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Sex is one of the biggest concerns for heart attack survivors and people with heart disease. How risky is it? A recent US report has some answers. Th researchers concluded that sex is safe for most heart patients, as long as someone was healthy enough to ascend two flights of stairs.

However, the studiey's author Glenn Levine, a professor of medicine at Baylor College of Medicine in Houston, stressed that people should also do cardiac rehabilitation before engaging in any sexual activity.

Sex would probably be all right, they said, up to one week after a mild heart attack, when a patient should be able to ascend a few flights of stairs without discomfort.

Viagra was generally safe for men who had stable heart disease, they concluded.

In general, the doctors found that sex was a minimal risk in contributing to a first heart attack. On the other hand, they found that married men having affairs with younger women had the highest risk of sex- sudden death.

For couples under less stressful situations, sex can be beneficial. Dan Fintel, a professor of medicine at Northwestern University in the US, said that resuming sexual activity was safe and actually counted as part of the post-heart attack healing process.

Usually, all you need to get a prescription for Viagra is to "have a talk" with your doctor. An amendment proposed by Virginia state senator Janet Howell (D-Fairfax), would have required patients seeking the erectile dysfunction drug to submit to a more "probing" check up - a digital prostate exam.

The amendment, which would have required men to have a prostate exam and cardiac stress test before obtaining Viagra, was payback on a bill requiring women seeking abortions to undergo sonograms. The bill, introduced by state Sen. Jill Vogel (R-Fauquier), is similar to one passed in Texas in 2011, aimed at deterring women from terminating their pregnancies by making them view a sonogram and listen to a detailed description of the fetus.

Said Howell, "The Virginia senate is about to pass a bill that will require a woman to have a totally unnecessary medical procedure at their cost and inconvenience. If we're going to do that to women, why not do that to men?"

The rectal exam amendment was defeated by a 21-19 vote in the state senate, while the sonogram bill, SB 484, passed the senate by 21-18. No doubt it will pass as well in the Republican-controlled Virginia house of representatives, although its constitutionality will certainly be challenged.

After Howell presented her amendment on the senate floor, Senator Vogel countered that erectile dysfunction and pregnancy are clearly not equivalent. Agreed, but requiring unnecessary sonograms and proctological exams is equally ridiculous.

The Polish company that tried to trademark the name Viaguara for a beverage is out of luck. The European Union's General Court rejected their appeal of a 2005 decision which blocked registration of the brand name on the grounds that it was too similar to the famous drug.

The court ruled that the beverage would be taking unfair advantage of Viagra's reputation. The court also expressed concern that confusion between the products could be medically dangerous, which seems like a bit of an exaggeration.

So what is Viaguara? Some sort of energy drink, probably containing guarana, possibly containing alcohol. Whatever it is, it's going to have to go to market with a much less exciting name, which hasn't proven to be an issue for, say, 5-Hour Energy. Although a product called 5-Hour Viaguara would really fly off the shelves.

British gardening expert David Domoney recently gave this pro tip on his TV show: to keep cut flowers from going limp, give them a dose of Viagra. The nitric oxide helps preserve the integrity of the flowers and prevents them from breaking down.

We've known about this trick for years. Israeli and Australian scientists documented that a small dose (1mg) of sildenafil added to their water could keep flowers fresh up to a week longer. Independent research  corroborates the laboratory findings. After a week, flowers given Viagra just stand up straighter, while the others are floppy and droopy.

Domoney said that if you're reluctant to part with your Viagra, or it's too hard to come by, a bit of aspirin might do instead - to keep your flowers perky, that is. It won't perk up much else.

Viagra may soon be the drug of choice for helping US military personnel keep their little soldiers at attention. The formulary advisory panel of Tricare, the military's health plan, has recommended that military pharmacies drop  their current erectile dysfunction drugs, Bayer's Cialis and Staxyn, in favor of Viagra.

Their pharmacies had dispensed Viagra until 2005, when cost considerations prompted a change. Now the blue bill is back in favor, as Tricare cites cost-effectiveness and clinical considerations as the basis for their recommendations.

