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Impotence Drugs Back to News and Gossip Pages;
in the Spotlight -- for Different Reasons
Could Mean Good News for Heart Disease and Parkinson's Patients
By Jeff Levine
May 2, 2000 (Atlanta) -- One of the major concerns about Viagra is whether the impotence drug is suitable for patients with heart disease. And those taking drugs known as nitrates for heart conditions already are warned not to use the distinctive blue pills. Now another treatment for impotence has been tested on men suffering with impotence and heart disease, and the results are encouraging.
At the same time, neurologists in California are finding that Viagra gives patients with Parkinson's disease substantial relief from uncontrolled movement symptoms associated with the brain disorder.
The new drug, Uprima, was studied in nearly 1,500 patients, about 225 of whom had a history of heart disease, over the course of two months. After trying various doses of the drug, the researchers found that at the recommended dose, about one in two attempts at intercourse were likely to be successful. Those not receiving treatment had successful intercourse in less than one out of four attempts.
The research, paid for by the manufacturer TAP Holdings, was presented at a urology conference here this week.
Uprima is taken by placing it under the tongue and allowing it to be absorbed into the bloodstream. It was recommended for approval by an advisory panel to the FDA last month, even though there were concerns about Uprima's side effects. About one-third of those taking the drug at a high dose suffered from nausea or dizziness.
It's still not clear how Uprima may interact with longer-acting nitrates, although there is some indication that the combination may lead to fainting or dangerously low blood pressure. That side effect may have proven lethal to some nitrate patients who tried Viagra.
However, lead investigator for the new study, Eugene Dula, MD, says Uprima does appear safer for many heart patients. Dula is medical director of the West Coast Clinical Research in Van Nuys, Calif.
Dula tells WebMD that Viagra or Uprima should be fine for patients not taking nitrates but who take one or two drugs for high blood pressure. If they are on nitrates, especially the short-acting variety, Dula thinks Uprima may be a good option for these patients. He also says the short-acting nitrates haven't caused a profound dip in blood pressure, and that the FDA is taking a hard look at the longer-acting versions. Other doctors feel that Uprima may be a useful alternative for patients trying to cope with heart disease and impotence.
"The nitrate studies are very small with Uprima. There's about a 10% incidence of blood pressure changes. They're not of the magnitude that occur with Viagra and nitrates, but they are somewhat concerning," John Mulhall, MD, assistant professor of urology at Loyola University Medical Center, tells WebMD.
There also are questions about Uprima's effectiveness since a relatively high percentage of those getting placebo treatments also were able to achieve an erection. "The patients that were entered into the study may not have had severe sexual dysfunction to start out with," says Patrick Walsh, MD, chief of urology at Johns Hopkins Medical Institutions in Baltimore.
Uprima is thought to work by stimulating that area of the brain responsible for causing erections. Interestingly, it's also been used to treat Parkinson's disease.
Now a new study suggests that Viagra may prove beneficial to people with Parkinson's disease. Symptoms of Parkinson's include shaking, poor balance, muscle rigidity, and dyskinesia, or abnormal, involuntary muscle movements.
In this study, presented at a neurology conference in San Diego, seven of nine Parkinson's patients treated with Viagra experienced a significant improvement in dyskinesia, with three patients reporting a complete resolution. The benefits lasted for as long as they remained on the drug and returned when the drug was discontinued. The patients continued taking their other medicines while on Viagra and experienced no worsening of their symptoms. Flushing of the face, reported by one person, was the only side effect, and there was no change in sexual function.
Neurologist David M. Swope, MD, who conducted the trial, tells WebMD he was intrigued when one of his patients, a 60-year-old man, said his Parkinson's symptoms improved after he started taking Viagra for impotence. Swope theorizes that the drug's effects may resemble those of dopamine, a chemical in the brain and nervous system known to be decreased in Parkinson's patients. Swope is assistant professor of neurology at Loma Linda University in Loma Linda, Calif.
