Ahad, 24 November 2013

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The Star Online: Lifestyle: Health

Getting to know ED


Facts and fallacies about erectile dysfunction (ED).

ERECTILE dysfunction (ED) is the inability to achieve or maintain an erection of the penis, which is satisfactory for sexual intercourse. Being a taboo subject, there are many myths circulating around that are worsened by men not talking openly about it with their doctors.

Here are some of the common misconceptions about this condition.

ED affects only elderly men

Although the majority of men affected by ED are elderly, younger men are not exclusively exempted. In Malaysia, data collected to date are for men above 40 years of age, and it showed a higher prevalence among men above 60 years of age.

However, in a study done in Brazil, the prevalence rate was 35% in men 18-40 years of age.

So if you are young and have ED, do not fret. You are not alone.

If you are above 40 years, up to 50% of men in Malaysia share your problem. In fact, in a recent local study, the prevalence of ED in those above 40 years of age was 69.5%.

ED is not dangerous or life-threatening

While it is true that ED on its own does not lead to death, it is actually an indicator of other underlying diseases that can shorten your life.

It has been proven that ED predicts coronary artery disease, with a lead time of two to five years. In other words, if you have ED, you are at risk of a heart attack in two to five years.

Therefore, if you have ED, you should be examined for the health of your heart as well. Both are equally important to men.

The presentation of ED by men in the clinic is an opportunity for doctors to screen for other diseases associated with it, and these include diabetes mellitus, testosterone deficiency syndrome, hypertension and high cholesterol levels (hyperlipidaemia).

ED is the partner's fault

ED is not to be blamed on the partner for not being attractive anymore. Although psychological factors do affect ED, there are other physiological or organic factors involved as well. These include diseases affecting the blood vessels and/or the nerves supplying the penis.

Often, men shy away from sex when they are unable to perform, and this can construed by their partners that they are not attractive any more. This misconception can lead to relationships breaking down.

Men with ED have no sexual desire

This is not entirely true. Men with ED usually do have the desire, but due to the underlying disease affecting the blood vessels or nerves, they are unable to perform.

There are men with ED who lack desire. These men either have low levels of testosterone or are affected psychologically by stress or emotion.

Masturbation causes ED

There is no concrete evidence for this.

In normal men, erection is automatic

This is not true. Men need stimulation for sexual erection. Non-stimulated erection may occur during sleep or on awakening in the morning, but this is not related to sex.

There is also a refractory period before men can have an erection again, and this can last from minutes in younger men to days in older men. This is not ED.

An erection means men want sex

Again, this is not true. Men may experience a normal physiological erection during sleep or on getting up in the morning. It is not always related to sexual activity.

ED needs extensive investigations and treatment is usually delayed

ED is diagnosed through doctors asking you some simple questions (taking a history). A questionnaire known as the International Index of Erectile Function (IIEF) may be used.

A physical examination and some blood tests will follow to detect any other associated diseases. Treatment will usually then be given.

Only in certain complex cases, and this is very rare, will further tests like a Duplex ultrasound, cavernosogram or nocturnal penile tumescence test, be needed.

The first step in treatment is lifestyle modification, and this includes maintaining an ideal body weight, cessation of smoking, moderate exercise and a balanced diet.

This on its own may improve ED. Needless to say, blood pressure, sugar and cholesterol needs to be controlled. Any psychological factors such as stress need to be tackled as well.

The next step is oral medication (tablets to be swallowed). Phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil, vardenafil and tadalafil, are effective in 80% of cases.

Filename : shutterstock_42.d1d43151958.original.jpg - To go with

Often, men shy away from sex when they are unable to perform, and this can construed by their partners
that they are not attractive any more. – AFP

Caution is needed for those with heart problems. They will need to be assessed carefully by the doctor. If the heart disease is deemed mild, they can be given PDE-5 inhibitors.

In moderately severe cases, further tests will be required, while those who have severe disease should not be taking such drugs.

Those on nitrate medications also cannot be given PDE-5 inhibitors.

The other treatment options are injection of medication (like prostaglandin) directly into the penis using a small needle and syringe, using a vacuum pump device or inserting a penile prosthesis (requiring surgery).

