Erectile dysfunction is a very frequent sexual disorder that reportedly affects over 20% of men all over the world to a certain degree. Sometimes, the disorder manifests itself as a complete impotence. There are cases when the dysfunction is a minor issue and bothers a man from time to time. Regardless of the intensity of the issue, one needs to have measures to minimize its impact on his life.

Just several decades ago, men were completely unarmed and could not fend off the symptoms of aging, prostatitis, and other diseases that brought with them erectile dysfunction. Before the arrival of Viagra, there were no effective means of treating the issue. In 1998, the world changed and flipped on its head. Viagra was released. In 2000s a bunch of other similar drugs followed. The following decade alone brought to the light highly effective drugs namely Cialis and Levitra.

The solution was highly effective and expensive. At some point, only chosen ones were able to use these drugs regularly. However, the reign of branded drugs ended at the beginning of 2010s when many other manufacturers were allowed to create copies of these drugs and distribute them in countries where patents were originally issued. The world finally got accustomed with scientific names of branded drugs. We learned that Viagra is essentially sildenafil, Cialis is tadalafil, and Levitra is vardenafil.

Many other large pharmaceutical companies from India, Turkey, and China were waiting for a perfect moment to enter Western markets where the term “generic” had just started to become a common buzz word in the industry. Today, many pharmacies sell generic versions of commercially successful drugs and allow men suffering from erectile dysfunction to have an effective solution against the issue.

How Can You Treat/Avoid Erectile Dysfunction with the Help of Smart Canadian Pharmacy? Let’s talk about 5 most obvious ways how this company helps men not only in North America, but all over the world.

#1. Bringing generics to a wider audience of customers.

Generics are still treated as grade-B drugs. Huge brands try to compromise the success of generics by conducting aggressive marketing campaigns and claiming that many generics are fakes. However, the vast majority of drugs that are sold in the western world have to undergo various tests conducted by official governmental structures like FDA. All generics that are officially sold on the Canadian or American soil are certified and completely safe just as they are effective.

Canadian Pharmacy wants to bring a rich assortment of generics to a wider audience of customers in order to promote better competition in the industry as well as provide its clients with enough information on various generic drugs. This means that men all over the world can be informed about effective PDE5-inhibitors like sildenafil and enjoy their accessibility.

#2. Ensuring that there are options.

It is highly important to have various way to choose the most effective way of treating erectile dysfunction. One of the issues with the market previously was that many men were limited in terms of choosing and had to purchase branded overpriced versions of drugs. This not only made the very treatment process quite limited in terms of versatility due to smaller dosages per pill and other limitations, but made the treatment itself completely unaffordable for some men.

Smart Canadian Pharmacy offers opportunities to all customers. You can choose from a very wide selection of products and prices in order to find the most perfect balance between prices and quality. At the same time, you will have an opportunity to find drugs that are perfectly dosed. If you need a stronger medication that will allow you to increase the dosage up to 50mg of sildenafil per intake, you can just purchase a generic drug that offers you such pills.

#3. Having an access to various drugs.

While Canadian Pharmacy is well-known for pushing various erectile dysfunction treatment drugs, we also our customers with an ability to choose from an assortment of complementary drugs that may help in treating a more complex problem that erectile dysfunction alone. Very often, ED is only a single symptom of a much more concerning issue. In many scenarios, this symptom accompanies benign prostate hyperplasia, various problems with blood vessel system (namely, arterial hypertension), and other serious health issues.

Drugs like tadalafil can help in treating both BPH and ED. You can pick up a bunch of supplements that will help in treating specific health issues while not conflicting with PDE5 inhibitors which are effective anti-ED drugs. A rich catalogue of additional generics is what makes erectile dysfunction treatable in a complex of measures that address health issues on a larger scale.

#4. Lowering prices across the market.

One of the core purposes of Canadian Pharmacy is promoting healthier pricing in the industry. The very arrival of generics allowed many patients to use efficient drugs for a much lower price. Drugs finally became accessible to a wider audience and brands were forced to compete in a freer market where the price is dictated by competition. Generics make the market healthier, allow a wider audience of customers to vote with their wallets, and change the very shape of the industry.

