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LIVING WITH SPINAL CORD INJURY: TREATMENT FOR ERECTILE DYSFUNCTION

Most men with spinal cord injury experience some type of erectile dysfunction – difficulty getting or sustaining an erection or inability to achieve full erection – that makes sexual intercourse difficult. Sometimes, erectile function improves over time as spontaneous recovery occurs.In men with injuries at a higher level of the spinal cord, reflexogenic erections can result from sexual or nonsexual stimulation to the genital area or penis. These erections are not necessarily related to sexual arousal, but with practice, couples can sometimes learn stimulation techniques to make these erections last long enough to have satisfactory intercourse. A satisfying sexual relationship may be possible whether you have reflexogenic erections, partial erections, or none at all. But many men and their partners want to have intercourse and may wish to use a treatment technique to create or sustain an erection firm enough for this purpose. Several options now exist, including vacuum devices, injections, medications, and penile implants.A vacuum device, or pump, is a simple tube that fits over the penis and creates an erection as air is pumped out of the tube and blood is drawn into the penis. A ring is then inserted over the base of the penis to maintain the erection by keeping the blood in the penis. After intercourse, the ring is removed and the erection dissipates. (Some people use a penis ring alone to maintain erections that occur naturally. Your urologist can tell you if this method is safe for you and can advise you on how long to use it, what size ring to use, and so forth.) The vacuum devices are generally safe, effective, and inexpensive.
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ALTERNATIVE THERAPIES FOR BONE DENSITY: TRADITIONAL CHINESE MEDICINE

In traditional Chinese medicine, bone health is believed to be inextricably linked to the health of the kidneys. So any treatment recommended for strengthening the kidneys (increasing their “energy”) would be good for your bones as well. The kidneys are also thought to be related to aging in general. Chinese medicine has long been used to relieve the symptoms of a difficult menopause with much success, so low bone density might also be improved along with more overt signs of a drop in hormone levels.
An expert in Chinese medicine will generally recommend a combination of diet, herbs, acupuncture, and exercise, particularly tai chi and qi gong, or a similar type of movement. I’m a fan of this kind of exercise, as described earlier in the book, since it builds bone mass and develops strength and balance, and at the same time reduces stress, so that’s one of the appeals of TCM to me. Acupuncture has some of the best science behind it of any other “alternative” therapy. But the key thing about traditional Chinese medicine is that it uses a combination of tactics that are greater than the sum of their parts. You can use just one strand, if necessary, but weaving them together results in a stronger whole cloth.
Acupuncture is an excellent way to relieve pain, including pain from osteoporosis or low bone density. The Kidney 3, Kidney 10, and Spleen 6 points for acupuncture—or acupressure, if you want to try this at home—are important for preventing and treating low bone density and the pain that can result. (If you don’t get results with self-administered acupressure, don’t throw the baby out with the bathwater. Working with a properly trained acupuncture professional could well make all the difference.) If done properly, it can also alter the body’s metabolism and biochemistry in ways Western science does not yet fully understand to actually stimulate bone growth and retard loss. It is generally acknowledged that acupuncture points have more nerves and increased blood flow than the areas around them, so stimulating them produces changes in nerve conduction and releases serotonin and endorphins, which improve mood and decrease pain throughout the body, among other things.
I read an anecdote in an alternative medicine reference book from a leader of a school of traditional Chinese medicine who treated a woman whose bone density was 30 percent below desirable. After two and a half months of acupuncture and herbs (and no other intervention), she had no more pain and her bone density had increased 50 percent. Blood tests showed her hormone levels had Increased. The expert in traditional Chinese medicine I work with doesn’t have his clients get bone scans, but reports his patients with suspected low bone density find balance and strength with the practice of traditional medicine, with little in the way of menopausal complaints.
For a shot at such remarkable results, consult a specialist in Eastern medicine, not someone with just the few months’ training required to hang out a shingle. Only a few hundred people in this country have taken the four- to five-year formal medical training available to become experts, and the number of people with the less intense training is growing by leaps and bounds. (A good acupuncturist should be able to help you with symptom relief, at least, even with the more rapid training course.)
Chinese herbs are usually given in combination and treat your body’s unique energy. So again you should seek professional guidance to find the mix that is best for you. Good herbologists won’t give generic recommendations for particular conditions. Rather, they treat each individual by working to restore balance to the body overall. If you want to experiment yourself, eycinnuam dipsaci is a common recommendation. Dong quai contains phytoestrogens 1/400 as strong as estrogen, but with some of the same effects on the body. (Do not take dong quai if you are pregnant.) Two Immortals Decoction and Eight Flavor Rehmannia formulas are generally good choices for women looking to protect their bones. Six Flavor Rehmannia supports the kidney, as do shou wu, dong quai, and ginseng, which are often used in combination (including a drink called Shou Wu Chih) for easing the aging process. Ginseng has a lot of beneficial phytoestrogens, but use it carefully, as high levels can cause high blood pressure, anxiety, and insomnia. Ox knee root and three-edge root have estrogenic effects, which should support healthy bones. In an animal study, tochu bark extract was proven to help the body absorb calcium, and was shown to increase bone density and muscle mass. In humans, licorice (gan cao) and peony (bau shao and chi shao) have been shown to increase the ratio of estrogen to testosterone, following animal studies that revealed the herbs helped convert testosterone into estrogen, raising overall estrogen levels. Liu wei di huang tang formula can increase estrogen levels and estrogen receptors after menopause. Dan shen also increased estrogen levels in another study in animals.
Be aware that using these herbs off-the-rack, without consulting with an expert, isn’t really traditional Chinese medicine (though it may or may not work for you). Simply substituting another chemical (“natural” though they may be, herbs work because they are sources of potent chemicals) for a prescription won’t get you any closer to optimal health or bone density.
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KNEE PROBLEMS: PATELLAR TENDON RUPTURE

You’re playing basketball, you come down from a rebound, and suddenly you’re in terrible pain. Your knee swells up, and you can’t straighten your leg. This is the typical scenario of a patellar tendon rupture, an injury that most often affects people in their forties while they are engaging in physical activity, although in more rare cases, it could also be caused by another type of injury, such as a fall.
In some cases, the tendon may only be partially ruptured, which is painful but not as serious as a complete rupture.
Diagnosis
Similar to a quadriceps tendon rupture, patients with a patellar tendon rupture will not be able to straighten their injured leg. In addition, they will be in a great deal of pain.
On an X ray, the patella will appear in a somewhat higher position (a few millimeters higher) on the knee than normal.
An MRI can determine if the rupture is complete or partial.
Treatment
A complete rupture must be surgically repaired with open-knee surgery. The tendon ends must be cleaned, reattached, and sutured back to the patella or tibia, depending on the location of the tear. You will then be casted for anywhere from 3 to 6 weeks, and once the cast is removed, you will begin exercises to restore your full range of motion. Leg strengthening exercises are also essential to help build up strength in the injured leg so that it is equal to the noninjured leg.
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