"I was surprised it worked in these patients as well as it did," he says. "I wasn't expecting it to be effective in these patients." Swope warns that these findings are "very, very preliminary. We need more evidence that it actually works before it is used routinely." He is now designing another study to test the effects of Viagra more carefully. "I think [the role of Viagra] has yet to be defined, but potentially this might be a new approach to treatment."
Vital Information:
A recent study suggests the drug Uprima may safely treat impotence in patients who also have heart disease.
A Uprima researcher says the drug seems safer than Viagra for patients who are taking nitrates for their heart conditions. Doctors still don't know the long-term effects of taking Uprima and nitrates together.
Researchers also are testing how Viagra might help people with Parkinson's disease control some of their movement problems.
Lifestyle and impotence Back to News and Gossip Pages;
From Medical Correspondent Elizabeth Cohen
ATLANTA (CNN) -- Drinking, exercise and body type are factors that can affect whether or not a man will become impotent, according to new research being presented at the American Urological Association's annual meeting in Atlanta.
The study, presented by Eric Rimm of the Harvard School of Public Health, included nearly 2,000 male subjects. Researchers found that any one of these conditions increased the likelihood of impotence: a large waist, too little exercise, not drinking any alcohol, or drinking too much alcohol.
Rimm says high cholesterol, which restricts blood flow, may be the common condition in these men.
"Much like factors that lead to atherosclerosis, or factors that impede blood flow to the heart, we think that similar factors may impede blood flow to the genital area," Rimm said. Blood flow to the genital area is necessary for erection.
Studies have shown that people who have one or two drinks a day have lower cholesterol, and therefore better blood flow, than those who don't drink at all, or those who drink to extreme.
Research has also shown that overweight people and sedentary people often have high cholesterol.
"I was somewhat surprised at the strength of the association, that individuals who exercised vigorously had such a substantial reduction in erectile dysfunction." Rimm said.
Until now, not much has been known about the relationship between lifestyle and impotence. Rimm's research points scientists in a new direction. Doctors hope these finding will help impotent men to make changes that may improve their sex lives.
New drug for impotence Back to News and Gossip Pages;
ATLANTA (CNN) -- About 30 million American men suffer from erectile dysfunction, an inability to attain and maintain an erection for sexual intercourse.
The impact of this impotence is often physical and psychological. But a new treatment option may soon be available. A medical advisory committee has recommended that federal approval be given for a new drug to assist men suffering from erectile dysfunction.
The drug Uprima, manufactured by TAP Pharmaceuticals, is similar to Viagra in the results achieved, but it works differently.
Both drugs are taken orally, but Uprima is designed to work faster, in about half the time it takes Viagra to take effect. Uprima is administered under the tongue, and its active chemicals are quickly absorbed into the bloodstream. It influences the brain's release of dopamine.
Viagra sometimes fails Back to News and Gossip Pages;
but there are alternatives
By Mari Edlin
(WebMD) -- In his early 40s, Ron Hanson was too young to be having trouble getting and sustaining erections. But like many men, he was too embarrassed at first to talk about the problem.
Hanson (not his real name) waited seven years to see a urologist. By the time he spoke up, erectile dysfunction had become a household word, thanks to the popularity of the drug Viagra. But the widely touted drug, Hanson soon learned, doesn't work for everyone.
When Viagra (sildenafil) hit the market in 1998, some men thought it was the long-awaited answer to their problems. Many rushed to doctor's offices to give it a try. According to the Grey Clinic in Indianapolis, which specializes in erectile dysfunction, 17 percent of men between 18 and 55 experience occasional impotence, while 6 percent have regular erectile difficulties. For men over 55, that number jumps to about one in three. Some common causes of impotence are diabetes, heart disease, and psychological problems. It also frequently occurs after prostate cancer surgery.
Because Viagra affects blood flow, however, it isn't recommended for men who take nitrates for heart disease or those with certain other heart conditions. In some men it causes bad headaches. In others, it just plain doesn't work.