If Viagra is reinstated, users would pay $9 for a 90-day supply through Tricare's mail order pharmacy and $12 at retail pharmacies for a 30-day supply.

The drug would be dispensed free at military pharmacies to qualifiying patients.

It's gratifying to know that our military truly is dedicated to letting its members be all they can be.

Everyone who's taken Viagra, or even seen a commercial for it, knows that an erection lasting four hours or longer, no matter how entertaining, is a sign you should see your doctor. Well, what if you had a stiffy 24/7. And a bad tattoo on it to boot.

Such was the dilemma of a young Iranian man whose case was recently written up and has the distinction of being "the first known case of nonischemic priapism following penile tattooing."

He had his peter engraved with his girlfriend's initial and Persian script reading borow be salaamat (that translates to "good luck on your journeys" not "borrow my salami"). Well, now his schlong is boldly going into a medical journal and urological infamy.

While penis tattooing isn't the wisest choice, the problem this guy encountered is a relatively rare occurrence. The tattoo artist used a heavy duty needle and a traditional middle eastern tattooing method that involves jabbing through the skin by hand, not with a machine that would allow for depth control, then rubbing in the coloring agent. The punctures caused fistulas and bleeding into the penile tissues - and no doubt a world of hurt both during and after.

The internal damage lead to an inter-penile aneurism, and blood began to pool in his member until it reached a permanently erect state. Doctors advised him to have the blood removed, but he opted for a shunt procedure, which failed. Since he's no longer in pain, and can function normally otherwise, he's refused further treatment - perhaps understandable given the amount of genital trauma he's endured.

As the authors of the medical article astutely conclude: "Tattooing should be added to the etiologies of nonischemic priapism. Considering this case, we discourage penile tattooing." It can also be added as an effective but inadvisable cure for erectile dysfunction.

Nitric oxide, the catalyst for Viagra's magic, has a number of other important functions in the body. It's been established that NO can stimulate healing (besides sexual healing, wise guy). NO has properties that combat bacteria, stimulate immune response, and promote healing in wounds, and it's ideal for tough-to-treat MRSA (methicillin-resistant S. aureus) infections. The problem is that it's a gas, and so far there hasn't been a good way to deliver it to the site of an infection.

Welcome to the world of nanoparticles. Nanoparticles are - well, the most important thing about them is that they're really, really, really tiny, so they can go places bigger particles can't. Now researchers have developed NO-releasing nanoparticles that can penetrate skin, where they unleash that NO like scrubbing bubbles on infected soft tissue.

Oh, yeah - and the nanoparticles had one other interesting effect in lab tests: they caused rats to get erections. Bonus.

So, how do you think the researchers came up with that bright idea? One of the co-authors of the paper describing the study "notes that, beyond the antimicrobial and wound healing applications, the important role of nitric oxide in maintaining vascular health also lead to the team's testing of the efficacy of NO nanoparticles in addressing conditions associated with endothelial dysfunctions."

Translation: "We know what Viagra does, so we thought we'd give it a shot and see if this worked too."

"NO nanoparticles were shown to increase erectile function when applied topically to the penis of rats...and even more importantly, in a post-radical prostatectomy animal model with cavernous nerve transection - a clinical scenario in which PDE-5 inhibitors (Viagra) are ineffective."

Sorry. Now you all need a little brain bleach to expunge the image of some unfortunate lab assistant tasked with applying this stuff to rat genitalia, but the takeaway is that it may be able to get the job done even when Viagra can't - giving hope to those whose erectile dysfunction is Viagra-resistant.

I could see the development of NO-delivering nanoparticles having a similar trajectory to that of Viagra: a drug developed for one purpose that turns out to be wildly effective at something much more compelling. Oh, sure, saving lives is great and all, but face it, stiff erections trump staph infections.

Some people hoard animals, some people hoard old newspapers or empty margarine tubs. And some people, apparently, hoard erectile dysfunction drugs.

