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The problem with all the medications I showed you up there is like giving you a Vicodin right. Give someone Viagra when you want to have sex but the disease continues to get worse and Vicodin is just masking the problem. tadalafil 20 mg So what can we do to reverse the disease process? Ian Thompson was the first in 2005.

He looked at the placebo arm of the prostate cancer prevention trial. But he found something interesting. That was interesting and so we say how do we explain that. Montorsi was able to explain it. He was able to also describe something called the arterio-diameter theory.

Cheap viagra cialis uk. He noticed that many of these men were developing ED about three years before they had their heart attack or stroke. And so he described his theory, and it makes a lot of sense. The arterio-diameter theory states this: the smallest arteries are the penile arteries 1 to 2 mm, the coronaries 3 to 4 mm, carotid 5 to 7 mm, femoral 6 to 8 mm.
And if you look at the statistics, a man always will get ED before he gets a heart attack, a heart attack before he gets a stroke, and a stroke before he gets peripheral vascular disease. So we screen these patients if a man walks in and has ED and two cardiovascular risk factors, those patients get a stress test. The endothelium is the common link. So the trick is how do we protect the endothelium or how to do we actually reverse the endothelium? And so there are many ways to do it. You can look at serum markers in the blood. You can look at cellular markers, you can look at imaging, and you can actually look at physiological measurements. So we use peripheral arterial tonometry. This as a device called the EndoPAT. So the patient walks into my office and I put a tourniquet around the bicep. Cialis buy south africa.
I will then elevate those pressures superficially. If a patient has very healthy arteries, the artery will be able to vasodilate when it sees the blood and it dilates very well. So we use a ratio called RHI, which is the dilation of the control finger over the normal finger, which gives me a number.
Now why is that important? Because in 2004 at the Mayo Clinic, they did a very clever study. They took all these patients and they did the EndoPAT study. And right after the EndoPAT study, they put them back into the cardiac cath lab and did a cardiac cath. And they showed that if a patient had RHI less than 1. So the finger was a surrogate marker for the heart. Same thing was cutoff was 1. If a patient had RHI less than 1. Cialis super active sale.
So again the finger could be a nice marker for the rest of the body and the endothelium as well. As I mentioned earlier, the common link is the endothelium. So I want to show you something.

Some of the smartest doctors I know out there are actually cardiologists. Because several years ago, they figured out how to reverse cardiovascular disease, how to reverse it. Cialis buy london.
And so they said, if we can improve the endothelium we can actually improve cardiac blood flow and we can actually treat coronary artery disease. So if you believe that the endothelium is the common link, how do they do it? They did several things. They did diet and exercise. If statins, improve insulin resistance, they get aspirin, smoking cessation, summaries using PD5 inhibitors, and believe it or not some are using testosterone placement therapy to improve the endothelium to reverse cardiovascular disease. All we have to do is copy the cardiologists. Just take their model right and now we can use the endothelium to treat ED. Cardiovascular disease and ED are related. So if we improve the endothelium, we can improve penile blood flow and treat ED.
So the first was Esposito in 2004, a remarkable study. And what she did was she took 110 men, 55 men were asked to do a diet and exercise program, 55 were not. They all have ED and they were obese. Discount cialis no prescription.
And the control group just had counseling, I mean no counseling whatsoever. So if after two years, those that did some diet and exercise lost weight. And a multivariate analysis changes in body mass, physical activities and C-reactive protein were all independently associated with IIS scores. So diet and exercise do matter. Statins believe it or not are very helpful as well, and this is just a small study looking at 18 men with hyperlipidemia as the only risk factor for ED. Organic ED was verified by abnormal nocturnal penile tumescence in a SHIM score. And they were given Lipitor to decrease their cholesterol. This is a smaller study to randomize, but double blind placebo control study looking at men who had ED who failed Viagra.
So these patients were given Viagra, it failed and what they decided to do was give these patients Lipitor. And at the end of four months, what they found was those patients that took the Lipitor had not only improvements in LDL, but many of them became responders to PD5 inhibitors. So again you may be able to salvage some of those nonresponders to PD5 inhibitors. Highest score significantly improved with statins compared to controls. This is pretty impressive. So this is a randomized controlled trial of 20 men with ED treated with Tadalafil 20 mg on alternate days or on demand. So this is chronic versus on demand. Endpoints were peak systolic velocity as I mentioned earlier, flow media dilation the cavernous arteries.

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