in the back, because nerves are pinched as they leave the spine and wrap around the chest.

An elderly woman was urgently admitted to the hospital because she had acute pain in her lower chest and upper abdomen. She could not find a comfortable way to lie in bed. An electrocardiogram failed to show evidence of a heart attack to account for her pain. Nitroglycerin did not alleviate the pain. An X-ray of her spine showed that she had fractured three vertebrae (spinal bones), which probably pressed on the nerves going to the front of her chest. I found that treatment with analgesics and heat to her back relieved her pain, which eventually subsided as the fractures healed.

Chronic chest pain occurs for the same reasons as acute pain. It can come from muscle and bone disorders, such as arthritis, that affect the spine and ribs, or occasionally from bone tumors affecting the spine or ribs. But the most common cause of chronic chest pain is angina pectoris, and it occurs when physical activity or emotional stress strains the heart. The pressure or heavy pain in the chest disappears when the exertion or stress is stopped. A common trigger of anginal pain is walking into a cold wind.

A common imitator of angina pectoris in older people is a hiatus hernia with reflux of stomach juices. Even though the pain typically has a burning quality, which is different from angina pectoris, it can sometimes be indistinguishable from anginal pain. It occurs especially when bending over and at night. Diagnosis often requires X-rays of the stomach and occasionally gastroscopy, which shows whether gastric juice is coming from the stomach and irritating the esophagus.

At times, the exact cause of chronic chest pain is difficult to determine, especially if more than one factor plays a role in its production. Your physician may have to use various drugs in sequence and in combination in order to relieve pain that has multiple and elusive causes.

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With the great emphasis on weight control, one would assume that weight loss is a welcome relief from the tendency toward obesity that plagues many older individuals. Your body will usually maintain its weight so long as there is no major change in food intake or degree of physical activity. If you consciously want to lose weight, you will no doubt change your eating habits or activities. The weight loss is not only expected, but anticipated and welcomed.

But sometimes you might begin to lose weight despite maintaining a steady degree of physical activity and a well-balanced diet. When this happens, weight loss may be the first sign of an illness that may present no other symptoms, especially in the early stages. The point at which you might begin to notice your weight loss depends on your lifestyle. If you live in an institution, weight loss may be noticed early if the staff weighs you regularly. If you live at home and do not weigh yourself periodically, the first sign may be that your clothes are loose. Neighbors, friends, or relatives may remark that you look thinner. Or your physician may notice your loss of weight since your previous visit.

If you are certain that you have not changed your food intake or physical activity, you should look for other symptoms that may be causing the weight loss. Medical advice should be sought.

A number of illnesses can lead to a loss of weight despite a good appetite and a normal diet. An overactive thyroid gland (hyperthyroidism) in the older person may show itself as weight loss without the symptoms that are usually found in younger people. You may experience heart palpitations and emotional irritability or perhaps some loosening of the bowel movement. Frequently, however, weight loss is the only symptom.

Long-standing (chronic) infections, such as tuberculosis and bacterial endocarditis can also lead to weight loss. In these cases, there is usually fever and a general feeling of debilitation, as well as a loss of appetite.

If you are aware that occult malignancy (hidden cancer), is also a cause of weight loss, you may become frightened and postpone medical advice. However, many other hidden noncancerous conditions can lead to the same symptoms. Even a cancer that shows itself as weight loss might be treatable. It is more likely to respond to therapy if discovered early than if allowed to progress until other symptoms appear. Never let your fears keep you from getting proper advice.

If you take digoxin and diuretics for a heart condition, you may lose weight in the form of excess fluid. This kind of weight loss is usually associated with improvement in heart symptoms and the disappearance of the swelling in your legs and abdomen.

Occasionally an older person develops diabetes mellitus and experiences weight loss with an increase in appetite and in the amount of urine passed. However, in the older person, diabetes mellitus more commonly is accompanied by obesity.

Malabsorption, in which food is not absorbed properly, may be the result of some problem within the bowel itself or within the pancreas, which manufactures enzymes (digestive helpers). Sometimes the pancreas does not produce enough enzymes, and the food is poorly digested in the intestine and therefore poorly absorbed. You may or may not have diarrhea. The inability to absorb nutrients leads to a gradual loss of weight just the same as if you stopped eating.

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Many illnesses appear to be similar and yet are quite different in terms of their ultimate outcome and treatment. Often, despite many tests of body fluids and innumerable X-rays and scans, a definite explanation of a disease is not clear. Under these circumstances a biopsy may be necessary to define its exact nature.

