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Sex is an integral part of life. Without it the very existence of mankind would not have been possible. As we reach our adolescence period some particular glands starts driving our sexual behaviour. And as we reach a certain age these glands stop producing enough hormones to have an effect on our sexual behaviour. This commonly results in Erectile Dysfunction better known as ED. Erectile Dysfunction renders a male useless and helpless while he is to have sex. Though there is an urge for having sex the penis does not come up to its expectations while its performance.
The major reason for this is that, as we age our body too starts aging. Aging is a natural phenomenon but we do not wish that our sexual performance too takes a beating for aging. As we age our body functions slowly and so there is less supply of blood in penis. But circulation of blood is necessary to have a penile erection for making love. Penis has porous tissues which absorbs blood when circulated. And when it absorbs blood it enlarges and stops the blood from getting out. Thus an erection of penis is maintained during the sexual act. Once the penis ejaculates the penis loosen up and starts circulating the blood.
But in case of a person with erectile dysfunction this process does not happen. And as this process does not happen he remains unsatisfied in his sexual acts. So, ED treatment drugs like Viagra, Levitra, Cialis and Edagra etc. come to your aid at that juncture. These drugs can provide an age old person the much needed penile erection. With it your sexual fantasies could be realised. The dosage for these drugs depends on your health status and food habit. A consultation with a doctor is a must in the event you are to take this drug. If a person has hypertension, diabetes, heart ailments, allergy he should tell the doctor about these diseases. These drugs are not to be used by women and children.
Whether it is for satisfying your sexual hunger or simply to satisfy your partner’s sexual need these drugs can stop your penis lying redundant. As successful sexual activity is a major component in any relationship these drugs could be of great help to you to have a bond that would be everlasting. So, go and enjoy the pleasure of love making again.
Carry the youthfulness, vigour and agility in your sexual activity as in your youth with these drugs. These drugs also have some side effects like – increase in blood pressure, heartbeat, obesity so it would be wise to consult a doctor before going for the drug. In case any side effects show up it would be wise to stop the treatment right away and consult a doctor.
To have an erection one must have the sexual urge to have sex. Erectile dysfunction drugs only help in maintaining the erection during sexual act. After ejaculation the penile erection should go away. In case erection continues after ejaculation or if the erection does not wither after 4 hours of taking it one should consult a doctor. He is the best person to provide remedy in that case.
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Italy is a breathtakingly beautiful country that will always be one of the highlights for anyone’s travel to Europe. It has everything from the impossibly blue Mediterranean Sea to the spectacular Alps, with fabulous food at every stop along the way. And while you are there, you can’t help but trip over history with every step you take.
Here are few things you cannot miss when you travel to Italy:
--Venice. Think about it. How many movies have you seen that were set in this romantic city? Well there is a reason. If there is a city with more charm and magic than Venice, someone is keeping it a very tight secret. (Oh sure, I can just hear those Parisians objecting that their’s is the most romantic city, but those folks are hardly objective. Besides, this is an article about Italy.)
The “streets” are waterways and the city is gradually sinking into the Adriatic Sea. But don’t worry, it will still be there by the time you get there to see it all.
--The Roman Colosseum.Talk about the original home for extreme games. You can almost hear the ghosts of gladiators clashing their swords and signing multi-drachma contracts with their agents.
The Colosseum is both a spectacular and grim place, considering the many senseless acts of violence that occurred here. Kind of like the beauty pageants are today.
--Florence. If you aren’t already an art lover, you will be after visiting Florence. Walk in the footsteps of Michelangelo, Da Vinci and Raphael and your life will be forever changed.
One word of warning however, if you are already prone to feelings of penis envy or inadequacy, Michelangelo’s 18-foot statue of David, may not be your cup of tea.
--The Vatican. The art, architecture, history and sheer aura of this place will leave you speechless.
--Wine country. The folks in France won’t admit this either, but Italian wines are often every bit as good (sometimes even better) than their French counterparts. Take a tour and you will enjoy the tastings all the more after having seen the sheer craftsmanship and patience that goes into making fine wines.
And need I remind you to purchase a few of your favorites so you can bring them home to impress your friends with your refinement and worldly sophistication.
