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With an ex-Presidential candidate as its pitchman, more mentions on late-night talk shows than Joan Embry and the dubious honor of being the world’s top pharmaceutical treatment for impotence, few drugs in history have been more in the public eye more than Viagra – or gotten more attention for affecting the public's eyes. Along with its impact below the belt, Viagra (Sildenafil Citrate) is well-documented to cause retinal dysfunction lasting several hours after it is taken. Most commonly, it causes increased light sensitivity, blurring, and a bluish tint or haze to vision in many men who take the medication.
Since receiving FDA approval in March 1998, Viagra has been prescribed more than 22 million times in the U.S. alone and is available in 90 other countries, according to manufacturer Pfizer. Here’s what you need know about Viagra and your vision:
Who is most likely to get ocular side effects?
Viagra is available in three prescribed doses – 25, 50 and 100 mg pills. Side effects are usually dose-related, meaning the greater the dosage, the greater the risk. According to reports by Pfizer and subsequent studies, ocular side effects occur in:
About 3 percent of men taking doses of 25-50 mg
About 11 percent taking 100 mg doses
About 50 percent of men taking 200 mg
Nearly all men taking 600 to 800 mg.
Why does Viagra cause vision changes? Viagra is effective on erectile dysfunction because it inhibits phosphodiesterase 5 (PDE-5), an enzyme that enhances the effects of nitric oxide, which is released during sexual stimulation to relax the smooth muscle of the penis and facilitate blood inflow. However, the drug also has a milder inhibiting effect on PDE-6, an enzyme actively present in retinal photoreceptors. This causes an increase in the concentration of cyclicGMP, resulting in a depolarization of the rod cell – and increased light sensitivity and the infamous "blue vision."
When do side effects occur? The side effects are short-lived and generally peak within 1-2 hours after the drug is taken. What is the long-term vision damage? Hard to say, since the drug has been on the market for only a few years. So far, no long-term retinal damage has been reported, but then again, long-term electroretinograms (ERG) have not been done, says Michael F. Marmor, MD, a Stanford retinal specialist who has published studies on the ophthalmic effects of Viagra. He believes the drug could conceivably result in lasting damage to photoreceptors, so he recommends that you avoid it if you have macular degeneration, diabetic retinopathy, retinitis pigmentosa or other retinal disease. (Meanwhile, Viagra's own label issues warnings to patients with existing AMD or retinitis pigmentosa because they were not studied in past clinical trials.)
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1. Planning Renovations
Any project will be more successful, given well-defined goals. In every household project, the following three points can be applied:
FORM: What do you want it to look like?
FUNCTION: What do you want it to do for you?
COMPATIBILITY: What factors exist that might limit what you can do, and will the finished product look good on your house?
Once you've completed this part of your homework, it's time to decide if you'll built it yourself, hire a contractor, or be your own contractor and perhaps sub-contract some of the work. Sub-contracting may sometimes seem to over-complicate things and even look wasteful, but just remember - some jobs can look deceivingly simple until you actual get into the nitty-gritty of them. A general contractor's job is to co-ordinate and orchestrate the whole schmozzle to completion.
2. Finding A Contractor
My card...The process of finding a good contractor is essentially the same, whether you decide to hire a general contractor, or one or more sub-contractors. The best reference for a contractor is word of mouth from a satisfied client. If you don't know anyone who has had renovations or repairs done in the area you need, look for work trucks or signs in your neighborhood. Knock on doors, and ask the homeowners if they are satisfied with the work being done. Once you contact a contractor, ask for references, and follow through by calling their previous clients with a set of questions that will give you the information you are looking for.
The following are samples of questions that could be asked of any reference:
1. Did the job come in at the quoted price?
2. Did the job come in on time?
3. Was the work site left clean each day?
4. Was the quality of the workmanship satisfactory?
5. Was the quality of the materials used satisfactory?
It is always recommended that you talk to more than one company, so that you have a basis for comparison. Listen to their technical information, and note their customer relation skills. If the contractor doesn't do a very good job of communicating with you before you hire him or her, there may be a higher likelihood of miscommunications during the work.
