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When Shakespeare was writing The Merchant of Venice, he was talking about the extent to which people are the same under the skin. But culture is more than skin deep and what one group of people find an everyday treatment, others find extraordinary. As an example, let’s take acupuncture. This is a technique perfected in Traditional Chinese Medicine (TCM). Put most simply, the practitioners treat sickness and disease by sticking needles into their patients. There are complex diagrams identifying all the key points round the body and, by inserting needles at just the right points for each condition to be treated, you produce relief or a cure. To those in the West who are used to the idea of taking a tablet, acupuncture just looks like masochism, i.e. you feel so much better when the pain stops. But in China, there are more than two thousand years of experience in administering treatment this way and many medical hospitals in Asia and ASEAN include acupuncture as one of the therapies available to treat patients. The point of interest today is that China is now also adapting its techniques to produce aesthetic acupuncture to treat acne and premature baldness, and to promote weight loss. Westerners are used to using a range of treatments for cosmetic problems such as acne and baldness. Some are available over the counter while others require a prescription. Accutane, being the most powerful treatment for acne, usually requires the approval of a dermatologist before it is prescribed. The treatment for acne in TCM relies on acupuncture, herbal preparations and a change in diet to food with a low fat content, low spiciness and not fried. The aim in the treatment is to improve the condition of the skin by stimulating the flow of blood around the face. This requires needles to be inserted in the upper back, shoulders and neck. Various infusions are also used together with a general recommendation to drink more dandelion tisane or chrysanthemum tea - popular drinks in the region to promote good health. There is increasingly sound scientific evidence about the effectiveness of TCM as more Western researchers begin to study these century-old techniques. Results are not simply a placebo effect produced by the strength of the patient’s belief. There are verifiable “cures” when TCM, including acupuncture, is used. For Westerners, the question is of some importance. As it stands, the drug of final resort for the treatment of acne is accutane which has significant problems associated with its use by women of child-bearing age. If the same improvements seen among those who use acupuncture could be replicated in the West, would this not be a better way to treat a serious skin problem rather than having to rely on heavy-duty drugs with sometimes dangerous side effects?

Why should the medical profession, which is supposed to be there to save lives, be leaving older men out of the diagnosis and treatment loop? This August has seen an interesting recommendation from the US Preventative Services Task Force. Men aged more than 75 years should not be screened for prostate cancer. Indeed, younger men should be counseled on whether screening is necessary or desirable. Well, it’s not quite as heartless as it might appear.

The Task Force argues it is better not to know. If men do begin to have problems with erectile dysfunction, they can simply take Levitra which almost inevitably allows sexual activity to resume.

Prostate cancer grows quite slowly and men are likely to die of old age before the cancer kills them. Indeed, if men are diagnosed with cancer, this is distressing. The men and their families obviously worry. Taking biopsies is invasive and can be painful. Some of the medications and treatments short of surgery can cause impotence. Surgery more often than not does cause sexual problems that Levitra can only partially solve. Thus, if there are no serious symptoms to investigate, it’s better not to look. Letting life take its course is the kindest option.

There is an unspoken rule that you should never write knocking copies. This is an article that contrasts one product with another, making the other look really bad. We don’t attempt to do that here. We are always trying to be absolutely fair and never do more than state facts, not opinions.

So here is something you can check out for yourself. If you look at the way in which the little blue pill is packaged (can’t think which drug that is), you’ll see it comes in 25mg, 50mg and 100mg. Most men seem to do best with an average dose of 50mg. Levitra, on the other hand, comes in another variety of doses. Most men seem to do best with 10mg tablets but many get perfect results with the lower dosages.

Well, you’re taking five times less of the same active ingredients to achieve the same results. As a general rule in the world of medication, the smaller the dose, the lower the risk you will experience any side effects. Not that many with either drug but, if you were looking for a reason to prefer Levitra, safety would be top of the list for most.

Federation of European Pharmacological Societies Congress began a discussion of the medicinal role of some light narcotics, including cannabis, last july. It is now licensed for the control of neuropathic pain in adults suffering from cancer and multiple sclerosis. So medical science has been able to strip away the “unwanted” psychoactive symptoms and use the cannabinoid components to target the specific diseases.