Treatment is only temporary and the condition can be cured

This is another misconception where some people think that taking just one magical pill will solve it all. If lifestyle modification does not help and taking medication is required, you will probably need to continue taking the medication as long as you want to have erections.

The only exception is if it is solely psychological in nature, where counselling or behavioural therapy may cure the problem, and further treatment may not be required.

Circumcision reduces ED

There is no evidence that circumcision reduces ED.

ED treatment increases the size of the penis

This is another misconception. ED treatment solves erection, i.e. rigidity and hardness. It does not increase the length or size of the penis.

Traditional treatment is cheaper and much better than seeing a doctor

Unapproved medications are risky and may contain substances that are detrimental to health. It is not worth the risk. Most of these medications have not undergone stringent tests, and unlike conventional medication prescribed by doctors, have not been proven effective by robust trials.

In a review by Ho et al., most of the herbal treatments for ED were tested in animals, and only yohimbine, ginseng and butea superba were tested in humans.

ED can be helped. An open discussion with the doctor, especially a urologist, would be beneficial. Do not be embarrassed.


1. Martins FG et al. J Sex Med 2009; 7(6):2166-73

2. Ho CCK et al. Curr Urol Rep 2011;12(6):470-8

3. Tong SF et al. Asia Pac J Public Health 2012;24(4):543-55

4. Tan HM et al. J Sex Med 2012;9(3):663-71

> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. 

For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

He's a bat, bat kid


Miles has had acute lymphoblastic leukaemia since he was 20 months old. His cancer went into remission, and with his last round of chemotherapy in June, he said he wanted to be Batman. He didn't get to be Batman. Instead, he became Batkid.

TO be an aspiring superhero these days, most five-year-olds must enlist clueless younger siblings, restless parents, backyard shrubs, fire hydrants and all manner of pets to serve as their foils and damsels in distress.

Not Miles Scott, for whom much of San Francisco morphed into Gotham City recently.

He pulled a woman from the cable car tracks as crowds cheered, then busted the Riddler during a bank heist. The Gotham City Chronicle ran a banner headline: BATKID SAVES CITY.

Miles has had acute lymphoblastic leukaemia since he was 20 months old. His cancer went into remission, and with his last round of chemotherapy in June, he said he wanted to be Batman.

Coordinated by the Make-A-Wish Foundation, and with at least 12,000 volunteers to cheer him on, his wish came true in a spectacular display of communal whimsy.

Miles Scott, 5, is cheered by the crowd at City Hall in San Francisco on Friday, Nov. 15, 2013. Miles is a leukemia survivor from Tulelake in Siskiyou County, Calif. After battling leukemia since he was a year old, Miles is now in remission. One of his heroes is Batman, so to celebrate the end of his treatment, the Make-A-Wish Greater Bay Area granted his wish to become Batkid for a day. (Gary Reyes/Bay Area News Group/MCT)

Miles is a leukaemia survivor. After battling leukemia since he was a year old, Miles is now in remission.
One of his heroes is Batman, so to celebrate the end of his treatment, the Make-A-Wish Greater Bay Area
granted his wish to become Batkid for a day. – MCT

"Batkid", as he was known, captured the attention of an entire city, and even, the country. San Francisco seemed to come to a virtual halt, with all eyes on Miles.

Local television covered it live, beaming aerial images of his adventures. Members of Congress issued video pleas for help, and President Barack Obama offered kudos in a brief video: "Way to go, Miles, way to save Gotham."

Maybe it came at the perfect time in this politically-riven nation. For brief moments, the national focus turned from the political battles in Washington to a child from rural Siskiyou County saving Gotham City.

"It was such an authentic wish that anyone could relate to; I'm trying not to cry," said Toni Baca, 30. "We all want to be superheroes." The bat signal went out Nov 14, a beam shining on the side of Miles' hotel. At 10am the next day, San Francisco Police Chief Greg Suhr issued a televised plea for help on a local newscast.

"Please, Caped Crusader, we need you," Chief Suhr begged.

