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PSA Levels Testing Controversy Resurfaces


In a recent Medical Fitness Network blog, Dr. James Fagelson discusses the findings from a recent Northwestern University study stating that metastatic (incurable) prostate cancer has increased by more than 90 percent in patients age 55-69 since 2004. This comes after a recommendation made in 2008 by the United States Preventive Services Task Force that advised doctors to cut back on PSA levels testing that evaluate levels of prostate-specific antigen that can indicate prostate cancer.

Read more about Dr. Fagelson’s stance on PSA testing

For Men with BPH Symptoms, No Drugs, No Surgeries, Just Relief

Two Colorado men experience what life was like before BPH – and Rezūm therapy

Benign prostatic hyperplasia (BPH) is an enlarged prostate and just about everyone knows that to have it means urinating a frustratingly small amount – and then needing to urinate again, and again, and again.

“A traffic jam on the interstate was a nightmare,” says 65-year-old Clarke Omdahle of Littleton, Colorado. “In short, I always planned my daily activities with the closest bathroom in mind.”Men with BPH | Rezum Therapy | Urology Associates

This was difficult for Clarke. After his morning coffee and using the bathroom before leaving work, he would still have to stop and find a bathroom after several miles on his way to work.

BPH symptoms weren’t very nice to 70-year-old Ken Whiteacre either, also of Littleton. “I would get up, mostly in the middle of the night – about 4 to 5 times – to go the bathroom,” says Ken. “It was often very hard to get back to sleep after that.”

Ken and Clarke faced the same scenario: If they didn’t get to a bathroom immediately, it was often too late. “I wore dark colored pants and pads as safeguards after a multitude of accidents,” Ken confides.

Not fun but not unusual. Benign prostatic hyperplasia is the most common diagnosis made by urologists for men between the ages of 45 and 75. BPH is the most common health issue of the prostate. It is not linked to prostate cancer and does not cause problems in all men who have it. But for those who do, it can be tough.

After visiting Urology Associates, Clarke discovered that although his prostate was enlarged and his PSA was 8.0, which was high, he did not have prostate cancer. That was good news.

Traditional options for managing BPH symptoms include medication, surgery, lifestyle changes and active surveillance. Although these are still viable methods for treating the condition, both Ken and Clarke were looking for new and innovative alternatives. Luckily, they were both patients of Dr. Cowan.

Their Rezūm experience

Ken and Clarke were both looking for an option that wouldn’t require them to have surgery or take medication for the rest of their lives. They were both healthy men who led active lives and wanted to address the issues that BPH was causing them, head on.

It was determineddetermined that both men were good candidates for a new treatment procedure for BPH called Rezūm. Urology Associates was the first practice in Colorado to offer Rezūm, which uses stored energy that naturally occurs in water vapor to shrink prostate tissue in men with BPH.

In Rezūm therapy the physician inserts a small device through the man’s urethra that delivers water vapor directly into the prostate tissue that has been enlarged by BPH. The water vapor then kills the enlarged cells and the reduction in tissue relieves most of the bothersome symptoms. Clarke became the first person in the state to undergo the Rezūm procedure.

“As usual, the fear of the unknown (and the fact that a bunch of people were messing with my junk) made me pretty apprehensive,” says Clarke. “After the prep work, the actual procedure only took five minutes and it didn’t hurt.”

And it worked. According to Clarke, “I no longer have that nagging urge to find the closest bathroom at all times. The urine flow is stronger and I feel I am completely emptying my bladder.”

Ken also experienced great results after having the Rezūm treatment done.

“I’m down to getting up only about once a night, which is pretty standard for most men my age,” he says. “I feel like I’m pretty lucky compared to other men my age who have to take all kinds of medication for similar issues.”

Today Ken rides his bike, volunteers and does all of the things he enjoys with no problems. “The procedure is very quick and the staff and Dr. Cowan made it very simple and painless,” says Ken. “I was very happy with the Rezūm procedure.”

Clarke recalls his experience working with the Urology Associates staff and doctors to be very professional, supportive and understanding of the challenges he faced.

“I will always remember what they said to me as I went through testing, procedure and recovery,” said Clarke. “He said, ‘You may hate me now, but you’ll thank me later,’ and to that I say thank you.”

PSA Tests: The First Step To Prostate Cancer Discovery

mens-healthUrology Associates patient Gary Perkins, featured in a Men’s Health story about how PSA testing saved actor Ben Stiller’s life, had a history of rising PSA levels. This led UA’s Dr. James Fagelson to encourage further testing for Gary. Though his PSA levels were never off the charts, the continuous increase over time raised concern. After a prostate biopsy confirmed cancer, he underwent UA’s targeted radiation therapy treatment and is now cancer-free.

