Men’s Health Blog

A good point of view by John Scott Source

Ready to combat ED but confused about which type of PDE-5 inhibitor to take? You’re not the only one. Of the 3 FDA approved PDE-5 inhibitors, Viagra (sildenafil citrate) is definitely the most popular, but popularity alone shouldn’t be a determining factor. The more recently approved Cialis (tadalafil) and Levitra (vardenafil hydrochloride) are also highly effective and very safe alternatives, although they may not be as popular yet. The problem for most people is actually deciding on the best alternative for them.

For starters, all three drugs are PDE-5 inhibitors so they help relax compromised or hardened penile arteries thus allowing more blood to flow into the penis and subsequently cause an erection. All three drugs also help keep high levels of cGMP within the penis. What’s cGMP? It means cyclic guanosine monophosphate and it is an incredible substance which is naturally produced by the penile tissue in response to sexual stimulation and which aids vascular muscle relaxation. When high levels of cGMP are present, the penile arteries become relaxed and a natural and stiff erection will occur.

Unfortunately, in most men suffering from E.D., the PDE-5 enzyme neutralizes any available cGMP and without cGMP an erection will become flaccid or will not occur at all. That’s where PDE-5 inhibitors such as Viagra, Cialis and Levitra come in. These drugs “inhibit” or block the unwanted PDE-5 and hence the very much wanted cGMP is allowed to remain within the penis after sexual stimulation occurs, thus aiding the erection process and keeping the penis erect. The question is, “Since all of these drugs have the same effect, why should I choose one over another?”

Let’s compare the three PDE-5 inhibitors side by side to determine their differences:

Manufacturers:

Viagra: Pfizer
Cialis: Eli Lilly and ICOS
Levitra: GlaxoSmithKline and Bayer

Generic Name:

Viagra: Sildenafil Citrate
Cialis: tadalafil
Levitra: vardenafil hydrochloride

Dosages: Available and Recommended:
Viagra: 25 mg, 50 mg, and 100 mg tablets. Most patients begin using the 50 mg pill and either increase or decrease the dosage based on drug tolerance and / or effectiveness. Most healthcare practitioners recommend taking Viagra 1 hour prior to sexual activity but studies have shown that Viagra can actually be taken anywhere from 30 minutes to 4 hours before having sex.

Cialis: 5 mg, 10 mg, and 20 mg tablets. It is recommended that you start out using 10 mg tablets and either increase or decrease the dosage depending on the results achieved. Traditionally, Cialis tablets can be taken anywhere from 30 minutes to 12 hours prior to sexual activity. Cialis soft tabs (which need not go through the digestion process) may be taken around 15 minutes prior to sexual activity.

Levitra: 2.5-mg, 5-mg, 10-mg, and 20-mg. Most people start out on the 10 mg pill and either work their way up or down depending on the results achieved. Levitra should be taken anywhere from 25 minutes to 1 hour prior to sexual activity, though some experts claim sex can be initiated in as early as 15 minutes.

How long does the effect last?

Viagra: approximately 4 hours
Cialis: approximately 17 to 36 hours (This is why they call Cialis the weekend pill.)
Levitra: approximately 5 hours

Year approved by the FDA:

Viagra: March 27, 1998
Cialis: November 1, 2003
Levitra: August 20, 2003

Cost of Pill

The cost for each of the 3 drugs is similar though Cialis tends to be a bit cheaper.


Success Rate

All three drugs work for approximately 70 percent of all men. Unfortunately, PDE-5 inhibitors won’t work for everyone. Certain men may need to use alternative treatments such as vacuum pump devices or even penile implants.

Side Effects

All three drugs share most of the same side effects. Some men may experience headaches, flushing, back pain, runny noses, stomach aches, or even changes in vision (example: some Viagra studies have revealed that on rare occasions a man may begin seeing a bluish tinge but that should go away after the drug has been eliminated from the body). These are all common side effects and should not be reason to worry excessively.

None of the three PDE-5 inhibitors should be taken in combination with low blood pressure medication as this can potentially cause a person to have a heart attack. People with high blood pressure should also take PDE-5 inhibitors only after consulting with their doctor. In fact you should never self-prescribe yourself with any of the 3 PDE-5 inhibitors or any other prescription drug for that matter. Even if you are purchasing your PDE-5 inhibitors online you must still open up and tell the pharmacist everything he/she needs to know in order to properly formulate the correct treatment for you.