Miles, dressed in the trademark batsuit, rode in a donated Batmobile – a black Lamborghini tricked out with Batman logos – along streets thronged with people holding signs and rooting him on, occasionally dabbing their eyes.

Shalyn Pugh Davis summed up the thoughts of many on Twitter: "Follow SFBatkid adventure and have your faith in humanity restored."

Social media had spread the word throughout the week, and people drove in from all around the Bay Area and beyond to support Miles.

The crowd cheers Miles Scott, 5, the Batkid, in the Batmobile in San Francisco on Friday, Nov. 15, 2013. Miles is a leukemia survivor from Tulelake in Siskiyou County, Calif. After battling leukemia since he was a year old, Miles is now in remission. One of his heroes is Batman, so to celebrate the end of his treatment, the Make-A-Wish Greater Bay Area granted his wish to become Batkid for a day. (Gary Reyes/Bay Area News Group/MCT)

Not only does the kid have a batsuit, he has a cool ride to go with it, driver included, of course. – MCT

"I stayed up late making signs and we carpooled down here," said Shaneh Santos, 22, of Sacramento. "It's moving to be part of something, people driving hours to be part of a special moment for this little boy."

San Francisco resident Sara Sanchez came decked out with a huge sign that read "SF <3 Batkid". She said the energy in "Gotham" rivaled the two parades celebrating the San Francisco Giants' recent World Series championships.

"Seeing the city come out in support, it makes you really proud to live in a city like this," she said.

The San Francisco Chronicle published a special edition of the Gotham City Chronicle, which were to be handed out in Union Square. After demand for copies soared, managing editor Audrey Cooper said the paper would reprint a special edition.

"This is what I love about San Francisco," Cooper said by email. "We're a quirky city that loves free-thinkers. We totally understand a five-year-old cancer survivor who wants to dress up like Batman."

The staged escapades lasted several hours. Miles' face was mostly hidden by his mask. But one glimpse of his expression showed he was serious, fully engaged in what he alone had to do.

Then he stopped for a burger with Batman, who served as his adult sidekick for the day.

That was interrupted when a Union Square flash-mob alerted him to a kidnapping in progress. The San Francisco Giants' mascot, Lou Seal, had been taken by the Penguin.

Batkid chased the flightless villain around AT&T park and rescued Lou Seal.

Before leaving the stadium, Batkid slipped off his mask and whispered something into his father's ear. Smiling, his father led him over to the infield, and then, home plate. Batkid ran the bases as a small crowd cheered.

By then, the Batkid campaign embodied more than just a sick boy's wish. It had become a national feel-good moment. "U're (sic) an inspiration to us all," Michelle Obama tweeted Miles.

Politicians and other public officials scrambled all day to get out tweets and news releases tying them to Batkid.

Batman assists Miles Scott, 5, the Batkid, as he prepares to save a damsel in distress on Hyde Street in San Francisco on Friday, Nov. 15, 2013. Miles is a leukemia survivor from Tulelake in Siskiyou County, Calif. After battling leukemia since he was a year old, Miles is now in remission. One of his heroes is Batman, so to celebrate the end of his treatment, the Make-A-Wish Greater Bay Area granted his wish to become Batkid for a day. (Gary Reyes/Bay Area News Group/MCT)

Batman assists Miles the Batkid, as he prepares to save a damsel in distress on Hyde Street in San Francisco. – MCT

Even the US attorney for Northern California, Melinda Haig, announced the arrests of the Riddler and the Penguin.

"Edward 'E.' Nigma, a.k.a. 'the Riddler', and Oswald Chesterfield Cobblepot, a.k.a. 'the Penguin', were formally arrested today and charged with multiple counts of conspiracy and kidnapping for their all-too-familiar villainous ways in Gotham City," according to a news release.

When it was all over, many in San Francisco hoped the spirit of Batkid would remain.

"It's a phenomenal day," said Jeff Myers, chief of emergency medicine for the San Francisco Fire Department. "It's something this boy is going to remember for a long time. And it's just phenomenal for the city." – Los Angeles Times/McClatchy-Tribune Information Services

Actor&#39;s battle with amyloidosis


When actor Michael York found dark rings developing under his eyes, it took three years to diagnose amyloidosis, a rare condition that can have fatal consequences.