--The Italian Alps. OK, I will admit that I kept thinking, “these mountains cannot be real. I bet some Hollywood film company put together the ultimate background to impress the tourists.” But in actual fact, they are real. And they are beautiful beyond anything you have ever imagined before in your life.
What has always amazed me was that Hannibal surprised the Romans by bringing elephants through the Alps. Elephants were the ancient warfare equivalent of our modern tanks, so you can bet Hannibal had the Romans running for their adult Pampers as soon as they saw his army coming over those mountains.
I read somewhere that Italy is the home of more American ex patriots than any other country. So you should be warned in advance that if you stay too long in Italy, you might never want to come back. With that in mind, proceed with caution.
COPYRIGHT © 2005, Charles Brown. All rights reserved.
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If you’ve ever witnessed someone suffer a stroke, you understand the humbling nature of this disease. It can reduce the mightiest human being to an immobile, helpless creature. Impairment of crucial functions like speech, walking, and control of bowel and bladder can wrench control from the body in a moment.
Even perpetually youthful TV personality Dick Clark was struck down by stroke at age 75, despite the outward appearance of perfect health. Clark’s stroke resulted in a six-week hospital stay and, judging from fragmented reports, significant disability. Stroke can be like a devastating fire that strikes without warning, leaving only smoldering rubble. Stroke can so ravage basic bodily functions that often all you can hope for is to regain a portion through rehabilitation.
The disease process that underlies stroke requires decades—30 or 40 years—to develop. With that much lead time, why aren’t we better able to detect or stop this crippling disease?
The truth is that we are able to predict many, if not most, strokes. Advances in imaging technology allow detection of atherosclerotic plaque that cause stroke years before it becomes a threat. Progress in deciphering the causes of stroke has also leapt forward.
Unfortunately, your neighborhood physician still focuses on diagnosing the crisis rather than anticipating it. Physicians prefer to deal with catastrophes and are just not that interested in prevention. Most physicians ask: “Is it time to operate or not?” The medical community obsesses over procedures like carotid endarterectomy (surgical removal of plaque) or carotid stents. Even when a person is afforded the warnings of a “mini-stroke”, or transient ischemic attack (TIA), little more is done once it’s determined that surgery is not necessary—even though this person has high risk for future stroke (50% over 10 years).
Let’s flip-flop this approach to stroke. Procedures represent a failure of prevention!
Where do strokes come from?
Stroke develops when some portion of the brain is deprived of blood. This usually results from a tiny bit of debris that dislodges from an atherosclerotic plaque along the walls of an artery (the same sort that accumulates in coronaries causing heart attack). The sources of debris have been a subject of controversy, but new imaging technologies have settled the question. Any blood vessel that leads from the heart to the brain can be a source. The two carotid arteries on both sides of your neck are a frequent source, as these arteries are prone to develop plaque. (Our discussion will be confined to what are called thromboembolic, or ischemic, strokes, i.e, strokes that occur from plaque that fragments, sending debris to the brain, and will not include the far less common hemorrhagic strokes due to rupture of small vessels in the brain, nor will we discuss atrial fibrillation and other heart causes of stroke. The thromboembolic strokes we discuss cause around 88% of all strokes.)
Over the last 10 years, the aorta has been recognized as another important source of stroke. The aorta is the main artery of the body whose branches go to the head, arms, and legs.
Atherosclerotic plaque is a live tissue that, through poor diet, inactivity, high cholesterol, overweight, etc., grows and becomes progressively more unstable. At some point, plaque fragments. Little bits break away, traveling to the brain. Fractured plaque also exposes its deeper structures to flowing blood, triggering blood clot formation, which in turn can also fragment and go to the brain. Atherosclerotic plaque is a prerequisite for the most common causes of stroke.
If the majority of strokes originate from plaque, why not measure plaque to determine if you’re at risk for stroke? How can we easily, safely, and accurately measure plaque in the carotid arteries and aorta? And if plaque can be measured, can it be shrunk or inactivated to reduce or eliminate risk for stroke?
How can plaque be measured?
Just 20 years ago, the only practical method of identifying plaque in the carotids or aorta was through angiography, requiring catheters inserted into the body to inject x-ray dye. Angiography was impractical as a screening measure.