Having a more flexible and larger audience of customers is very important. Alongside our philosophical belief that we make the world a better place for many men, there is a very obvious mercantile motive behind our desire to create a larger market. With more potential customers, the size of the market and its profits grow exponentially. Offering better and cheaper products is better for the whole industry and negatively affects only huge corporations.

#5. Providing an effective way of treatment.

Many treatment options that were accessible previously were highly inefficient. Yes, there are certain aphrodisiacs that may mildly affect your sexual arouse. There are also drugs that can be efficient at treating erectile dysfunction to a certain degree. However, only PDE5 inhibitors like sildenafil and tadalafil are truly effective at treating the condition well. This means that we need to offer to our customers the most efficient way of treatment which we do.

We offer a wider variety of drugs that contain various active ingredients like sildenafil and tadalafil. Our visitors can choose from a catalogue that contains generic versions of the most effective erectile dysfunction treatment drugs.

Extra strong, twice as effective, with fewer side effects and greater duration results – these are the basic features of a new erectile dysfunction treatment drug called Viagra Professional or PRO. It contains more active ingredients that are powerful in activating blood flow to the penile area. Hardness and expansion are the effects that follow after the blood flow increase. If a man is sexually excited after the intake, the peak sexual performance is guaranteed.

You may say that if pretty many other drugs suggest the same results, then why you should turn to Viagra PRO? The reason is simple: all results are achieved faster than after other alternative medications, because the active ingredients are soaked up quicker. One won’t have to wait up to one hour to achieve erection.

Viagra Professional vs. Normal

Today the Professional drug version is regarded as a sort of an extension to the regular pills. It makes erection appear faster and keep longer than it was before. Extra quality at affordable prices is another bonus a man gets! Let’s to go in particulars:

1. reaction time: it is faster compared to regular pills (works within 15-20 minutes after the intake). A man is provided with more moxie and stamina. Unlike other drugs, it’s capable of increasing desire for sex as well as enthusiasm;
2. major ingredient: it can open the blood flow faster and effectively to make erections much stronger and harder;
3. effect duration: after the erection is achieved, the effect of the drug can remain for nearly 8 hours, which allows performing all night long;
4. side effects and cons: there are a few of them. Besides, side effects are faced only by those individuals that risk and overdose. Minor by-effects are resentful stomach, smudged vision, headache or migraine, flushing.

Warnings & Precautions You Can’t Neglect

• Not suitable for women
  This is the first thing patients should understand. If a woman faces problems, she should look for alternative medications, as Viagra PRO is just not her cup of tea. In fact, the drug can trigger great problems in women.
• Patients on Other Medictions
  Heart, liver, kidney, diabetes, high/low blood pressure patients are to be cautious, while choose Viagra Professional for ED cure. They are usually prescribed diverse nitrate drugs. When the latter ones are combines with Viagra, serious side effects are to be expected.
• Hypertension History
  Do you have one? Tell your doctor. ED pills tend to make heart work faster and harder. If hypertension is a frequent issue for you, Viagra can lead to health complications.
• Overdose

Never take more than one dose a day. Overdosing is a synonym to strokes and heart attacks. Share the condition with your physician before he makes a prescription.

Talking to Your Doctor

There may be different recommendations written on the pack. Yet they all are very general. Men are different, so are the cases. Only a specialist can explain you the parts you don’t really understand. For example, if you take a pill after fish, cheeseburgers, French fries chips or whatever high-fat meal you like, it will need more time to start working. What shall be done, if you’re interested in really fast results? Just take a pill either after a low-fat meal or on an empty stomach.

Where to Buy Viagra Professional online?

Though pills are available at drug stores, there are online services that can help you in saving money. Place your order and the medication will be delivered to your place! Isn’t that easy? Besides, no one is going to find out about the purchase you made or the problems you have.

We offer our service to those, who are looking for reliable Canadian Pharmacy with high quality drugs, affordable prices and a 24/7 support. We are a team of highly qualified professionals ready to supply with best tips, recommendations and information that is so in need among all ED sufferers.

We are chosen because of:

• easy access;
• ranges of medications;
• affordability;
• professionalism;
• experience;
• fast orders and even faster deliveries;
• great online support.

