jump to navigation

High Blood Pressure and Erectile Dysfunction: Working With Your Doctor August 31, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

If you have high blood pressure (or hypertension) and are having problems
with erectile dysfunction (ED), the first step toward a solution is to see your
doctor. You may be a bit hesitant to discuss your sex life with a doctor, but
rest assured. Your doctor has heard it all before and will know how to help
you.

Erectile dysfunction is fairly common in men with high blood pressure. One
study in the Journal of the American Geriatrics Society found that
nearly half of men aged 40 to 79 with high blood pressure had it.

Your doctor will need a lot of information from you before suggesting any
treatment. If this doctor had been involved in your care for high blood
pressure in the past, you can talk about how well you’ve been controlling your
blood pressure and about how you are doing with the medications you’re taking.
If you are meeting with a new doctor, you will share all that, plus
information about other health problems you may have, like diabetes or high
cholesterol.

Telling a doctor that you have difficulty with your erection is not the
easiest thing to do. But to get the right care you have to tell your doctor
everything, including the truth about things like drinking a lot of alcohol,
doing drugs, or smoking cigarettes. It’s in your best interest to be totally
honest.

You may also feel uncomfortable if the doctor asks a lot of questions about
your sex life and your emotions. You may be asked things like:

Again, it’s best to answer honestly, even though these things are very
personal.

A doctor you are seeing for the first time may also need to examine your
penis, testicles, and prostate gland. Some men have their testosterone level
tested.

There is another test that is done sometimes to see whether you get
erections while you are asleep. The doctor may send you home with a special
tape that you wrap around your penis before you go to bed. If the tape is
broken in the morning, you’ve had an erection during the night. That means the
cause of your erection problem may not be physical.

In many cases erectile dysfunction does have a physical cause.

The first treatment doctors usually try is one of the erectile dysfunction
pills: Cialis, Levitra, or Viagra.

Typically you will see the doctor again for follow-up around the time that
your prescription runs out. You can talk then about any issues you may be
having with the medication. Maybe it’s not working as well as you’d like. If
not, you can make sure you’re using it correctly. The doctor might switch you
to a different drug or a different type of treatment if thing’s aren’t
improving.

It’s a good idea to stay in touch with your doctor about your erectile
dysfunction. Changes in your health over time may affect your treatment. But
you don’t need to be in the doctor’s office more often. Since you will already
have regular checkups for managing your blood pressure, bring up your erectile
dysfunction treatment at those visits.

Remember, there’s no such thing as a bad question. Your doctor asks you lots
of questions. Feel free to ask as many of your own, until you’re confident that
you understand all the risks and benefits of your treatment. Also, it’s
important to show your doctor all the other medications that you take. And, if
the doctor doesn’t know the answer to a question you ask, you can have them get
back to you with it.

If you ever feel like your concerns are being ignored, don’t accept it. Find
another doctor who will talk to you.

But most doctors genuinely want to work together with you to solve your
health problems. You can help them help you by taking an active role in your
care. (more̷ ;)

Italian Study: Viagra May Be Risky for Men With Heart Failure August 30, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

Sept. 25, 2001 — We’ve all heard and laughed at Viagra jokes. Poking fun at “the little blue pill” is a favorite of late-night talk show hosts and regular folks alike. But for men with erectile dysfunction and their partners, the hope Viagra offers — of restoring a healthy sex life — is no laughing matter.

There have, however, been worrisome reports of health risks linked to the drug. Now Italian researchers say that taking Viagra can be deadly if users also have chronic heart failure, a condition where the heart is unable to pump healthy amounts of blood through the body.

Their new study, led by Gianfranco Picirillo, MD, of Medical Policlinic Umberto I in Rome, looked at the heart rhythms of 10 healthy men and 10 others with chronic heart failure after they took a standard dose of Viagra. While both groups experienced certain changes to their heart’s normal electrical activity, those changes were more pronounced and were potentially more dangerous in the men with heart failure.