Why does cannabis work? Because the human body naturally produces cannabinoids and has cannabinoid receptor cells in all parts. Science is now designing medications that focus on the parts of the body affected by disease and not the central nervous system. Thus, research is now aiming to produce more medications that maintain cannabinoid levels in the affected areas for pain relief and for the control of anxiety and depression.

The converse treatments are also working well for dealing with nicotine addiction and overweight. One of the problems with cannabis is that is tends to be addictive and it causes the “munchies”, i.e. it encourages users to eat more. So, medications like acomplia that block the cannabinoid receptors help to reduce addictive behavior and reduce appetite.

Why is more not heard about these advances? Possibly because of the prejudice that cannabis is a drug that should be banned. It is a shame society cannot see beyond a name to the good results science can produce. By coincidence, the French health authority Afssaps also released new statistics confirming the safety profile of acomplia in relation to depression. People with no history of depression show no adverse symptoms. Others only show an increase in depression at the beginning of a course of treatment. This can easily be monitored and compensated for.

The July conference heard news that one constituent of cannabis, THVC, may offer a better way to reduce appetite than acomplia and, more importantly, may be effective to treat neurodegenerative disorders like Huntington’s disease, Parkinson’s and Alzheimer’s.

Appropriately enough for a site devoted to Ambien, it is Insomniac by Gayle Greene (published by the University of California Press in March, 2008 - 978-0-520-24630-0). Well, yes, I am going to talk about a new book. So here is an autobiographical take on what it is like to live with insomnia by a woman who ought to know. She wins this prize even though not a medical researcher because she is the “patient representative” on the board of the American Insomnia Association, which operates within the AASM’s umbrella. In her spare time (sic), she labours at the Scripps College, Claremont California as Professor of Literature and Women’s Studies. This latest tome (quite heavy at 520 pages) adds to her impressive resume of academic publications. Gayle Greene has the distinction of being a non-professional member of the American Academy of Sleep Medicine (AASM). This is a highly personal account by an articulate and intelligent woman who has been afflicted by insomnia for most of her adult life. In one sense, the only person who can really tell you what it is like in a foreign country is one who has been there. For those of us who have always been able to sleep without difficulty, insomnia is like a foreign country, and the idea of having to use a medication like Ambien as the passport to get into sleep is alien. Insomnia means nothing more than you cannot get the number of hours of sleep you need to feel good about yourself and function efficiently. There is no reason for this. It is nothing more than a failure to sleep. There should be no pejorative implication. To use stress as an excuse is to blame the person for being weak or neurotic when there is no reason to blame yourself or anyone else. Instead of looking for some psychological explanation or a less judgemental physical cause, we should just accept that it happens to about 20% of the population at one time or another during their lives. Conventional wisdom always says that insomnia is somehow related to anxiety or stress levels, perhaps aggravated by drinking too many cups of real coffee. Folk tales may tell us that we went to sleep when dusk fell and waited for the cock to crow before waking. But was that actually the case? Who can say what the real biological norms were before electricity came along and gave everyone the chance to live through the darkness. Greene comes up with a simple and practical explanation of what insomnia is.Greene comments that the National Institutes of Health in the United States spent less than $20m in 2005, whereas Sanofi-Aventis spent more than $120m promoting Ambien in the same year. This is neither to praise nor condemn Ambien. It is all a question of priorities. Why bother to spend Government money on researching the cause of a condition when private capital has already invented Ambien as a cure for it? As it stands, no researcher can actually explain why we have to sleep nor why some people sleep more than others. It is all guesswork. All that we can say with any certainty is that those who are deprived of sleep do not do as well as those who sleep through the night. For one who has had to depend on Ambien and the other medications for so long, she feels she and all other sufferers deserve better answers than those served up by the pharmaceutical companies. For one who has never had problems sleeping nor had to take Ambien, Insomniac was a riveting insight into the condition and the problems it causes. Required reading for everyone who reads this article.The sleepless so often end up demotivated, their sense of humour worn thin, their judgement warped. Some grow fat. She debates what we really understand about cause and effect. It is so easy to get the cart before the horse, or should that be the other way round? Perhaps conventional wisdom has also got things back-to-front. Instead of stress and anxiety being the cause of insomnia, perhaps living with insomnia makes you stressed and anxious. Who is to say in these more modern times, that we did not have disturbed sleep patterns in past times living on the land? Others find their immune system affected. Sleep seems so indispensable yet no-one can really control it. Greene describes everything she has tried over the years from relaxation therapies to medication like Ambien, but concludes that, like any intimate relationship, how we relate to sleep is always personal. She is a passionate advocate for greater patient power to persuade disinterested bodies to research insomnia.