In a biopsy a small piece of the diseased tissue is removed and examined under a microscope. The specimen may also be sent for special biochemical studies, as well as for culture. In most instances a biopsy involves at least a mild degree of discomfort, and sometimes there may be a small risk, depending on the type of biopsy and how it is obtained. For instance, a biopsy of the skin has less hazard than a biopsy of the liver, which lies within the abdominal cavity. A biopsy can make a great difference in the ability of the physician to treat you effectively. Unless it will add to your well-being, a biopsy will not be requested unless it is absolutely necessary. If a biopsy is ordered for you, ask your physician why and what the complications might be.

Bone Marrow Biopsy

A bone marrow test is a kind of biopsy. The blood cells are made in the bone marrow, and a bone marrow specimen shows the early development of blood cells before they enter the bloodstream. It is not always possible to diagnose disorders of the blood by blood tests alone.

Either the area of the breastbone (sternum) or the pelvic bone is anesthetized with a local injection. A needle is then inserted into the bone and a sample of the bone marrow removed. The procedure takes about ten minutes and usually causes relatively little discomfort and poses virtually no danger.

Lung Biopsy

A biopsy of the pleura (lining of the chest wall) or lung may be necessary if you have a disorder of the respiratory system that cannot be determined by X-rays and an examination of sputum. If fluid collects in the pleural space, it is not possible to tell its cause without obtaining a sample of the liquid, because a number of illnesses can affect the pleural fluid in the same way.

A disease can affect the lung without causing fluid to collect. It may be necessary to do a bronchoscopy, which allows the physician to see any abnormalities within the bronchi. If something unexpected is seen, it is often possible to take a biopsy through the bronchoscope. If the abnormal area is out of reach of the bronchoscope, a needle is inserted through the skin of the chest wall into the lung, after preparation with a local anesthetic. This is called a needle lung biopsy, and it is not always successful in obtaining the tissue. Therefore, an open lung biopsy may be necessary. This involves making a small cut through the chest wall and removing a tiny piece of lung. After this type of procedure a tube may be placed in the chest for a few hours a keep the lung expanded until the hole closes. Although more complex than the other biopsies, in almost all cases an open lung biopsy can be done without danger. It is considered only when the diagnosis is elusive. Lung biopsies are usually done in hospital because of the risk of temporary collapse of the lung.

Liver Biopsy

The liver can be affected by many diseases that may show similar abnormal liver function test results and nuclear scan findings. A liver biopsy often permits a definite diagnosis. Some liver diseases improve quickly; others linger and may require more potent medications. More than one biopsy may be done during the course of an illness and treatment.

Invariably, the seriousness of the disease warrants the small hazard involved. The skin of the upper abdomen is frozen with a local anesthetic. You will then be instructed to hold your breath as a fine needle is quickly inserted in your liver and withdrawn with the specimen. The test takes only a few moments and causes little discomfort. In rare instances there is some bleeding after the test, but this usually stops quickly. It is extremely rare for there to be any dangerous effects of this examination.

Muscle and Skin Biopsies

Muscle and skin biopsies can also be done. Small tumors of the skin are often removed at the time of biopsy. Many conditions affect the cells or the blood vessels of the muscles. Some neurological diseases that affect the muscles can be determined through a biopsy. The procedure is simple and can often be done within a few minutes with local anesthesia and minimal discomfort. The muscles of the thigh or upper arm are common sites of the biopsy, and no danger is involved.

A number of unusual illnesses that mainly affect the elderly can cause damage to blood vessels. A biopsy of a blood vessel may clarify a diagnosis of these diseases, for example, polymyalgia rheumatica, a disease that causes unusual aches and pains. A biopsy of a small artery in the scalp may be necessary. The test done with local anesthesia takes a few moments and has no danger. An accurate diagnosis in this case is essential, because lack of proper treatment can result in blindness.

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Serum Electrolyte Tests

Blood contains various salts that are needed for normal function. The electrolytes can be affected by high blood pressure, diabetes mellitus, and heart failure, as well as by many of the medications used for their treatment. If you are receiving diuretics for one of these conditions, you should expect to have your electrolytes measured every few months. This is necessary to avoid side effects.

