As a urologist it was very common for me to see patients for the diagnosis and treatment of impotence. Impotence refers to the ability to achieve and maintain an erection for sexual intercourse. Before treatment I had to arrive at the correct diagnosis.
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Through the process of history taking, a physical exam and testing, we first categorize impotency as either physical or psychological. Over the decades of evaluating men, it became quite evident that when a man has a physical cause of impotency, there is often psychological overlay worsening the physical cause. This often makes treatment more challenging.
The are subcategories to physical impotency. This may be caused by neurological disorders, vascular disease, physical changes, hormone issues or medications.
Of the neurological disorders, some are easily identifiable through history or physical exam. Typical causes are diabetes mellitus, alcoholism, multiple sclerosis, spinal cord and nerve injuries and nerve injuries due to pelvic surgery such as prostate surgery.
Regarding the vascular causes, this could be due to either the arteries (inflow) or veins (outflow). There has to be more inflow of blood than outflow in order to have an erection. The most common inflow abnormality is atherosclerosis (hardening of the arteries). This can be caused by smoking, high cholesterol levels in the blood or may be familial. If the valves in the veins are incompetent, this may cause the erection to be incomplete or early loss of an erection.
There are multiple physical changes which can occur. The most common are Peyronie’s disease, penile fracture, pelvic injury or pelvic surgery.
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Low testosterone or thyroid hormonal changes can cause impotency.
There are multiple medications which may cause impotency. These commonly are antidepressants, antihypertensives, chemotherapy medications, Parkinson’s medications, prostate cancer medications and anti anxiety medications. Drugs that affect or suppress the central nervous system such as alcohol, barbiturates, nicotine and opioids can be suspect in causing impotence. My experience with patients using cannibus is that for some it improves erections and others it worsens them.
Finally psychological issues can cause impotence. The most common I saw in my practice was performance anxiety. This is when a man is so worried about having difficulties that he psychs himself out of it. Other causes can be depression, loss of sleep, relationship issues, anxiety, stress and low self esteem.
After resolving the cause or causes of impotence, the physician has a better guide as to treatment.
The open waters are full of potential dangers including sharks, jellyfish, people on jet skis and more….but there is a new one recently which is surprising everyone. Why do whales keep swallowing people. The chance of a whale swallowing you is smaller than winning the Powerball, but it is happening…and science isn’t quite sure why.
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There have been a few extraordinary incidents where people have been swallowed by whales, sparking both fascination and concern. These events, though extremely rare, have garnered significant attention due to their unusual nature. Such incidents are rare because whales generally do not target humans as prey. Humpback whales, for example, feed on small fish and plankton using baleen, making it physically impossible for them to swallow a human whole.
In the last couple of days, a humpback whale briefly swallowed a 24-year-old kayaker last Saturday during a father-son excursion out on the icy waters around Chile’s southernmost Patagonia region. After being spat out of the whale, the son swam towards his dad’s pack raft and holds onto it as they pull away.
Another documented case is Michael Packard, a lobster diver from Massachusetts. In June 2021, Packard was briefly swallowed by a humpback whale while diving off the coast of Provincetown. He managed to survive with minor injuries, including soft tissue damage and a dislocated knee. Experts believe that poor visibility and the whale’s feeding behavior likely contributed to this accidental encounter.
Two girls were swallowed by a humpback whale while kayaking in California. The whale spat them out after a few seconds, highlighting the accidental nature of such incidents.
In addition, Since 2020, orcas off the Iberian Peninsula have been attacking sailboats, with at least three vessels sunk and hundreds damaged. These coordinated attacks typically involve orcas targeting the rudder, often approaching from the stern. Scientists believe that a traumatic event, possibly involving a female orca named White Gladis, may have triggered this behavior, which is then imitated by other orcas. Theories suggest the attacks could be for hunting practice or revenge. Despite the incidents, no human fatalities have been reported, but sailors are increasingly concerned about safety in these waters.
Whales, particularly humpbacks, feed by lunging through the water with their mouths wide open to engulf schools of fish. If something lies directly in their path, they might not always detect or avoid it in time. This feeding behavior, combined with factors like poor visibility, can lead to accidental encounters with humans. So it is always good to be clear of you environment and what type of wildlife frequent the area.
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