CT scanning and magnetic resonance imaging (MRI) are emerging as exciting methods of imaging both carotids and aorta. Unfortunately, most centers and physicians are much more focused on the diagnostic uses of these technologies for people who have already suffered stroke or other catastrophe, and application of these devices for preventive uses is still evolving. One exception is when aortic calcification or aortic enlargement is incidentally noted on the increasingly popular CT heart scans; this is an important finding that can signal presence of aortic plaque.
The one test that is widely available and can be performed in just about any center is carotid ultrasound. It’s simple, painless, and precise. Two basic observations can be made:
1. Plaque detection—Atherosclerotic plaque can be clearly visualized. If plaque blocks more than 70% of the diameter of the vessel, or if there are “soft” (unstable) elements in plaque, then stroke risk may be high enough to justify surgery or stents. However, if there are plaques that are less severe, substantial risk for stroke may still be present that can be reduced with preventive measures. 2. Carotid intimal-medial thickness—This is a measure of the thickness of the lining of the carotid artery in areas not involved by plaque, but often precedes the development of mature plaque. Carotid intimal-medial thickness also provides an index of body-wide potential for atherosclerotic plaque that can place you at risk for stroke. The aorta, for instance, cannot be well imaged by surface ultrasound but can still be a source for stroke. Increased carotid intimal-medial thickness and carotid plaque are closely associated with likelihood of aortic plaque. The Rotterdam Study of 4000 participants demonstrated that if carotid intimal-medial thickness is greater than normal (1.0 mm), then you can be at risk for stroke (and heart attack), even if no carotid plaques are detected.
Carotid ultrasound is the one test you should consider that provides the most information with least effort. Ultrasound is harmless, painless, and can be obtained just about anywhere. Even if your doctor disagrees with your request for a carotid ultrasound, an increasing number of mobile services are popping up nationwide that make this test available for around $100. One important point: many scanners and interpreters will only report whether plaque is present or not. While this is important information, you should request that the carotid-intimal medial thickness be made as well. Not all centers can make this simple measure (because of software requirements), but it doesn’t hurt to try. Any amount of carotid plaque is reason to follow a preventive program, even if the plaque is insufficient to justify surgery.
Can plaque be reduced?
Can we shrink plaque in carotid arteries and aorta and thereby reduce, perhaps eliminate, these sources of stroke? That question is gaining momentum as effective therapies become available that pack real punch for reducing plaque.
Study after study has now documented that plaque can be reduced and, with it, risk for stroke. Reduction in plaque of 10–20% is possible within a year or two. Let’s consider the most potent influences on carotid and aortic plaque growth that need to be considered in a plaque-reducing program. (I assume that you are a non-smoker—if you are a smoker, you first need to concentrate on quitting.)
Hypertension
Considerable experience documents the power of blood pressure-lowering for prevention of stroke. The most recently updated guidelines, the JNC–VII, recommends a blood pressure of 407 mg/dl heightens stroke risk six-fold.
C-reactive protein (CRP)
This measure of inflammation is proving to be a useful marker for identifying people at risk for stroke, with increased risk beginning at a level of 0.5 mg/l. High CRP also predicts more rapidly growing carotid plaque.
Homocysteine
Homocysteine is an important marker of increased likelihood of both carotid and aortic plaque, as well as stroke. In 1997, the European Concerted Action Project reported more than a doubling of stroke when homocysteine levels exceeded 12 mol/l. As homocysteine increases to 20 μmol/l, risk for stroke and heart attack increases an amazing 10-fold over that at a level of 9 μmol/l.
Asymmetric dimethylarginine (ADMA)
ADMA is recently discovered amino acid whose blood levels can skyrocket up to 10-fold in the presence of hypertension, metabolic syndrome, diabetes, high cholesterol and triglycerides, obesity, and high homocysteine levels. ADMA blocks the action of the amino acid, l-arginine. This mimicry reduces the availability of nitric oxide, a powerful dilator and protector of arteries. ADMA levels in the top 10% predict a six-fold heightened risk for future stroke, and ADMA levels in people with strokes are double that in other people. A carotid ultrasound study in 116 subjects showed that higher blood levels of ADMA are associated with more severe carotid plaque. Because of ADMA’s shared role across a variety of abnormal conditions, correction or blocking the action of ADMA has been suggested as a unique therapeutic tool to reduce stroke risk.