During an erection, blood flows quickly into the penis, which increases its length, width, and firmness. If the "in" vessels (arteries) are too narrow or if blood drains too quickly through the "out" vessels (veins), men may have trouble achieving or maintaining an erection, says Arnold Aigen, M.D., a urologist with Camino Medical Group in Sunnyvale, California. Viagra, which increases inflow, may not be strong enough to work its magic if the arteries are too narrow.
Hanson tried Viagra, but he couldn't tolerate the headaches it caused. Luckily, when Viagra fails, he discovered, there are several alternatives.
Alprostadil to the rescue
A drug called Alprostadil, either alone or sometimes in conjunction with others such as papaverine and/or phentolamine, can be injected directly into the penis to dilate the arteries, experts say. The drug produces an erection in about 10 minutes that can last up to an hour.
But there are several disadvantages, says Teresa Beam, M.D., a urologist with the Grey Clinic. Some patients are averse to using a needle, which is why many men abandon the therapy. Those who give it a try may experience pain at the injection site or priapism (a painful erection lasting too long).
As an alternative, Alprostadil is available as a pellet-like suppository that is inserted into the tip of the penis and absorbed through the lining of the urethra. This can help produce erections lasting for 30 to 60 minutes, according to the Impotence World Association (IWA). Unfortunately, the suppositories are less effective than injections and may cause pain and irritation, according to both Aigen and Beam.
Last November, a topical gel formulation of alprostadil was approved by the U.S. Food and Drug Administration. It is too soon to know if this form of alprostadil therapy will become widely used.
Mechanical help
With a vacuum constriction device, the penis is placed in a cylinder with an attached pump, creating a vacuum to draw blood into the penis. Firmness is sustained by a constriction band placed around the base of the penis. The IWA estimates the technique can produce erections for up to 30 minutes. Beam calls the alternative "a good way to go" because it has minimal side effects, but admits it is cumbersome and takes some practice.
Some men opt for penile implants, which involve the placement of tubes in the penis and a pump in the scrotal sac. The pump (usually the size and shape of a testicle) enables men to obtain an erection whenever and for as long as they desire by pumping a saline solution from a reservoir into the penis. Implants are a last resort, however, says Beam. "Once a prosthesis is implanted, a patient cannot respond to anything else because it alters the natural anatomy."
Fortunately, Ron Hansen didn't have to go that far. He has become used to injecting himself with Alprostadil, which produces a firmer erection than he experienced with Viagra, and one that lasts at least 30 minutes. It also doesn't cause the headaches associated with Viagra. Hanson occasionally uses the suppositories, though they take longer to work.
For Hanson, admitting that he had a problem in the first place was the hardest part. "But when you don't function as you should," he says, "the therapy makes a big difference."
Risk of impotence Back to News and Gossip Pages;
after prostate surgery higher than thought, study says
PROSTATE CANCER:
From Medical Correspondent Dr. Steve Salvatore
(CNN) -- It has long been known sexual dysfunction is a risk associated with the surgical removal of the prostate gland. However a new study in the Journal of the American Medical Association finds the risk may be higher than previously thought.
When Ellis Corets, 69, was diagnosed with prostate cancer six years ago, he had to choose between radiation treatment, just waiting, and radical prostatectomy -- the complete removal of his prostate gland.
Corets opted for the radical prostatectomy. Like most men, he was told his chance of impotence from the procedure was 20 to 30 percent, but the JAMA study found the risk to be twice that.
"We found that overall, about 60 percent of men reported at 18 or months after surgery -- and this was after they had a chance to recover from surgery -- told us that they were unable to have sexual intercourse because their erections were inadequate," said Dr. Janet Stanford of Fred Hutchinson Cancer Research Center.
Men who underwent a special nerve-sparing procedure didn't fare much better.
Experts attribute this difference in numbers to the type of studies previously conducted. Past studies have been based on experiences with individual institutions and surgeons, not the general population.
"In highly technical surgical procedures, one is always best served by having it done, having it performed by somebody who has had a lot of time in the pilot seat, who's basically adept at all the nuances and the potential complications," said Dr. Natan Bar-Chama of Mt. Sinai Hospital in New York.