The scientists conclude that for men with heart failure, taking Viagra may result in abnormal heart rhythms, or arrhythmias, that could lead to sudden death. The risk is even more pronounced, they theorize, for patients who also take certain other drugs including certain antibiotics, antihistamines, antifungals, and cholesterol medications.

But other heart experts are not convinced there’s anything to worry about.

“What we know about Viagra is clear,” says Gary S. Francis, MD, director of the coronary intensive care unit at The Cleveland Clinic Foundation. “Physicians are well aware of it. The drug should not be taken with nitrates [nitroglycerin] because there’s a risk of sudden, dangerously low blood pressure,” he says. There has been no evidence, however, that heart failure patients in general should avoid Viagra, he tells WebMD.

Rony Shimony, MD, FACC, says that people with heart failure who have a weak heart and irregular heartbeats automatically have a higher death rate than healthy people.

“You’re already in a higher risk group,” says the attending cardiologist at Lenox Hill Hospital and at Cornell Columbia Presbyterian Medical Center, in New York City. He says that these sudden deaths can’t necessarily be linked to Viagra and that the study “is not a reason to panic. Heart failure patients are at higher risk to start with,” he tells WebMD.

What’s more, says Shimony, “cardiac patients are clearly at increased risk from doing any form of exercise or taking any form of medication. You have to use common sense.” No doctor would prescribe Viagra to a very ill patient, he tells WebMD, but if you’re appropriately screened by your heart doctor, even if you have well-controlled heart failure, all evidence indicates that you will not drop dead.

According to Shimony, “the overall experience of the medical community has been that Viagra is a very safe drug” without long-term side effects. But because it is used only to enhance the quality of life, rather than prolong it, “when a doctor prescribes Viagra and something bad happens, that’s when the drug comes under great scrutiny.”

Francis does not completely dismiss the notion that something may be going on here, but significantly more work is needed to determine if the findings are important or not. Results from any test conducted on only 10 people “don’t mean a whole lot,” he says, but this one small study suggests is “that the use of Viagra in patients with heart failure has the potential to alter the electrical stability of the heart.” And that change, he says, “may predispose them to arrhythmias, some of which may be fatal.” (more̷ ;)

Sex and Aging August 29, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

People seem to want and need to be close to others. As we grow older, many
of us also want to continue an active, satisfying sex life. But the aging
process may cause some changes.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes
sometimes affect one’s ability to have and enjoy sex with another person. Some
women enjoy sex more as they grow older. After menopause or a hysterectomy,
they may no longer fear an unwanted pregnancy. They may feel freer to enjoy
sex.

Some women do not think things like gray hair and wrinkles make them less
attractive to their sexual partner. But if a woman believes that looking young
or being able to give birth makes her more feminine, she may begin to worry
about how desirable she is no matter what her age is. That might make sex less
enjoyable for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens
and narrows. The walls become thinner and also a little stiffer. These changes
do not mean she can’t enjoy having sex. However, most women will also have less
vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of
ability to have and keep an erection hard enough for sexual intercourse. By age
65, about 15 to 25% of men have this problem at least one out of every four
times they are having sex. This may happen in men with heart disease, high
blood pressure, or diabetes-either because of the disease or the medicines used
to treat it.

A man may find it takes longer to get an erection. His erection may not be
as firm or as large as it used to be. The amount of ejaculate may be smaller.
The loss of erection after orgasm may happen more quickly, or it may take
longer before an erection is again possible. Some men may find they need more
foreplay. (more̷ ;)

Web Sites Selling Herbal ‘Viagra’ Criticized August 28, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

March 24, 2005 — Web sites touting herbal “Viagra” for erectile
dysfunction draw criticism in a new British study.

It’s easy and confidential to find such sites, say the researchers. But
“patients should be cautious as safety and
reliability of this approach is poor,” they write.

They’re particularly concerned that some sites may not provide all the facts
about the products or warn patients to get their heart checked out.