Sometimes the best companies will be very busy and you will have to wait for their services. Other times, good companies may have time slots between large projects that smaller jobs can fit into. Ask what the company's schedule has been like for the past 6 months to a year. Reputable companies are usually busy all year round in any economic situation.
3. The Estimate, or Quote
Meeting the Contractors
Remember that the contractor you choose could be spending a lot of time in your home, so look for someone you feel at ease with. You should meet individually with each potential contractor. Be prepared to discuss products and designs; know what you want and how much you can spend. Take note if the contractors are on time, if they listen and answer questions, willingly give information about their company and their customers; and if they seem to have any aversion to your ideas.
The Estimate
This is where you'll likely make your choice of contractor. Each potential contractor will present a proposal, including design and cost information. Review the estimates, ensuring that they accurately relfect your wishes, and make comments and/or any changes that are required.
How Are Jobs Estimated?
Work that involves structural changes to the home, custom designs, or enlargement of some of the mechanical systems is typically quoted by the job. It can be very difficult for a contractor to know exactly how much time an intricate custom job will take, particulary if a number of trades are required, and the different parts of the job are interdependent.
Get it in writing!Simpler, straightforward jobs are often quoted by the square foot. Examples are laying sod, painting, roofing, drywall or refinishing floors. The quoted price will typically be set to include everything (ie. labour, materials, travel, etc.).
Smaller jobs may also be quoted buy the hour, and if the job is fairly routine, such as installing addtional electrical outlets or drywalling, the figures are typically in line. In this situation you will pay the tradesperson for time, plus the cost of the materials used in the project.
The Final Design and Quote
If you have a contractor with good references and the estimate looks good, you now need to get a firm quote, including final designs. The design should include detailed specifications for the work and the materials to be used.
(Another option is to have an architect or designer produce the plans and ask the contractors to bid on the job, based on these plans.)
Make sure the final specs are accurate and reflect your wishes, and make your final comments and changes. After you accept the final quote, the cost of further changes will likely be added to the job. Ask how long the stages of the work will take, so that you can monitor progress.
4. The Paperwork
Cash is King, however...
... take care, lest the cash deal of the century turn into the mistake of a lifetime! One reason for cash payment is the avoidance of paperwork and taxes. Taxes and other legalities aside, the absence of contracts and permits can be extremely risky.
Ooh, I love to save money!Cash contractors often don't pay Workers' Compensation fees, and you could be held legally responsible for any worker injured on your property. If the contractor gives you the product warranty cards, you'll be covered for defective materials provided they were properly installed, but don't expect good follow-up service on a cash deal. You would also have difficulty supporting any legal actions without any paperwork. The overall quality of a project may be compromised in the absence of paperwork, and cash paid in advance (rather than by cheque) will be all but impossible to retrieve if things go sour.
Building, plumbing and electrical codes may require that all or parts of your project be performed by licensed tradespeople, and sometimes licenses are required to obtain the permits. If the tradespeople aren't licensed, the contractor probably isn't insured. And if your contractor isn't insured, then depending on the nature of the job, neither is your house while he works on it.
The Contract
Agreements in writing are less vulnerable to miscommunications, than are verbal ones, and far easier to enforce. Some of the points included in a good contract are:
1. Full job description, including all aspects of the work; demolition, renovation, reconstruction and finishing.
2. Material specifications, including type, model, number, color, and size where applicable, and who's supplying what.
3. Start and finish dates.
4. Payment schedule; 40/40/20 is generally acceptable.
5. Permits, and who's responsible for obtaining them.
6. Clean-up and trash removal.
7. On site behaviour.
8. Change order clause: Have any changes to the original job specifications in writing with a requirement that you "sign off" any change before the work is performed.
9. Arbitration: Aree how disagreements will be handled before the work begins.
10. Contractor's insurer and policy number.
5. The Work MORE POWER!
Problem Avoidance: If you've carefully chosen your contractor, and made adequate preparations (including making the site ready for the trades people and workers), this part should be easy! The actual work should closely follow what was written into the contract, however you still need to monitor the ongoing project, and in some cases you'll be required to make additional decisions. There are often unforseen difficulties, or you may simply wish to ask for changes as the work proceeds.