Cholesterol
Data suggest that lowering cholesterol with statin cholesterol-lowering drugs slows carotid plaque growth and reduce stroke risk approximately 22%. An interesting study from the Cardiovascular Institute at Mt. Sinai School of Medicine in New York using the precise measuring ability of MRI of the carotids and thoracic aorta showed an impressive 20% regression of plaque area with simvastatin (Zocor®) taken for two years.
Although guidelines for cholesterol treatment recommend reduction of LDL cholesterol to 100 mg/dl in high-risk persons, a report from the Walter Reed Army Medical Center in Washington, DC, showed that carotid plaque was more effectively reduced when LDL cholesterol of 70 mg/dl or lower was achieved with statin cholesterol drugs. Lower LDL cholesterol may, therefore, be better.
Treatment Strategies to Reduce Carotid and Aortic Plaque
The essential question: How do we reduce carotid and aortic plaque? If we make this the focus of our efforts, many pieces begin to fall into place. If you’ve had any measure of carotid or aortic plaque such as a carotid ultrasound or aortic calcification on a CT heart scan, you know that you’re at increased risk for stroke. You also have a baseline for future comparison to gauge whether your program is working or not.
Because most people have not one but several causes of carotid and aortic plaque, there is no one single treatment that effectively eliminates risk for stroke. Instead, most people require a comprehensive program of healthy diet, exercise, supplements, and medication when indicated. Here, we focus on the nutritional supplements that can be critical components of your plaque-reduction program.
Fish oil
Fish oil is a cornerstone of your stroke prevention program. Epidemiological observations suggest a strong relationship of fish intake and reduction of stroke risk. Carotid ultrasound studies demonstrate less carotid plaque with greater intakes of fish.
A cleverly designed University of Southampton study made the fascinating observation that fish oil transforms the structure of carotid plaque. 150 people with severe carotid plaque scheduled for carotid endarterectomy (surgical removal of the plaque) were given fish oil, sunflower oil, or no treatment over several months while waiting for their procedure. (Delays in the British health system permitted this unique design.) Plaque was removed at surgery and examined. Participants taking fish oil had reduced inflammation in plaque and thicker tissue covering the fatty core, markers of more stable plaque. Those taking sunflower oil or no treatment had unstable plaques with greater inflammation and thinner, less sturdy covering tissue. This suggests that fish oil stabilizes carotid plaque, making it less likely to rupture and fragment.
A standard capsule of fish oil (containing 300 mg of EPA + DHA) contains the same amount of omega-3s as a 3 oz serving of cod or halibut; three capsules (900 mg DHA + EPA) contain the equivalent of a serving of farm-raised salmon. The dose that seems to provide greatest protection from stroke, lowers triglycerides (that form abnormal lipoproteins; see above), and reduces fibrinogen, is four capsules per day (1200 mg EPA + DHA).
Coenzyme Q10 (CoQ10)
Although there are no data specifically addressing whether CoQ10 reduces plaque, it is a marvelously effective way to reduce blood pressure, one of the crucial factors causing carotid and aortic plaque growth. A pooled analysis of eight studies showed that, on average, CoQ10 in daily doses of 50–200 mg reduced systolic blood pressure by 16 mm Hg, diastolic pressure by 10 mm Hg. Data suggest that CoQ10 can reverse abnormal heart muscle thickening (hypertrophy), another manifestation of high blood pressure, strongly suggesting that CoQ10 has benefits beyond just reducing pressure.
Supplements to correct the metabolic syndrome
Weight loss is, without question, the most immediate and direct path to correction of this dangerous pre-diabetic condition. A drop of even 10–20 lbs yields improvements across the board: increased sensitivity to insulin, increased HDL, and reductions in triglycerides, CRP, fibrinogen, small LDL particles, and blood pressure. Diet and exercise are fundamental components of an effort to lose weight; low carbohydrate or reduced glycemic index diets (e.g., South Beach or Mediterranean) rich in fibers are clearly effective. Several supplements can amplify weight-reduction efforts and be useful adjuncts to your lifestyle program. Among them:
White bean extract White bean extract blocks intestinal absorption of carbohydrates by 66%. 1500 mg twice a day with meals yields, on average, 3–7 lbs of weight loss in the first month of use. The only side-effect is excessive gas, due to unabsorbed starches.