Blood Urea Nitrogen and Creatinine Tests

Blood urea nitrogen (BUN) and creatinine are normal waste products produced by the body. Under ordinary conditions they are removed from the blood by the kidneys. In a disease of the kidneys these elements accumulate, however. Kidney disease and high blood pressure are closely interrelated. It is important to have these substances measured if you suffer from high blood pressure as well. Medications used to treat heart disease, kidney disorders, and high blood pressure include diuretics and digoxin. The level of BUN and creatinine in the blood will determine their dosage. If the kidney disease becomes severe, the level of BUN and creatinine rises. During tests of kidney function, the electrolytes are often measured at the same time.

Liver Function Tests

The liver manufactures important substances from nutrients. The liver also disposes of the waste products of metabolism. Bile, produced by the liver, is necessary for the digestion of fats. Therefore, liver abnormalities can have a severe effect on the body.

Liver tests also examine enzymes, which are contained within liver cells. These leak into or accumulate in the blood when the organ is damaged or diseased. An excess amount of bilirubin in the blood may indicate a blockage of the biliary ducts, which allow bile to flow from the liver to the small intestine. When this accumulates, a yellow discoloration of the skin (jaundice) usually occurs.

The severity of liver diseases varies, so it is often necessary for function tests to be taken frequently during a liver illness. As the disease subsides, your physician may continue to measure these substances to ensure that the liver has returned to normal. In some disorders, the symptoms may be very mild. Sometimes the only abnormality that may confirm that an illness is present is a mild irregularity in liver function tests, so these would be done periodically to judge whether the disease is progressing or resolving.

Uric Acid Tests

Uric acid is a normal constituent of the blood. If it accumulates, it can cause kidney damage or gout, a painful condition of the joints. People who suffer from gout usually have raised amounts of uric acid in their blood. Kidney disease and diuretics used to treat high blood pressure and heart failure can increase the level of uric acid in the blood.

If you suffer from gout or have a raised uric acid level as a result of kidney disease or the use of medications, your blood should be checked periodically. This is important because medications can lower the amount of uric acid. Periodic blood tests confirm that the drugs are working.

Calcium and Phosphorus Tests

Calcium and phosphorus are usually measured together because they interact with each other very closely. They are affected by diseases of the bones and kidneys and when the parathyroid glands are abnormal. Certain medications also affect their blood levels. The tests may be repeated if you suffer from an illness that alters their normal values.

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Thyroid Function Tests

Disease of the thyroid gland is quite common in older individuals, but the diagnosis is less easily made than in younger people. Physicians often order thyroid function tests to look for evidence of excessive or decreased working of the gland. If you have thyroid disease and have been treated for it or are presently taking thyroid medications, you can expect to have your thyroid function measured periodically.

Hormone Tests

In addition to thyroid, hormones produced by other endocrine glands can be measured to determine whether these glands are working normally. When the body produces an excess or too little of an individual hormone an illness ensues. Measurement of the amount of hormone in the blood can help diagnose these disorders and evaluate treatment.

Blood Sugar Tests

Abnormalities of blood sugar levels occur in diabetes mellitus, so it is important that your blood sugar be tested to diagnose the disorder and to follow its control once treatment has started. If you are suspected of having diabetes mellitus, it may be sufficient to have an isolated sample of blood sugar measured. If this is excessively high, a definite diagnosis sometimes can be made. Often it is better to have the level of blood sugar estimated while you are in a fasting state (without breakfast). At other times, a measurement done two hours after a meal is more useful.

If diabetes mellitus cannot be diagnosed from a fasting sugar sample or one taken two hours after a meal, your physician may request a glucose tolerance test, in which you drink a measured amount of liquid sugar. An estimation of your blood sugar level is done before you drink the liquid and tests are repeated for the next few hours. This determines whether the amount of blood sugar is excessively high.

If you are being treated for diabetes mellitus, you must have your sugar levels measured periodically. The blood may be taken when you are in a fasting state, or after a meal, or in the afternoon, depending on whether you are taking pills, insulin, or merely following a diabetic diet. Some people utilize home-monitoring kits to measure blood sugar levels. This allows frequent monitoring without having to visit the doctor’s office or a laboratory. This testing must be done in conjunction with your doctor.

Erythrocyte Sedimentation Rate Tests

The erythrocyte sedimentation rate (ESR) test has been available for many years, and even though we still do not completely understand how it works, it is very useful. The sedimentation rate becomes elevated when the body is suffering from an inflammatory illness. The test’s main use is in arthritic diseases, but it is also used in some blood disorders. It may also be helpful in alerting the physician to an arthritic, inflammatory, or blood disorder and in assessing the results of treatment. Therefore, the ESR may be measured frequently if you are being treated for an inflammatory or arthritic condition.