Site Preparation: Remove furniture and stored articles from the work area, and cover carpets and other items that may not be moveable. It is in your own best interest to make arrangements for storage, clean-up and refuse areas convenient to the work area.
Project Coordination: Effective communication is the greatest secret to successfully completing any project. Maintain regular contact with your contractor(s) so that the unexpected can be dealt with expediently.
Hidden Conditions: A thorough inspection performed in conjuction with estimation should preclude any major changes, however there are structural and mechanical conditions initially hidden from view, which even the most experienced renovator may not be able to predict. Be prepared to negotiate changes for "hidden conditions".
What to do if a problem develops:
1. Bring all problems, perceived and real, to the attention of your contractor(s).
2. Is it major or minor? If minor, and the contractor is present at the time, discuss it and negotiate a resolution. If it's minor, and/or looks like it can wait, start a list of minor observations that you can bring to his or her attention when appropriate.
3. Major problems should be dealt with immediately. If your contractor is not present at the time, make every effort to contact him or her as soon as possible. This may avert furtherance of the problem.
4. Given that your contractor responds satisfactorily, carry on. If not, try again and if necessary, write a letter. If you still don't get satisfaction, look to a third party such as the Ontario Renovators Council or the Ontario Home Builders Association. These agencies should be approached only if you are certain that a resolution cannot be achieved with the contractor. Legal counsel should be an absolute last resort. There's no use making a mountain out of a molehill, and thereby delaying succesful completion of the project.
THE BOTTOM LINE: careful contractor selection + a good contract = successful job
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Researches have established that a diabetes patient is more prone to succumb to erectile dysfunction than a normal person. Erectile Dysfunction besides diabetes can prove a disastrous combination that can have an impending effect on the psychological and physical well being of a man's life. Men who are having erectile dysfunction problem may became so concerned with the inadequacy that they try to avoid the sexual situation altogether. Same time it increases the stress level, frustration and can trigger a bout of depression.
It is estimated that more than 50% diabetic patient are suffering from ED. Erectile Dysfunction occur at younger age. Within 10 yrs of the diagnosis of the disease trait of ED begin to surface, although not all diabetics develop ED.
Why the diabetics are easy prey to Erectile Dysfunction? Men endowed with healthy blood vessel, nerves, male Harmon and “desire” to perform gets the erection on wish. Diabetes can kill blood vessels and nerves that make the erection possible. Therefore even the normal amount of male hormones and desire to have sex can not help getting a firm erection.
Medical people believe that presence of a blood sugar in diabetic prove an impediment to the enzyme that start the series of events which lead to erection.
Endothelial nitric acid syntheses (eNOs) enzyme considered responsible to start the chain of vascular events that produce and sustain erection.Enzyme (eNOs) cause the release of Nitric Oxide at the nerve ending in penis. The initial release of NO get a quick and short duration increase in penile blood flow it also cause short time relaxation in penile muscle to get an erection. Enhanced penile blood vessel and smooth penile muscle relaxation increase the blood flow in penis which results in erection.
When blood sugar O-GLcNac present in hyper glycemic(high blood sugar) circumstances interrupt eNOs enzyme this may cause permanent penile impairment over time.
A patient of diabetes should always take extra care to understand the complexities of his health psychosexual counseling is mandatory in these situations. Sexual therapy is vital for people with diabetes, since the chronic condition is fraught with situational stresses, performance anxiety, and problems in relationships.
A range of different modes of medication are available for the diabetics. Penile injection or vacuum erection device therapy has been used by many patients with satisfaction. A penile prosthesis was certainly a viable option in these individuals should they fail those therapies or wish to go directly to penile prosthesis. Obviously one must bear in mind that diabetics have a higher incidence of infection and thus they should be counseled in that regard. Sildenafil is also proving a good source that diabetics can look up to.
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Do you want bigger breasts? Do you think exercise might give them to you? If so, here's a true story that might interest you. (Of course, we asked permission to print this story for you, and the names are changed to protect privacy).
