Obesity and weight-related health problems are the new epidemics in twenty-first century Ireland. Obesity is now almost as bad as cigarette smoking as a major preventable cause of premature death.

Obesity is defined as excess body fat. In men, body fat tends to accumulate particularly around the belly area and upper chest, which increases the chances of heart attack and stroke. In addition, the explosion of diabetes in recent years is directly related to the increase in the number of people suffering from obesity.

The amount of body fat you have and where it is distributed is very important for your health. What you weigh is less important than where that weight is distributed.

Some Scary Facts and Figures

• Over 60 per cent of Irish men are either overweight or obese.
• About two-fifths of Irish men are overweight and one-quarter of Irish men are obese.
• The trend towards obesity is increasing and it is estimated that by the year 2050 up to 60 per cent of Irish men may be obese.

Apples and Pears

Did you know that the shape of your body can be directly related to your

later risk of ill-health? Pear-shaped people tend to store fat around their hips and thighs while apple-shaped people store fat around their bellies. This apple shape, known as central obesity, increases your risk of heart disease, diabetes and ill health. Big bellies beware!

What Are the Health Consequences of Being Overweight or Obese?

Obesity is associated with a whole range of physical conditions, including heart disease, high blood pressure, diabetes, arthritis, gall stones, hernia, varicose veins and several cancers, including bowel cancer. In addition, obesity may be associated with a range of psychological issues, including low selfesteem, poor body image and depression.

What Causes Obesity?

In the vast majority of cases, being overweight or obese is due to a simple mismatch between the amount of energy consumed, in the form of food and beverages, and the amount of energy medstore canada expended, in the form of exercise. A typical adult male requires 2,000-2,500 calories a day, depending on age. The calorie requirements get lower as we get older. It is believed that 1 pound of fat equates to about 3,000 excess calories.

For many men the increased demands of work, career and family life mean that exercise habits and sporting interests often keenly pursued during the teens and early twenties get put to one side. The result is that much less energy is burned up. The sedentary lifestyle of modern living can mean hours in the car and sitting watching television with no opportunity to burn calories. Combine this with a high-fat diet of large portions and lots of processed food and the effects can be lethal. Even subtle lifestyle changes over time can lead to a net gain in terms of calories consumed. These excess calories are stored in the body as fat. A small increase in calorie intake (food or drink) combined with a small reduction in activity or exercise levels leads to net weight gain over time.

As a female with saltwasting CAH, growing up was quite traumatic. My parents knew very little, as doctors had simply told them I would need steroid replacement for life in order to stay alive and that they could ‘fix me surgically’ for the genital ambiguity. While doctors were allowed to examine, poke and prod intimate parts of my body, no explanation was given to me other than ‘Take the tablets, have the surgery, don’t ask questions, don’t tell anyone anything and don’t touch, everything will be OK.’ In reality it has been far from OK. I became very shy and withdrawn. While my peers always seemed to have lots of friends, went out and so on, I stayed in, had few friends and felt unable to talk to them. I was forever in and out of hospital and had endless hospital visits for check-ups. The surgery was very traumatic.

Age 4

Total clitorectomy. My enlarged clitoris of two to three cm did not bother me or cause pain. Following surgery, I had lots of pain and heavy scarring and was always told not to look at or touch my body. I was extremely frightened as I was well when I went into hospital and came out feeling ill with a huge sense of loss, even though at the time I did not know what had been done to me, or what the significance was going to be later in life. I just knew that something was missing. I went from being a happy child, although quite sickly, to being withdrawn.

Age 11

First vaginoplasty. Again no explanation other than ‘Something’s not quite right and the doctor will fix it. Don’t ask questions.’ As I was just into puberty, this was traumatic with a gynaecologist poking and prodding intimate parts of me followed by surgery.

Age 12

Told at check-up that I would never be able to have children. I was totally devastated and became more withdrawn. I was also told that if I wanted to marry I would need to see a gynaecologist before doing so and not to ever let anyone, especially men, see my body except for doctors. The surgery is supposed to make a female with CAH more ‘visually’ and physically acceptable sexually to men and to enable ‘married life’, which I later realized was a euphemism for sexual intercourse.

Age 13

More surgery as the first vaginoplasty had scarred and developed stenosis (scarring that causes surrounding tissue to shrink) and had adhesions (small pieces of tissue that had stuck to the sides of the repaired vagina). No one had explained to me at the time why surgical packing had been placed inside me or why there was lots of blood so I had pulled the packing out as it was agonisingly painful. This had resulted in a sharp telling off by the doctor, nurses and parents at the time and the warning that I would require more surgery as a result. The final surgery was to remove the adhesions and widen the vaginal opening.

Prophylactic Treatment Viagra Online in Canada

Hormonal agents should be cautioned in children due to their ability of promoting fusion of the epiphyseal plate and also the effect on sexual maturation. These agents are contraindicated in children who have not completed sexual maturation and growth or in patients who are attempting to conceive. The use of phosphodiesterase type 5 inhibitors as prophylaxis has been recognized as a result of extensive work into the molecular pathophysiology of priapism, especially in patients with sickle-cell disease. The use of this agent may seem counterintuitive. Early reports suggested the mechanism of phosphodiesterase type 5 inhibitors may be via selective vasodilatation in the corpora. Downregulation of phosphodiesterase type 5 expression has been seen in cavernosal tissue in cases of recurrent priapism. In young adult rats chronically treated with sildenafil, phosphodiesterase type 5 expression is increased.

So the use of phosphodiesterase type 5 inhibitors increases levels of cGMP which leads to increased phosphodiesterase type 5 pro-moter activity and hence transcription and production of the enzyme. This enzyme metabolizes cGMP and controls the excessive cGMP signaling in priapic tissue. Burnett et al. reported on four cases of stuttering priapism, three of who had sickle-cell disease and were treated with phosphodiesterase type 5 inhibitors. The agents were able to reduce the episodes of stuttering priapism and preserve potency. The drug should ideally be taken in the morning to avoid high concentrations at night during sleep related erections. Only one episode of major priapism has occurred with use and this was taken in the evening preceding sexual stimulation.

Phosphodiesterase type 5 inhibitors are generally well tolerated, but may cause headache, facial flushing, rhinitis, and dyspepsia. There may be transient effects on the blood pressure and heart rate as these drugs are vasodilators. They are contraindicated with the use of nitrates.

Adrenergic agents may be administered as self intracorporeal injections in patients who fail or refuse systemic oral therapy for stuttering priapism. McDonald et al. documented success with home self injections of metaraminol in a patient with sickle-cell trait with stuttering priapism. These patients should be taught about the injection site, dosing and systemic adverse effects. It must be emphasized that this is not true prophylaxis, as episodes of priapism are being treated rather than prevented. In addition, there is the potential for adverse systemic effects if drugs Australia Pharmacy shop are injected inadvertently systemically. Alpha agonists are contraindicated in patients with uncontrolled hypertension, coronary insufficiency, and arrhythmia. There have also been case reports of success with use of intracorporeal injections of epinephrine and etilefrine.

Nevertheless, this form of treatment is not preferred over oral systemic prophylaxis.