Erectile
dysfunction (ED) may be a sign of heart disease or blood vessel
problems.
These conditions could go undetected and untreated in
patients using herbal treatments, say the researchers. Without knowing the
ingredients or side effects of such treatments, patients could unwittingly put
their health at risk.

ED Affects Millions of Men

Erectile dysfunction (ED) affects nearly 30 million men in the U.S., say the
researchers. ED may stem from physical or psychological issues or a combination
of both factors. It doesn’t mean that men lack desire or sexual interest, and
it’s not a normal, occasional problem. Instead, ED is a man’s consistent
inability to maintain an erection to have satisfactory sex.

The risk of erectile dysfunction increases with age:

Doctors can prescribe treatments to help, but many men don’t discuss ED with
their doctors. “It is estimated that close to 90% of ED sufferers are still
reluctant to visit their family doctors because of embarrassment,” says the
study.

With Internet access common, some men may go online to look for solutions.
But they may not always get what they bargained for, the study suggests.

Looking at 33 web sites selling herbal substitutes for Viagra, the
researchers spotted red flags including:

“All sites fell short of the Health on the Net requirements,” says
the study.

The Health on the Net (HON) Foundation is a medical and health web site
accreditation organization supported by the World Health Organization. HON
provides standards that it recommends health information web sites adhere
to.

What’s in the Bottle?

Herbal treatments aren’t regulated by the government. The most common
ingredients cited in the study were yohimbe,ginseng, and ginkgo
biloba.

Yohimbe can cause headaches, sweating, and high blood pressure, making it
inappropriate for patients with heart and neurological disease, say the
researchers. Reports of diarrhea, vomiting, headaches, and allergic skin
reactions have been linked to gingko biloba, they say.

That’s not to say that those herbs might not have an effect on ED. But the
pros and cons of any treatment — herbal or not — should be made clear, the
study suggests.

Health experts recommend that patients tell their doctors about any
supplements they take (including herbal products and vitamins). That could help
avoid interactions between treatments.

Herbal or Not?

Two years ago, the FDA cracked down on a supposedly all-natural herbal
treatment marketed to men and women to enhance sexual experience. The FDA
learned that the product, called Vinarol,Vinarol, actually contained Viagra’s active
ingredient, says the study.

“It is unknown how many other treatments for ED marketed as
“herbal” supplements actually contain active and potentially dangerous
compounds,” write the researchers, who included Ramesh Thurairaja of the
urology department at England’s Bristol Royal Infirmary.

The study appears in the March/April issue of the International Journal
of Impotence Research. (more̷ ;)

Viagra Safe for Men With Heart Disease August 27, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

Feb. 12, 2002 — If you’re strong enough to take the sex, you’re strong enough to take Viagra. A new study finds Viagra safe for men with heart disease — if they’re able to exercise without having the symptoms of severe disease.

Men taking nitrate drugs (such as nitroglycerin) to ease the symptoms of heart disease can’t use Viagra. Even when a man isn’t taking nitrates, there’s been concern that Viagra might make his underlying heart disease much worse. There have been reports of men suffering heart attacks or chest pain after taking the popular erectile dysfunction drug.

Adelaide M. Arruda-Olson, MD, PhD, led a team of Mayo Clinic researchers who studied the effects of Viagra on 105 men with coronary artery disease (or heart disease). The men took Viagra or a harmless sugar pill an hour before exercise tests. Then medications were switched, and the men exercised and were tested again.

The results: Viagra itself didn’t make exercise harder on the heart.

“It seems more likely that the [heart attacks and pain] reported with [Viagra] are related more to the performance of sexual activity in a patient with coronary artery disease than the use of the drug,” notes Thomas H. Marwick, MD, PhD. Marwick is a heart disease researcher at the University of Queensland in Brisbane, Australia. The Arruda-Olson study, and Marwick’s accompanying editorial, appear in the Feb. 13 issue of TheJournal of the American Medical Association.

Arruda-Olson and co-workers warn that men with heart disease should see their doctors before taking Viagra. They recommend exercise tests to determine whether patients’ hearts are strong enough for the drug.