A young lady asked me this, regarding exercise and fitness personal training. Her question was "If I train with you, will my breasts get bigger? Will they lift themselves up, become firmer and fuller like they used to be when I was younger? Truthfully, I hesitated momentarily, before answering this one. Yes, I really wanted to motivate her, as well as gain her service as a new fitness client. And, I also wanted to stimulate her existing desire to re-kindle her fire and passion for exercise. My greatest personal satisfaction comes from seeing other people improve themselves, especially when their benefits come from advice, education, suggestions, and/or training techniques that I have brought to them.
However, my ethics are much stronger than my desire for profit. Ethics in the diet, exercise, and personal fitness training industry are an extremely valuable commodity. They denote character and intent to provide quality service. Therefore, I smartly hesitated before answering the young lady's question. I could see the look in her eyes. She may have wanted me, as a trainer, to say, "Yes, of course your breasts will become larger, firmer, and fuller, just like they used to be. All you have to do is exercise." The truth, however, is quite surprising and perhaps contrary to your probable expectations.
As I began to research the subject, "natural breast enhancement," many truths became obvious, almost instantly. Of course, you find your most immediate replies from Internet sources. Members of the general public, many of whom have no accreditation, formal education, or long-term training expertise, are free to create such highly opinionated responses. Although these individuals (and some small businesses, too) may mean well, they simply lack accuracy, especially in the art and science of conducting skilled research.
Now, let me tell you what I noticed right away. Upon my first query on natural breast enhancement, several web sites displayed conflicting information. For example, one site said that herbs, minerals, and vitamins would cause a woman's breasts to enlarge. The next site said that "exercise" would boost breast size by at least one "letter." A third said that "nothing" would help because genetics alone determined breast sizes. A fourth claimed that wearing pressure clamps all day long would increase breasts by at least two cup-sizes.
As you might already see, the offerings, replies, and suggestions included various alternatives, methods, and techniques. There were suction and pressure devices, creams, encapsulated hormone products, immune system "enhancers," nutrient supplements, etc. A few sites even boasted about "special secret exercises." (Of course, you had to pay first before they told you what these unique, new "special secret exercises" were, if any.) The exercise science industry says nothing about "special breast enhancement exercises." This type of information is only hype. Don't buy into it. Stick with science. Stick with accredited information sources. Maintain your knowledge through licensed, formally trained professionals. Especially, deal only with specialists who maintain high "ethical" standards.
You may be interested to know this. Here is the basic outcome of a comparison between the various natural ingredients associated with "breast health." These ingredients were different from those that claimed to increase "breast size." If you are a candidate for such products, you must be meticulous about the phrasing of such descriptions. There's a saying on the Internet that, "You have to already know what you want, before you can find it." In other words, asking for "breast health" gives you different results than "breast enhancement" or "breast enlargement," or even "natural breasts."
For example, properties of nutrients claimed to exert "anti-cancer" functions. Still, others were reportedly claiming to make the breast expand (or, at least "appear" to) swell in size. Certainly, you could rationalize the following. Some nutrients do indeed tend to protect your cells from deterioration. At least, there are some that may offset the formation of cancerous cells. This, however, does not automatically mean that the tissue will appear larger and/or grow bigger. When you refine your "purpose," you are more likely to find something that can provide you with a satisfactory solution.
Do You Want the Bottom Line on "Natural" Breast Enlargement?
There really is "nothing" available and practical that will give you such results. The only thing that possibly comes close to achieving this for you is the "pressure clamp" concept. That is, you wear pressure clamps all day long for about 20 to 30 days non-stop. Surely, you can see how many people cannot arrange the time for such an activity. Convenience is certainly a factor that affects you. And, can you withstand the discomfort of this type of breast enlargement technique? At least, this idea has some merit, but it's still not your most practical and achievable solution. Now, consider the following.
In a "natural" way, nothing exists that will actually make your breasts firmer, fuller, or larger. You can, however, protect the "natural health" of your breasts. Additionally, with exercise, you can naturally increase the size and strength of the MUSCLE layers BENEATH your breasts. These muscle layers (called "pectorals") can give you a slightly more firm appearance. This is true only because the muscles themselves become more firm, NOT your mammary glands. In reality, breasts consist of fat tissue, not muscle. Fat can seldom be "firm" to the touch, and fat is hardly likely to give you a firm, solid appearance.
