Dale, 2nd reply to your recent posting Re: MUSE side effects:
"This really isn't new information. I was told much of this at the
company sponsored meeting I attended in early April and heard about the rest at the AUA last spring. I posted a summary on this thread back then. My posting elicited a torrent of personal attacks so I now feel somewhat vindicated. The longs are even more in charge of the thread now, so I will post this and duck back to lurking.".
I am giving you the same anwswer now that I gave you back then, ( and
I FEEL VINDICATED NOW!!! gg ).
/ Respond |
To: Richard Singer (2144 )
From: Tunica Albuginea Jun 20 1997 1:47PM EST
Reply #2148 of 3670
Richard, here is where I see Erectile Dysfunction therapy in 1-2
years in the US as well as probably around the world:
I think a large part of it will be in the hands of Internists
( specialists in multiple organ disease, heart, diabetes, kidneys,
hypertesion, arteriosclerosis,atc, who are THE MOST KNOWLEDGEABLE
IN HANDLING MULTIPLE DRUGS & DISEASES at the SAME TIME.Some knowlegeable family physicians also, but very often Family Doctors are too busy to spend the time needed to go through the neccessary checklist for EDtherapy.
Most of this people will need carefull pre therapy screening, to
include a cardiac stress test with a Thallium nuclear scan as well as
carotid and vertebral colorflow duplex ultrasound to make sure that
they do not have arterial coronary and carotid occlusive disease WHICH
CAN GIVE AN INSTANT HEART ATTACK 7 OR STROKE if you drop your blood
pressure by 30% as the good Anaxagoras reported to us with Zona/Vasomax this morning: Anaxagoras, Doctors want ZERO HEART ATTACKS/STROKES/ DEATHS.Even ONE is too many .All a doctor needs is ONE death and ONE lawsuit to screw your life and finances royally for >5 years!!!.
Internists are best suited to screen all the 3 to 5 drugs that many of
these patients will be taking to avoid drug interactions.
Also once the above screening is done then one can attempt a higher
dose of Muse or other Drugs to achieve erection since if you know
that the blood vessels are clean the patient can tolerate low blood
pressure better.
Urologists are not adept in all of the above and they will tend to
handle ONLY THE HEALTHIER , YOUNGER, LESS SICK, ON FEWER DRUGS,
PATIENTS.
The patients are most likely to be in a COMBINATION THERAPY such as
exists for numerous medicalproblems now: ASTHMA and EMPHYSEMA
-->theophylline+Atrovent+inhaled bonchodilators+inhaled steroids. CORONARY ARTERY DISEASE--> Betablocker+nitrates+calcium channel blockers. HYPERTENSION--> Vasodilator+betablocker+ Ace inhibitor. These are some examples.
The combination therapy will consist of some Testosterone (with
appropriatemonitoring however for the potential of cancer and liver disease from it) plus, Muse;Possibly,plus the addition of Trazodon and Yohimbine now in the market.
If Viagra gets approved, add Viagra, which if erectile nerves are
still alive that is, so only mild cases of ED dcan be treated with it,they may realese vasodilatory Nitric Oxide whose action
will be enhanced by Viagra which will prevent it's degradation by cyclicgAMP ( Viagra blocks cyclic gAMP as its mode of action. ).
The patient could start for example simply with Muse.( The safest, most immediately predictable ( 7-10 min ) drug.
If that is noteffective you could add a monthly intramuscular injection of Depotestosterone( long acting ).
If that doesn't work then 1-2 hours before intercourse take Viagra
( whose onset of action is less predictable tha Muse )to start
" tuning the system " and then take Muse or ,later,
Muse/ Alprostadil with Prazosin.
There may well be a place for " IMPOTENCE CLINICS " were you would
have a " team ' of physicians taking care of you : Urologists to
evaluate the cause of your impotence and then taken over by
Internists or interested family doctors to monitor the Drugs given
and adjust the dose in consultation with a Urologist . I am certain
this is how it will be done in LARGE cities, > 250,000 people.
This is how I see it.
TA |