There’s no doubt, that soon you will add a few more benefits to the list! We are ready to provide all the info on Viagra Professional as well as the drug itself. But we are honest and want you to remember that men with severe health problems and erectile dysfunction should be very careful while taking Viagra Professional. It’s not that the pill can cause death, yet the dose should be minimal and one has to report any side effect occurrence, if he wants to save his sexual life.

Just think about it: pharmacies and drugstores based on land are restricted by physical notions like square miles primarily. If they rent some store, they should pay big money for it. To cover those expenses they have to add to the rates of the products that they sell. However, when it goes about an online pharmacy, medications have a reason to cost less. This is one of the main reasons to prefer My Canadian Pharmacy to any of your neighboring pharmacies based on land. Besides that, an online store can contain and, thus, supply a lot more medications than the real one due to the same reason.

Another cause for decreased prices provided by My Canadian Pharmacy is the ultimate care about customers. Reasonable costs for high quality medications are the vivid performance of compassion and an emphasis on our professional attitude to everyone who turns to us in need of medications. Such policy attracts many customers whose trust we have no right to fail.

What You Need to Know about My Canadian Pharmacy

At My Canadian Pharmacy (go to site) we offer generic medications that are bioequivalents of the brand ones with the only exception – their price. Such meds always cost less because no patent is required for selling them and, thus, there are no extra payments to cover those patent costs.

Medicines should be paid extra attention to as they are the products that make a certain effect on an organism. Some poor quality pills are sure to perform the promised effect, but it often happens that side effects come along because of cheap components or things of that kind. However, buying generics from us you can be absolutely sure in the quality of drugs that won’t cause any side effects as we cooperate with the most reputable and world-known drug manufacturers.

My Canadian Pharmacy is a responsible supplier with a strict attitude to everything we do. All conditions and terms are kept to as promised without any excuses or force-majeure circumstances, which means that you can strongly rely on us in every possible case. Making an order for as much as $100 or as little as $20, there is 100% guarantee that you are going to get your high quality drugs delivered within the denoted terms safe and sound no matter how far you live. Buying from us is more than just safe as we treat each of our customers with ultimate care offering 256-bit SSL digital encryption protection to their personal and credit card data.

Wide Range of Viagra Medications online from Mycanadianpharmacymall.com

My Canadian Pharmacy specializes in medications that treat erectile dysfunction including the following:

• all available versions of Viagra: usual Viagra, Viagra Super Active+, Brand Viagra, Viagra Professional, Viagra Super Force, Viagra in soft tablets, etc.
• Cialis and its variations: Cialis Professional, Cialis Super Active+ and Cialis in soft tablets
• Propecia
• Levitra
• VPXL and many others.

Detailed information about Viagra, Cialis and Kamagra read here: http://www.mycanadianpharmacymall.com/viagra-cialis-kamagra

Besides the medications of direct purpose there are also antibiotics, antidepressants, meds for blood pressure, pain relief and many more. So if you have been looking for a trustworthy online pharmacy to buy the needed drugs, no matter what condition you are suffering from, you can fully rely on My Canadian Pharmacy. Choose quality and get super quality with a plethora of other benefits!

The introduction of Viagra almost 18 years ago has revolutionized the way erectile dysfunction is treated. Since the time US Federal Drug Administration has approved Viagra for the local market, the preparation has conquered 48% of ED pills market share, leaving Cialis and Levitra far behind according to IMS Health research center. According to FDA stats, Viagra was prescribed to 10ml people in 2014 with a total sales amount exceeding $2 bn in U.S. only. Viagra has become a first choice medication in so many cases and became a silver bullet solution of erectile dysfunction treatment.

What is Viagra?

Viagra is a brand name of the drug produced by pharmaceutical company Pfizer International Inc., and is the world’s first tool that is manufactured in the form of pill, having a large authentic effectiveness in millions of males. The unprecedented efficacy behind the Viagra lies in sildenafil citrate – the preparation’s active ingredient. The drug is manufactured in the form of 25, 50 and 100 mg pills.

How it works?

Understanding the nature of Viagra effect is hardly possible without knowing the mechanism of erection. Sexual stimulation contributes to an extension in blood vessels of small pelvis and increased rush of blood to the penis, so it becomes harder, and increases in size. After sexual arousal weakens, blood filling the penis decreases in quantity and the state of erection passes away. Taking certain medications (e.g., antihypertensive pills), and a number of chronic diseases impair vascular blood flow in the body, including arteries of the penis.