As Perkins’ case shows, PSA tests may not be conclusive but they can be an essential element in an early diagnosis, which is what saved both Gary and Stiller. So doctors must monitor changing PSA levels and do further tests on men with higher levels to confirm a prostate cancer diagnosis.

Ready about Gary in the Men’s Health story

Learn more about our stance on PSA testing

Metastatic Prostate Cancer on the Rise

Urology Associate’s offers a patient update on prostate cancer screening & PSA testing following a new study on rising prostate cancer rates.


Summary transcript

A great bombshell was dropped when a new study regarding prostate cancer screening was recently published.

For years, prostate cancer was diagnosed after screening with a PSA [prostate specific antigen] blood test and digital rectal exam. However, over time there was a decreased emphasis on PSA because we understand that it’s an imperfect test.

About 10 years ago the U.S. Public Health Task Force recommended a grade of D for PSA screening because of its imperfections.

In the urology community, we were very concerned about that recommendation because we felt that PSA screening was the only reason why deaths due to prostate cancer had dropped dramatically over the past 10-15 years.

In fact, the study released recently confirms that comparing 2003 data to 2013 data, there was a 72 percent increase of men presenting with metastatic or incurable disease.

In fact, in the group that we are most concerned about, men who are at highest risk between age 55 and 69, there was a remarkable 92 percent increase in presentation with metastatic or incurable disease.

We conclude that it is important for men to continue to get screened with PSA and digital rectal exam annually.

We understand that it’s an imperfect science, but we still believe that it’s the only way that will allow us to identify men who are at risk for early progression to metastatic disease.

We also understand that in today’s world we have dramatically enhanced abilities to stratify patients into risk groups. Specifically, we can identify patients that have such low risk of progression that we can offer active surveillance and actually no treatment. Therefore, no risk of the side effects that men are concerned about.

If in fact they have higher risk factors for progressive disease, then our treatment options today are much improved including both da Vinci robotic therapy, or stereotactic body radiation therapy, or CyberKnife radiation therapy for treatment with much, much less treatment-related side effects.

As a result of this data, we strongly recommend that men continue to do screening for prostate cancer using both PSA and digital rectal exam. This allows them the best chance of early diagnosis, early risk stratification and treatment, if necessary, to prevent death due to prostate cancer.

Learn About PSA Testing

Hardly Par for the Course Prostate Cancer Treatment

Diligent doctor checkups & radiation seeds removed this avid golfer’s slow-growing prostate cancer

prostate cancer success story | Brachytherapy treatment at urology associatesAs a 62-year-old self-employed retirement and financial planner for the past 40 years, James had a lot on his plate running his own business. Visiting the doctor wasn’t always his top priority.

Thankfully, James’ wife Toni, who happens to be his business partner as well as a registered nurse, made sure he went to the doctor each year. “I owe a great deal of my health and successful prostate treatment to her,” says James.

Seven years ago, following one of those annual checkups, James’ primary care physician discovered elevated prostate-specific antigen (PSA) levels. The PSA level is recognized as the single best indicator for detecting prostate cancer occurrence and severity. His level was high enough to require a visit to a specialist.

James came to Dr. Brad Bell at Urology Associates. The relationship between doctor and patient is key — especially when treating cancer. For James and Dr. Bell, this was the easy part. The two struck an instant bond with each other from the beginning, and James said he felt like he could trust Dr. Bell from the start.

For men in their 70s and 80s diagnosed with prostate cancer, it’s unlikely that the prostate cancer will be life threatening. However, each prostate cancer case comes under different circumstances and with varying patient goals, so it’s still important to assemble a treatment plan that both the patient and doctor agree on.

After his visit with Dr. Bell, James learned that the cancer was slow growing and contained within the prostate. Dr. Bell discussed the options and they decided on a treatment which utilizes radiation seeds placed internally.

Radiation seeds in, prostate cancer out

“I felt really comfortable with Dr. Bell and his strategy for treating my prostate cancer from day one,” said James. “He always explained every last detail, but also in simple terms that were easy to understand.”

In James’ treatment, radiation seeds were inserted directly into the prostate and released radio waves that killed the cancer cells but did not travel far. Treating prostate cancer this way has taken some flack in the past because of the reported incidence of side effects and loss of sexual function.* [see Author’s note]

“I didn’t experience any negative side affects,” says James. “Radiation may not be right for every man, but it certainly was for me.”

