THE CONSULTATION

A man came to see me one day asking for Viagra. He wanted it for his ailing erectile strength. He travels a lot, both overseas and interstate. He has different girlfriends in several different cities.
As he was 55 years old, overweight, and on medication for high cholesterol, I decided to investigate his cardiovascular system to ensure that he would not be at risk when taking Viagra. While I was examining him, he began to tell me about his many different relationships that he has going through out the world. This was not the first time that I had heard such happenings, so I was not impressed, but I pretended to listen with awe.
I ventured to ask him why he travels so much. He became quite evasive. 'I am involved with the community/ he told me.
'What do you do with the community?' I inquired further. 'Doc, you're going to think badly of me,' he said. 'I'm a Catholic priest.'
I was truly surprised.
Talking about sex and sexual problems is not usually a topic that is discussed in public. This may be due to religious upbringing, cultural factors, or it may just have been a result of conservative attitudes. Sexual issues are also not openly discussed in many marriages.
Many men who consult health experts about this problem have been dying to talk to someone about it for years, but they have 'just never gotten around to it.' These men live with deep-seated concerns about their supposed sexual inadequacies. Such feelings could be dissipated if they had the confidence to talk to a professional about their concerns. In contrast, many women are encouraged to talk about their personal problems freely. They even have their own specialist, the gynaecologist, who deals specifically with women's medical issues. These doctors are exclusively concerned with the medical well being of women and, until recently, men did not have an equivalent medical professional to consult.
Only in the last few years have men's medical issues been the exclusive concerns of specialists. In general, if a man has a personal or sexual problem, he will keep it to himself. He won't go to his mates at the pub and ask for advice, nor will he approach a complete stranger and pour his heart out. In some situations, he might talk about his problem in a religious confession. If he is of a more open nature, he might consult his general practitioner. However, he is likely to be concerned that a general practitioner who sees other members of his family might accidentally reveal his problem to others. There's never been a 'men's health physician', the kind of person with whom you can have a 'bloke-to-bloke' talk.
The last ten years have seen a rapid development in available 'men's health treatments'. This has been long overdue. The relief that many men experience who come to a 'men's health clinic' is enormous. 'Why weren't you here 10 years ago?', is what I hear regularly. 'Erectile Dysfunction Week' is now even celebrated in Australia. What next?!
It is clear that men's health clinics are a welcome addition to the medical scene. Practitioners now realise how important it is to advertise their services. Men are conditioned to keep their problems quiet and not look for assistance. In fact, many men believe that if they ignore the symptoms and for-
get that the problem exists, then perhaps it will go away. They are completely unaware that a solution in many cases actually exists.
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News

EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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Articles

ERECTILE DYSFUNCTION SYMPTOMS

Most patients have a combination of two or more of these problems. They are usually first given a thorough medical history and examination to determine the extent of the prob­lem and to hopefully pinpoint a cause. I want to briefly outline the nature of these four symptoms so that your problem will make more sense to you as a patient if you are experiencing any of them.

PRESCRIBED DRUGS

Taking prescribed medications with most vitamins is safe as is taking herbal complexes that are available through health food stores. However, you should always check with your doctor, your pharmacist or your naturopath. They are all trained to know what can go with what.

Weight loss

Overweight is most commonly a result of overeating and lack of exercise. Overweight and fluid retention often go together with people who have glandular problems or under-active thyroids. In such cases an iodine and phosporous deficiency may be the cause.