A Little Background…
I have been administering extracorporeal shock wave therapy (ESWT) for erectile dysfunction (ED) for almost a year (May 2020). One of my goals was to use this non-invasive therapy that delivers pulsed sound waves in conjunction with lifestyle change and low dose PDE5i medications (“Viagra type”) if necessary, to help men/couples achieve successful intimacy. At the same time, I was hoping to motivate men (and their partners) to reverse their heart disease, diabetes, obesity and reduce their medication use for chronic diseases which are common contributors to ED and inhibit healthy aging.
Intimacy Is A Lot About Confidence…
One thing is obvious in talking to my male patients is if you do not have confidence that you can get an erection and maintain it, you probably won’t start or attempt to be intimate for fear of performance failure. This could be taken wrong by the partner as not being desired or the male partner just does not care if they have intimacy or not. My experience is men care very much about intimacy and closeness, especially as they get older.
What is Success?...
In doing this work for almost a year “success” isn’t just about just helping a fellow male get and maintain a firm erection. It’s about helping a man move to a position that he feels confident in sharing his caring and physical enjoyment with his partner and “does not hesitate” to do so.
The Great American Anti-Depressant…
Almost everyone who undergoes the above combined approach to ED has some improvement within the first 4-8 treatments. The patient will walk in with a grin on their face, a little more swagger in their step, mention something regarding an old lost friend in an “early morning erection”, or just an unexpected “rise” without intended stimulation for the first time in years. This does not mean a perfect erection for successful intercourse, which is a main goal, but it is a sudden change for the better. You can see the confidence boost, hope and relief. This is rewarding to see!
Erections are Back Now What?...
This was a surprise finding to me in working with men (couples) on the ED issue. But the more I think about it (and listen to my patients) it should have been obvious. The patient’s physiology may work good enough to have an erection from this combined treatment program, but the relationship or partner may not be ready for intimacy for a variety of reasons!…?
What? You thought the problem was just the male’s inability to have a good enough erection for intercourse? Not exactly! The relationship AND the partner’s health/physiology must be on solid ground for intimacy to start occurring again.
This was a problem that I was not thinking about when I started on this journey of treating men using ESWT, medication and lifestyle change. But it is a BIG issue! Probably bigger than trying to help fix the patient’s inadequate erections. I would say that of all the men who have improved their erections to where they could have intercourse maybe half AREN’T having regular relations with their partner. Not because they cannot but because their relationship with their partner or their partner’s health/physiology is not ready, or a combination of both. And most of these situations where there is no regular intercourse is usually in long-term married couples! The “whys” of this are a discussion for another day.
Two “Stories (Cases) From the Stirrups!”
Let me explain the title of this section. It has brought laughs from everyone I have shared it with as a a possible book chapter title of case studies of men receiving ESWT.
When this pulsed sound wave therapy is administered it can be done with the patient flat on their backs on the table with their legs in “V” like position with heels together or apart to help expose the perineal area which is the space underneath the scrotum to the rectum. On either side of this area is the Crura which are areas treated with the sound waves or “shocks waves” (not electrical shocks). These areas are usually treated after either side of the shaft of the penis is treated and around its base. So for the first few months I treated people in this laying flat position with the patients heels together and legs in a V shape to get access to crura. Then one day a patient came in and said he was treated at another clinic and received these treatments while in the “stirrups.” Like females have to do for their female exams. So I tried it. It was easier on my back and no problem for the patients so I have been doing the treatment with men “In the Stirrups” ever since. So at the first visit the man is bit apprehensive and looking at the table, then me kind of funny. Like they are saying (thinking) “Really?” Even though I have shown them the device before and how it works, getting up on the table undressed from the waist down can make a man a bit “hesitant.” But after the first treatment it’s like getting into the neighborhood ”Barber Shop Chair”. And being a 63 year old male myself men quickly feel comfortable sharing with me many things about their lives as we do our 1/2 hour treatment once or twice weekly.
By the way I always invite the partner to come and see the device, how it works and the room. The female partners have a “quiet laugh” when they see that their man has to get up in the “Stirrups” for their treatment. It lightens things up which is good!
Case #1 - You are Never Too Old to Have Intimacy…Never!