The JAMA study, a population-based study, also found that certain groups of men did better than others.
"In particular, men with more education, higher incomes tended to fare better," Stanford said. "In addition, we found the younger men recovered more fully and they recovered earlier than older men in this study."
But experts say while impotence is upsetting, it not untreatable.
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DOCTOR Q&A:
Read what doctors say about Viagra and impotence or ask your own questions.
"There are patients that might respond to Viagra, which is an oral medication and there soon might be other medications available on the market," Bar-Chama said.
Despite the side effects, about half of the men surveyed said they were delighted or pleased with the surgery. And 18 months later, 71 percent said they would make the same choice again.
But researchers say doctors can do better by giving patients a more accurate assessment of risk, so that they can make a more informed decision.
Study suggests new therapy for impotence
From Medical Correspondent Holly Firfer
DOCTOR Q&A:
Read what doctors say about Viagra and impotence or ask your own questions.
I
(CNN) -- Impotence used to be a taboo subject, a highly personal issue not to be openly discussed. But with the introduction of Viagra and public figures like Bob Dole announcing their personal battles with the problem, millions of people are talking about erectile dysfunction.
This public interest in impotence is one reason scientists are scrambling to find new treatments.
In a study reported in this week's editions of the medical journal Nature Structural Biology, researchers at the University of Pennsylvania say nitric oxide may hold the key to treating the problem. It's found naturally in the body and aids in smooth muscle relaxation, a requirement for erection.
"Nitric oxide is the messenger, if you will, the signaling molecule, and without that signal you can't get that signal from the brain to the penis for the erectile process," said Dr. David Christianson of the University of Pennsylvania.
An amino acid call L-argenine produces nitric oxide in the body. Researchers say they have found that a natural enzyme, argenase, that breaks down the L-argenine and renders it useless to make nitric oxide. This results in impotence.
What they have done is create an amino acid to stop this breakdown of L-argenine.
Erectile dysfunction affects half of the male population over 40 and according to Viagra makers Pfizer, their drug does not work in three out of 10 men.
"Their hopes have been so high, that when you get a patient and it (Viagra) doesn't work, they are depressed. They feel devastated by the problem," Urologist Steven Morganstern said.
According to the study's authors, Viagra works later in the erection process than this new therapy. They hope their findings may one day help Viagra work better as well as help those who are unable to take Viagra for medical reasons.
Continued testing is planned, but researchers warn it could be years before the therapy reaches the public.
Sex after 60 Back to News and Gossip Pages;
WASHINGTON (CNN) -- Almost half of Americans age 60 and up have sex at least once a month and one in four say they would like to have it more often, says a survey released Monday by the National Council on the Aging.
The survey of 1,300 people was funded by the Pfizer pharmaceutical company, maker of the male impotence drug Viagra.
"Our study debunks the prevailing myths about sexuality in older years," said James Firman, president of NCOA, in a statement. "For many older Americans, sex remains an important and vital part of their lives."
Thirty-nine percent said they are satisfied with the amount of sex they have even if they were having no sex at all. Men were about twice as likely to report wanting more sex.
The survey found 61 percent of older men and 37 percent of older women are sexually active. The survey credits the difference to women's longer life spans and lack of mates. Just 19 percent of widows and widowers in that age group are sexually active compared with 59 percent of married women and men.
Two-thirds of respondents said their sex lives are more emotionally satisfying now than when they were in their 40s, and 79 percent of men and 66 percent of women said that maintaining an active sex life is an important part of their relationship with their partner.
"This study underscores the enduring importance of sex among older men and women, even among these who report infrequent sexual activity," said Neal Cutler, NCOA's director of survey research. "When people are not sexually active, it is usually because they lack a partner or because they have a medical condition."
Marian Dunn, who heads the Sex Therapy Clinic at the State University of New York in Brooklyn, said older Americans need to be educated that sex is not bad for them. She added younger physicians often don't talk to older patients about sex due to what Dunn called misperception that older Americans are not actively involved in sex.
