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Summer's almost over and I thought I'd let you all know that I'm not dead.
Summer's always a great excuse for travelling, so apart from a few heavy weeks of working on some re-designs for a few websites, I got in my van and went out.
This year's destination was middle Norway. Have a look at my . Some of the highlights were the climbing of Storronden in Rondane, the climbing of Galdhopiggen (the highest mountain in northern Europe) in Jotunheimen, a three day hiking trip through Jotunheimen (Leirvassbu-Olavsbu-Gjendebu-Leirvassbu), and the spotting of wild reindeer and musk oxes in Dovrefjell.
It's always a pleasure to be in the outdoors, certainly in a country like Norway which feels just like a giant National Park. This year weather wasn't really on our side with mostly rain and cold. But of course there is no such thing as bad weather, there's only bad clothing!
If that wasn't enough we also took a short week off in August to go hiking in the Saastal in Switzerland: . When I was a kid my parents took me to Saas Fee and Saas Grund a few times in the summer for walking, so I figured I had to go back once to see if there would be anything to remember from my childhood.
If you ever go there, you should take the Felskinn lift in Saas Fee for sunrise. Once a week the lift goes up at about five in the morning so you can see the sun rise at 3500m on Mittel Allalin, near the Allalinhorn. Bring good clothes though, big chance you'll freeze your ass off!
Next time I'll hopefully climb Allalinhorn - didn't feel like paying for a guide this time, it's expensive!
Let autumn begin...
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The use of exogenous androgens suppresses natural androgen production. Elevating serum androgen levels has the potential to stimulate prostate growth and may increase the risk of activating a latent cancer. Periodic prostate examinations, including digital rectal examinations, prostate-specific antigen determinations, and blood counts (ie, CBC counts), are recommended in all patients receiving supplemental androgens. Obtaining a testosterone level while on therapy is also suggested to optimize the dosage.
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms. The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology.
Avanafil: This newer phosphodiesterase inhibitor is currently showing promise in clinical trials for the treatment of erectile dysfunction. Unlike the current oral medications for the treatment of ED, this one may be able to be taken twice daily for people who want to have intercourse more than once a day. Further studies are underway.
Half the men were assigned to receive 2 Gray (Gy -- a measurement of radiation) in 38 sessions spread over seven and a half weeks.
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Sometimes men who abuse alcohol and drugs that depress the central nervous system may find themselves unable to achieve erections, too.
Herbal medicines usually do not have significant side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or a headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.
Concurrent administration with ketoconazole (200 mg PO qd), itraconazole (200 mg PO qd), or erythromycin: Not to exceed 5 mg PO q24h
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Alprostadil can be injected into the penis or inserted using a special applicator - usually just before sexual intercourse.
Vasoactive drugs may also be injected intracavernosally. Such therapy represents an important second-line therapy for erectile dysfunction. It is the most effective pharmacologic treatment but has a high dropout rate because of the associated pain and apprehension involved. Phentolamine is an -blocker that was used in initial studies; its efficacy is poor, but it may be used in combination with other agents. Papaverine is a nonspecific PDE inhibitor and was the first effective intracavernosal therapy for erectile dysfunction. Currently, intracavernosal alprostadil therapy is preferred; it is more effective than other agents and produces fewer side effects. In a comparison study comparing alprostadil, a papaverineĖphentolamine combination and papaverine alone, rates of success (ability to achieve and maintain an erection) of 72%, 61% and 31% were reported respectively.54 No patients in the alprostadil group experienced priapism, as compared with 2% and 4% of patients in the combination therapy and papaverine-only groups respectively. On the other hand, patients who used alprostadil were the only ones to report penile pain. For patients who do not respond to or do not tolerate alprostadil monotherapy, a triple mixture of papaverine, phentolamine and alprostadil may be prescribed. Such combination therapy has been shown to be more effective and, because of a lower dose of alprostadil, results in less pain.62 Complications of intracavernosal injections include pain, priapism and fibrotic changes at injection sites.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Navy Medical Department or the Naval Service at large.
Could ED be a sign of heart disease? Tell your doctor about any heart disease risk factors you may have, such as:
Sildenafil is available in 3 doses: 25 mg, 50 mg, and 100 mg. The starting dose depends on the clinical situation. A man in his fifth decade of life with mild sexual dysfunction that is probably related to psychological factors can start on the 25-mg dose. Men with moderate-to-severe ED can begin at the 50-mg dose, and, after testing the effect of the drug on at least 3 occasions (although 5-6 tries is recommended), the dose can be modified. Men with severe ED can start on the 100-mg dose; these men are not likely to achieve a satisfactory response, but they should make 3-4 attempts before starting another form of therapy.
The development of future medical options will emphasize the restoration of physiologic function. A better understanding of the molecular biology of ED will allow the development of new classes of agents. Research involving gene therapy is beginning to show promise.
CYP4503A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase levels; potentiates hypotensive effect of nitrates or alpha-blockers; avoid coadministration with other drugs that prolong QT interval (eg, quinidine, procainamide, amiodarone, sotalol)
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