The fact is that now about 90 percent of all men with erection problems can be treated successfully. In recent years, there has been a virtual revolution in the ways erection problems can be diagnosed and solved. If there’s one message we wantto convey to our readers—men a nd women—if s that you don’t have to be deprived of the pleasure of intercourse. We tell you how to find the expert assistance you need, and what you can do to help yourself—and your partner.

An erection problem is not a sentence to life without intercourse. Very often, impotence is the body’s way of signaling a health problem which needs to be properly treated. Sometimes, the solution is as simple as changing some daily habits. Other times, medical treatment is needed—treatment which may include a combination of sophisticated tests and procedures. But almost always, the problem can be solved and the man and his partner can go back to enjoying a full, complete sex life.

Most of us have grown up with myths about sexuality, and certainly misinformation about erection is widespread. The complexity— and the delicacy—of the erection process are explained in our book. Once you understand what goes on, and how easy it is to disturb the system, you’ll be better equipped to avoid self-sabotage. And you’ll know the importance of getting help early, so a simple difficulty doesn’t develop into something more complicated.

We also explain why growing older does not mean sex must become a thing of the past. Impotence is not a normal part of aging. Whether you are 50, 60, 70 or older, you don’t have to be deprived of sexual enjoyment.

Potency is an issue for men and women. As you read this book, you’ll meet men and women who encountered a potency problem. Some faced the problem, sought help, discovered a solution and even found their relationship became stronger as a result of their shared experience. Some were afraid of facing the problem, but, happily, were able to overcome their anxieties and obtain proper treatment. And some, sadly, only got help after many years of pain, after emotional estrangement from their loved ones and self-blame had taken their toll. We think their stories will move you, hold your attention and educate you.

Finally, this is a book to share. Whether you are a man or a woman, young or old, married or single, we hope you’ll share the information with those closest to you. Use it where it can do the most good.

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A number of factors result in the wrinkling of skin that may occur as you grow older. Some people are more likely to develop wrinkles than others because of heredity. In addition, external influences can aggravate the inherent tendency to wrinkling and greatly accelerate the process, even in those individuals who might otherwise be resistant to skin wrinkling.

The most powerful factor in skin wrinkling appears to be exposure to the sun. Exposed parts of the body (face, neck, hands) develop wrinkles more rapidly than do protected surfaces. In geographic areas where people expose much of their body to the sun for long periods of time, wrinkling can be seen on the torso as well as on the face, neck, and arms.

Another recently recognized cause of skin wrinkling is cigarette smoking. It has become evident that facial wrinkles and an aged appearance are more common in smokers than in nonsmokers, and some experts believe that it is possible to distinguish the two groups by examining the pattern of facial wrinkles. A combination of sun exposures and cigarette smoking will greatly accelerate the skin’s aging process and result in obvious wrinkling.

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Rarely, the insulin-producing glands within the pancreas develop a tumor and produce too much insulin, which causes the blood glucose to become low. This is called hypoglycemia, often referred to as low blood sugar. You may have frequent episodes of mental confusion, giddiness, dizziness, or fainting. The diagnosis is made by finding extremely low blood glucose levels. Surgical removal of the insulin-producing tumor usually results in a cure. The tumor itself is most often benign and will not spread or return once it is removed.

Diabetics who are receiving insulin may develop hypoglycemia if they take more insulin than they require. Insulin dosage adjustments should be discussed with your physician if you are experiencing hypoglycemic reactions while receiving insulin therapy. Home glucose monitoring may help you learn how to adjust your insulin requirements.

A great deal has been written about spontaneous hypoglycemia as a possible cause of many emotional problems, especially in younger people. Whether this is true in the older individual is not certain, but it seems to be much less common, if it exists at all. Insulin-producing tumors are very rarely found in people considered to be suffering from sponta neous hypoglycemia. In some overweight people who have latent diabetes mellitus, there may be a transient period of hypoglycemia a few hours after a large carbohydrate-rich meal. The best treatment for this condition is to lose weight and decrease the intake of simple carbohydrates.

Diabetes insipidus is an uncommon ailment in the elderly. It is the result of a lack of antidiuretic hormone, or ADH, produced by the pituitary gland. The main symptoms are constant thirst and the passage of large amounts of urine. In the early stages it may be mistaken for diabetes mellitus, but blood and urine tests of the glucose level easily differentiate these two illnesses. Diabetes insipidus can be treated with injections of ADH every few days. A nasal inhalation of ADH is also available and may be easier to use than the injections. The ADH treatment must continue for life.

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Some older individuals seem to have a tendency to break bones. Falling and the broken bones resulting from falls are more common as you grow older. Although the bones of the spine and the arm may break, the most common broken bone in the elderly is the hip. Sometimes a bone may fracture without much trauma or stress, or you may fall and break your hip and assume that the fall caused the break. In some cases the break occurs spontaneously because of bone brittle-ness and leads to the fall, often without much pain.