Sexual arousal does not lead to an increase in sufficient blood flow to the reproductive organ; and therefore an erection either doesn’t occur at all or becomes insufficient to initiate and sustain a full sexual intercourse. A repeated inability to have and maintain sexual intercourse during prolonged periods of time is referred to as erectile dysfunction. The phenomenon gathers a good number of of other manifestations, such as premature ejaculation, sexual fatigue and many more… and this is where Viagra comes to the rescue.

The preparation provides a selective effect that extends the vessels of the penis and leads to an increase in blood supply to the penis during sexual arousal, i.e. Viagra contributes to the emergence and maintenance of a normal erection. In addition to affecting the potency, Viagra improves more and sheer quality of sexual intercourse prolongs its duration, reduces the restoration and improves the emotional perception of orgasm.

How to take Viagra?

The original drug produced by the pharmaceutical company Pfizer is offered in several doses 25, 50 and 100 mg, charged with sildenafil citrate, the active ingredient. For the first experience is better to pick up 50 mg pills. However, in many cases the adjustment of dose is required because of largely individual reaction of the drug. The dosage depends on many factors age, health background, individual tolerance and many more, so ideally, to press for an optimal effect, you should better consult your treating doctor. Self-medicate must be excluded if you suffer from serious liver, kidney or cardiovascular system diseases. The medication should be applied with caution if you are constantly taking any drugs or you more than 65 years old.

To achieve the desired effect and avoid side effects, you must follow the basic rules of administration. Thus, the drug should not be taken more than once each 24 hours, while the maximum dosage must not exceed 100mg. You should take the drug an hour before planned sexual intercourse; however, the onset of action differs from person to person, so it is recommended to measure the time to adjust the intake. Thus, the action of the drug begins 30 60 minutes after the reception and lasts for about 4 hours. Viagra pills must be swallowed without chewing and with a full glass of water. Viagra allows you to get an erection, affecting only natural mechanisms of the body, which means that nothing will happen without natural stimulation and uncontrolled erections are excluded. It is not recommended to take Viagra after a heavy meal, especially fatty foods. Such products slow the absorption of the drug, so an onset of action can be delayed by several hours. With regard to alcohol, it should be better excluded; nevertheless, small doses are acceptable.

What are the side effects of Viagra is?

Side effects of Viagra manifest in about 10 percent of men. Although it should be noted that most of these adverse events occur in mild form, have short-term nature and mainly do not require a complete withdrawal of the drug. According to the Pfizer data, the most common side effects are headache, redness of the face and neck as a result of a rush of blood, impaired sense of smell and nasal congestion. Less frequent symptoms may also occur, such as blurred vision, change in color perception, dizziness, nosebleeds, heart palpitations and nausea. In a few cases it was noted that over a long reception of drug painful erections occur; the cases required medical attention. Importantly, all of these side effects occurred more frequently in excess of recommended doses.

Any contraindications to keep in mind?

The drug is not intended for children and adolescents under the age of eighteen. You in any case should not take Viagra if: you on nitrate or donators of nitric oxide drugs. These drugs are prescribed to treat heart diseases, in particular angina pectoris, and exhibit hypotensive (blood pressure lowering) effect. Viagra in turn, also dilates blood vessels, and the combined use could lead to a critical drop in pressure up to the collapse. Never use Viagra along with other sexual stimulants. Individual intolerance can be expressed in different ways – from the appearance of allergic rashes and itching to facial edema and anaphylactic shock.

The procedure for assessing health care plans is one that’s difficult to undertake. This can be an enormous challenge, not only in Perth, but other areas on the planet at the same time. There are quite many variables which are at play when referring to healthcare plans. One would have to perform sufficient research regarding this issue in order to not arrive at decisions that are improper. Among the variables which can be employed to assess these applications is price. In the event the application is regarded as rather expensive, many pursue the ones they deem to be affordable and will keep from it.

Second, assessment of primary health care Perth can also be on the basis of the choices which are readily available for many patients, irrespective of race or background. When assessment is dependant on the alternatives that are available, it will not pay too much focus on the problem of prices. That is to not state that since they’re also crucial prices of the plans should be disregarded. Yet, as emphasis is put more about the choices which are accessible, it will help to supply access to people to a number of alternatives they are able to seek for in order to maintain themselves in quite good health and care.

