When The Blue Pills Stop Working

If you are a man suffering from erectile dysfunction (ED) and have been taking Viagra or Cialis or Livitra for many years with satisfactory results, there may well come a time when these medicines no longer help. Its age related.


As you go on through your seventies and into your eighties you may find that, even doubling up on the dose, you can no longer have intercourse. So what do you do now? Give up? Go for the dreaded penile implant? I strongly advise you do neither for the moment.


Penis self-injection


I would urge you to consider self-injection of your penis some minutes before intercourse is contemplated. This can and should avoid the necessity of penile implant or at least postpone that day indefinitely. Penile injection is almost painless, despite of what you might think.


Here is the order in which I would choose penis injections:


  1. Alprostadil. This usually comes in the form of Caverject although you may find a compounding pharmacist who can make it up for you.  It comes in strengths of 5, 10 and 20 micrograms. However, if the top strength is letting you down (as it were) you can double up to 40 or even 60 micrograms. This can be very expensive if you are paying for it yourself and you would probably do better having a compounding chemist make it up for you at the strength you require.
  2. Papaverine.  This comes in 30 mg and 60 mg 2ml vials. Start with 30 mg and double the dose if necessary. Often Papaverine on its own is insufficient to bring about a sufficient erection.
  3. Papaverine and Phentolamine mix. This is sometimes marketed under the brand name of Bi Mix or Androskat licensed by Takeda in the Netherlands and Germany. The two drugs work synergistically the former as a vasodilator the later as a muscular relaxant. In the case of Androskat it contains 30 mg of papaverine and 1 mg of phentolamine.


Here it is necessary to sound a word of warning. Any drug injected into the penis can cause priapism. Priapism is defined as an erection, often painful, that lasts for more than 4 hours. It is a very rare complication of Alprostadil and Papaverine given on their own or in combination.  But when phentolamine is introduced into the equation things can change radically. Priapism in association with phentolamine has an occurrence rate of 8 to 10 %. And priapism, let go for much after 4 hours, has the strong potential of permanently destroying your delicate erectile tissue. So now you have been warned. Introduce phentolamine slowly starting with a ¼ dose even if this does not produce an erection. Far better that than going straight to the top dose and ending up in the ER department of your local hospital!

How To Inject Your Penis:

  • Best while standing up.
  • Hold loaded syringe and needle such as they are parallel to the floor.
  • Introduce the needle into the side of your penis towards the base far back on the abdominal end.
  • Do this in one quick movement going in for full length of needle given that its about 12 mm in length. You will know you are in the right place because there will be no resistance to the fluid flowing in. If there is resistance then you are in the wrong place.

If I can help you with anything covered here please contact me through www.medicaladviceforyou.com

Adults Who Wet the Bed

What is nocturnal enuresis?

Nocturnal enuresis is defined as involuntary urination in bed during the night, after an age when bladder control should be established. It is more common in children, and usually, after the age of 3 or 4, night control begins to be established and dry nights begin to become the norm. With adults, however, bedwetting is not rare – or anything to be ashamed of. This is usually referred to as adult enuresis.

There are two kinds of enuresis: primary and secondary. The former refers to bedwetting since birth and where night control was never permanently established.. Secondary enuresis is a separate condition that develops after you have a long history of might-time bladder control.

What causes bedwetting in adults?

There are various reasons a person might have, or develop nocturnal enuresis. These range from medical conditions which require ongoing treatment or management, to more temporary reasons such as:

  • Urinary tract infections. Need urinary culture to identify the offending bacteria and initiate the appropriate antibiotic treatment.
  • Or a reaction to the medication. Such as a strong diuretic.
  • There isn’t always an obvious cause of bedwetting in adults. Some suggested causes include:
  • Genetics: Although this doesn’t apply to everyone, there is research to suggest nocturnal enuresis can be hereditary.
  • Smaller functional bladder capacity: For some, it may be due to smaller functional bladder capacity, which refers to the amount of urine your bladder can hold before telling the brain to go to the toilet. Sometimes, overactivity of the bladder muscle means it’s never fully relaxed during the filling phase, so bladder capacity is not as large.
  • Overactive bladder: This causes an uncontrollable urge to urinate, even if the bladder holds little urine. Research has identified overactive bladder as occurring for many people experiencing nocturnal enuresis. This will require the use of urinary antispasmodics.
  • Increased diuretic intake before bed: Some drinks (known as diuretics) can irritate the bladder, making the body need to pass water.
  • Certain medication: Medication for the heart, blood pressure problems or mental illness and anxiety can alter the way your urinary system works, at times, reducing control over your bladder.
  • Stress or anxiety: Conditions related to mental wellbeing can trigger bedwetting in adults, and the condition may continue after the root cause has been treated.
  • If you are experiencing adult bedwetting, remember you are not alone, and it is important to treat or manage. Although the condition may not have serious consequences to your physical health, it can affect your self-esteem and quality of life. It is important to discuss enuresis with your GP, to determine the cause and seek advice on the best treatment and management options.
  • There are neurological causes like multiple sclerosis, spinal cord injury and Spina Bifida occult and all of this needs looking into.

How to stop adult bedwetting

If you wet the bed, the first step is to diagnose the underlying cause. I can help you with this online. Before the appointment, your doctor will find it useful if you keep a diary of your urinary activity. This includes how often you go to the toilet, the frequency of your bedwetting, and notes on what, when, and how much you drink.