How Is a Broken Hip Treated? If you break your hip, the chances are you will suffer pain and not be able to walk. Sometimes a hip will break in such a way that the two broken ends become impacted, and you may be able to walk on the leg without much pain. This is rare, however. Most people are unable to walk unless the hip is repaired surgically.

The dangers of surgery are not as threatening as remaining bedridden for a prolonged period. Besides the increased risk of serious illnesses such as pneumonia, phlebitis, and urinary tract infections, the health of the skin may be difficult to maintain when bedridden. Also, the psychological effect of being bedridden is extremely negative.

Most surgeons use a metal device to hold the broken hip in place. Sometimes a pin is put in to connect the ball of the hip joint with the shaft of the thigh bone. Occasionally, the surgeon may have to replace the ball of the joint with a metal one. If you have surgery for a broken hip, in most instances you should be out of bed within a few days and able to begin a physical rehabilitation program.

During the past few years I have treated a number of women, all over 90, who suffered hip fractures. Every one had hip surgery and most returned to full independence in less than three months. Age alone should not be considered a reason not to have hip surgery. Careful evaluation before and after surgery by an internist or geriatric specialist may help avoid some of the complications due to underlying medical problems or the use of medications that may follow hip surgery.

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Dryness of the mouth and nose can be caused by an impairment of the mucus or salivary glands, which normally moisten and lubricate your nose and mouth. Treatment of these disorders is very difficult. You can suck hard candy such as lemon drops to stimulate the salivary glands to produce some fluid. Good oral hygiene is important, including caring for your teeth, drinking plenty of fluids, and rinsing your mouth frequently. Rinses with bicarbonate of soda in water are sometimes helpful.

Some medications cause dryness of the mouth, particularly antidepressants, tranquilizers, sedatives, and medications used for urinary incontinence, some intestinal disorders, high blood pressure, and certain heart conditions. If you take any or a number of drugs, ask your physician if they might be responsible.

Small amounts of lanolin or petroleum jelly are beneficial in alleviating nose dryness. If the cause is allergy, a small amount of cortisone cream may be helpful. A common aggravating factor is extreme dryness of the air in the home that occurs in the winter when the heat is on. A humidifier can ease the problem considerably. If you cannot humidify the whole house, a small room humidifier for your bedroom may be effective.

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Myasthenia gravis, a disorder in which the nerves of the muscles do not transmit the impulses properly, results in weakness of the muscles in the arms and legs. The disease may begin very gradually and take many months before the disability is severe enough for you to seek help. One of the first symptoms can be eye weakness, with difficulty in focusing and double vision from time to time. You may develop difficulty in speaking. The amount of weakness may vary from day to day and at different times during the day. Swallowing may become impaired, and you may have difficulty clearing the saliva from your throat.

An electromyogram and nerve conduction studies can help diagnose this disorder. Certain drugs that temporarily reverse the abnormality can be used to verify the diagnosis. Some people respond well to medications that improve the electrical impulses at the connection between the nerves and muscles; other individuals respond to cortisone treatment. It may be necessary to remove the remnants of the thymus gland, which sits behind the breastbone. In myasthenia gravis the thymus gland produces antibodies that interfere with the transmission of impulses from nerves to muscles. The gland usually atrophies after childhood but may persist in people with this disorder. Although this operation can be difficult, it frequently results in major relief of the symptoms, even though drugs may still be required for its control. Before surgery, some medical centers first treat patients with a blood exchange to clear the body of the substances that aggravate the disease. This temporarily improves the condition until surgery can be done. Not all medical centers are equipped for all aspects of therapy. A neurologist can direct you to the most suitable medical center in your vicinity.

Several other disorders can affect the muscles and nerves and cause weakness and pain, or both. Some illnesses occur with inflammatory conditions such as arthritis, whereas others result from virus infections or malignant disorders. At times it can be difficult to unravel the cause of muscle weakness and a muscle biopsy and special electrical studies are necessary. Some of these unusual ailments are treatable, whereas others will improve or progress depending on the nature of the underlying disorder.

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Normally, there are different kinds of white cells in the body, including polymorphonuclear white cells, lymphocytes, and plasma cells. They have different appearances and serve different purposes which, however, are related. Their main function is to help combat infection. They do this by various methods, such as making antibodies that help destroy harmful bacteria or removing them from the circulation by ingesting them. A malignant growth of white cells is called leukemia.

The types of leukemia that affect the elderly are chronic leukemias, which progress much more slowly than those that occur in younger individuals. Each type of leukemia arises from one kind of white blood cell, either polymorphonuclear or lymphocyte. Because of its slow progress, patients can have leukemia for many years without problems. The symptoms include lowered defense against infection and some weakness because of anemia. Sometimes the spleen, liver, and lymph nodes may enlarge, and bones can become painful as the illness advances. There is often a tendency to bruise and bleed easily.