Appropriate assessment pursued and can’t be achieved if targets will not be establish in the beginning. The whole exercise will be carried out where there are not targets to base the assessment of the health care plans Perth on. Perth North Metro Medicare Local is among the top businesses which can be utilized to get advice about the assessment healthcare plans in this area. The ethical standards that are kept within the healthcare plans are included by a few of the problems worth taking a look into. In case the ethos are not proper, the plan will not be of much help.

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But, the aims of the primary health care Perth plans should be quantified based on reality. Lots of times, some associations don’t consider what actually exists on the floor when inventing these targets. That is damaging to the success of the plan generally and should be shunned at any cost. These types of assessments must be performed on a regular basis to help determine their degree of failure or success. Nevertheless, Perth North Metro Medicare Local has a lot of tips regarding the best way to instigate the most effective systems for primary health care in this area and has been really active.

Lots of attention needs to be taken to make sure that all issues that are noted are addressed promptly, if you are assessing primary health care Perth plans. The goal of assessment should be redress and to recognize any issue that arises out of every one of of these problems. The function of government as well as other local authorities is essential for the success of the assessment of the plans. The comments of the sections is crucial for success and the entire assessment of the health care plans Perth, so they should never be failed.

A lot of people after the following visit to the doctor get frustrated because of high prices they should pay for all those prescription medicines. So there is a choice for each separate client either to waste money on expensive medications in the local Pharmacy or buy them in Canadian Health&Care Mall at lower prices. 

Canadian Health&Care Mall is the approved online pharmacy that gained the world fame as one of the cheapest, convenient and reliable drugstores. Only the most qualitative drugs, best service and affordable prices are presented here to make your life more comfortable and easy.

The staff of the Pharmacy includes licensed and experienced pharmacists, doctors and technicians that are always ready to help you and provide all the necessary and indispensable information. The customer service is another great advantage of this company as it is available round the clock to help you deal with all the problems and clarify all the details.

Concerning safety and security issues, Canadian Health&Care Mall is secured with the help of SSL technology that helps to keep your personal information confidential. There is no access to the given data by the third parties. The website is quite easy to navigate so you will be able to find everything necessary. It is created to satisfy all the customers’ needs and desires. If you use the options offered by Canadian Health&Care Mall, you will never regret that and continue ordering medications from there.

Facebook page Canadian Health&Care Mall: https://www.facebook.com/canadianhealthandcaremall. You Can read last news and articles and learn about new discounts and sales of medicines.

Top 5 Facts about Quick and Cheap Purchases

1. The first fact HealthCare Store can boast of is low prices. Not even taking into consideration all the other benefits, all the prices are up to 80% lower than in any other local pharmacy, still offering medicines of the same quality. This platform is proved to be safe and reliable and it has gained the popularity of a secure place to buy from that offers the best drugs much cheaper. So if you consider yourself to be a wise consumer, you will definitely try Canadian Health&Care Mall.

2. Apart from low prices there are constant discounts and sales, so you can get an additional discount on the medicines you need. These offers are available for both new customers and regular ones to please them and stimulate them to continue purchasing from Canadian Pharmacy.

3. Canadian Health&Care Mall cares not only about the customers’ money, but also about their time. Instead of going or driving to the nearest drugstore you can order necessary prescription or over-the-counter medicines without leaving your house.

4. Besides, the team that works at the website is friendly, helpful and responsive. Customer support works 24/7 to save your time responding to any question in a matter of minutes.

5. Another great advantage of Canadian Pharmacy is online consultation. You do not have to spend time waiting in the hospital, because you can consult any healthcare worker online at any time of day and night and be sure to get the needed recommendation.

Have you ever had a dream where you have been pursued or felt threatened? What kind of feelings did it leave you with? Did you feel frightened, frustrated, victimized? Ordinarily we call these dreams nightmares and deliberately devalue and ignore them. But in doing this work, Bob realized this dream provided him with an opportunity to change his stance. He wanted to break free of the loop of enslavement he had created by choosing to act with courage instead of reacting out of fear. Undoing the dream made this possible.