The researchers warn that men taking nitrate-based drugs for their heart condition should not take Viagra. (more̷ ;)

The New Rules of Sex: How We Want It, Get It, Love It August 24, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

Marie Claire magazine logo

Welcome to your sex life, 2007, where the bases have changed (but they’re
still all loaded), we’re plugging in to get turned on, and we understand and
misunderstand each other more than ever, depending on the day. How to make
sense of it and get more of what you want? We went into real people’s bedrooms
(someone had to) to discover their deepest, sexiest secrets (and a few
missteps). We also surveyed the country on what’s happening in bed (don’t miss
out), and we asked the guys at men’s mag Esquire to tell us what men
really want. Don’t worry; we told them a few things, too. Indulge yourself.

In the first-ever Marie Claire/Esquire national survey, we got more
than 1700 adults between the ages of 21 and 49 to tell us you horny things
exactly what it is you do between the sheets…and at your computer, on your
desk, on the first date, in the elevator, and more. Now we know the real reason
everyone’s so addicted to their BlackBerries, what’s wrong with cyberflirting,
and how many times a week you’re getting it on. The truth, by the numbers.

ARE YOU ABOVE AVERAGE IN BED?

Average number of…
times per week you have sex: 2.6 for men; 2.3 for women
partners in lifetime: 14 for men; 11 for women
times per week you masturbate: 3.8 for men; 1.6 for women

MAYBE WOMEN JUST TYPE FASTER
61% of men surf the Net for porn; about half of them spend an hour or more
per week doing it.
17% of women surf for porn; only a third put an hour or more into it.

ITS RESEARCH, I SWEAR!

14% of women have looked at porn on the Internet at work; 32% of men have.

What’s your sex secret?
“The only way I can get off is if I fantasize that I’m a secretary and I’m
doing it with my boss.” Michelle, 27

“I keep erotic stories in my iPod and secretly read a few while watching
TV with my boyfriend. That way, by the time we go to bed, I already have a head
start.” Brooke, 26

“I hate feet, so I always have sex with my socks on and I prefer if he
does, too.” Karen, 27

“I’m not getting any!” Kristy, 32

“My friends would be amazed if they knew the real number of men that I
have slept with. It’s up there.” Kimberly, 28

“I’ve been having sex with my ‘friend with benefits’ since my sophomore
year of college. We dated for four weeks and have been sleeping together for
four years.” Kristen, 23

“I didn’t sleep with a man because he had a small penis.” Carla,
26

“I’ve always wanted to do it in a public restroom.” Jaime, 27

“I lost my virginity on my dad’s 50th birthday.” Gina, 27

Sex Around the World: How We Stack Up

Is It Something in the Waffles?

People in Belgium are happiest with their sex lives; the Chinese, not so much,
ranking last on the satisfaction scale. (USA: tied with Croatia for fourth
place)

First to Lose It

40-year-old virgins? Not exactly, but in India, the average age of first sex is
19.8, the oldest in the world. (USA: 16.9 years old)

Film Buffs

Canadians and Americans are the most likely to have cameras rolling during
sex.

Busiest in Bed

The Greeks top the frequency charts, having sex an average 138 times per year;
the Japanese just 45 times a year. (USA: in 11th place, averaging 113 boinks
annually)

Why We’re Thinking of Moving Our Offices
Place you’re most likely to have sex at work: South Africa. (USA: fifth most
likely, same as Serbia and Montenegro)

Turkish Delight

People in Turkey have had more sex partners (14.5) than in any other country,
while in India, they have had the fewest (3). (USA: ranks 13th)

Good Vibrations

Vibrator use is highest in Taiwan. (USA: tied with the U.K. for second)

Top 5 Sex Videos We’ve Seen but Wish We Hadn’t

1. Pamela Anderson and Tommy Lee
2. R. Kelly and the underage girl
3. One Night in Paris
4. Screech’s threesome
5. Bob Dole’s Viagra commercial