The survey questioned more than just sexual activity. It also asked seniors what qualities they seek in a partner. Nine out of 10 cited high moral character, pleasant personality, a sense of humor and intelligence.
More women than men said they were likely to seek financial security in a mate, while men where more likely to seek a partner who is interested in sex.
By Andre Cross
Back to News and Gossip Pages;
.
Love has become a four-letter word. It's one of the most overused, under-appreciated, misunderstood words in the English language. Nowadays, the image of love seems more like a 7/11; a convenience store on the road of life, designed to provide satisfactory feelings without too much effort, rather than the classic sentiment associated with fairytales like Cinderella.
What am I talking about? I'm talking about how we've changed the definition of love to an all-encompassing term to describe any relationship we are in, even if it is one void of any deep emotional connection.
settling for less
The subject really began to intrigue me when a person I recently met confided in me that a relationship he was involved with for six years was little more than a bad habit; an empty shell of what was once a great relationship. When I asked him why he was still with her, all I got was a shrug of the shoulders and a futile attempt at explaining (more like justifying) his decision. It was good enough.
Thus began a soul searching journey into the subject of love, and why men in general have given up on finding real love.
When did we stop believing in love? Actually, a better question is when did the word love carry the same connotation as fantasy and fairytale? And when I mean love, I'm talking about real love, the kind of love you'd give up your soul -- and your left arm for. Have we become so shallow and jaded as a society that we instantly dismiss the notion of falling in love as a story from our grandparents' time?
love and lust
There are plenty of couples that love each other; it's a normal, natural emotion that exists when one spends a considerable amount of time with another. But time makes us love someone; being in love is a whole other story. You can love your sister, your mother, your brother, your friends (though you'll never admit to that one unless you're under the influence), but you can only be in love with a woman that sets your heart on fire.
Unfortunately, nowadays we easily confuse the concept of love with attraction. Men, pigs by nature as we are (even I, Mr. Sensitive, must admit to falling prey to the curse of lust), tend to think a good time in bed equates love. Actually, let me correct myself -- a good time in bed and remembering her name may be mistaken for love. But deep down, men are as skeptical about love as they are about a phone call claiming a free prize if they reveal their credit card number.
Men often get together and devise a plan of how to try to capture as many females as possible. It's not that we do it on purpose -- actually the Discovery Channel even tells us it's part of our genetic makeup -- but the truth is that men are bitter creatures. Contrary to popular opinion (or any football movie you see), the male ego is as fragile as a Faberge egg.
when did we stop believing?
We are not born bitter; we become bitter, more likely after a sour relationship that left us with a bad taste in our mouths. We were all optimists once, believing that we only date women we are in love with, but we quickly came to terms with reality. If the love you had has become a fleeting emotion, it was never really love to begin with. And what happens? We stop believing it ever really existed.
End result? We stay in relationships that can be summed up as good enough, meaning it has enough elements that justify continuing the relationship despite the fact that we don't have a glitter in our eyes when we talk about her, and our heart doesn't skip a beat when we receive a call from her. Basically, we stay in relationships for too long, even though there isn't an iota of passion between us. Are we so afraid of being alone that we would sacrifice something that would obviously make us happy, for a person we merely get along with?
How do we know that a certain woman is pulling at our heartstrings?
the passion test
Passion. Isn't that a word in the dictionary? Doesn't it mean: a powerful emotion, such as love, joy, hatred, or anger? Isn't it something that refers to what Romeo and Juliet once had? How many of us have ever felt it? Not many. Remember, I am talking about passion, not lust.
Passion expresses itself in the weirdest of ways, but it can be summarized like this: if you tremble when you are close to her, then you are feeling the effects of passion (unless you are just an incredibly shy guy). If you get into a fight, say the cruelest things in the world, and end up sharing a kiss that could make the world stop, then passion is there.
If your goodbye kisses are but simple pecks on the cheek or lips, devoid of any emotion, then your relationship has no passion. If you can sleep well at night, despite having a major fight with your significant other, then passion is non-existent.