Here is a joyful, rewarding “case study” embodying the concept that you are never too old to enjoy intimacy, sex and play.
First let me say I am not seeing “young bucks” in their 30s, 40s or early 50s with ED just needing a “tune-up”. Most of my patients are in their late 60s, mid to late 70s and a couple of 80 year-olds and one 90 year old… It’s never too late and you never are too old to think about sex and take action on it. This type of thinking and action will help keep you young and functional in other ways besides just sexual activity. And, enjoy more of your life in those “Golden Years”.
“Success!”, Intimacy and Play at 80!
An 80 year old male came to see me who had NOT been sexually active for 10-15 years. Actually, he could not remember how long really, but it was a long time. His wife had died several years ago. He could not remember the last time he had an erection.
He met another widower who had gone through a stressful care taking experience with her husband before he died. He met her at a party. Asked her out. And the rest is history. They hit it off from the moment they met. Since then, they have been having a “blast” together. You can just tell by the way he (and she) talk that they are having so much fun just being together. What is great about this couple is how playful and genuine their gratitude and appreciation is for this relationship, especially both having lost their spouses at this stage in their lives. After a few months they decided to live together.
All this joy and fun initially occurred without having physical intimacy. Well, I should say having sexual intercourse, the intimacy was there.
This 80 year old individual came to me with a desire to have functional erections and more importantly to improve his fading memory. He also had a problem with high blood pressure and was on two blood pressure medications.
His “new” partner and he were at the first visit togehter and while ED was a big issue the bigger issue was memory. Blood pressure was a secondary but a significant problem. The good thing is all these problems are connected and have about a 95% similar lifestyle approach to improving these conditions. If you improve circulation and artery function (relaxation of the inner lining of the artery – endothelium) you will improve memory, heart disease, blood pressure and probably erections.
Combining Therapies Because of Cognitive and Vascular Issues
I recommended IV chelation therapy along with comprehensive lifestyle and diet change to this patient because I was concerned about his vascular health and questioned how fast and how willing he would be to dramatically change his diet. He also has received some intravenous NAD which at least initially has improved cognition and energy in some patients.
There is a sense of urgency when dealing with cognitive decline. You need to get the patients involved in their self-care when they are still independent. NOT after they have lost so much cognition they must rely too much on their partner, family or caretakers to maintain and/or improve their health. Early treatment with a comprehensive program is critical for cognitive maintenance and renewal. Yes memory and cognition can improve. And the initial push must be done consistently for 3-6 months (print out my Alzheimer’s prevention and treatment handout). Call and make an appointment with me for a 20-30 minute cognitive assessment test and a review of the key points and risk factors from this handout if cognition is a concern for you. Visit $150 Call 916-489-4400 Make with Kirk Hamilton PA-C.
Brain, Erections and Vascular Health
I digressed a bit in this ED case study because cognition was the major issue in this patient even though improving sexual performance was very important. The patient has been on multiple blood pressure medications for years. His blood pressure came down over a two month period mainly by lifestyle change and presently he is off both medications and his blood pressures are normal. Blood pressure medications can effect ED and they are a sign you have some endothelial dysfunction which is not good for ED, hypertension or your brain. He has also been able to stop his GERD (heart burn medication) mostly by diet change.
The truth is if you really improve the contributors to cognitive decline you will probably be well on your way to improving the physiology of erectile dysfunction and improving one’s blood pressure as well (endothelial dysfunction).
We added physiologic testosterone therapy because his levels were low and because testosterone can help all three conditions (blood pressure, memory and erections). What I mean by “physiologic testosterone replacement” is replacing the testosterone to blood levels in the upper half of the normal range of free and/or bioavailable testosterone. Not necessarily “young buck” 20 year-old levels. Though many men want to go there. Testosterone helps with memory, mood, assertiveness, “can do” attitude, lean muscle mass, libido, to a lesser extent helps with erections and normal blood levels are generally cardioprotective. So, correcting this one imbalance helps with ED, cognition and vascular disease.
Back From Brain and Memory Preservation to Erectile Dysfunction
So back to this wonderful patient who has improved his ED dramatically, resolved his high blood pressure at least for now, and has stabilized his cognitive decline doing these multiple therapies.