James says the procedure lasted a couple of hours and according to both him and Dr. Bell, the procedure went perfectly. “I couldn’t imagine a much easier cancer treatment,” says James. “I was out golfing later that week.”

Today, James’ PSA level is about as close to zero as it could be—a minuscule .01. James still sees Dr. Bell once a year to evaluate his PSA level, which continues to remain low.

“My recommendation is for every man to be aware of how common prostate cancer is and to treat it as quickly as possible,” says James.

*Author’s note: As of 2016, Urology Associates does not offer this treatment to patients and instead recommends CyberKnife technology for a majority of radiation treatments.

Learn more about prostate cancer 

Two Down but Testicular Cancer Free

Pete earned his “racing stripes” from surgery to remove his testicles at Christmas time — and they proved to be a life-saving gift.

Truck on the roadIf people like Pete Bowes weren’t tirelessly at their work, this country would grind to a halt. Pete has driven a 53-foot semi-truck every day for the past seven years!

Like other truck drivers, he often spends days many miles away from friends and family, and doesn’t have the luxury of a “normal” schedule. Pete’s usually on the road during the holiday season when the rest of us are enjoying quality time with our families.

But Christmas holiday 2014 was unlike any other he had ever experienced.

All through that year, Pete had struggled with an abnormal hardening in his testicles. They were also growing smaller and less and less sensitive to touch.

“I knew something wasn’t normal,” says Pete. “You could have kicked me in places that men do not like to be kicked, and I wouldn’t have felt much.”

After visiting his primary care physician about the issues, Pete had an ultrasound scheduled on December 24, 2014 – Christmas Eve. When the ultrasound was completed, Pete began to drive away from the office only to be called back immediately. The results were not good and they wanted to send him to a specialist.

We need to fix this, now

Having been a patient of Urology Associates (UA) in previous years, Pete reached out to and made an appointment with Dr. Edward Eigner – for that same afternoon.

“Dr. Eigner took one look at my history and my ultrasound results, and told me, in a truthful manner, that something was very wrong and it needed to be addressed,” says Pete. “He asked me what I was doing that Saturday, December 26 – the day after Christmas.”

Although uncertain about the specific prognosis, Dr. Eigner understood that if any testicular growth is found, it tends to be malignant testicular cancer and could get rapidly worse.

“It was a worrisome situation. The ultrasound and the exam were distinctly abnormal and there was a real threat of a dangerous issue ongoing,” says Dr. Eigner. “We zeroed in on the threat and wanted to promptly address it.”

Despite the holiday, Dr. Eigner scheduled Pete on the coming Saturday for testicle removal, a surgical procedure called an inguinal bilateral orchiectomy in which both testicles are removed. Dr. Eigner and the staff took the time to carefully explain all of the pre-operational details of the procedure, what was going to happen and what Pete could expect after the surgery.

“The fact that all of this happened over the holidays certainly complicated things. There were lots of staff who had taken time off to spend with their families so it was a little hectic,” says Pete.

“They saw me on a Saturday – the Saturday after Christmas at that. But that’s the level of concern and compassion that was displayed. Dr. Eigner and the staff at Urology Associates were willing to make it work, no matter what day it was.”

Dr. Eigner performed Pete’s surgery on Saturday morning and he was released for recovery that afternoon. Pete recalls both a UA nurse and a physicians assistant calling him to make sure he was comfortable and had everything he needed.

“I was as comfortable as you can be with two four-inch incisions in your abdomen,” Pete adds with a laugh. He now comically refers to the incision scars as his “racing stripes.”

While Pete recovered, UA sent his results to Cleveland Clinic for a second opinion on the pathology report, much like the online second opinion service UA also offers. That’s where things stood for the next few weeks, waiting for the results to come back from Cleveland Clinic.

“They told me that they still didn’t know what it was,” says Pete, “but they knew what it wasn’t – which was malignant.”

Pete found that the diagnosis was a benign tumor due to fibrous scarring from previous trauma. Although the tumor was benign, his testicles had been shutting down for the past few years.

“Throughout that entire process, Dr. Eigner and his staff were there for me and were more than willing to answer any questions that I had,” Pete says. “Ultimately, it was the best news that I could have received in that situation. My ‘kids’ are gone, but I’m cancer-free!”

Vasectomy Myths Debunked

A vasectomy is the most reliable form of permanent birth control, so why aren’t more men having them done?