Unfortunately boys, this isn't something we can pick up at the nearest grocery store; it's either there or it's not. And since so few of us have never experienced passion, we don't believe it exists. People who are passionate love hard, hate hard, and have a joy for living others can only envy.
all you need is love
I have some good news and some bad news. The good news is that true love does exist; the bad news is that it is as unlikely to occur as seeing Arnold Schwarzenegger and Sylvester Stallone appear in a remake of Thelma & Louise.
The Beatles had a moderately successful career (an understatement if there ever was one) singing about love, as almost every one of their tunes broached the subject and became a Top 10 hit. Did they know something we didn't, or were they referring to it in the same way New Age artists refer to the mythical rising Phoenix?
Of course not. The lesson we have to take from this is simple: love is out there, somewhere in this dark, lonely world, but don't bet the farm on finding it.
You can't go around looking for love, it just happens the same way you reach puberty: unexpectedly and painfully. Almost everyone who has fallen in love (again, I'm referring to the I'd give up my right kidney kind of love) has said it came out of the blue, having caught them off guard. You can find it today, or you could have missed it yesterday, forever.
Everyone falls in love at least once in their lives; before they become bitter, divorced, and join support groups. Too often, it happens when they are too young to realize its grace and beauty, and before they become suspicious of anything too good to be true.
everyone's a critic
Am I being too cynical? Yes, I am, but I have reason to be. Just ask those closest to you how many of them are deeply in love, and you'll be surprised by the answer. We've become an almost loveless, sex crazed society with no concern for any significant amount of emotional investment or attachment -- but there is hope.
The hope I have (and yes this is a stretch), is that the men and women in this world stop being trapped in loveless, lifeless relationships. That they refuse to engage in any kind of relationship in which they do not wish to spend every living, breathing moment next to the person they are passionate about.
Right.
What I said has about as much chance of happening as squirrels landing on the moon. At least do me this favor. If you are in a relationship that doesn't bring you happiness, be men and end it. Yes, I know the steady dose of sex is hard to give up, but have some self-respect boys. At least stop fooling the other person.
So how do you know if you're really in love with the woman you're with?
6 signs you're in love
So how do you know that Cupid was up to his old tricks again? Beyond feeling like a bumbling idiot when talking about the object of your affection, here are 6 signs that you're feeling the Big L. Those who are allergic to sappy items, please do not read on, it's going to get messy.
1. You have an uncontrollable desire to be nice and do good deeds. In short, you want to be a better man. The sarcasm dies down, the snide remarks take a vacation, and you start smiling all the time.
2.Taking a cue from the movie Jerry Maguire, you start to feel whole. You start to feel that this person understands you like no one has before, and you start having visions of your children in her eyes. Yes, you feel like Tom Cruise did when he uttered the words, "You -- complete -- me."
3.The damn radio songs. All of a sudden, even Phil Collins starts to make sense to you. You listen to songs differently, understanding their meaning in a way you never thought you could. The worst is yet to come: when a Celine Dion comes on, you don't turn the dial.
4.You feel pangs of pain when you're not close to her. Your heart beats quickly all day, and you find every excuse in the world to blow off your buddies and see her. The longing to be with her is almost like a drug. This is where you start doodling her name everywhere.
5.You start thinking about her not every 5 seconds, but every 2.7 seconds. The other 2.3 seconds are spent on sports, food and sex (with her, of course).
6.Your head used to be planted firmly on your shoulders. But suddenly, everything else becomes secondary to her, and you start doing crazy things you never thought you would ever do. This is where you are likely to buy a Celine Dion album; scary thought, isn't it?
Laugh all you want, but deep down, what we all really want is to feel this way (minus the Celine Dion part). For those lucky enough to feel it, put a sign on your shirt, so the rest of us can point at you and say, "If he can do it, I can too."
And if you want the ultimate test of whether you are in love or not, just remember:
Real love will devastate you.
If love does not shatter you,
You do not know love.
I couldn't have said it better myself.
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