Now, "think outside of the box" for just a moment. Returning to our original story line, the ironic thing is that the woman you read about already possessed very large breasts. Thousands of "decent-sized" ladies would "kill" to have what she already has. However, the feeling that your breasts may not be nice enough also comes from other facts. Your surrounding body parts can also lack THEIR proper shape and symmetry. Your overall fitness (including body fat ratio, flexibility, strength and endurance) may be poor or below average.
So, here's a breast enlargement/enhancement/health solution that you can count on, virtually, forever. BECOME TOTALLY FIT. For example, with the woman you read about above, reducing waist size would conversely increase breast size appearance. Do you understand how this works? In exercise science, there is something called a "waist-to-hip" ratio. It measures your cardiovascular risk as well. However, with an excellent waist-to-hip ratio, your body "looks" good, too. In other words, reduce your waistline to enhance your upper body stature, appearance, and appeal.
Next, there is your "body composition." This is an approximated measurement of the amount of fat you carry in your subcutaneous tissue layers (immediately below your skin's outer surface). This is a ratio of the fat to muscle your body carries. Via practically any combination of aerobic, bodybuilding, endurance, toning, or strength workout activities, you can remarkably enhance your body composition. This, in turn, enhances the size of your waist, plus the shape of your torso, and consequently, the appearance of your breasts. Therein lies your "breast enlargement," the "natural way."
It's time to train your way into a more pleasing appearance, and a higher level of stamina comes with it. It's a win-win situation for you, without medical complications, and with no negative side effects. Help "nature" take its course by helping your body do what it is supposed to do – that is, to PERFORM. Call your trainer or weight management specialist and get more information. Then, step into higher gear with enjoyable and effective diet, exercise, and fitness physical activities. Your breasts will say, "Thank You."
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The penis enlargement market has fallen under a new sign: development. From a small and much maligned niche market, penis enlargement is now moving at full speed toward mainstream acceptance. Widespread prosperity and the possibility of living a more successful life with just a little effort have convinced thousands of men to seek solutions to a problem that older generations did not discuss or openly acknowledge. However, the times have changed and the taboos of yesteryear are no longer in force. Men have simply chosen to spend time and money in order to get more pleasure out of their sex lives.
Over the years, the range of penis enlargement products available for sale has exploded. From the old-fashioned and dull pumps and weights and on to the modern traction devices and enlargement pills, various products have been invented in order to respond to various needs. Since not all men are comfortable with penis enlargement pills, enterprising investors have launched male enhancement patches and creams. Pumps have been largely replaced by traction devices, while weights and exercises have their own niche markets. As you can see, there’s something for everybody on the penis enlargement market.
Surgery is still a controversial issue. The high cost of penis enlargement surgery keeps it out of reach of most men for which improving a satisfactory sex life is not worth the effort of raising thousands of dollars. More so when surgery comes bundled with a host of nasty hazards, such as impotence, scarring and loss of feeling in the penis. Another significant issue is the fact that surgical procedures like the injection of fat have to be performed again and again since fat is absorbed back by the body, while injected silicone tends to migrate to other parts of the body. These factors combined have convinced men to look for cheaper and safer penis enlargement opportunities.
Men are far more interested today in how they look and how they perform in bed. They want to learn new ways of pleasing their partners and to increase their dating and sex chances. This is one of the reasons men turn to penis enlargement techniques and a very good one. There is no need to talk about feelings of insecurity and anxiety in order to find out why men want larger penises. Suffice to say that men want to look good and that they love to see that special look on their partners’ faces when the pants come off. A well-endowed man commands the respect of women and men alike and this is what every man wants to see: respect.
As the penis enlargement market moves into the mainstream, more and more men will stop being embarrassed about their penis size and will have no problem to openly discuss size and ways of improving it. Penis enlargement is certain to become an accepted topic, mainly because of the large number of men who are satisfied with the results obtained from enlargement products and techniques. Beyond all advertisements and hype, results are the only thing that matter and your best reason to join the growing penis enlargement movement.