Glucomannan This unique fiber taken prior to meals absorbs many times its weight in water and thereby fills your stomach. You consequently take in less food. Most people lose around four lbs per month using 1500 mg prior to each meal. Interestingly, glucomannan also blunts the rise in blood sugar after meals, an effect that, by itself, may lead to weight loss. Be sure to take with plenty of water.
DHEA This adrenal hormone is key to maintaining physical stamina, mood, muscle mass in men, and libido in women. A recent randomized, placebo-controlled study at Washington University in 56 subjects showed a 13% decline in abdominal fat (fat that drives resistance to insulin) measured by MRI with 50 mg of DHEA per day at bedtime, along with improved sugar control and lower insulin levels.
Pectin, beta-glucan Pectin is the soluble fiber in citrus rinds, green vegetables, and apples, also available as a supplement. Beta-glucan is the soluble fiber of oats and is also available as a supplement. Both are wonderful fibers that provide feelings of fullness, lower cholesterol, slow release of sugars, and can yield modest weight reduction. A USC study in 573 subjects using carotid ultrasound showed that greater intake of healthy fibers like pectin and beta-glucan is associated with less carotid plaque growth.
Folic acid, vitamins B6 and B12 Dr. Daniel Hackam at the Stroke Prevention and Atherosclerosis Research Centre in Ontario conducted a study using carotid ultrasound in 101 participants treated with folic acid 2.5 mg, vitamin B6 25 mg, and B12 250 mcg per day. Treatment resulted in plaque reduction, especially when homocysteine levels exceeded 14μmol/l at the start, compared to untreated participants who experienced substantial plaque growth.
An attempt to clarify the role of homocysteine treatment was made through a National Institute of Health-sponsored study of stroke prevention. 3680 participants with a prior history of stroke were enrolled and given either a “low-dose” (20 mcg folic acid, 0.2 mg B6, 6 mcg B12) or a “high-dose” (2.5 mg folic acid, 25 mg B6, 400 mcg B12) regimen. Although starting homocysteine levels showed a graded association with stroke risk (higher homocysteine levels predicted greater stroke risk), the treatment groups experienced, on average, only a 2 μmol drop in homocysteine levels and no reduction in stroke risk over two years. The study investigators as well as critics have suggested that the study failed due to an insufficient treatment period and that the doses were too low. (The doses we use in our plaque reduction program are folic acid 2.5–5.0 mg, B6 50–100 mg, B12 1000–2500 mcg.)
L-arginine L-arginine can be used to overpower the adverse effects of ADMA. L-arginine is emerging as an important carotid plaque-reversing tool. Early reports in animals showed that l-arginine completely halted growth of aortic plaque, and did so more effectively than lovastatin (a cholesterol-lowering drug).
In humans, L-arginine reduces blood pressure, abnormal constriction of carotid and coronary arteries, blocks entry of inflammatory cells into plaque, increases sensitivity to insulin, and heightens exercise capacity. Following coronary angioplasty or stent placement, l-arginine results in up to 36% reduction in plaque growth.
The average American takes in 5400 mg of l-arginine through food every day. Supplementing with doses of 3000–12,000 mg per day has proven useful to correct many of these phenomena. (We use a dose of 6000 mg of l-arginine powder, twice a day on an empty stomach, dissolved in water, for our plaque regression program.) Does this result in a reduction of stroke risk? The emerging data suggest that l-arginine is likely to exert a powerful plaque-reducing and stroke-preventing benefit, but we await more clinical trial data.
Conclusion
Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, with better tools becoming available. To know whether you’re at risk, the best and most available imaging tool is carotid ultrasound, aiming to identify intimal-medial thickness >1.0 mm, or carotid plaque. Any degree of calcification of the aorta, such as on a CT heart scan, is another useful measure of risk.
Treatment to reduce risk is multi-faceted but is based on examining all your sources of risk, including metabolic syndrome, small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one absolutely crucial ingredient in any stroke prevention program. Other supplements can be used in a targeted fashion, depending on the causes identified for your carotid or aortic plaque. Ideally, repeat scanning of your carotids should be done sometime after your program has begun to assess whether you’ve successfully achieved reversal of plaque growth.