As if you hadn’t noticed, summer has arrived, summer skies has bloomed. That means we have to get interested in Lyme disease all over again. Let me inform you about bad news first. The number of such cases has increased dramatically. Why is this happening? Because more people are building their houses out in the countryside where there are deer and other animals that carry the ticks. Now add in climate change (yes, global warming is here as well). There are many undoubted reasons. The result is a surge in the number of serious cases of infection. The good news is that Doxycycline is still a steady performer. You pop the pills for two to four weeks, and the infection clears up. So this year, more people are getting the chance to see this antibiotic at work. There is likely to be a positive changes in following years. The Center for Disease Control has started development of a slow release variant of Dox. This may be by injection or by patch for those who are needle-shy. The aim is to replace the tablets with a single therapy active over a two week period. Until this comes out of the lab, you’ll just have to pop the tablets, but life may soon improve.

Hot spots are probably creations of our nightmares. There you are in the morning, looking in the bathroom mirror in despair. That acne is just crowding out all your good features and leaving a red, spotty mess. You’re lining up to take the Accutane - signing up for the iPledge is a real pain but it will all be worth it when the acne’s gone. And then you catch sight of the headline in a newspaper as you’re on your way to school - “Hot Spots in Somali”. Weird headline, you think. Somali is just so way out there. So you stop and then smile. It’s not quite what you thought. You’ve just got acne on your mind. It seems those Somali folks burn their forests and our great network of spy satellites can see the hot spots where the fires are burning most fiercely. No one on the Earth spying Somali hot spots like you spying your own. That’s why you’ve signed the iPledge and your parents are going to buy Accutane online. With a little luck, it will all be gone in six months time.

It is very bad when your reactions at the outer influences are changing under your diseases. It can be simply that you feel excessively tired. You walk around in a daze, feeling as if you had no sleep at all. This can affect your performance at work because you find it more difficult to concentrate. Moods can also change for the worse with you feeling more irritable and bad tempered. Headaches are becoming very annoying.
One quite understandable reaction is to reach for the ambien bottle which has a proven track record for helping people get to sleep and stay asleep for longer. But, like many conditions, insomnia is not “cured” by taking medication. The best that ambien or another medication can do is to give relief to the immediate symptoms. In the long term, cognitive behavioural therapy provides a “cure” in most cases. So the answer is just walking into your local doctor’s surgery and get an appointment? It is an irony that universal health cover is meaningless without a significant increase in the number of doctors in general practice. This situation will only grow worse as older doctors retire over the next decade. As it applies to insomnia, not only is there is a shortage of physicians but also of therapists. Against this background, it was interesting to see a new potential solution for the treatment of sleep disorders. Well, not necessarily. In an increasing number of rural and urban areas in the US, there is a widening gap between the supply of primary care physicians and the demand for their services. Because pay levels are lower than in hospitals and the debts from medical school are higher, only about a quarter of newly qualified physicians go into general practice. It can now take months to get an appointment as the population ages and more boomers require treatment. The shortage of doctors is also highlighted in states like Massachusetts where new health insurance legislation is restoring cover to many who have gone years without insurance.It has long been known that as people fall asleep, the circulation of blood slows and more blood stays longer in the arms and legs. As a result, the hands and feet warm slightly. In the Center for Sleep Medicine in New York, specialists have begun to train insomniacs in the use of biofeedback techniques to replicate this physical response. It usually takes between two and three hours of training spread over a number of weeks for the brain to learn how to control the body’s heart rate, circulation and temperature rise. About 90% of those taking part in the experiment have mastered the necessary skills and have found it easier to get to sleep. Although biofeedback and relaxation skills have been used alongside or as an alternative to ambien for some time, this is one of the first major centers to run a full-scale training exercise.If demand rose, the price would drop further. A simple “how to” guide plus the equipment might be all that many people need to relearn the art of failing asleep.

