Dear Doctors: I am 70 years old and working as I did when I was 25. I am having trouble finding the answer to erectile dysfunction. Is there a way other than the pill to restore virility? I have tried them.
J.J.
By "the pill," I take it you mean Viagra, Cialis or Levi-tra. They have a good record for restoring potency. However, you have to take them by strictly observing the instructions that come with them.
Viagra, for example, works best when taken on an empty stomach - no food for four hours. If you weren't taking it like that, try again.
Secondly, all three of these drugs have three dosages. If the lowest dose doesn't work, a higher one might.
Before taking any ED (erectile dysfunction) medicine blindly, you, along with your doctor, have to make a search for the cause of the problem. Clogging of arteries that deliver blood for an erection could be the cause. Such obstruction indicates that other arteries suffer the same condition. For your general health, you need to know if the process is occurring in other blood vessels, like the ones to the heart.
Diabetes and high blood pressure are two other factors involved in ED. Have you been tested for them? Depression also leads to ED.
Has your level of testosterone been checked? The male hormone is very important in maintaining sexual function. You might need a boost to the amount of testosterone you're producing. You are 70 years old, and with age, testosterone production decreases.
Devices that don't involve taking medicines are an approach that should be considered. A vacuum pump draws blood into the penis, and a constriction ring around the base of that organ keeps blood there.
Another device is an implant that pumps saline into the penis. You activate the pump by squeezing it. It's implanted in the scrotum.
Alprostadil is a medicine inserted painlessly into the penis with an applicator. The name of this device is MUSE.
A talk with a urologist can give you detailed information on finding the cause and determining the best treatment for it.
Dear doctors: I have a couple of questions about discoid lupus. Does it turn into systemic lupus? I have four spots on my back that itch a lot for a while and then stop. Is this normal? A sore on my shoulder was biopsied, and the report came back discoid lupus.
D.M.
Discoid lupus is lupus that is confined to the skin. It doesn't attack internal organs like the kidneys. Systemic lupus does that. Discoid lupus starts out as a red patch or patches with surface scales. With the passage of time, the centre of the patch shrinks and often leaves a scar. At most, 10 per cent of discoid lupus eventually meets the criteria for systemic lupus.
Looked at in a more optimistic way, 90 per cent of discoid lupus does not become the systemic variety.
I don't know what the itchy spots on your back are. They don't sound like lupus. You do need to be vigilant about sun exposure. You should not go out without applying sunblock.
One of the cortisone drugs applied to the skin often can keep discoid lupus in check. If it doesn't, then the doctor can inject the lupus patch with cortisone.
Dear doctors: You once indicated that cranberry juice was a way to prevent bladder infections. Now you say not to drink cranberry juice cocktail. Why?
D.R.
My advice was targeted only to those who use cranberry juice to break the cycle of bladder infections. The juice often works. Cranberry juice cocktail contains other juices in it. That dilutes the juice's prevention properties. If you like the cocktail juice, drink it, but be aware it has no effect on bladder infections.
Doctors Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.
