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Non-Throbbing Heartthrob

Just a few days ago, a rather cherubic middle-aged  man walked into my office.  Accompanying him was a considerably younger and attractive women, who I presumed was the wife.  One can usually tell.  The 'for better or for  worse; part is unmistakable. 

'Do you like the Beatles, doc?'  Mr Cherub  began abruptly, without  preamble.  This was certainly a new one on me, but I didn't flinch.  'Sure,  I grew up with the Beatles,' I returned,  concealing my bewilderment rather adroitly.

'Have you heard the song Yesterday?'  he fired next.
I nodded in the affirmative.  Suddenly, cherub seemed very happy  with his choice of doctor.  I suspected that it   I had said  that I hadn't heard of the Beatles or if I had said that  I didn't  much care for their music, he might have even changed his doctor.  He seemed like a men can be curvaceous too.

'Well, my story is somewhat like the  lyrics of that song, doc,' he began.  And then,  you are not going to believe this, he burst into song!  Can you imagine this?  This guy was actually sitting across a doctor's consultation table in the capacity of a patient,  and singing a song!  The Americans have a  world for this.  They call it chutzpah.  Once I was over the initial alarm, I played along with the singing.  I normally ask my patients to calm down, take  it easy, and relax basic instinct or learned behaviour.  Cherub  was doing  the same thing  with his singing, I reasoned.  I thought him to be a pretty cool and original kind of chap with  his own unique  methodology.  I began to feel bad   that such a jolly good fellow had developed an andrological problem that necessitated a visit to me.  I turned empathetically towards the   wife.  Her  eyeballs  had rolled  heavenwards,  and remained fixed there.  Her eyeballs  were clutching the armrests of her chair, and her knuckles had turned  white.  It was quite obvious  that she wasn't  one bit  impressed.  I wondered now long  she had had this brand  of music inflicted on her.

This is what  his musical  medical history was:
Apparently, until yesterday, all of Mr Cherub's troubles  had seemed far away, but now, it looked like they were here to stay.  Also, until yesterday, apparently makes love not war was an easy  game  to play, but now Mr Cherub, not being  even half the man he used to be, needed a place to hide away.

Unarguably, this was the  most musical medical  history ever obtained by any doctor in medical history.  I wondered  if something like this would qualify  for a place in the Guinness Book of World Records.   I've always  yearned for a place  there.  I made a mental note to check  this out and men oh pause for it before  another doctor beat me to it.  You see,  our medical profession is a fiercely competitive  one.  The cut-throat mentality begins at the pre-medical level itself.  I have to be fast and discreet, I told self  help is the best help.  Adding  a Guinness Book to my Limca Book would be quire nice.

I was jolted back into sharp focus by the sound of Cherub's  voice.  Song sung, he was now speaking.  It took me a while to  figure the difference between his singing and his talking.

'By now, it must seem pretty clear to you doc  that I am suffering from severe erectile dysfunction,' he announced self-diagnostically.

'Any more songs or is this all for  today?'  was all that I was dying to know.  By now, I had even forgotten that this was a consultation in my office.  I had the surreal feeling that I was  in some nuthouse.  Had he at least sung tunefully, I'd  have put up with all this,  buy Cherub's singing was reminiscent of an old HMV gramophone  player when voltage fluctuations alternated with power trips.  It was unbearable.  What made it even more annoying was the fact that he thought himself very mellifluous  and sang with a blissful lack of insight.

'How long have you had this problem?'  I asked, moving on.
  'It's been going on for more than six years now, doc,' the  lady finally  piped in, logging  in her presence when it mattered  most.  This must be the topic she is most interested in, I deduced.  'Over the past four years, ever since he underwent his bypass operation, out sex life has become zero.  Zilch.  Zippo.  Nada.  Cipher.  We are more like platonic enemies these  days.'

That  explains all the discordant music, I thought to myself.  But to refer to sex years as yesterday seemed a bit euphemistic.  Yesterdays might have been more appropriate.  Mr Cherub  was certainly in a time warp.

'How did it all  begin?'  I needed to know.
'Well doc, I am forty-eight now.  Things  were fine  about  seven  or eight  years ago.  In fact, at  that age I was sexually insatiable and very demanding .  my wife thought that I had a one-track mind  and  naturally didn't  share my enthusiasm  on the subject.  I also never had any problem in the performance department  and my wife didn't  even complain. Then suddenly,  I noticed  a steady  decline  in my erections. Not only were they not as rigid  as before, I also  developed sustenance  problems.  At first  I thought it's just one of  those  passing phases,  but it wasn't.  It only  got worse.  Then cam  my heart attack  and I underwent a multiple coronary bypass.  I recovered well after the operation but  lost erection completely.  My wife, whose nickname  for me was "heartthrob", says jokingly now that both my heart and my throb are gone.'

I was not at all sure about the 'jokingly' part of it.  again, I turned to look at the wife.  It appeared that the only thing in her life that was throbbing  right not  was her head.
'But why have you lost so much time seeking andrological help?'  I asked, 'You  could've taken treatment so much earlier.'

'I agree with you, doc.  For the first year or so  after my bypass,  we were devastated and didn't  even think about sex.  The heart  attack was a life and death  issue, after all.  It was only when life started returning  to normal that the  need for sex reappeared.   But we didn't know where to go.  Only recently,  someone referred your name  to us.  In between, I thought I would try Viagra but my doctor  warned me that it would be dangerous  since I am  still on nitrates.  So here we are.'

In fact, because impotence (ED) is mostly an arterial disease,  and because  the arteries to the penis are so narrow, it often  precedes heart disease.  The incidence  of impotence in patients  with treated heart disease is seventy-eight per cent  for non-smokers and a staggering 94.3 percent for smokers.  The incidence of coronary  artery disease among Indians is very high  and it is estimated to affect forty-four  percent of those under fifty  years of age.   It is indeed ironic that despite the magnitude  of the problem,  few seek  help for their condition.  Recently, ED (impotence) has been identified as a marker for coronary arterial and cerebrovascular disease.  This means  that many men  who develop   ED will go on to develop heart attacks and strokes.  In this sense,  ED is a useful  warning bell since it warns of impending catastrophe.  Another clinical triad, in which depression, Ed, and vascular disease (high blood pressure, high cholesterol, etc.)  often  co-exist  in the same patient, has also been descried recently.

Mr Cherub finally got cured with penile prosthetic implantation surgery.  His case is classical  and is representative of the plight of millions like him.  heart (and vascular ) disease is one of the commonest causes of ED.

Cherub  called me recently  to tell me that he was writing  the lyrics for his  new song.  'It's called 'Tomorrow will be even brighter than today', doc,' he told  me conspiratorially over the phone, like he was giving me a sneak preview.  I was  happy for him and  congratulated him on his song, but hung up abruptly.
I was afraid he'd start singing over the phone!

Take Home Message:

There is a very close  inter-relationship  between erectile dysfunction and coronary heart disease.  The same  venereal disease   processes, viz.  arterial narrowing  and cholesterol deposition  in the arterial walls, are  often responsible for both.  In fact,  the arteries to penis are much narrower than  the coronary (heart attack ) and carotid (stroke) arteries, and get blocked much earlier in the course of progression of the arterial disease.  This  is why ED is a marker  for coronary and other vascular  disease.  Men with high blood pressure, diabetes, high cholesterol, high  lipids, obesity, and smokers, must be on high alert.  Physicians treating these conditions  in their patients must also discuss  with them  the risks of developing ED and other vascular disease.  When they co-exist, all conditions must be treated simultaneously.