60 and Over

as this comes up again and again andI always want to mae the same comment
Dr. joe 32 Reviews 1579 reads
posted

May I go on record today with a few words about ED meds.  
Three seem to work well (Cialis, Viagra and Levitra) and the effectiveness of each depends on the individual, the dose, and above all the cause of the ED, If it is neurologic, they do not work, if vascular they do, If the cause is mainly psychological or hormonal they can help a bit but are not near a real solution. 'The locally injectables, like Trimix, really do work in the neurological problems.
Here's the key: they are medications.  Medication like antibiotics, like beta blockers , like amioderone, like cancer drugs.  They have dangers, they should be used in certain ways by certain people end not all all by some other,
Any good urologist, internist, internist geriatricians (like me), or family practitioner should be knowledgeable and also able to address ED with a sense if its importance and seriousness. If you do not feel comfortable discussing it with your doctor either because he/she does not take the time or would not be serious enough; find another doctor.  
Do not undertake these meds using advertisements, friends advice, advice found here (no disrespect meant) or your own excellent judgement.  
I have a cardiac arrhythmia, which in a patient I would gladly treat, is being treated by a competent cardiologist rather than by me.  
I recognize it is good to share experiences here.  I know a number of the people who post on TER andI respect sandlike all of them.  Sharing is one thing, taking medical advice is difference.

Superb advice. I may ask you for a referral.

Yes this does sound like excellent advice Dr Joe. I don't know if you can answer this but does, Viagra, Cialis & Levitra all work the same way?    
   
  I always thought they had the same ingredients and were just manufactured and marketed by different companies.

All three work the same way but do not have the same ingredients.  They all sensitive arteries to stimulation which makes the vessels dilate and blood flow.  They all work extremely well on the arteries of the penis and work somewhat differently on other arteries.  Cialis for example works on arteries in the lung and so helps with a condition called pulmonary hypertension. Because they dilate arteries in the head they can give users a headache.
They have differences in pharmacologic traits so different duration of action, different absorption etc.

ALWAYS discuss  medical conditions with your Doc first.

Doc: I have good news and and news for you
Patient give me the bad news first
Doc: You have acute myelogenous
leukemia and you'll be dead within a few weeks
Patient. My God, what is the possible good news.
Doc: You know that gorgeous new receptionist I hired
Patient: Yes
Doc Well I'm fucking her.

He had told a cute young woman that she had acute angina.

(ba-doom)

2horses2many450 reads

Everyone has their own personal medical solutions, cure that works for any illness, gives you procedures, self diagnosis, self surgery, mutilations, herbs, insects, exotic wild animals products, combinations of over the counter, industrial chemicals convincingly works for you, and you tried and wind up in ER and your hobby life was put on hold for a long time and busted by your SO.

I have had a long career in academic medicine and ended up a chair of Medicine of one of the great teaching hospitals in America.  I still had a young son (still having kids in my 50s) and decided to come home and "retire'.  Bored to tears but unwilling to be held to a 6 patient an hour schedule by the bean counters who have seized control of clinical medicine.  
I found an opportunity to run a very specialized geriatric practice and I can easily able  an our or more with each patient snd their families if needed.  
I find it takes a lot of time and concentration to get things right.  
I have deep respect for almost every practicing physician I know, but at times they are a bit rushed and complicated issues can lead them astray.
I am sorry you had  a bad experience.  There are great doctors around (I know I am being cared for by two of them (a cardiologist and urologist so you an see fluid flow can be my problem: including flow of blood snd flow of urine....not very romanic topics for cocktail parties conversation.  
If you want to send me not with what's going on and where you live I would be glad to make what I hope might be a useful comment that could direct you in a good direction

with all due respect, the various oral medications may work for Neurologic problems... in some cases, because they do in mine.  I would not give a blanket it will or it won't.  Logoically it should  depend on your individual impairment.  I will say it's worth trying...  Under your doctor's supervision, of course.  

-- Modified on 9/4/2016 10:05:05 PM

I was imprecise: If the problems in the end (no pun) is due to inadequate blood low, even in part, they often work.  When I say neurological, I don't mean Parkinson's disease etc.  I mean the local nerve has been interfered with.  For example, many times having a surgical prostatectomy results in destruction of the nerves involved. (Interesting side point, the main nerve is called the pudendal nerve which comes from the latin for "shameful") This nerve can be destroyed or perhaps only damaged, In diabetes there is often some nerve damage and some vascular damage. I was not trying to give advice (the opposite) but to give an over view of how things work.  
I am glad you are having good luck no matter what the causes.  Ofter you can't tell for sure unless you try just as you so wisely suggest.
Thank you.

I do indeed have a progressive Neurologic condition that affects most of the body, some areas more than others.  I had several excaserbations which left me with neurologic defisites even after recovery.  My nerves are not severed as in a Spinal Cord Injury or surgical injury.        

Sex feels different now.  It feels pleasurable but I do not feel the intensity of the build up & the O it can be a surprise or nearly so.  The O feels good but it feels different than before

since we're all getting free medical advice here - I've wondered what changes to cause the refractory period in a male to increase as he ages - while such a change does not seem to happen in a female.  Thanks Dr. Joe!

I always assume that my doctor's primary goal is to transfer money from my pocket to his/hers. It may not be a conscious goal but it is at least a subconscious one and I've never had a doctor do anything to disprove my theory.

I've bought ED medicines online for a long time. There is not doubt in my mind that if I discussed it with my doctor, assuming I had one (which I don't because they always fire me), he would give me a prescription with the caveat that he needs to see me every six months to at least to determine how well it's working. Like in - "how is it working" - "okay", - "see me again in six months"

I don't see a MD just for ED meds...  I get annual renewals without difficulty.

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