Top 5 Books That Sound Like They’re About Sex but Aren’t

1. The Call of the Wild , by Jack London
2. Anything by E.E. Cummings
3. Hard Times , by Charles Dickens
4. They Came Like Swallows , by William Maxwell
5. My Life , by Bill Clinton

Top 5 Roles We Wish We’d Been Cast In

1. Rose Byrne in Troy . Held captive and expected to service Brad
Pitt? The horror, the horror…
2. The mango in How Stella Got Her Groove Back the one caressed by
Taye Diggs’s tongue.
3. Demi Moore in Indecent Proposal . Sex with Woody Harrelson and
Robert Redford: What’s so indecent?
4. Shannyn Sossamon in 40 Days and 40 Nights . Josh Hartnett uses an
orchid on Sossamon to…well…let’s just say he gives “deflowering” a
new meaning.
5. Jake Gyllenhaal in BrokebackMountain. Heath Ledger is
rough and manly. Grrrr. Oh, and when he asks you to go fishing, you don’t
really have to go. We’d take that bait.

More Articles on Marie Claire.com

(more̷ ;)

Type 1 Diabetes: Living With Complications - Home Treatment August 23, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

type 1 diabetes are:

For more information, see the Home Treatment section of the topic
Type
1 Diabetes: Living With the Disease. (more̷ ;)

Breast Implants Lift Sex, Self-Esteem August 22, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

March 23, 2007 — Women report better sexuality and improved self-esteem
after cosmetic breast augmentation surgery, a University of Florida study
shows.

Cynthia Figueroa-Haas, PhD, clinical assistant professor at the University
of Florida College of Nursing, advertised for volunteers in the offices of
cosmetic plastic surgeons. Eighty-four women completed questionnaires on
self-esteem and sexuality before and after cosmetic breast augmentation
surgery.

Overall, the women didn’t have particularly low self-esteem or particularly
poor sexual function prior to surgery. But both aspects of their lives
significantly improved after they got breast implants.

“They were already OK with self-esteem and sexuality — they just wanted
larger breasts,” Figueroa-Haas tells WebMD. “They got increased levels
of self-esteem and sexuality.”

Figueroa-Haas bristles at the idea that it’s frivolous for women to want to
improve their body image. Body image, she says, is an important factor in a
woman’s self-esteem.

“A lot of people consider plastic surgery a procedure that doesn’t need
to be done. They say women should stay with their bodies and what God gave them
and be satisfied. I don’t agree,” she says. “This procedure does change
women’s psychosocial issues. There are differences [in life satisfaction]
between people with good and poor self-esteem.”

Figueroa-Haas reports her findings in the January/March issue of Plastic
Surgical Nursing.

Sex and Breast Augmentation

After getting breast implants, women experienced every measure of sexuality
more strongly, Figueroa-Haas found. After breast augmentation, women reported
significant increases in arousal, sexual desire, sexual satisfaction, and
lubrication.

Figueroa-Haas says women tend to be left out of the discussion when it comes
to enhancing sexuality.

“Improved sexuality is not all about men’s sexuality and Viagra,”
she says. “It is a subject women even have trouble discussing with other
women. But women who suffer sexuality issues feel like they are not feminine
enough.”

Despite the benefits she finds in cosmetic breast augmentation,
Figueroa-Haas warns that surgery cannot address serious underlying issues women
may have.

“This isn’t a cure-all. If you have underlying psychological issues,
don’t run out and see a plastic surgeon. These issues have to be addressed
first,” she says.

That’s a very important point, agrees clinical psychologist David B. Sarwer,
PhD, director of the weight and eating disorders program at the University of
Pennsylvania. Sarwer has studied psychological issues surrounding breast
augmentation surgery.

“Sure, body image is an important part of self-esteem,” Sarwer tells
WebMD. “But self-esteem is based on all sorts of things other than body
image. It may be unrealistic to think that, just by having breast augmentation,
a woman will improve her overall self-esteem.”