What the drug looks like:

Viagra: Small blue tablet with the word Pfizer engraved in the middle.
Cialis: Yellow tablet that is almond shaped and film coated.
Levitra: Orange tablet with a flame logo.

Notable Differences

Basically the only major difference between the three drugs is that Levitra begins working the fastest and will work regardless of what kind of food you have previously eaten. Viagra has the proven track record and has been trusted by over 30 million men and Cialis is the longest lasting. In the end though, the real choice is up to you.

By John Scott
Source

For nearly 50 years it was thought that it was dangerous to use testosterone in men with prostate cancer.  Doctors even used the expression that it was like adding gasoline to a fire and that the cancer would grow and spread if testosterone was given to men with prostate cancer.  Dr. Abraham Morgantaler from Harvard has clearly demonstrated that testosterone in some men with prostate cancer may be permissible.  (New England Journal of Medicine, http://content.nejm.org/cgi/content/extract/350/5/482)   If men have cancer that is confined to the prostate gland that has been treated successfully either with radiation or surgical removal of the prostate gland, and that the PSA has decreased to almost zero and remains at a low level for 9-12 months after treatment, then testosterone can be given to men who have symptoms of low testosterone such as decreased libido, decreased erections, and lethargy.  The next step is to obtain a blood test to confirm that the testosterone level is below normal. However, it is imperative that men treated for prostate cancer who are going to use testosterone visit their doctor regularly for a PSA test.  If the PSA level increases, then the man must discontinue the use of testosterone.  For more information contact your physician or write to me at nbaum@neilbaum.com.

He cried in a whisper at some image, at some vision—he cried out twice, a cry that was no more than a breath—”The horror! The horror!”
– Joseph Conrad, Heart of Darkness

The steri-strips finally fell off and clothing is a lot more comfortable. There’s still some pain, but not too bad. That means I can wear my pants buttoned and zipped, which is good because I got to go to federal court on a case this past week and had to dress out two days.

My six-week layover has now been finished officially for a week. I originally thought that I’d be able to start getting back in shape after that, but eventually reality manages to knock it’s way through my head. Once the six weeks was over, I was able to start getting ready to get in shape. I can start lifting things beyond my post-op limit of 10 pounds, and I can start walking farther than a couple of blocks, but that’s about it.

Whup, I can take a couple of flights of stairs as well.

As far as my dirty habits go, things are still as dead as Jay Leno’s monologue. I’m not too happy about that. Yeah, it takes a while to recover potency after a prostatectomy, but there’re always those stories about some guy who was getting things on two weeks after the surgery. My luck just doesn’t run that way, reckon.

There are phases and levels to the rehabilitation. So far the next couple months I get to mildly build up strength and stamina, with the emphasis on stamina. About the most strenuous thing I’ll be able to do is walk. Maybe in March I’ll be able to get on the bike for leisurely rides around the park, but I’m not counting on it yet. I am hoping on getting into a gym the first of April, and maybe start bike commuting again. I’ve lost about 10# since the surgery. Most of that was off my paunch, but my thighs are also slimmer so I’m figuring I dropped muscle mass there. Likely, since I didn’t even put in 500 miles on the bike last year.

There’s a gym near work that might do the trick. Being downtown, it’s a typical yuppy meat market, but I get off early enough I should manage to miss that crowd most days. It’s convenient to work, and location is going to be critical. The idea is to go directly after work. Since it’s two and a half blocks away, the location works. The only other gym around there is a Y, and I’m still carrying a jones against them for screwing over Kristen.

No gyms in the area of the apartment that are options, so the one near work looks like “it.”

That leads into the question of our annual summer week with the grand kid. We’ve been taking her for at least a week for about the last 10 years and subverting her, introducing her to concepts like “grandpa watching the news is more important than that “Power Puff Girl” DVD you watched 18,000 times since breakfast,” barbecuing, camping, canoe floating, diamond mining, bike riding, looking at dead Egyptians and just getting dirty. Last year we went on a Katy Trail trip, combining bike riding and camping. It was a great idea in theory, but considering it was done with a 12-year old on her first road bike, a crazy woman and a guy with a bleeding apple in his ass, well, it wasn’t a very smart idea.