Reconstructing Bob’s Dream

In the first part of the Undoing process, Bob recognizes the dream as a mirror of his own anger, which reveals itself in the form of the angry mob. Next he does the opposite of running away and instead confronts this mob. Bob uses a technique where he closes his eyes, and after a brief breathing process, described later in “Create Your Own Dream Medicine,” he returns to the dream.

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He sees himself running from the mob. At this point, Bob comes to the edge of a rooftop. Here he stops and confronts the mob with the awareness that in imagination and dreams all things are possible. He now uses his will and intention and makes a turn, both figuratively and literally, that brings him face-to-face with his pursuers. To respond in this way is an act of faith, an Undoing of his fear. As he looks the leader in the eyes, he watches the anger dissolve, and in its place is a deep sadness.

The mob members become smaller, sinking down to the tar surface of the rooftop, and begin crying like children. At first Bob watches, then he embraces them. He feels as if something is cracking open inside himself in the region of his heart. As he does this, the anger vanishes. In its place is a feeling of acceptance — of the children and of their loss and grief. At the moment, this is enough. There is no need to fix it or to squelch the sadness as though it has no value.

Valuing the Shocks

Bob feels cleansed and relieved. Initially, he had feared a battle where he would either slay or be slain. By embracing the weeping children in the dream he has embraced the sad-child quality of himself. He admits to being shocked by what happened. According to Madame Colette Aboulker-Muscat, a renowned teacher of imagery and dream work, it’s just this shock that is necessary: it provokes a stress on the organism, which responds by trying to overcome the stress, thus generating movement and healing.

“We are transformed by our interaction with the environment.’’ And not all these interactions need be pleasurable to be rewarding. Since often we are unconscious, or at least so deeply asleep that any movement in our lives is negligible, we need these shocks to make healing and rejuvenation possible. After the dream reconstruction, Bob writes and draws this experience in his notebook, giving it a title, dating it, and signing his name at the end.

It’s not important for him to analyze his experience, to find out who made him sad, or to understand what his sadness means. Though this kind of psychological insight is interesting, too often it becomes a trap. It’s living out this experience in imagination that leads to his evolution and healing.

As Bob uses the exercise for the next 21 days, the process keeps changing. He has several different experiences along the way, both in his imagery and in his waking life. The children may cry or laugh; the night changes into day; the rooftop becomes a meadow, then leads him down to a river. And as he releases his long-held emotions of anger and sadness, he notices a change in his breathing as well.

It becomes freer, less constricted, and the asthma attacks start to grow further and further apart. This one experience can’t ensure that Bob will never feel angry or sad again; neither does it guarantee that his breathing will always be unrestricted. However, it does give him a technique that enables him to accept and integrate these feelings into his waking life.

My husband’s grandmother is 84 and has diabetes. Although she is fiercely independent, she cannot look after herself properly and will have to go into a residential home. Can you let me know of any homes that cater especially for people with diabetes?

Because diabetes is becoming increasingly common in the elderly, the staff in most residential homes are experienced in looking after people with diabetes. They will probably be happy to do urine tests, ensure that diet is satisfactory and see that she gets her tablets and, if necessary, insulin injections.

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My wife, who developed diabetes a few weeks ago, is about to return to work. I feel that she should wear some sort of identity disc or bracelet showing that she has diabetes but she is reluctant to wear anything too eyecatching. Have you any suggestions?

It is very important that all people with diabetes, especially those on insulin, should wear some form of identification. Accidents do happen and it may be vital for any medical emergency team to know that your wife has diabetes.

Medic-Alert provides stainless steel bracelets or necklets which are functional if not very beautiful. They can also be obtained in silver, gold plate, and 9-carat gold. Medic-Alert’s.

SOS/Talisman produces a medallion which can be unscrewed to reveal identification and medical details. These can be bought in most jewellers and come in a wide range of styles and prices, including some in 9-carat gold. Other products are always coming on to the market, and Balance, the magazine produced by Diabetes UK, usually carries advertisements.

I recently enquired about having electrolysis treatment for excess hair. I was told that, as I had diabetes, I would need a letter from my doctor stating that my diabetes did not encourage hair growth. Could I use wax hair removers instead?