Your doctor may request a urine sample so they can test for an infection. They may also recommend a bladder test.


Other methods of treatment include:

  • Medication: Certain medications are available to control nocturnal enuresis and may be advised as a long-term solution.
  • Enuresis alarm: This is designed to wake you up if you begin to urinate during the night by sounding a buzzer or vibrating. It helps to teach your body to hold the urine until you wake up, allowing you to reach the toilet in time. These alarms are small and discreet and can be worn close to the body.
  • Complementary therapies: For some, alternative medicines are preferable, including hypnosis or acupuncture. It’s best to seek advice from a trained practitioner before trying these methods.

Ways to manage nocturnal enuresis

Other ways you can manage bedwetting in adults include:

  • Watching what you drink: Ideally, you should aim to drink at least six to eight glasses of fluid a day. Where possible, it’s best to drink most of this in the daytime and try to cut down in the evening. Try to avoid diuretics, like coffee, tea, and Izzy drinks too, as these can increase the need to use the toilet.
  • Setting an alarm at night: Setting an alarm to wake you during the night for a loo break may reduce accidents. Vary the times you set the alarm, however, otherwise, your bladder may fall into a habit of emptying at the same time, regardless of whether you are awake.
  • Incontinence aids: Wearing an overnight incontinence product means you can sleep soundly and worry-free.

Incontinence products for bedwetting

Adult bedwetting affects more people than you might think. The condition can make normal activities, like holidays, business trips, or starting a new relationship feel daunting, but the condition can be managed.

By talking to your GP and close family or friends, you can learn more about the condition and explore treatment and management methods with the support of those around you.

It’s also worth considering an incontinence product that can offer overnight protection, so you can sleep without concern. Depend on Comfort Protect pants, available for women and men, have an overnight guarantee – so you can sleep soundly, feeling protected.

Last update of the article: 05/05/2020.

Keloid Scars

Keloid Scars. Little known about them

Keloid scars are defined as abnormal scars that grow beyond the boundary of the original site of a skin injury. The scar is a raised and ill-defined growth of skin in the area of damaged skin. They are unsightly and people may go to great ends to try and get rid of them.

Who Is at Risk?

Although a keloid scar can form on anyone, some ethnic groups are at a greater risk of developing them. African Americans and Hispanics are 16 percent more susceptible, for example, and keloid scars are seen 15 times more frequently in highly-pigmented ethnic groups than in Caucasians.

Some areas of the body do seem more susceptible to keloid scars, including the deltoid region of the upper arm, the upper back, and the sternum. The earlobes and the back of the neck are also common sites.


The truth is nobody knows why or how keloid scars form. Skin trauma appears to be the most common cause, although scars can also form for no apparent reason. Skin or muscle tension seems to contribute to keloid formation, as is evidenced by the most common sites of their formation (the upper arm and back). But if that was the full story, you would expect that other sites, such as the palm of the hand or the soles of the feet, to be just as vulnerable; however, this is not the case.

Infection at a wound site, repeated trauma to the same area, skin tension or a foreign body in a wound can also be factors. There does appear to be a genetic component to keloid scarring: it is known that if someone in your family has keloids, then you are at increased risk.

Other theories for the causes of keloid scarring include a deficiency or an excess in melanocyte hormone (MSH); decreased percentages of mature collagen and increased soluble collagen; or the blocking of very small blood vessels and the resulting lack of oxygen.

While the lack of a clearcut theory does demonstrate the lack of understanding of the condition, some work is being done to find the cause.

Determining the exact cause will hopefully mean better preventative medicine and more effective treatments in the future, but there are many problems with adequate follow up of people with the condition, lack of a clear cut-off from treatment, and too few studies in general — all hampering the search for a cure.


There is nothing that will prevent keloid formation. If its to happen it will happen. There may be little you can do if you are unfortunate enough to have the sort of skin that reacts by forming keloid scarring.

There is a high rate of recurrence: up to 50 percent. Some doctors say that all highly pigmented people should avoid tattoos and piercings to be on the safe side.


There are three treatment options for keloid scars:

  • surgical removal
  • non-surgical interventions
  • combination treatments.

Surgical Treatment for Keloid Scars

This is the most effective and the least complex of the available forms of treatment, the recurrence ​rate, however, is thought to be about 50 percent.

Lasers have been tried as an alternative to knife surgery but so far the outcomes are no better.

Non-Surgical Treatments for Keloid Scars

Interferon therapy (drugs acting on the immune system) has been reported as effective in reducing keloid scarring; however, it does have significant side effects. Examples are toxicity, flu-like symptoms, depression, nausea, and vomiting.

Prolonged compression of scar tissue can theoretically soften and break up keloid scars, but the practicality of this option depends on the location of the keloid. Other non-surgical interventions that are currently being tried with varying results include antihistamines, vitamins, nitrogen mustard, Verapamil, and retinoic acids.

Combined Treatments for Keloid Scarring

One option involves surgical removal of scar tissue in combination with a couple of steroid injections -one at the time of the surgery and the second injection about a month later. However, this type of treatment is variously reported as having between a 50 to 70 percent rate of recurrence.

Another option combines surgery with external type radiotherapy. Radiation has the effect of interfering with skin growth (fibroblasts) and collagen production. Research varies on which type of combination therapy is more effective.

Both radiotherapy and steroid drugs have side effects, so you need to discuss with your doctor the most effective treatment. It may be worth getting a second opinion before proceeding with either treatment.

Last update of the article: 05/05/2020.