Sarwer has found that women who seek cosmetic breast surgery have their own,
personal motivations. They are not, as stereotype would have it, trying to
please their husbands or boyfriends.

Sarwer says women considering breast implants should consider three
things:

And Sarwer warns that researchers are now becoming aware of a dark side to
breast implants: suicide.

“What we think is going on here, although we are not sure, is these
women have some pathology, perhaps clinical depression, prior to surgery,”
he says. “And when implants don’t improve their depression, these women
become suicidal. For women with profound underlying issues, there is something
going on here that is potentially dangerous.” (more̷ ;)

Viagra Safe for Some Men With Heart Failure August 21, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

March 9, 2004 — Men with mild to moderate forms of heart
failure may be able to safely use the drug Viagra to treat erectile
dysfunction, a new study shows.

Researchers found selected men with heart failure were able to
use the drug without dangerous side effects if they were not taking nitrates
(drugs commonly used to treat heart failure) and had no evidence of a lack of
blood flow and oxygen to the heart muscle — commonly caused by narrowed heart
arteries.

Previous reports have shown that Viagra could trigger
potentially dangerous drops in blood pressure in these men. But this study
showed that although the drug caused a slight reduction in blood pressure in
this group of 35 men, no one experienced a dangerous drop in blood pressure or
other significant side effects while taking Viagra.

However, Viagra can cause significant decreases in blood
pressure in people taking nitrates and should not be taken by this group.

According to researchers, erectile dysfunction affects more
than half of all men aged 40 to 70 and is common among men with heart failure,
both are conditions that are linked to vascular problems. Heart failure is a
condition in which the heart is unable to pump enough blood to meet the body’s
needs.

Despite the fact that ED is common among men with heart
failure, researchers say the effectiveness and safety of treatment of erectile
dysfunction has not been thoroughly studied.

Study Clears Some Viagra Fears

Researchers say initial reports of deaths associated with
Viagra use soon after the drug was released have caused physicians to hesitate
before prescribing the drug to patients with significant heart disease.

However, it is now known that the drug does not increase
heart-related deaths, say researcher Linda J. Webster, MScN, of the University
of Alberta, and colleagues.

In this study, researchers looked at the effects of treating ED
with Viagra in a carefully selected group of 35 men with mild to moderate heart
failure who did not use nitates. The men were randomly divided into two groups:
one took Viagra for six weeks and then switched to a placebo for six weeks, and
the other took a placebo for six weeks and then took Viagra for another six
weeks.

The results appear in the March 8 issue of the Archives of
Internal Medicine.

The study showed that Viagra caused an average drop in blood
pressure of about 6 mm Hg — an insignificant drop that did not lead to
symptoms.

Researchers found Viagra improved ED and quality of life among
this group, and also appeared to reduce symptoms of depression.

“This study provides new evidence that it is safe and
effective to treat men with ED and moderate heart failure with sildenafil,”
they write. (more̷ ;)

Sexual Dysfunction in Women August 20, 2007

Posted by donald in : Sildenafil Citrate, Erectile Dysfunction Drugs, Generic Viagra , add a comment

A sexual problem, or sexual dysfunction, refers to a problem
during any phase of the
sexual response cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43%
of women and 31% of men report some degree of difficulty), it is a topic that
many people are hesitant to discuss. Fortunately, most cases of sexual
dysfunction are treatable, so it is important to share your concerns with your
partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
psychological problem.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women
include:

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a physical exam and a
thorough evaluation of symptoms and a physical exam. The doctor may perform a

pelvic examination to evaluate the health of the reproductive organs and a

Pap smear to detect changes in the cells of the cervix (to check for cancer
or a pre-cancerous condition). He or she may order other tests to rule out any
medical problems that may be contributing to the problem.

An evaluation of your attitude regarding sex, as well as other
possible contributing factors (fear, anxiety, past sexual trauma/abuse,
relationship problems, alcohol or drug abuse, etc.) will help the doctor
understand the underlying cause of the problem and make appropriate
recommendations for treatment. (more̷ ;)