On return, the patient noted a decrease in his IPSS score to 12/2 and felt very comfortable with his level of symptoms. The patient was counseled not to take the 2 drugs within 4 hours of each other. His initial dose of the PDE5 inhibitor was low due to the concomitant use with tamsulosin. In an effort to improve his erectile function, the patient was begun on tamsulosin 0.4 mg each morning as well as a PDE5 inhibitor that is indicated for concomitant use with tamsulosin. His hormone profile demonstrated a normal total, free, and bioavailable testosterone.īecause of his LUTS, the patient is at higher risk for ED. Laboratory studies included normal lipid profile, blood sugar, creatinine, and prostate-specific antigen level. The patient was also taking valsartan for hypertension control that had maintained his blood pressure in a reasonable range.
The patient had tried saw palmetto without relief. His medical history was also significant for loss of erectile function since his LUTS had increased in severity. His international prostate symptoms score (IPSS) measured 18/3. JD is a 72-year-old man seen by his urologist for significant lower urinary tract symptoms (LUTS) with nocturia times four, urgency, frequency, but no incontinence. The patient and his wife were given the opportunity to seek marital counseling for further improvement in their interpersonal relationship and resolution of ED. Because of his ED, the patient was motivated to improve his overall risk-factor profile with the assistance of a PDE5 inhibitor as a motivational alternative. The patient was referred to his internist for further evaluation and a change in his anti-hypertensive medications from a thiazide diuretic and beta blocker to angiotensin-converting enzyme inhibitor, alpha 2 receptor blocker, calcium channel blocker, alone or in combination. It was suspected that another cause of his ED was the combination of antihypertensive medications due to his hypertension. The patient was initiated on statin treatment for his dyslipidemia and referred to a dietary controlled weight-loss program. Obesity, dyslipidemia, and high blood sugars suggest that the patient is suffering from metabolic syndrome.
MARITAL STRIFE FULL
Continue Reading Show full articles without. At the same time, the patient was counseled regarding risk factors for ED. The confirmation of marital strife comes a few months after divorce speculation hung over their marriage, largely due to the missing wedding band. Since he was not taking nitrates or alpha blockers, phosphodiesterase enzyme 5 (PDE5) inhibitors were initiated to improve his erectile function. Laboratory studies include total cholesterol 265 mg/dL, high-density lipoprotein 38 mg/dL, low-density lipoprotein 120 mg/dL, triglycerides 270 mg/dL, and blood sugar 185 mg/dL. Physical examination is normal with normal genitalia, prostate examination, but a rotund abdomen that is nontender.
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