What Can Be Done When ED Drugs Fail?

Q. For the past few years, I have been experiencing erectile dysfunction. My urologist had me try all the oral medications on the market. They helped a bit, but none gave me the results needed for intercourse. I tried the vacuum pump and got an adequate erection, but it faded after about 60 seconds.
Now my doctor is suggesting Caverject, but I shudder at the thought of injecting a needle in my penis. He has assured me the pain is minimal, and the results will be very impressive. Do the Caverject injections really create suitable erections?
A. Despite the hype, drugs for ED don’t work for everyone. Other options that were used even before Viagra became a household name include vacuum pumps or injections.
Caverject contains the prescription drug alprostadil, which usually produces an erection within five to ten minutes. The needle is so small (like those used for insulin) that it causes very little discomfort. There can be pain from the medication, however.
We are sending you our Guide to Treating Sexual Dysfunction for more details on ways to treat both male and female sexual difficulties. Others may obtain a copy for $2 by downloading it from the Web site www.peoplespharmacy.com. It can also be purchased by check or money order sent with a long (no. 10) stamped, self-addressed envelope to: Graedons’ The People’s Pharmacy®, No. P-93, P. O. Box 52027, Durham, NC 27717-2027.
If injections are too intimidating, you can get the same medicine in MUSE. It is inserted into the urethra and has similar effectiveness.
Q. I read in your column that Sonata might be a good solution for early morning wakening because it only lasts for a few hours. Have you any idea of its cost? I was charged around $100 for couple dozen pills. What a rip-off! I find cutting a Tylenol PM in half just as effective.
A. Diphenhydramine (the “PM��? in Tylenol PM and other nighttime pain relievers) is certainly cheaper than the prescription sleeping pill Sonata. Taken in the middle of the night, though, even a lower dose could result in morning grogginess and make driving dangerous.

Q. I am a retired doctor with Type II diabetes. Metformin has kept my blood sugar in the normal range for 10 years. Despite good control, my foot numbness was getting worse. I was also a little unsteady on my feet.
In reviewing the medical literature I discovered that metformin interferes with vitamin B12. I suspected I might be deficient in this nutrient so I started oral vitamin B12.

Within a week, I noticed a sharpening of my mental capacity. I stopped having any trouble walking and my foot numbness has decreased.
Many older diabetics take metformin, and their subtle neurologic and mental deficits may be overlooked but could be treated.
A. Thank you for pointing out that metformin (Glucophage) can deplete the body of vitamin B12. This can lead to serious neurological symptoms if not corrected promptly.
Q. Is there a self-test for checking your cholesterol without having to go to your physician for blood work? I am trying to get my cholesterol under control with diet and I want to track my progress.
A. Over-the-counter cholesterol tests for home use have been around since 1993. But according to Consumer Reports (Aug. 2003), they don’t provide enough information to be very helpful.