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.
'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:
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.
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.
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.
'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.
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.