But we learned from it. The question now is will I be in shape to do it? Last year we only rode 108 miles total, and other than my huge prostate bleeding from a recent biopsy I was in pretty good shape. I have no idea how long it will take to get built up again. We might have to do a late trip, maybe mid-August, which is always dicey around here. The temps could easily be over 90 the entire trip. I don’t know if we’d be able to bail her from school in September or not. If I stayed with the regimen, I would be in shape then. Tentatively, I’m looking at mid-July right now. That would give me three months to build my legs back up and develop some stamina.

Went in to the urologist for a follow-up this past Wednesday. I’m on target for recovery. The incontinence is manageable; I could be in pads most of the time, but days I take the bus (or have to be in court) I diaper up. I need to keep practicing my Kegels (up to five seconds hold time. Ten reps per set; four sets per day).

The sensations I’ve been feeling in the Chief Justice are part of the “healing process.” The “itchy numbness” has decreased, and is related to the nerves getting their stuff together. The “12-year old hard on” feeling is normal, and is due to the nerves again.

Unfortunately, the impotence is normal and has it’s own time table. Even with a 20 mg dose of Cialis, nada. Mistah Kurtz, he dead. But I’m still dosing weekly with it in hopes of a miracle on the order of Christ’s resurrection.

I initially met with a rep for Timm Medical Technologies, a company that distributes constrictive vascular devices– penis pumps– in mid-November. Considering the surgery and all, I was qualified to get one for therapy. I told the guy several times that we had a end-of-December deadline to deal with because that was when our insurance carriers changed. Aetna would cover a pump, we weren’t sure about Blue Cross. He told me it would take two weeks max.

Two-and-a-half weeks later, zilch. I called the rep and left a voice mail. He didn’t return my call, so I called customer service. They told me they needed more paperwork, apologized for not calling, and said they’d call the rep. I called him again, left another voice message. He called the next day, said the paper work was in the mail, two weeks for the pump, et cetera.

I got side-swiped by the surgery then, but started leaving voice mails for the rep. He never returned my calls. Resultant: no pump since Timm Medical fucked up on the Aetna paperwork and isn’t a Blue Cross provider, and more paperwork to go through with a new insurance carrier that won’t give me a straight answer on coverage.

Have I ever mentioned that I really fucking hate insurance companies? At this point it would be safe to say that I’m not overly fond of the goat fuckers at Timm Medical, either.

Fortunately my urologist and his office manager are taking my concerns seriously and are working on expediting the paperwork to Blue Cross.

The bills from the surgery are starting to trickle in and I’ve gone into my automatic “no prisoners” mode since I consider any relationship involving an insurance company or hospital billing department to be adversarial by nature. Kristen is standing by to review every last scrap and bill for signs of back stabbing by the hospital or the insurance company. So far they’ve been good boys & girls, but it’s early in the game.

Only other item of note is that I retired my bikini underwear for the time being. They just doesn’t lend themselves to the insertion of absorbent pads. I went commando for years, and didn’t even consider wearing underpants until after my vasectomy. By then I’d gotten used to the support from wearing a jock strap for a month and went with bikinis. But they don’t work with pads, so I’ve gone over to boxer briefs until full continence returns.

It’s always some damned thing…

Life is about choices.  My personal mission guides me all the time.  It guides my thoughts and how I make decisions.  Because I want to “invite people to abundant life by choosing God’s best” I am writing this particular blog on the area of my prostate cancer surgery and future.  This is my experience.  I want to weave through it how my personal mission helped me (and continues to help me) make decisions 1 ½ years after my cancer surgery.  I write it as an encouragement to men who are facing the reality of prostate cancer and potential surgery or other treatments.

I am writing, too, because when it was determined that I had prostate cancer; I joined a ‘secret club.’  I use this phrase because of encounters I have had with men concerning their own potential of cancer.  I have often had men come and talk close up to me about ‘their situation.’  This is a private matter for men, but I want to break that silence and talk frankly and authentically about prostate cancer, its treatment, and the life journey.  In the end, it is my hope by sharing my story; other men will find abundant life by how they make choices in their own prostate cancer situation.