Vasectomy Myths | Denver Urology

One of the most common procedures we conduct at Urology Associates is a vasectomy. A vasectomy is a form of permanent male birth control by permanent sterilization that prevents the release of sperm to mix with semen when a man ejaculates.

Compared with the female sterilization process of having the fallopian tubes “tied,” vasectomies are much more reliable, faster and safer. So why do only 9 percent of sexually active men in the United States get vasectomies, while 27 percent of women get tubal ligations?

Well, there’s a lot of fear involved when men think about vasectomy, because they’ve been buying into myths about the V word.

In an attempt to debunk the various myths surrounding vasectomies and get all the facts out in the open, I’ve compiled a list of typical misunderstandings that patients have regarding vasectomies.

A vasectomy murders your sex drive

No way. A vasectomy will not affect your sexual desire, sex drive or your ability to have erections and ejaculate. Everything, including your orgasms, should remain unchanged. Although it’s important to wait until you feel recovered enough to have sex following the procedure. Some men experience mild aching in their testicles when they are sexually aroused, however most of the enjoyable aspects of intercourse won’t be altered.

A vasectomy hurts like the Dickens

I get it, it’s a sensitive area and you are likely anxious about a surgery around this part of your body. While every patient is unique and some discomfort is always possible with any surgery, a vasectomy generally is not painful. Some patients may experience a slight tugging or pulling while the doctor locates the vas deferens during the procedure, as well as a dull ache and mild pain in the scrotum and groin as the anesthesia wears off. In order to reduce pain and swelling you can take over-the-counter anti-inflammatory medication or apply a bag of ice or frozen vegetables to the affected area. If pain lasts for longer than a week and the symptoms aren’t getting any better, it is important to let your physician know.

I’m going to have a long, painful recovery

Not really. Many patients are pleasantly surprised with how quickly they are able to get back in action. Patients usually recover from a vasectomy in about a week. I recommend they wait a few days before having sex or jumping back into strenuous activity.

One of the most important parts of recovery from a vasectomy is rest. Many men, after my own heart, schedule their procedure during March Madness. It’s a great opportunity to grab a bag of frozen peas and post up on the couch for a couple of days while your body recovers.

A vasectomy procedure takes a good while and feels weird

Weird? Maybe the idea can make you feel weird, but the procedure is very quick, lasting about 20-30 minutes from start to finish. Here’s what to expect:

  • A local anesthetic to numb the scrotum.
  • A small puncture with needle is made on each side of the scrotum.
  • The doctor finds, cuts and seals the vas deferens, the small tubes sperm travel in to mix with semen.
  • The cut tubes are returned to the scrotum and closed with a few small stitches.

Patients who are considering having a vasectomy should be sure about not wanting to have any more children in the future. By blocking the vas deferens during the procedure, the sperm’s pathway is blocked, it can’t combine with the semen that is ejaculated during sexual climax. Without sperm a woman’s egg cannot become fertilized in order to result in a pregnancy.

Vasectomies fail and men end up getting women pregnant

Here’s where old data might be tripping you up. Over the years, urologists have greatly improved vasectomy success rates. Today, if done properly by a well trained and experienced surgeon, failure rates for vasectomies are around 0 percent. It’s considered the most effective form of birth control.

But, just because you’ve had a vasectomy doesn’t mean that it’s immediately effective. It usually takes 10 to 20 ejaculations to clear sperm completely from the semen. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy – and that’s typically due to failure to wait until sperm has completely cleared from the semen before having intercourse without birth control. After a vasectomy, sperm produced is absorbed into the body.

It’s a good idea to check back in with your doctor for a sperm count before forgoing other birth control methods. Very rarely, the vas deferens will spontaneously reconnect on their own allowing the sperm to mix with semen.

Having a vasectomy will make my semen look funny

For the most part, your ejaculatory fluid will look exactly the same as it did prior to the vasectomy procedure, because less than 3 percent of the volume of ejaculate is made up of sperm. Because the tubes are blocked before the seminal vesicles and the prostate, you will still ejaculate the same amount of fluid, just without the sperm.

If I change my mind and want children, I’m out of luck

Actually, the “permanent” in permanent sterilization can be reversed by reconnecting the vas deferens in vasectomy reversal. But it’s a difficult procedure.

During a vasectomy reversal, the surgeon will make a small incision on either side of the scrotum and check the vas deferens fluid for sperm. If sperm is present, the physician will reconnect the ends of the vas deferens to the epididymis, thereby allowing sperm to pass through again. If there is no sperm, the surgeon will need to perform a more difficult procedure to bypass the blockage in the epididymis to reconnect the vas deferens.