Treatment is usually not necessary during early stages, but a number of medications and, occasionally, radiation therapy can successfully slow the progress of the disease later on. If the spleen becomes too enlarged and painful, it may have to be removed. After many years, the disease suddenly may progress rapidly. Although at this stage it may be difficult to treat, some forms of chemotherapy are sometimes effective.

An unusual disease of the white cells is caused by the development of a malignant growth of plasma cells. The disease, multiple myeloma, produces abnormal proteins which, although similar to antibodies, do not have the ability to combat infection. In fact, these abnormal antibodies interfere with the normal defense mechanism and make the person more susceptible to harmful bacteria.

The symptoms include anemia, weight loss and, quite frequently, bone pain. Sometimes the abnormal protein in the blood causes a blockage of blood vessels. The diagnosis usually requires a bone marrow biopsy, in addition to blood tests. There are various forms of therapy for this illness. It will often respond to treatment for a few years. Further improvement possible with newer drugs as they are developed.

Whatever the form of cancer, treatment is available to de crease its spread, relieve the symptoms, and in early stages perhaps cure it altogether. And new therapies are being discovered. It is important that you know what treatments will be used and what their possible effects will be, both negative and positive. Sometimes there is nothing more to be done, but even in the most desperate situation, it should be possible to improve the symptoms and relieve discomfort. Do not be afraid to express your fears to your physician: Tell him what you are feeling and what kind of help you would like. Communicate openly with your family so they will be comfortable with your decisions and those that they may have to make on your behalf.

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One of the most difficult questions that physicians and families face is whether or not to tell an older person that he or she has cancer. I believe that it is usually beneficial for you to know what is happening in your life. Most people are far stronger than their families and physicians believe. You should have the right to know about your problem so that you can make appropriate plans for your future.

However, you should be told with tact and care. Often a physician can assess just how much you really want to know about your illness. He may gradually unfold the “full truth” to you as confidence between the two of you grows.

I looked after an elderly woman who had metastatic lung cancer. Fluid in the lung spaces (pleural effusion) caused difficulty in breathing. Her children begged me not to tell her of her disease because “it would kill her” if she knew. With reluctance, I agreed to call the illness a type of “inflammation.”

A number of treatments to prevent the lung fluid from reaccumulating were tried. Unfortunately, they were not successful. The woman became more and more ill; every day she asked me, “What kind of illness is this that makes the fluid return?” I answered, “It is a type of inflammation.” One day, when she was gravely ill, she said to me, “This illness is worse than cancer, because with cancer at least you know what you’re dealing with. This one is a real mystery.” She died not long after this.

Because of their inability to discuss the problem with their mother, her children were not able to face the likelihood of her death. And she was not able to make the kind of honest decisions that people may want to make when they know they do not have much more time in this world. Thus it is essential that you discuss with your family and your physician how much you would like to know should you become ill. And it is best to discuss this while you are healthy, rather than waiting until a serious illness occurs.

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When an enlarged prostate causes symptoms of incomplete bladder emptying, the blockage must be relieved. This is usually done by surgery through the abdomen or through the penis (transurethral resection, or TURP). Even very elderly men can usually withstand prostate surgery that is done through the penis. Your age should not deter you from having TURP surgery. It is not a difficult procedure, and it is usually successful in relieving symptoms. In very frail individuals, it can be done with a spinal anesthetic. Sometimes a complete removal of the prostate is necessary. This is a major operation, but if required it should be done.

Rarely do problems arise after a transurethral resection. You may temporarily lose some control of your urine, but this is usually not permanent unless a neurological problem was present before surgery. There is usually no significant interference with sexual abilities. Your sexual capabilities may improve, because the excess pressure in the bladder and kidneys may have interfered with normal sexual function. Sometimes, however, sexual function may not be satisfactory after prostate surgery.

In the case of a malignant tumor, if your prostate gland is removed while the tumor is small, the malignancy may not have spread. If the tumor has already expanded, surgical removal of the testicles, which eliminates the male hormones that the tumor needs for growth, can halt its progress. Various medications, including female hormones, are often also helpful. Radiation to the prostate or to painful areas of invaded bone are sometimes useful. The malignancy may take years to progress if it is treated energetically. You can often enjoy years of comfort and health with proper medical management

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Antibiotics are produced by microorganisms, such as bacteria or fungi, which prevent the growth and multiplication of deleterious bacteria. Years ago it was discovered that this antibiotic material could be collected and purified and then used to kill harmful bacteria in humans. Today some antibiotics are produced synthetically, a more efficient and cheaper method.

Drugs other than antibiotics also interfere with the growth and multiplication of harmful bacteria. They are called chemotherapeutic agents, and sulfonamide (usually called sulfa) is an important member of this group. Sulfa was developed before penicillin, the first antibiotic, and is still useful in certain types of infections. In general, most people use the word antibiotic to include all of these drugs.

There are many varieties of antibiotics, but no antibiotic is effective against every type of bacteria. In fact, this is good because the human body contains many useful, friendly bacteria and it could be dangerous if these were killed.

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