A happy patient who has the return of his erections hopefully gets a “shot in the arm” to continue practicing the lifestyle factors that will also help keep his blood pressure and improve his cognition.
So, the happy beginning of this story, along with energy improvement, blood pressure and BP medication reduction (off both BP medications for now), was erections that were firm enough to have successful intercourse several times per week after only 2-3 weeks (4-6 treatment sessions) on the “total” program.
For me it is a great joy and incredibly rewarding to see the pieces come together where a patient combines non-invasive, low risk therapies with lifestyle change and you see not only the main complaint improve but other complaints as well. And to see a happy couple genuinely enjoy each other more! The Best!
There is more work to be done with this patient. With the erections working for happy sexual relations my biggest concern is keeping the patient’s focus on living a lifestyle and doing therapies that continue to maintain and improve his cognitive decline (see handout) and vascular health (see handout) . The effort has to be for the rest of his life!
Case #2 - An ED Success Story Working Through Prostate Cancer Treatment, “Nerve Damage” and Recovery
A 68 year old male who had prostate cancer and recovered but the treatment left him with erectile dysfunction and a numb penis for a year or two with some partial improvement in sensation over the last 2 years. When he came in he still had partial numbness, his erections were “soft” and if there was intercourse he could really not “feel” during sexual intercourse. He had been taking low dose Cialis 5 mg twice daily and used a penile pump daily for “penile rehabilitation” after the prostate cancer treatment for the last 4 years.
Since he had this ED problem for several years and he had numbness he committed to 18 treatments, twice weekly using a radial shockwave device (rSWT) initially and then a focused device (fSWT) for the rest of his 18 treatments. They both produce pulsed sound waves but by a different mechanism. A mechanical air driven pellet versus and magnetic coil. Both ways can be effective in the treatment of ED.
His began to feel a “sensation” in penis after 3 or 4 treatments. This was a dramatic result since he has had partial numbness for almost 4 years. His erections started to improve midway in those 18 treatments and now they are working very well. He is on 5 mg of Cialis daily down from 10 mg. He is not doing the penis pump any longer. The amount of semen and strength of ejaculation continues to increase in volume and strength on a consistent basis. He is having strong orgasms. His sexual desire is very good (he is not on testosterone but has “normal” levels). While he has great desire and is sexually functioning well his wife had some issues with comfort which had to do with her physical health and probably hormonal status. But they are working through them. His wife’s discomfort was improved considerably just by changing positions. They continue to communicate and work on ways to make intimacy more comfortable for her.
Him having feeling in his penis has been a dramatic positive change since having the treatments. Having a firm erection without feeling would be better but not satisfying. So whether the treatments help with nerve regeneration or increased blood flow or both good sensation along with the erections is great for him and his wife.
In a sense now he is “ahead” of his wife in being able to have a more active and more frequent sex life. His physiology is working great and “on demand” and he can count on it. He is ready to go because so many things have improved, including arousability and desire. How much renewed confidence has in all this is hard to tell but I think it is significant.
ESWT Side Effect? Less Nighttime Urination!
Along with improvements in his erections, desire, orgasm, arousability, sensation this patient also had more sensation of complete emptying after urination. He is not urinating at night at all. So nighttime urination and complete voiding have improved significantly. This improvement is probably do to the second part of the ESWT where the shock waves are directed at the Crura on both sides of the area underneath the scrotum to the rectum that are treated with shock waves as well. These areas are rich in arteries and nerves. There is evidence that treating over the middle portion, or directly “aiming” at the prostate, can help with enlarged prostate symptoms of nighttime urination frequency and incomplete emptying with urination (Radial Extracorporeal Shock Wave Therapy as a Novel Agent for Benign Prostatic Hyperplasia Refractory to Current Medical Therapy) . Lifestyle, especially what you eat and drink, plays a big role in effecting nighttime urination. Try an eliminate dairy products, caffeine, coffee and alcohol for a week and see what happens to nighttime urination along with doing the shock wave therapy.
This patient is on a monthly treatment (ESWT) maintenance for six months then he will see what he feels he needs to do to maintain his progress.
Continued communication with this wife’s comfort is key. Hormones vaginally or topically would be reasonable and probably helpful once the concern about a breast abnormality found on a recent scan is clarified.