A vasectomy reversal’s efficacy varies depending on how long it’s been since the initial sterilization, how it was done and the patient’s overall health condition. Another consideration is that a vasectomy reversal is a very delicate process that requires an experienced surgeon. The procedure can take, on average, 4 to 5 hours. About 10,000-30,000 men reverse their vasectomies annually.

Active 81-Year-Old Takes Cancer and Kidney Loss in Stride

When diagnosed with cancer, always active and healthy Jean took a step back and relied on her faith to help her through a trying time.

Dr. Bell's patient

Jean Standish is one tough cookie. In fact, she laughs as she remembers receiving the news of her kidney cancer diagnosis early in the summer of 2014 prior to a planned trip to support her grandson who is a professional mountain biker.

Dr. Brad Bell suggested that I try to take it easy on my trip that summer, prior to my surgery, to which my husband humorously responded, Do you have a pill that will make her do that?

He knew that for Jean, taking it easy wouldn’t be easy.

Originally born in Nebraska, Jean and her husband settled in Colorado where they raised two boys. Jean returned to the working world when they were in high school, acting as the business manager for a senior facility for 16 years. She always spent much of her time on-the-go, traveling with her husband, skiing, hiking, camping and she still walks regularly. Taking it easy just isn’t a part of her DNA.

Jean, who lived in Conifer, Colorado, consistently received clean bills of health during her yearly physicals. Which is why she was shocked one May morning in 2014 to discover a large amount of blood in her urine. After receiving a computed tomography (CT) scan from her primary physician, the staff recommended that she see Dr. Bell at Urology Associates in Denver.

With her husband by her side for serious support, Jean visited Dr. Bell.

“He seemed young, but he was extremely knowledgeable and upfront,” recalls Jean. “He told us that it could be cancer, but they’d have to do a bit more checking.”

Jean remembers asking, “How could this be?” After all, she had always been an extremely active and healthy person. Dr. Bell scheduled a biopsy, just in case.

Her faith guided Jean to kidney removal

In June, Jean was informed that her cancer was a renal pelvic cancer (similar to a bladder cancer in which the cancer affects the cells attached to the kidney). Unfortunately, these cells do not respond well to chemotherapy or standard radiation, and surgery remains the gold standard for treatment.

Dr. Bell, Jean and her family reviewed her films and performed a ureteroscopy biopsy of the abnormal cells in the renal pelvis. Upon return of the diagnosis, they discussed her treatment options together. Surgery to remove her entire kidney and ureter (nephroureterectomy) was recommended and monitoring, though not recommended, was also discussed.

It was a tough predicament. At the time Jean was 81-years-old, a risky factor in performing this surgery, because it meant that her health would ultimately depend on the successful function of her remaining kidney.

She thought it over carefully. After relying on the advice and support from her friends, family and acquaintances at her church and on her confidence in the team at Urology Associates, Jean made the decision to schedule the surgery.

“I have a great faith that the Lord is always looking out for us and guides us,” said Jean of her decision.

The kidney removal surgery was performed September 11, 2014. More than a year afterward, her regular check-ins and cystoscopies have shown no problems.

“She came through her surgery with flying colors. No doubt her many years of good health and staying active played a huge part in her successful recovery and ultimate outcome,” said Dr. Bell.

She admits that she experienced her own personal frustration during the recovery and recuperation period. “I suppose I need to realize that I was 81 at the time, not 18,” Jean said with a laugh.

Today, aside from a slightly slower gait and a newly found appreciation for an afternoon nap, Jean still enjoys being active and traveling. In the past few months she has returned to participating in water aerobics and continues to volunteer in the community and at her church.

Through all of the fear and emotions Jean relied strongly on her faith and the belief that she had much more life to enjoy – including five grandchildren ranging in age from 17-25. In fact, every week Jean sends each of her grandchildren in college a care package.

“I like to stay in touch and stay connected since we don’t live near each other,” said Jean. “They may be kind of strange care packages, but I think that they enjoy them and they respond.”

Staying connected and involved, Jean lives her life to the fullest. This woman’s drive and resiliency ensured that cancer was not the end of her story.

Today Jean remains grateful and appreciative of Dr. Bell and his staff for their care and attention throughout the entire process.

“Jean and I, and her family, became a team,” said Dr. Bell. “She is a shining person and I feel fortunate to have been a part of her care.”