One of the strange things about writing is working out what we take for granted. The problem is judging how much to explain. Sometimes, we explain everything as in the “for dummies” series of books. That’s everything you didn’t know about most things in big yellow packages. So here I am writing about ultram as the best painkiller, and then I realized I might be assuming that everyone knows all there is to know about pain - other than it hurts, of course. To fill in the gaps, I therefore offer the following quick guide (with my humble apologies if you already know all this). Pain is acute when it’s severe (i.e. it really, really hurts) but it’s only going to last for a short period of time. A good example would be the pain you feel after you’ve been cut open for surgery. Apart from the scapel-wielding surgeon, the reason for this kind of pain is to act as a warning not to move around too much. The body is telling you that more movement is going to cause more tissue damage.
The latest studies of neuroplasticity show that severe acute pain can become chronic because the process to limit the transmission of pain messages breaks down. The nervous system slowly becomes more sensitive and reacts more strongly to pain signals. Nerves learn or remember pain. New habits form. Again ultram can suppress pain signals but, this treatment should be accompanied by cognitive behavioral therapy to learn how to cope with pain. When you experience symptoms of shooting, electric, tingling or burning but there are no obvious causes, this is described as neuropathic pain.

So, ultram gives you immediate relief both while your body heals and as you begin to exercise again to rebuild muscle tone. If pain persists over time, it is termed chronic and becomes a disease/disability process in its own right. Many factors can contribute to converting short-term into long-term pain. It may be a function of the initial injury or disease, whether there is nerve damage, the onset of depression or age. As with chronic pain, treatment with ultram slows down the pain and gives you a breathing space during which physiotherapy, relaxation training and other pain management techniques are applied. If the pain is localized at the site of an injury or some other physical problem such as arthritis, and you feel it as sharp, throbbing or aching, this is described as nociceptive. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and stronger painkillers such as ultram are recommended.

Once upon a time, I’m going to put on my physician’s hat and give you the view from the other side.

Viagra so dominates the public consciousness that many men seem have never even heard about Cialis or Levitra, let alone all the other treatments that are available and may be necessary. Still that doesn’t matter, my patients still trying to get treatment i still can give them by only one method. The world is a better place thanks to Pfizer Inc.

Well, my first step was to review the medical records to see if there were any immediate clues. If I found some similar diceases, I should let you in on a small medical secret. About a quarter of all the cases that we see are drug-related. Usually, we simply change the medication and the ED goes away. Alternatively, we have to counsel lifestyle changes because the excessive alcohol consumption or recreational drug of choice is not doing the patient any favors.

Next step I take is take into account dyabetes. This is growing more common but this patient isn’t complaining about any increase in thirst or appetite, his weight looks much as it was the last time we met. During the physical, I’ll look for acanthosis nigricans which are darker patches of skin in the arm pit or round the neck. I may also do a blood sugar test just to be thorough. Blood pressure tests out in the normal range, so that’s another good sign.

The questions are designed to establish whether we’re dealing with problems of desire (which could be psychological or physical), whether it’s purely ED or there are also problems with ejaculation and orgasm, and to check up on those lifestyle choices which could be the real problem.

The physical examination tries to cover as many possibilities as possible in as short a time as possible. Most men find an examination deeply embarrassing so keeping it short is a “good thing”. I’m looking for anything that might suggest a systemic problem. So, I’m obviously going to start with the penis. Some of my questions have probed whether the penis has changed shape in any way or perhaps the erection is painful. A physical examination could find evidence of lumps or the answers to the questions may reveal that the penis now bends or curves when erect, all of which could suggest Peyronie’s disease. Similarly, if the penis is not sensitive when I touch it, this may indicate possible problems in the peripheral nervous system.

So the quick and easy explanations do exist, ant in most cases there is little to suggest the need to go on to further tests and I can then get into a discussion of the medication options. This is when the patient finally begins to look more comfortable again. We have finally come back to his original questions, except that I’m also telling him about Cialis and Levitra. Viagra may have the name, but Cialis in particular does have some interesting characteristics.