This patient is on the following supplements of which all of them, except the multivitamin, are to improve blood flow and artery health.
SUPPLEMENTS
Aged Garlic Extract 2/d
Algal Oil 2/d
Arterosil 1/d
Berkley Life Nitric Oxide 1/d
DGF Multivitamin 1/d
CoQ10 100 mg/d
Red Yeast Rice 1/d
EXERCISE every other day 1 ½ hours
MEDICATIONS:
Armour Thyroid 150 mg a.m.
Cialis Tabs 5 mg 1/d
Tamulosin HCL Caps 0.4 mg 1/d
________________________
Prostate Help, Nighttime Urination Treated with ESWT and Diet
Patients being treated for ED with ESWT and diet change have mentioned on numerous occasions that their urinary frequency at night has been reduced from 3-5 times to 1-2 times per evening and they have a more complete urination after 3-5 treatments for ED in which I frequently treat the prostate as well. I have only had one “treatment” failure using ESWT for frequent nighttime urination. This person didn’t have a big prostate on exam or elevated PSA so the urination issue may not have been related to the prostate. I recommend diet change including a low-allergy (no dairy, wheat, eggs and yes caffeine), whole food, mostly plant-based diet (palm full or less of animal food daily, pages 1 & 2) for 2-4 weeks along with weekly ESWT treatments (20-30 minutes each, virtually pain less, $150 per treatment). Eight weekly ESWT treatments is a fair trial (see study). I would HIGHLY recommend taking a 2 week trial off alcohol and caffeine, yes your beloved coffee, and alcohol, to see how these two liquids effect your nighttime urination.
You can make a scheduled FREE 15 Minute phone appointment with me to discuss your prostate or urinary situation before committing to 4-8 treatments. CALL 916-489-4400 to schedule your FREE 15 minute appointment with me Kirk Hamilton PA-C.
______________________
Appointments for ED Program…
If you have interest in improving erections and sexual intimacy, make a free 15 minute phone appointment with me to discuss. Tell the office it’s Kirk’s Free 15 minute EPAT appointment. If you are a patient tell them so they can pull your chart. If you already know that is what you want to work on, then just make a normal 90 minutes appointment with me and we can get the program going which is usually 12-18 treatments over 2-3 months though most people start to feel some improvement in 4-8 treatments. All ED patients have a complete physical exam and blood work screening for heart disease, diabetes, blood sugar metabolism, inflammation and hormone status before they start, and on an annual basis at least.
Appointment for Memory and Cognition Check…
If you have a concern about your memory (or a loved one) and cognition see me for a 20-30 minutes just to do a screening cognitive test and educate you on preventive things you can do right now and how you or your loved one might be assessed before going forward on a comprehensive memory improvement program. I will go through risk factors for cognitive decline, potential treatment approaches (see handout) and do a standardized cognitive screening test that takes 15 minutes to give you an idea if you or loved one has mild, moderate or severe cognitive decline. Cost $150.
The three books to read on cognitive decline are The End of Alzheimer’s Disease Program by neurologist Dale Bredesen and The Alzheimer’s Solution and the The 30 Day Alzheimer’s Solution by neurologists Dean and Ayesha Sherzai . My handout outlines their books. I have done physician trainings under Dr. Bredesen and am very familiar with his work as you will see from the handout. I would also recommend Dr. Bredesen’s NeuroQ assessment and supplement. I have heard the Sherzais speak many times. I think their work is great for prevention and reversal of early cognitive issues.
CALL 916-489-4400 and make this 20-30 minute “Memory Check” appointment ($150). Unlike heart disease or diabetes where you can wait and reverse those disease years later with diet and lifestyle, and ,be “held” together with medication or procedures for years, there is no traditional medical therapies that buy you time with your memory. With cognitive decline you need to act sooner than later. Like NOW because the individual with cognitive decline will not be able to do the complexed program on their own later if their memory and cognition are poor, even though their body is functioning well. Call now and get your “Memory Check” visit (916) 489-4400.
CALL ME WITH QUESTIONS OR MAKE AN APPOINTMENT...916-489-4400
Be Thankfull!
Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com