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As we all know, sex is a natural part of any intimate relationship.
But sometimes life interferes with nature. Every guy has had an incident where he can’t have or sustain an erection. The flu, exhaustion, even anxieties (an upcoming client meeting or even a date with a person that you’ve been dreaming about for months) can affect erectile abilities.
But sometimes ED becomes an ongoing issue. Diabetes, high blood pressure, or clogged arteries can reduce blood flow to the penis. ED can also be caused by physical blockages (like prostate enlargement), hormonal imbalance, or medications (like antidepressants). And it’s not always easy to talk about, even with your doctor.
Is it worth talking to my doc?
Yes, it is. These days, scientists and doctors understand that ED can affect both you and your partner’s mental health and well-being; they’ve also begun to understand the many causes of ED. Sometimes, dealing with the cause (for example, treating prostate enlargement) can improve sexual function. Sometimes, medications can help get things back to the way they were supposed to be. Remember, your doctor’s there to make sure you’re in great shape, so don’t feel embarrassed.
There’s more than one ED drug these days - how should I choose?
Once upon a time, not so long ago, there was only one “sex pill” to help with ED- Viagra. But as more people used Viagra, they discovered some limitations: for some men, having to time sexual activity around the pill (or taking the pill to coincide with sexual activity) took some of the spontaneity out of sex.
One alternative is Levitra. It, like Viagra, works on some of the muscles in your penis that help control the blood flow. Levitra encourages these muscles to let more blood flow into the penis only at the right time - during sexual stimulation.
Levitra effectively targets the right parts of the muscles, so less medication is needed. It starts working quickly (within 30 to 40 minutes) and stays active for up to 16 hours - more than a day! So you don’t have to be thinking 3 hours ahead to “will she? or won’t she?” and gambling on whether to take a pill - you can just enjoy the moment!
No worries, just check it out
If it sounds like Levitra is a good bet, then make an appointment with your doctor to talk about your health. If you’re taking certain kinds of drugs (like nitrates your for heart-related chest pain and alpha blockers, a type of high blood pressure medicine), Levitra may not be the best option for you.
Make sure to talk to your doctor about what side-effects you might experience and how to manage them. The most common side-effects are headaches, flushing (blood rush to the face), and a slight runny nose. If these side effects continue or get worse, make a follow-up appointment with your doctor about changing your dose (after all, there can be too much of a good thing!) or medication.
As with any drug (even aspirin) there are a few rare but serious potential side-effects: if you experience vision changes or a prolonged (several hour) erection, see a doctor right away.
Back to Life!
Your doctor’s prescription can be filled discreetly at a good on-line pharmacy - and then, back to the love life you have always had!
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“What terrible times I had when I was the age of my kids? They don’t have to undergo the same despondent feelings my wife and me had to endure”, you lazily say to yourself as the hammock sways to and fro in the gentle breeze. You still dread the day you were diagnosed with erectile dysfunction. “Impotence won’t affect my kids”, you think reassuredly looking at the magic blue pill in your hand.
Viagra has replaced the reliance on painful surgeries and therapies with the popping habit. Viagra was the first approved prescription pill for the treatment of ED. Erectile dysfunction is the sexual dysfunction of men characterized by the inability of penis to attain and maintain sufficient erection for satisfactory and enjoyable sex.
For long, ED was considered as a potential relationship-breaker by the affected patients. Men and women were reporting emotional upheavals and other physical ailments directly to indirectly attributable to ED. The treatments available were not very popular owing to their invasive and painful nature. No oral drug was approved by the US FDA to treat ED till 1998 when Viagra came to the fore.
Actually, the advent of Viagra in itself was nothing more than accidental. Sildenafil Citrate – the active ingredient of Viagra – had been in use for the treatment of angina for the past 20 years. The results for the treatment of angina were not very positive. But sildenafil citrate proved to be a boon for the sufferers of ED. 4 out of 5 patients showed promising signs in the clinical trials. And the rest is history.
Viagra works within 14 minutes of its intake, in some cases. The effects of the drug last up to 4 hours in some cases. With minimal side effects, Viagra became overnight hit and has posted record sales since its launch. The patients, after a proper prescription from the doctor, can buy Viagra online. The privacy and convenience of the patients is generally well looked after by the sites dealing with Viagra online