MICHAEL York, the British-born film and stage actor and star of Cabaret, was blessed with youthful skin. He never needed eye makeup for his roles. So when dark rings began to develop, he knew it was something more than lack of sleep.

"I wondered whether it was a virus or something innocuous," he said. "Then in 2009, I was doing a mini-series and noticed it was getting really bad. Because of my profession, I could slap some makeup on, but if I had a shower, they would turn purplish, so I began to think something was amiss."

It was more than three years before York discovered he was suffering from the rare and potentially fatal condition, amyloidosis.

In spite of his connections and access to the best medical care, things became steadily worse as the hunt for answers took him down one wrong path after another.

Amyloidosis is caused by the abnormal production of insoluble proteins that clump together in different parts of the body, eventually causing vital organs to shut down. Because it is unusual and the signs and symptoms are different in each person, it is very hard to recognise.

York, 71, spoke about the long road to diagnosis on a visit to London, where he performed in a charity reading at the Old Vic theatre and visited the Royal Free Hospital, north London. It is the only hospital that offers a scan to locate and quantify amyloid deposits in the body. Prof Sir Mark Pepys, director of the Wolfson Drug Discovery Unit at the Centre for Amyloidosis and Acute Phase Proteins, who invented the scan, is now working with GlaxoSmithKline on a drug he hopes could clear the deposits.

Late diagnosis is far from unusual and can have dire consequences. Although median survival for Prof Pepys' patients is now eight to 10 years, 20% arrive with irreversible organ failure and do not live so long.

York had ignored the rings until he and his wife, photographer Pat, went to Washington for Barack Obama's inauguration and stayed with a close friend, the biologist William Haseltine. "He said, 'What the hell is wrong with your eyes?' Go back to LA and have an eye examination. Because of the weight of his authority, I did," said York.

The ophthalmologist said he had Fabry's disease – a disturbing, but incorrect diagnosis, which proved to be, said York, "the first of many".

He tried to carry on as normal, but felt tired and ill. The turning point came when he agreed to give a talk on a cruise organised by National Public Radio. "We picked up the boat in Dubai and I started to feel really bad. Everything was swelling up and it was very hot outside and very cold on the boat, and I began to feel so wretched that I don't know how I did my lecture.

"Two weeks after that Pat found me comatose on the floor. I'd passed out and was rushed to hospital, and they couldn't determine what it was."

He went to the Cedars-Sinai hospital in LA, where doctors decided he had multiple myeloma, a bone marrow cancer, also with a poor prognosis – only 37% of patients survive five years after diagnosis. The treatment did not help.

York credits his wife with the eventual breakthrough. She got in touch with Dr Robert Kyle at the Mayo Clinic in Rochester, Minnesota, the multiple myeloma pioneer who is also an expert in amyloidosis, to which it is related. A long email correspondence began. Dr Kyle, 84, no longer sees patients, but introduced the couple to doctors at the Mayo, where tests confirmed amyloidosis. In July last year, York underwent an autologous stem cell transplant – involving the removal of immature blood stem cells from the body, followed by high-dose chemotherapy to get rid of diseased or damaged marrow. The treated stem cells are then reinjected into the body. It is a risky procedure, but the actor sailed through.

The rings under the eyes are still there, but York says he no longer feels ill and tired. The scan at the Royal Free recently showed most of the deposits had gone, although his voice and heart muscle have been affected.

"I've been reprieved," he said. "I don't know about cured, because it can come back. I'm not looking normal – I could put makeup on, but I don't see the point. This is me now and when people ask about it, I'm able to tell them."

Not everyone has the manners to ask. The Globe, a US tabloid, ran a picture of York last year with claims from two cosmetic surgeons that he'd had surgery. York wrote to the journalist offering her the true story and she replied in a one-line email: "Happy you're feeling well."

The couple hope the rings below his eyes will eventually disappear. In the meantime, he jokes, he is available for parts for men in dark glasses of a certain age - lots of mafia bosses. – Guardian News & Media.

Kredit: www.thestar.com.my

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