Arthritis Tests

In addition to the sedimentation rate, special tests can be used to diagnose various types of arthritis. For instance, rheumatoid arthritis may be characterized by the rheumatoid factor, an abnormal antibody found in the blood of people with this disorder. With treatment, the level of this substance in the blood may decrease, confirming that the therapy is effective. There are many other types of tests for arthritic disorders. Depending on the particular type of arthritic problem, your physician will request the appropriate test.

Cholesterol and Triglyceride Measurements

Cholesterol and triglycerides are important fats found in the blood. These fats are carried by special proteins known as

HDL (high density lipoproteins) and LDL (low density lipoproteins). We know that the amounts of these blood components in individuals may reflect their risk for certain diseases such as atherosclerosis and heart attack. What is not known is whether the risk from elevations of these blood fats continues into your later years.

Your physician may decide to measure your blood cholesterol, triglycerides, and HDL and LDL concentrations to learn whether you are at special risk from elevated levels. Depending on the results of the tests, your age, and your medical condition, your doctor may recommend that you follow a special diet or take medications that may lower your blood fat levels.

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Vulvitis is inflammation of the vulva and may be caused by:

primary or allergic contact irritations;

vaginal discharge due to infections (candidiasis, trichomoniasis etc.); vaginal discharge due non-infectious conditions (foreign bodies in the vagina, neoplasms of the genital tract);

primary dermatological conditions e.g. seborrhoeic dermatitis, eczema and psoriasis.

The clinical features depend on the aetiology but pruritis, discomfort, erythema and oedema are typical features. Management depends on the cause.

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No effective vaccine has been developed. Modification of behaviour is the only valid strategy for prevention of HIV infection. Education programmes to encourage sexual practices that reduce the exchange of genital secretions (‘safe sex’) may achieve risk reduction for sexually active individuals. Condoms provide a barrier if used properly and consistently but may be too easily damaged to offer reliable protection during anal intercourse.

Transmission from mother to infant may occur before, during or after birth; 25-50% of the infants of infected women become infected. Infected women should use contraceptives to avoid pregnancy; if pregnancy occurs, termination should be considered.

Contacts of HIV positive patients should be traced and offered testing and counselling.

Patients with HIV infection must be advised of the risk they pose to seronegative sexual partners.

A person who has HIV infection or is at risk of HIV infection must not make any blood, semen or tissue donation.

Because of the probable association between genital ulcerative disease and HIV transmission, the effective management of STDs is part of the general strategy for HIV control.

A number of publications have been produced by Commonwealth, State and Territory governments, by other agencies and by community groups to assist practitioners and patients in preventive education and in the management of HIV infection. These are available from health departments and various other agencies.

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The patient with early syphilis should return for repeat examination and serology at the following intervals:

at one month;

at regular 3 monthly intervals for 1 year, and

at 6 monthly intervals for the second year.

Patients with late syphilis should be followed indefinitely; patients with neurosyphilis should have periodic CSF examinations for at least 3 years.

The titre of the reagin test (VDRL or RPR) will fall until it becomes non-reactive or minimally reactive (e.g. 1/2) by the end of 2 years after effective treatment of early syphilis.

In late syphilis, low titres are usually found and only a slight reduction should be expected after treatment. In some cases, no change in titre occurs. Provided the CSF has been tested and found to be non-reactive, no further treatment is indicated.

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Patients, except pregnant females, who are sensitive to penicillin can be treated with spectinomycin (see below), tetracyclines or trimethoprim/sulphamethoxazole. Pregnant patients should be treated with erythromycin.

Penicillin resistant infection (first line treatment where PPNG is endemic) Adults:

Ceftriaxone 250 mg intramuscularly in a single dose OR

Spectinomycin 2 g intramuscularly in a single dose. (Spectinomycin should not be used in pregnancy)

Children:

Spectinomycin 40 mg/kg intramuscularly in a single dose.

Complicated infections (PID, septic arthritis, septicaemia etc.)

Complicated infections such as PID, prostatitis or epididymitis, arthritis, ophthalmic lesions, disseminated infection, meningitis, endocarditis, myocarditis or pericarditis require multiple dose therapy. Hospitalisation and specialist referral is usually indicated. These patients often require intravenous chemotherapy which is replaced by oral treatment on clinical improvement. Duration of treatment will be at least 7 days extended to at least 14 days for meningitis and at least a month for endocarditis.

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