In Union City, New Jersey, 75-year-old Rafael Molfa Gandulla called police to report a break in and theft of some luggage. While searching the premises for evidence, the cops came across $2,000 worth of Viagra and Cialis.

Wow.  Costco pharmacy must have been having a special on the 5 lb. jars.

How much is $2,000 worth of Viagra? Well, at $7.50 per pill (a typical price), that's about 266 tablets. A few pills short of a kilo, but still, that's a well-stocked medicine cabinet. Is there any legitimate reason to have that much in your possession? Maybe he was kind of OCD and had anxiety about getting caught without his Viagra when he needed it. Maybe he was hoarding it to drive the price up.

It probably seems a little sketchy to have thousands of dollars of pharmaceuticals on hand. Especially when you also have $20,000 in cash sitting around your house. Theoretically, all those pills might have been for Mr. Gurdulla's personal use - he is 75, after all. Although, judging from his mug shot he doesn't exactly look like Casanova material. But whether or not all of that was for Mr. Gardulla is moot - since he didn't have a prescription. He also had a small amount of (non-medical) marijuana, and received drug charges for both.

Detectives speculate that the stolen luggage may also have contained thousands worth of pills. Mr. Gurdulla said the luggage had been packed for a trip he was about to leave on. There would have been a lot of rockin' on that cruise ship.

So what's this guy's story? Viagra smuggler? Geriatric swinger? Or obsessive compulsive pharmaceutical hoarder? If you could work a dead body in there somewhere, it would make a great episode of CSI.

The UK's National Health service is getting sharp criticism from both patients and doctors, after announcing it's new "guidelines" for General Practitioners around Viagra prescriptions. The NHS has recommended that GPs limit Viagra user to two tablets per month.

Viagra is already hard enough to get under the NHS's restrictions, so it's no surprise that patients are displeased with the edict. But their doctors aren't happy about it either. Maybe they resent the NHS dictating how they should care for their patients - especially when the agency refuses to share the reasoning behind the new pill quotas with the public.
 
The recommendation was based on evidence in a study by an organization contracted by the NHS, who say they can't publish the information for copyright reasons. Said an NHS spokesperson, " 'As far as we're concerned we're not allowed to, because of the contract we hold with them, publish the evidence they give us because it's their product, it's what they produce, it's not our intellectual property, it's not something we produce.' "

Dr. Paul Roblin, chief executive of a GPs Local Medical Committee, accused the bureaucrats of finger-pointing: 'There are four organisations involved...we're trying to find who actually supports the restriction of information, it's actually quite difficult, they all blame each other'.

The organization that conducted the original study is called Solutions for Public Health, which might be a misnomer. Wouldn't you think the public would have a right to know how public health policy is determined?

If you know your Viagra history, you know that the drug sildenafil was originally developed as a medication to treat heart conditions and high blood pressure. At the time, it was considered a flop at that, but more than made up for it with its spectacular sexual side effects.

Viagra's monumental property of countering erectile dysfunction all but eclipsed any other medical applications. There has been some continued research, and sildenafil has proven effective in treating pulmonary hypertension as well as a few other less common conditions.

Now it seems researchers were perhaps a little too hasty in tossing in the towel on using Viagra for cardiac treatments. Some 15 years later, a recently published study shows that sildenafil may have dramatic benefits for patients suffering from diastolic heart failure, working within minutes. This has big implications. "Of all the patients aged over 60 who are in hospital because of a weak heart, half suffer from diastolic heart failure" explains Prof. Dr. Wolfgang Linke, author of the study.

The article indicates the initial experiments were done with dogs having diastolic heart failure. Perhaps that's what was ailing Ingrid the pitbull, who we met in our last post. She was rescued from death's door step by a quick-thinking vet who prescribed Viagra. Maybe the doc was ahead of the curve and had already read the medical literature.

Paradoxically, the drug helps by relaxing heart tissue that has become too stiff. Not what comes to mind when you think Viagra, but the enzyme that the drug inhibits acts differently in different organs of the body.

Just goes to show, the little blue pill truly is a wonder drug: it softens hard hearts and hardens soft...