He is also personally inspired by Jean’s unwavering dedication and support of her grandson’s biking career. “Jean is an amazing person and exactly who I would want on the sidelines cheering me on,” said Dr. Bell. “Our goal was to get her to her personal finish line so she could get back to cheering for her loved ones at their finish line.”

Why a Second Opinion?

Dr. Edward EignerTalking-About-Mens-Heath was recently featured on Talking About Men’s Health, a national blog focused on the health and well-being of boys, men and their families, discussing why seeking a second opinion is a critical step before deciding on prostate cancer treatment. By asking the right questions and utilizing helpful resources, such as Urology Associates’ free, online second opinion platform, you can have peace of mind that you are making the right decision for your health and future.

Learn More by Reading the Blog

Herbal Viagra Supplements: Safe or Shady?

Lamar Odom’s case shows that taking ED supplements like sildenafil to aid in erections can do more harm than good, so check with your physician before trying them.

Man with ED Considering Herbal Viagra for EDFull disclosure: I don’t follow professional basketball. There is something about the strategic fouling that drives the last two minutes of the game that doesn’t ring true to me. I want to yell “PLAY THE GAME!!!” But, in fact, that is exactly what they are doing, just not in the way I like.

So, up until a few weeks ago, I had never heard of Lamar Odom, former NBA star and husband of a Kardashian. Now I hear his name several times a day from many of my patients. As a urologist who specializes in sexual medicine, I’m asked questions that all focus on the so-called “natural” Viagra he consumed before going into a coma.

From reading news reports, I’ve learned that he used cocaine and consumed numerous tablets of over-the-counter (OTC) nutritional supplement designed to assist erections. I’m not going to focus on the cocaine because the danger there is obvious and well proved. The questions my patients are all focused on surround the use of nutritional supplements.

Can the purchase of a supplement at a corner convenience store cause harm? The short answer is – absolutely!

Let me be clear. I do believe that the reasoned use of high-quality nutritional supplements can enhance erectile response. The problem is that a number of enhancement supplements are tainted with counterfeit Viagra, Cialis or Levitra.

If it works, I’m taking it

Now, at $40-50 per pill for those drugs, a number of my patients have asked why it is so bad that these OTC supplement are “tainted” with prescriptive medications. As one of my patients put it, “If it works, it works. And if it works and is affordable – I’m taking it.”

Here’s the problem. Erectile dysfunction (ED) pharmaceuticals cause immediate and significant physiologic changes. These changes, when occurring in moderation and under the supervision of a physician, are beneficial.

Unfortunately, when purchased at a 7-Eleven and self-administered, they can be dangerous. This is because, (i) we don’t know the dosage of the active medication within the supplement, (ii) we don’t know the quality of the ingredients (remember, these are often counterfeit medications made by unregulated labs from overseas), and (iii) a physician is not monitoring whether there are pre-existing conditions that would place the individual at greater risk from the medication.

So, what should a consumer do? How can someone differentiate between quality nutritional supplements and those that are drug-tainted? Unfortunately, this can be challenging. The FDA keeps a list of known offenders, which they call “tainted products” because they are supplements that contain a pharmaceutical drug. But the market changes so quickly that I question whether the list is completely accurate.

Lamar Odom is reported by the Washington Post to have taken Reload and Libmax Plus. The FDA tagged Reload with a warning that it contained sildenafil, an active ingredient in Viagara. The FDA reported in 2009 that Libmax was removed from the market by the manufacturer because it contained tadalafil, another ingredient in a drug approved for ED. But the (legal) brothel in Nevada where Odom had his problems sold him the product from its store.

Rather than get into trouble assuming that a natural supplement for an erection is safe, I advise my patients to listen to their gut. I explain that pharmaceuticals like Viagra are utilized on an as-needed basis and often taken 1 hour prior to sexual relations. Quality nutritional supplements, on the other hand, work over time and require daily dosing.

With that in mind, I would avoid any supplement that promises fast action, any supplement that is sold in small quantities (1-5 pills taken in a one time dose), and any supplement that makes outrageous claims of success. ED is a condition that often times requires a specialist’s care. I offer the full array of treatment options from medications to injection therapy and, if needed, surgery.

Remember, if the claims are too good to be true then they aren’t true.

The most recent reports on Lamar are ominous. There appears to be significant and permanent brain injury. He has a long road ahead of him. I can only assume that it wasn’t cost that motivated him to utilize the particular nutritional supplements that he consumed. My sense is that he was moved, in part, by the desired results but also, in part, by the pervasive belief that something purchased over-the-counter can’t hurt you. That’s just not the case.

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