There is no objection to your having electrolysis. Diabetes does not cause excessive hair growth. It sounds as though the firm doing the electrolysis is being overcautious.

People with diabetes can use the same methods of hair removal as those without diabetes – no special precautions are needed.

Could you tell me what ointment to use for skin irritation?

The most common cause of skin irritation in people with diabetes is itching around the genital region (pruritus vulvae). The most important treatment is to eliminate glucose from the urine by controlling diabetes. However, the itching can be relieved temporarily by cream containing a fungicide (e.g. nystatin).

I have recently been given afoot spa and was surprised to see a caution on the side of the box that it is not suitable for people with diabetes. Is this true?

If you have neuropathy (nerve damage), you should check with your diabetes team before using the spa. If you don’t have neuropathy, make sure that you check the temperature of the water carefully and don’t soak your feet for too long as this will make the skin soggy, easily damaged and prone to infection.

Acute asthma is responsible for 2 million emergency department (ED) visits and nearly 500,000 hospital admissions in the United States annually. Although most patients improve enough to be discharged from the ED after treatment, such improvement does not signify complete recovery. Often, asthma symptoms will persist for days or weeks. Moreover, relapse after the acute asthma episode, requiring either urgent asthma treatment or hospitalization, is common. Relapse rates ranging from 10% within 7 days after ED discharge to 31% 10 to 21 days after ED discharge have been reported.

Cysteinyl leukotrienes have been shown to be mediators of inflammation and bronchoconstriction in asthma patients, and marked elevations of these compounds may occur during acute asthma epi-sodes. Evidence supports the use of leukotriene-modifying drugs in the treatment of chronic asthma, and a number of studies have indicated potential benefit in patients with acute asthma. The effects of this drug class on relapse after an acute asthma episode have not yet been described.

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Treatment guidelines include therapy with systemic corticosteroids and inhaled (3₂-agonists as ED treatment for acute asthma, and a course of oral corticosteroids after ED discharge to prevent re-lapse. Nevertheless, high ED admission and relapse rates persist. Findings that corticosteroids do little to decrease the production of cysteinyl leukotrienes after allergen challenges, that the beneficial effects of leukotriene-modifying agents are additive to inhaled (3₂-agonists, and that the bronchodilatory effects of (3₂-agonists may diminish during asthma exacerbation suggest that there may be a role for leukotriene-modifying agents in the current ED treatment of asthma.

In this multicenter trial, we studied the effect of zafirlukast, an oral leukotriene receptor antagonist (LTRA), when added to standardized care in a population of patients who presented to the ED with acute asthma. The main objective was to assess the effects of zafirlukast on relapse after discharge from the ED. Other assessments included the rate of extended care before ED discharge, and treatment effects on pulmonary function, symptoms, and other patient outcomes in both the ED and outpatient periods.

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Until 1998, effective pharmacotherapy of erectile dysfunction was limited to intracavernous self-injection therapy and transurethral therapy with alprostadil (MUSE™), the latter with clearly less efficacy. The approval of sildenafil marked a breakthrough in the conservative treatment of erectile dysfunction and revolutionized completely the management of this disease. With the availability of effective oral therapy, the management of erectile dysfunction became more and more an issue for the general or family practitioner, and meanwhile more than 70% of all Viagra™ prescriptions aremprovided by non-urologists. 

One major negative consequence of this development is that many physicians have given up any diagnostic screening in these patients, and are limiting their activities more or less to pure prescription of the medication. The urologist, who was for a long time the first referral for erectile dysfunction patients, should continue to underline his expertise in this field by providing a thorough diagnostic workup of patients comprising medical and sexual history, somatic examination, laboratory tests, including testosterone, prolactin and serum glucose, and intracavernosal pharmacotesting with 10–20 μg alprostadil combined with Doppler/ duplex sonography of the cavernous arteries.

In this connection, systolic peak flow velocities <25 cm/s are indicative of an arteriogenic etiology, and should prompt the urologist to refer the patient for a further cardiovascular screening, as a considerable subset of these patients are suffering from generalized atherosclerosis and therefore are at risk of coronary or cerebral artery disease.

DIABETES CLINICS

My CP is starting a diabetes clinic in the local group practice and tells me that I no longer need to attend the hospital clinic. It’s much more convenient for me to go to see my CP but will this be all right?