After I was diagnosed with prostate cancer, I began researching about this disease.  While I found a lot of good medical advice, I didn’t always find how men actually worked through this emotionally.  As I stated in a previous blog, the outcome of prostate cancer always revolves around three ongoing concerns: impotence (the inability to have an erection or sustain an erection during intercourse); incontinence (the inability to hold one’s urine and thus a man leaks, often forcing them to wear absorbent underwear), and; cancer management.   I have this discussion every time I see my surgeon.  But I did not find any reflection about these topics in my internet search.

I don’t take these lightly because for men they are important issues.  Plus I think it important not to just deal with these three areas of concern, but with the emotions that go with them.  I will deal specifically with impotency in another blog, because it is the one that I did not find a good deal of information on.  Since this deals with sexuality, I will deal with that later.

There is a billboard near our house that says, “You wouldn’t tell a person with cancer to just get over it.”  The billboard is about how we sometimes respond to people about depression.  It is an apropos statement because a person getting a diagnosis of cancer does not get over it, but this diagnosis also can lead to depression.  In my own case, I realized that I was a victim of a drama not of my own creation.  There were ‘actors’ coming in and out of my life that I did not create, but had to acknowledge and work with in this journey.  For me, I would have moments of heavy sighing….just a ‘soul sigh’ because I had cancer in me that I could not control.  It was growing and I couldn’t do anything about it.  I was moving to the instructions of a lot of people simply following their directions and making decisions on the advice they gave me. 

This is where my personal mission came into play.  In these moments, I kept asking myself what was important in life. What had I determined was important for living well?  How would I honor God in how I lived my life and made choices about this cancer journey?  How would I set an example for my children and other men I came in contact with?  My personal mission served as a foundation for the choices I would have to make.

The first choice was to accept that I had prostate cancer and would have to do something about it.  At 53, there are not a lot of options.  Older men have more options related to prostate cancer, but younger men have to be intentional in seeking consultation that will help them win over this disease; to find a cure.  If one is in their 70s, wait and see can be an option; but at 53 waiting is not in one’s favor.  So the first choice was, “Who should I listen to?”

I had a plethora (dozens actually) of people ‘telling’ me how to proceed.  Everyone had their own story, their own advice.  I had a number of people point me to experimental drugs, herbs, new techniques, and a host of other ways to deal with prostate cancer.  But, each man has to deal with this journey how they view as the right path.  After a lot of reading, I intentionally chose a well respected surgeon (plus a dear friend put me in touch with him).  This was and has been a key for me.

As I close today, my mission guided me to choose a good doctor.  In today’s health environment, YOU are responsible for your own health care.  The Ad Council has a good commercial.  A person is asking all kinds of questions of a waiter about what is in a particular menu item at a restaurant before they order it.  But in the next scene, they are sitting on a table in a doctor’s office.  The doctor says, “Do you have any questions?” To which the patient says—“no.”  We would rather know how many calories are in a plate of food than what is happening in our bodies!  Men, in particular, are more likely not to ask questions. 

Thus the desire to live well allowed me to make a good choice—I have things that I believe I am to do in this world; a table of opportunity set before me.  So I chose a good doctor and took control of my health care at that moment.  I had some depression along the way as well, yet my personal mission, faith, and life of prayer helped me work through these moments of ‘soul sigh.’ 

A personal mission and future hopes guided me in this initial endeavor.  It can guide you, too.

Blessings, grace and peace.

David Neidert

The increasing number of men suffering from prostate disorders has resulted in the pharmaceutical industry’s development of various products that act as supplements for prostate health. These products are not meant to cure disorders such as prostatitis, enlarged prostate and cancer; instead, they are formulated to help keep the prostate gland healthy and less susceptible to these disorders.

Most supplements for prostate health are based on herbs, vitamins and minerals that have been proven to help in the maintenance of the prostate gland. Most of these supplements are manufactured in gel or tablet forms and are taken either once or twice a day. Lycopene, saw palmetto, Pygeum and other vitamins and minerals commonly form the foundations of these supplements. For the most part, they are priced just like ordinary vitamin or mineral supplements that are being offered in the market.

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