You are fortunate that your general practitioner has a special interest in diabetes and has gone to the trouble of setting up a special clinic in the practice for this. Many GPs and practice nurses have had special training in diabetes and these general practice-based diabetes clinics are becoming more common.

They usually work well as long as you have uncomplicated diabetes and are well controlled, but you should be aware of the sort of care you can expect: Diabetes UK’s recommendations are given at the end of this section. We are sure that your hospital specialist will know about your CP’s new clinic and may even attend it from time to time. If you have any anxieties, why not discuss them with your doctor?

My CP is keen to test my urine every year to ‘look for evidence of kidney damage’. This sounds very frightening. Please explain.

The test goes by the name of microalbuminuria. For years nurses in diabetic clinics have asked for a urine sample which they test for protein. This is a crude test and is only positive when there is a lot of protein in the urine. The new test is very sensitive and detects minute traces of albumin (the body’s most common protein). Research has shown that protein detected in such small amounts is the first sign of kidney damage but at this early stage it can be reversed. This damage can be slowed by keeping the blood pressure below 135/75 and controlling the blood glucose – HbA1c 7% or less. The result of this test is often presented as a ratio of albumin (the protein) to creatinine, which corrects for the flow of urine at the time. The best result is to have a ratio of less than 0.5. The top limit of normal is usually quoted as 3.5 for women and 2.5 for men. If left untreated, the amount of protein in the urine will increase until it can be detected by conventional urine testing sticks. Over a period of years, this may progress to kidney failure and the possible need for dialysis or a kidney transplant. At the early stage of microalbuminuria, this process is reversible by control of blood pressure and glucose. There is good evidence that people with normal blood pressure and microalbuminuria can be protected by treatment with a tablet called an ACE inhibitor.

BLOOD GLUCOSE TESTING

I have trouble obtaining enough blood to perform a blood sugar test. Is there anything that I can do to make this easier?

The good news is that many of the new meters need only tiny amounts of blood in order to perform a test. However, if you are having trouble obtaining enough blood then try warming your hands by washing them in warm water before you start, and drying them thoroughly before pricking your finger. When squeezing the blood out of your finger, try ‘milking’ the blood out gently, allowing the finger to recover between each squeeze. Do not squeeze so hard that you blanch the finger white.

I am about to buy a meter that allows blood to be taken from the arm. Are there any problems with arm testing?

At the time of writing there are three meters that allow blood for testing to be taken from the arm. They are the OneTouch Ultra from LifeScan and the FreeStyle Freedom and Freestyle Mini from Abbott. The OneTouch Ultra and FreeStyle use strips that allow a tiny blood sample to be taken, which makes arm testing feasible. Under certain conditions, samples taken from the arm may differ significantly from fingertip samples, such as when blood glucose is changing rapidly:

• following a meal;
• after an insulin dose;
• when taking physical exercise.

Arm samples should only be used for testing prior to, or more than two hours after meals, an insulin dose or physical exercise. Fingertip testing should be used whenever there is a concern about hypoglycaemia (such as before you drive a car), as arm testing may not detect hypoglycaemia. Obtaining sufficient blood from the arm is not always easy but for some it is a welcome alternative to fingertip pricking. Your health professional should be consulted before you begin arm testing.

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I have heard that there is a way of obtaining blood from a finger using a laser. Is this true?

The Lasette is a single shot laser that makes a small hole in the finger to obtain a drop of blood, but it is not a blood glucose monitoring device. The use of laser light, as opposed to a steel lancet, reduces tissue damage, and many users of the device report feeling less pain than when using a traditional lancet. It weighs just less than 260 g (9 02). However, it is very expensive. It is slightly smaller than a videocassette.

I would like to measure my own blood glucose levels, but as I am now blind I do not know if this is possible. Can it be done?

After a long spell when no speaking meters were available there is now the new SensoCard Plus Meter which will speak instructions and also speak the result. The meter has recently come down in price. Strips are available on prescription and your pharmacist would need to contact the company, Cobolt Systems Ltd, directly. It also supplies control solution to check that the meter is working properly, and software to download results from a computer.

Source: Canadian Health and Care Mall at acanadianhealthcaremall.com